Rachel E. Kahn

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.

Callous-unemotional traits robustly predict future criminal offending in young men.

Callous-unemotional (CU) traits (e.g., lack of empathy, deficient guilt/remorse, and shallow affect) are a circumscribed facet of the adult psychopathic personality. Although several studies have found that adult psychopathy is a robust predictor of future criminal offending, research exploring the predictive utility of CU traits and future offending are lacking. Moreover, empirical studies examining the predictive utility of psychopathic features often neglect to account for other well-documented risk factors (e.g., prior offending, delinquent peers, marital status), and thus the incremental predictive utility of CU traits remains uncertain. To address these limitations, the current study examined the unique contribution of CU traits in the prediction of future criminal offending in a large ethnically diverse community sample of young adult males (Mean Age = 25.76, SD = .95). Official criminal record information was collected approximately 3.5 years later using multiple sources. Results indicated that after controlling for several other well-established predictors of future offending, men with elevated CU traits had a greater number of arrests and criminal charges and were more likely to be charged with a serious offense and obstruction of justice. CU traits also predicted future theft for Caucasian men, but not African American men. Overall, the results support the notion that CU traits significantly add to the prediction of future offending, even after controlling for several other risk factors.

A Validation of the Inventory of Callous-Unemotional Traits in a Community Sample of Young Adult Males

Callous-unemotional (CU) traits have been shown to delineate a subgroup of individuals at high risk for exhibiting severe and persistent criminal behavior. The Inventory of Callous-Unemotional Traits (ICU; Frick 2004) was recently developed as a comprehensive rating scale designed to measure multiple facets of CU traits. However, validation of this measure has been limited to youth in adolescence and emerging adulthood (age range =12–20), leaving questions about the utility of this measure in early adulthood unanswered. The current study evaluated the factor structure of the ICU within a racially diverse and well characterized community sample of adult males (n = 425) using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). While results found the best fitting model to be the three-bifactor structure that has been previously reported in adolescent samples, the fit indices were only marginally acceptable and suggest the need for scale refinement. Total and subscales scores demonstrated significant and distinct associations with relevant external criteria (e.g., delinquency, psychopathy, psychopathology, psychosocial functioning). Implications and directions for future research are discussed.

Distinguishing primary and secondary variants of callous-unemotional traits among adolescents in a clinic-referred sample

The current study used model-based cluster analyses to determine if there are 2 distinct variants of adolescents (ages 11-18) high on callous-unemotional (CU) traits that differ on their level of anxiety and history of trauma. The sample (n = 272) consisted of clinic-referred youths who were primarily African American (90%) and who came from low-income families. Consistent with hypotheses, 3 clusters emerged, including a group low on CU traits, as well as 2 groups high on CU traits that differed in their level of anxiety and past trauma. Consistent with past research on incarcerated adults and adolescents, the group high on anxiety (i.e., secondary variant) was more likely to have histories of abuse and had higher levels of impulsivity, externalizing behaviors, aggression, and behavioral activation. In contrast, the group low on anxiety (i.e., primary variant) scored lower on a measure of behavioral inhibition. On measures of impulsivity and externalizing behavior, the higher scores for the secondary cluster were found only for self-report measures, not on parent-report measures. Youths in the primary cluster also were perceived as less credible reporters than youths in the secondary cluster (i.e., secondary variant) or cluster low on CU traits. These reporter and credibility differences suggest that adolescents within the primary variant may underreport their level of behavioral disturbance, which has important assessment implications.

Emotional Intelligence in Incarcerated Men With Psychopathic Traits

The expression, recognition, and communication of emotional states are ubiquitous features of the human social world. Emotional intelligence (EI) is defined as the ability to perceive, manage, and reason about emotions, in oneself and others. Individuals with psychopathy have numerous difficulties in social interaction and show impairment on some emotional tasks. Here, the authors investigate the relation between EI and psychopathy in a sample of incarcerated men (N = 374), using the Psychopathy Checklist-Revised (PCL-R; Hare, 2003) and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT; Mayer, Salovey, & Caruso, 2002). The MSCEIT is a well-validated ability-based EI measure that does not rely on self-report judgments of emotional skills. The Hare PCL-R is the gold standard for the assessment of psychopathy in clinical populations. Controlling for general intelligence, psychopathy was associated with lower EI. These findings suggest individuals with psychopathy are impaired on a range of EI abilities and that EI is an important area for understanding deficits in psychopathy.

