Rebecca Waller

What are the associations between parenting, callous-unemotional traits, and antisocial behavior in youth? A systematic review of evidence.

A growing body of research has examined callous-unemotional (CU) traits among samples of antisocial youth. Debate surrounds the malleability of CU traits and their responsiveness to parenting and parent-focused interventions. This review examines evidence from studies that have investigated various relationships between parenting, CU traits, and antisocial behavior (AB). Studies were categorized according to five distinct research questions each addressing associations among parenting, CU traits, and AB in a different way. The results suggest that dimensions of parenting are prospectively related to changes in CU traits. Subgroups of youth with both high levels of CU traits and AB also appear to have experienced negative parenting practices. However, negative parenting is not consistently related to AB in cross-sectional studies for youth with high levels of CU traits. At the same time, parenting-focused interventions appear effective in reducing the level of AB and CU traits in youth. The findings and implications for future studies are critically discussed as they pose challenges for current etiological theories of AB.

Do harsh and positive parenting predict parent reports of deceitful-callous behavior in early childhood?

BACKGROUND The relationship between parenting and the development of antisocial behavior in children is well established. However, evidence for associations between dimensions of parenting and callous-unemotional (CU) traits is mixed. As CU traits appear critical to understanding a subgroup of youth with antisocial behavior, more research addressing the link between early parenting and CU traits is needed. METHODS The current study investigated longitudinal predictions between measures of harsh and positive parenting, and early CU behavior. Data from mother-child dyads (N = 731; 49% female) were collected from a multi-ethnic, high-risk sample with young children, and included self-reported and multi-method observed parenting. CU behavior was assessed using a previously validated measure of deceitful-callous behavior (Hyde et al., 2011). RESULTS   Results suggest that dimensions of harsh parenting, but not positive parenting, contribute to the development of child deceitful-callous behavior. Nevertheless, deceitful-callous behavior showed strong stability over time and the effects of harsh parenting, especially observed harshness, were modest. CONCLUSIONS The current findings have implications for developmental psychopathology and early interventions for antisocial behavior. The results also raise a number of issues about measuring emerging CU behavior in very young children, including the interrelation between parent perceptions and reports of child behavior, parent reactions, and the subsequent development of severe antisocial behavior.

Factor Structure and Construct Validity of the Parent-Reported Inventory of Callous-Unemotional Traits Among High-Risk 9-Year-Olds

The presence of callous-unemotional (CU) traits delineates a subgroup of youth with severe antisocial behavior. However, debate surrounds the best method to assess CU traits. This study examined the factor structure of the parent-reported Inventory of Callous-Unemotional Traits (ICU) among high-risk 9-year-olds (N = 540) and its predictive validity over 1 year. Confirmatory factor analysis showed support for a three-factor bifactor model and revised two-factor model using a shortened ICU. Within a three-factor bifactor framework the general CU traits factor and specific uncaring factor scores were related to higher externalizing and lower internalizing behavior problems at ages 9.5 and 10.5. Findings were replicated using teacher-reported outcomes. However, results also suggest the need for item refinement and highlight the utility of a two-factor solution using a shortened ICU. In particular, the meaning of the unemotional items is discussed in relation to the conceptualization of CU traits.

Heritable and Nonheritable Pathways to Early Callous-Unemotional Behaviors.

OBJECTIVE Callous-unemotional behaviors in early childhood signal higher risk for trajectories of antisocial behavior and callous-unemotional traits that culminate in later diagnoses of conduct disorder, antisocial personality disorder, and psychopathy. Studies demonstrate high heritability of callous-unemotional traits, but little research has examined specific heritable pathways to early callous-unemotional behaviors. Studies also indicate that positive parenting protects against the development of callous-unemotional traits, but genetically informed designs have not been used to confirm that these relationships are not the product of gene-environment correlations. In a sample of adopted children and their biological and adoptive mothers, the authors tested novel heritable and nonheritable pathways to preschool callous-unemotional behaviors. METHOD In an adoption cohort of 561 families, history of severe antisocial behavior assessed in biological mothers and observations of adoptive mother positive reinforcement at 18 months were examined as predictors of callous-unemotional behaviors at 27 months. RESULTS Despite limited or no contact with offspring, biological mother antisocial behavior predicted early callous-unemotional behaviors. Adoptive mother positive reinforcement protected against early callous-unemotional behaviors. High levels of adoptive mother positive reinforcement buffered the effects of heritable risk for callous-unemotional behaviors posed by biological mother antisocial behavior. CONCLUSIONS The findings elucidate heritable and nonheritable pathways to early callous-unemotional behaviors. The results provide a specific heritable pathway to callous-unemotional behaviors and compelling evidence that parenting is an important nonheritable factor in the development of callous-unemotional behaviors. The finding that positive reinforcement buffered heritable risk for callous-unemotional behaviors has important translational implications for the prevention of trajectories to serious antisocial behavior.

