James V. Ray

Can callous-unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? A comprehensive review.

This article provides a comprehensive review of the research on the use of callous and unemotional (CU) traits for designating an important subgroup of children and adolescents with severe conduct problems. It focuses on the etiological significance of recognizing this subgroup of youths with severe conduct problems, its implications for diagnostic classification, and the treatment implications of this research. The review highlights limitations in existing research and provides directions for future research. The available research suggests that children and adolescents with severe conduct problems and elevated CU traits show distinct genetic, cognitive, emotional, biological, environmental, and personality characteristics that seem to implicate different etiological factors underlying their behavior problems relative to other youths with severe conduct problems. Recognizing these subgroups could be critical for guiding future research on the causes of severe conduct problems in children and adolescents. Further, children and adolescents with both severe conduct problems and elevated CU traits appear to be at risk for more severe and persistent antisocial outcomes, even controlling for the severity of their conduct problems, the age of onset of their conduct problems, and common comorbid problems, which supports the clinical importance of designating this group in diagnostic classification systems. Finally, although children and adolescents with both severe conduct problems and elevated CU traits tend to respond less positively to typical interventions provided in mental health and juvenile justice settings, they show positive responses to certain intensive interventions tailored to their unique emotional and cognitive characteristics.

Annual Research Review: A developmental psychopathology approach to understanding callous‐unemotional traits in children and adolescents with serious conduct problems

Recent research has suggested that the presence of significant levels of callous-unemotional (CU) traits designates a clinically important and etiologically distinct subgroup of children and adolescents with serious conduct problems. Based on this research, CU traits have been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5; American Psychiatric Association, 2013)--as a specifier for the diagnosis of conduct disorder. In this review, we attempt to understand CU traits within a developmental psychopathological framework. Specifically, we summarize research on the normal development of the prosocial emotions of empathy and guilt (i.e., conscience) and we illustrate how the development of CU traits can be viewed as the normal development of conscience gone awry. Furthermore, we review research on the stability of CU traits across different developmental periods and highlight factors that can influence this stability. Finally, we highlight the implications of this developmental psychopathological framework for future etiological research, for assessment and diagnostic classification, and for treatment of children with serious conduct problems.

The Relation Between Self-Reported Psychopathic Traits and Distorted Response Styles: A Meta-Analytic Review

A concern among researchers is that self-report measures may not be valid indicators of psychopathic traits due to the core features of psychopathy (e.g., lying, deception/manipulation). The current study addresses this issue by combining effects sizes from studies published on or before March 31, 2010 to examine the relation between scores of 3 widely used self-report psychopathy measures--the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) and its revised version (PPI-R; Lilienfeld & Widows, 2005) and Levensons Self-Report Psychopathy scale (LSRP; Levenson, Kiehl, & Fitzpatrick, 1995) and scores on measures assessing response style (i.e., faking good and faking bad). Effect sizes were obtained from 45 studies for total, Factor 1, and Factor 2 scores (faking good: k = 54, 55, and 55, respectively; faking bad: k = 51, 50, and 50, respectively). Based on a random effects model, a significant negative association was found between social desirability/faking good and both total (r(w) = -.11, p < .01) and F2 (r(w) = -.16, p < .01) scores, and moderation analyses suggested that effect sizes varied as a function of psychopathy scale and validity scale used. Significant positive associations were also found between faking bad and both total (r(w) = .27, p < .05) and F2 (r(w) = .32, p < .05) scores. Also, moderation analyses suggested that effect sizes varied as a function of study location, psychopathy scale, and validity scale. Despite several limitations (e.g., inclusion of only published studies, limited moderators, exclusion of other measures), the general findings temper concerns of positive response bias and underscore the validity of self-report psychopathy scales.

Evaluating callous-unemotional traits as a personality construct

We evaluate the importance of callous-unemotional (CU) traits as a personality construct in isolation from other facets of psychopathy. Specifically, we review research suggesting that these traits are useful for designating a subgroup of youth with serious conduct problems who differ from other antisocial youth on important biological, emotional, cognitive, and social characteristics. In addition, the temperamental features related to CU traits are risk factors for impairments in conscience development in young children. Thus, these traits could advance theoretical models explaining the development of severe antisocial behavior and psychopathy. CU traits also have important clinical utility because they designate a particularly severe and impaired subgroup of antisocial youth, leading to their inclusion in the DSM-5. As a result of this inclusion in diagnostic classification, there has been an increased focus on how to best assess CU traits, and we discuss several key issues in their assessment, highlighting several limitations in existing measures. Finally, the increased use of CU traits, separately from other facets of psychopathy, makes it important to determine how these traits relate to other personality constructs. Thus, we examine how measures of CU traits relate to the broader construct of psychopathy and to other basic personality dimensions.

Positive and negative item wording and its influence on the assessment of callous-unemotional traits.