Callous-Unemotional Traits and Anxiety in a Community Sample of 7-Year-Olds

In forensic samples of adults and adolescents, there is evidence to suggest that there may be distinct variants of psychopathy marked by the presence/absence of significant levels of anxiety. Callous-unemotional (CU) traits can be used to characterize children who share behavioural and neurocognitive features with adult psychopaths. The aims of this paper are to (a) investigate the genetic and environmental influences on CU traits with/without anxiety and (b) explore differences in terms of concurrent and early parenting and adjustment. Discrete groups were formed on the basis of scores in the top 10% of the sample on CU and anxiety scales at age 7. Estimates of group heritability were calculated using a Defries-Fulker (DF) extremes regression model. Follow back analyses of early parenting and adjustment were conducted using multivariate analyses of covariance. There was high group heritability for CU traits with/without anxiety. Children with both high CU and anxiety showed greater levels of adjustment problems than those with CU only at age 7. The two groups did not differ in parenting characteristics. In this general population sample, evidence did not support differences in etiology for the two groups high on CU traits differing in level of anxiety.

Risky decision making in a laboratory driving task is associated with health risk behaviors during late adolescence but not adulthood

Adolescence is characterized by increasing incidence of health risk behaviors, including experimentation with drugs and alcohol. To fill the gap in our understanding of the associations between risky decision-making and health risk behaviors, we investigated associations between laboratory-based risky decision-making using the Stoplight task and self-reported health risk behaviors. Given that there has been no examination of potential age differences in the associations between risky decision-making and health risk behaviors, we also examined whether the association of risky decision-making with health risk behaviors is consistent across adolescence and adulthood using two-group structural equation modeling (SEM). The results indicated significant differences across the two age groups: adolescents (17–20 year olds) who took more risks on the Stoplight task reported greater frequency and earlier onset of substance use, whereas stoplight performance was not associated with substance use frequency or onset among adults (31–61 year olds). Our findings suggest that a laboratory-based measure of risky decision-making is significantly related to health risk behaviors among adolescents but not among adults.

The road forward for research on callous-unemotional traits: reply to Lahey (2014).

Lahey (2014) provides a thoughtful and scholarly discussion of our review of the research on the potential utility of callous-unemotional (CU) traits for designating a distinct subgroup of children and adolescents with severe conduct problems. In this reply, we attempt to clarify several issues raised in Laheys commentary. Specifically, by focusing largely on only 1 part of the research review (i.e., implications for evaluating the new specifier included for the diagnosis of conduct disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 2013), the commentary underestimates the available empirical support for the utility of these traits for designating an important subgroup of children and adolescents with severe conduct problems. Furthermore, we highlight a number of studies that provide data inconsistent with the model proposed by Lahey in which CU traits are best considered as solely a marker of more severe conduct problems. Finally, we highlight limitations in estimating the stability of CU traits based solely on the number of individuals who continue to fall above and below a diagnostic cutoff at 2 points in time.

Psychometric Properties of the Reactive-Proactive Aggression Questionnaire Among a Sample of Detained and Community Girls:

Research on adolescent aggression often distinguishes between reactive and proactive aggression, but there is limited knowledge regarding the application or measurement of these subtypes of aggression among female youth, especially forensic samples of female youth. Drawing on 377 girls (103 selected from forensic settings and 274 selected from school settings) from Portugal, the current study is the first to simultaneously examine the psychometric properties of the Reactive-Proactive Aggression Questionnaire (RPQ) in incarcerated girls and community girls. The results support the use of the RPQ in terms of its two-factor structure, measurement invariance, internal consistency, convergent validity, discriminant validity, and known-groups validity. Significant associations were found with several criterion-related variables such as age of criminal onset, age of first problem with the law, conduct disorder, crime severity, violent crimes, and alcohol and drug use. Findings are discussed in terms of the use of the RPQ among incarcerated girls and community girls.