Toward an Understanding of the Role of the Environment in the Development of Early Callous Behavior.

Key to understanding the long-term impact of social inequalities is identifying early behaviors that may signal higher risk for later poor psychosocial outcomes, such as psychopathology. A set of early-emerging characteristics that may signal risk for later externalizing psychopathology is callous-unemotional (CU) behavior. CU behavior predicts severe and chronic trajectories of externalizing behaviors in youth. However, much research on CU behavior has focused on late childhood and adolescence, with little attention paid to early childhood when preventative interventions may be most effective. In this article, we summarize our recent work showing that (a) CU behavior can be identified in early childhood using items from common behavior checklists, (b) CU behavior predicts worse outcomes across early childhood, (c) CU behavior exhibits a nomological network distinct from other early externalizing behaviors, and (d) malleable environmental factors, particularly parenting, may play a role in the development of early CU behaviors. We discuss the challenges of studying contextual contributors to the development of CU behavior in terms of gene-environment correlations and present initial results from work examining CU behavior in an adoption study in which gene-environment correlations are examined in early childhood. We find that parenting is a predictor of early CU behavior even in a sample in which parents are not genetically related to the children.

Callous-unemotional behavior and early-childhood onset of behavior problems: the role of parental harshness and warmth

Youth with callous-unemotional (CU) behavior are at risk of developing more severe forms of aggressive and antisocial behavior. Previous cross-sectional studies suggest that associations between parenting and conduct problems are less strong when children or adolescents have high levels of CU behavior, implying lower malleability of behavior compared to low-CU children. The current study extends previous findings by examining the moderating role of CU behavior on associations between parenting and behavior problems in a very young sample, both concurrently and longitudinally, and using a variety of measurement methods. Data were collected from a multi-ethnic, high-risk sample at ages 2 to 4 (N = 364; 49% female). Parent-reported CU behavior was assessed at age 3 using a previously validated measure (Hyde et al., 2013). Parental harshness was coded from observations of parent–child interactions and parental warmth was coded from 5-min speech samples. In this large and young sample, CU behavior moderated cross-sectional correlations between parent-reported and observed warmth and child behavior problems. However, in cross-sectional and longitudinal models testing parental harshness, and longitudinal models testing warmth, there was no moderation by CU behavior. The findings are in line with recent literature suggesting parental warmth may be important to child behavior problems at high levels of CU behavior. In general, however, the results of this study contrast with much of the extant literature and suggest that in young children, affective aspects of parenting appear to be related to emerging behavior problems, regardless of the presence of early CU behavior.

Practitioner Review: Involving young people with callous unemotional traits in treatment – does it work? A systematic review

BACKGROUND Children and adolescents with callous unemotional (CU) traits are at risk of severe and persistent antisocial behavior. It is commonly assumed that these children are difficult to treat but it has been proposed that they may benefit from being involved in interventions that go beyond typical parent training programs. This systematic review sought to answer two previously unanswered questions: do interventions involving young people reduce levels of CU traits? Do CU traits predict the effectiveness of interventions for antisocial behavior involving young people? METHOD Studies were included that adopted an randomized controlled trial, controlled or open trial design and that had examined whether treatment was related to reductions in CU traits or whether CU traits predicted or moderated treatment effectiveness. RESULTS Treatments used a range of approaches, including behavioral therapy, emotion recognition training, and multimodal interventions. 4/7 studies reported reductions in CU traits following treatment. There was a mixed pattern of findings in 15 studies that examined whether CU traits predicted treatment outcomes following interventions for antisocial behavior. In 7/15 studies, CU traits were associated with worse outcomes, although three of these studies did not provide data on baseline antisocial behavior, making it difficult to evaluate whether children with high CU traits had shown improvements relative to their own behavioral baseline, despite having the worst behavioral outcomes overall. CU traits did not predict outcomes in 7/15 studies. Finally, a single study reported that CU traits predicted an overall increased response to treatment. CONCLUSIONS Overall, the evidence supports the idea that children with CU traits do show reductions in both their CU traits and their antisocial behavior, but typically begin treatment with poorer premorbid functioning and can still end with higher levels of antisocial behavior. However, there is considerable scope to build on the current evidence base.