This study examined the item functioning of the Inventory of Callous-Unemotional Traits (ICU) in an ethnically diverse sample 1,190 of first-time justice-involved adolescents (mean age = 15.28 years, SD = 1.29). On elimination of 2 items, the total ICU score provided a reliable (internally consistent and stable) and valid (correlated with and predictive of measures of empathy, school conduct problems, delinquency, and aggression) continuous measure of callous and unemotional (CU) traits. A shortened, 10-item version of the total scale, developed from item response theory (IRT) analyses, appeared to show psychometric properties similar to those of the full ICU and, thus, could be used as an abbreviated measure of CU traits. Finally, item analyses and tests of validity suggested that the factor structure of the ICU reported in a large number of past studies could reflect method variance related to the ICU, including equal numbers of positively and negatively worded items. Specifically, positively worded items (i.e., items for which higher ratings are indicative of higher levels of CU traits) were more likely to be rated in the lower response categories, showed higher difficulty levels in IRT analyses (i.e., discriminated best at higher levels of CU traits), and were more highly correlated with measures of antisocial and aggressive behavior. On the basis of these findings, we recommend using the total ICU as a continuous measure of CU traits and do not recommend continued use of the subscale structure that has been reported in multiple past studies.

Validation of the Inventory of Callous-Unemotional Traits Among a Portuguese Sample of Detained Juvenile Offenders:

The main aim of the present study was to examine the psychometric properties of the Inventory of Callous-Unemotional Traits (ICU) among a sample of incarcerated male Portuguese juvenile offenders (N = 221). Based on this sample, the Portuguese version of the ICU demonstrated promising psychometric properties, namely, in terms of factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity that generally justifies its use among this population. Statistically significant associations were found with conduct disorder, age of criminal onset, crime seriousness, physical violence use in committing crimes, alcohol use, cannabis use, and cocaine/heroin use.

The reactive-proactive aggression questionnaire: validation among a Portuguese sample of incarcerated juvenile delinquents

The aim of the present study was to examine the psychometric properties of the Reactive–Proactive Aggression Questionnaire (RPQ) among a forensic sample of incarcerated male juvenile offenders (N = 221). The Portuguese version of the RPQ demonstrated promising psychometric properties, namely, in terms of factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity that generally justifies its use among this population. Statistically significant associations were found with conduct disorder, age of criminal onset, age of first problem with the law, crime seriousness, physical violence use in committing crimes, alcohol use, cannabis use, cocaine/heroin use, and having unprotected sex. The findings provide additional support for the extension of the RPQ across different cultures, ethnic groups, and samples.

Adaptation of the Basic Empathy Scale among a Portuguese sample of incarcerated juvenile offenders

The main aim of the present study was to examine the psychometric properties of the Basic Empathy Scale (BES) and of its adapted short version among a forensic sample of incarcerated male juvenile offenders (N = 221). The Portuguese validations of the BES and its adapted short version demonstrated good psychometric properties, namely in terms of the two-factor structure, internal consistency, convergent validity, discriminant validity, and concurrent validity that generally justifies its use among this population. Statistically significant associations were found with callous–unemotional traits and social anxiety. Findings are discussed in terms of the use of the BES and its adapted short version with juvenile offenders.

Impulse control and callous-unemotional traits distinguish patterns of delinquency and substance use in justice involved adolescents: Examining the moderating role of neighborhood context

Both callous-unemotional (CU) traits and impulse control are known risk factors associated with delinquency and substance use. However, research is limited in how contextual factors such as neighborhood conditions influence the associations between these two dispositional factors and these two externalizing behaviors. The current study utilized latent class analysis (LCA) to identify unique classes of delinquency and substance use within an ethnically diverse sample (n = 1216) of justice-involved adolescents (ages 13 to 17) from three different sites. Neighborhood disorder, CU traits, and impulse control were all independently associated with membership in classes with more extensive histories of delinquency and substance use. The effects of CU traits and impulse control in distinguishing delinquent classes was invariant across levels of neighborhood disorder, whereas neighborhood disorder moderated the association between impulse control and substance use. Specifically, the probability of being in more severe substance using classes for those low in impulse control was stronger in neighborhoods with fewer indicators of social and physical disorder.

Testing the Stability of Self-Control Identifying Unique Developmental Patterns and Associated Risk Factors

Gottfredson and Hirschi suggest that individuals’ levels of self-control remain stable over the life course; however, the empirical status of this proposition remains equivocal. Most tests of the stability hypothesis have employed aggregate assessment methods (e.g., mean-level and correlational analyses) that overlook unique developmental patterns, although some have identified unique developmental patterns in self-control. The current study assesses the stability of self-control across 4 years using both traditional analytic methods and methods that account for the existence of unique developmental patterns (i.e., semiparametric group-based trajectory modeling) and exploring risk factors that differentiate these patterns. The results suggest six unique developmental patterns of self-control: two with high stable trajectories and four that evinced lower, less stable trajectories of self-control. The findings indicate that lower, less stable patterns of development are associated with more delinquent peer association, higher rates of parental criminality, fewer school bonds, and weaker maternal attachment.