Parenting and the Family Check-Up: Changes in Observed Parent-Child Interaction Following Early Childhood Intervention

Coercion theory posits a cyclical relationship between harsh and coercive parent–child interactions and problem behavior beginning in early childhood. As coercive interactions have been theorized and found to facilitate the development and growth of early conduct problems, early interventions often target parenting to prevent or reduce early disruptive problem behavior. This study utilizes direct observations of parent–child interactions from the Early Steps Multisite study (N = 731; 369 boys) to examine the effect of the Family Check-Up, a family-centered intervention program, on measures of parent–child positive engagement and coercion from age 2 through 5, as well as on childhood problem behavior at age 5. Results indicate that high levels of parent–child positive engagement were associated with less parent–child coercion the following year, but dyadic coercion was unrelated to future levels of positive engagement. In addition, families assigned to the Family Check-Up showed increased levels of positive engagement at ages 3 and 5, and the association between positive engagement at age 3 and child problem behavior at age 5 was mediated by reductions in parent–child coercion at age 4. These findings provide longitudinal confirmation that increasing positive engagement in parent–child interaction can reduce the likelihood of coercive family dynamics in early childhood and growth in problem behavior.

Callous-Unemotional Traits Trajectories Interact with Earlier Conduct Problems and Executive Control to Predict Violence and Substance Use Among High Risk Male Adolescents

Callous-unemotional (CU) traits, conduct problems (CP), and deficits in executive control are all linked to the development of more severe antisocial behavior, including violence and substance use. Though previous research has examined the impact of these factors on antisocial outcomes, little work has examined trajectories of CU traits across adolescence and how these trajectories predict greater antisocial behavior in adulthood. Moreover, no study has assessed how severity of early CP and executive control may exacerbate these pathways and increase risk for later violence and substance use. The current study (a) identified trajectories of CU traits among a large, high-risk sample of adolescent males, (b) examined the relationship between CU traits trajectories and future violence and substance use, and (c) examined whether early CP and executive control moderated the effects of a high CU traits trajectory membership and high CP on violence and substance use. Results indicated that: (a) CU traits could be grouped into three stable trajectories across adolescence, (b) the ‘high’ CU traits trajectory, particularly in the presence of ‘elevated’ CP, was related to higher violence and substance use, over and above a variety of environmental risk factors, and (c) the effects the ‘high’ CU traits trajectory on both violence and substance and in the presence of ‘elevated’ CP was stronger among youth with high executive control. These findings highlight the utility of identifying subgroups of youth who differ on trajectories of CU traits for understanding the development and maintenance of severe antisocial behavior.

A Common Polymorphism in a Williams Syndrome Gene Predicts Amygdala Reactivity and Extraversion in Healthy Adults

BACKGROUND Williams syndrome (WS), a genetic disorder resulting from hemizygous microdeletion of chromosome 7q11.23, has emerged as a model for identifying the genetic architecture of socioemotional behavior. Common polymorphisms in GTF2I, which is found within the WS microdeletion, have been associated with reduced social anxiety in the general population. Identifying neural phenotypes affected by these polymorphisms would help advance our understanding not only of this specific genetic association but also of the broader neurogenetic mechanisms of variability in socioemotional behavior. METHODS Through an ongoing parent protocol, the Duke Neurogenetics Study, we measured threat-related amygdala reactivity to fearful and angry facial expressions using functional magnetic resonance imaging, assessed trait personality using the Revised NEO Personality Inventory, and imputed GTF2I rs13227433 from saliva-derived DNA using custom Illumina arrays. Participants included 808 non-Hispanic Caucasian, African American, and Asian university students. RESULTS The GTF2I rs13227433 AA genotype, previously associated with lower social anxiety, predicted decreased threat-related amygdala reactivity. An indirect effect of GTF2I genotype on the warmth facet of extraversion was mediated by decreased threat-related amygdala reactivity in women but not men. CONCLUSIONS A common polymorphism in the WS gene GTF2I associated with reduced social anxiety predicts decreased threat-related amygdala reactivity, which mediates an association between genotype and increased warmth in women. These results are consistent with reduced threat-related amygdala reactivity in WS and suggest that common variation in GTF2I contributes to broader variability in socioemotional brain function and behavior, with implications for understanding the neurogenetic bases of WS as well as social anxiety.