Is Callous Always Cold? A Critical Review of the Literature on Emotion and the Development of Callous-Unemotional Traits in Children

The Relationship Between Frontal Cortical Thickness and Externalizing Psychopathology is Associated with Treatment Outcomes in Children with Externalizing Problems: A Preliminary Pilot Study: La relation entre l'épaisseur du cortex frontal et les troubles extériorisés est associée aux résultats thérapeutiques chez les enfants ayant des problèmes extériorisés : une étude pilote préliminaire

OBJECTIVES

Children with externalizing disorders commonly show emotion dysregulation and callous-unemotional (CU) traits. However, it is unclear whether emotion dysregulation and CU traits share underlying neurobiology that can be predictive of psychosocial treatment outcomes. In this preliminary study, we examined neural correlates of externalizing psychopathology dimensions and their prediction of treatment outcomes.

METHODS

We analyzed a pilot sample of 17 children with an externalizing disorder (9-12 years; 10.45 ± 1.02) who underwent structural magnetic resonance imaging (MRI) before participating in a 15-week psychosocial group intervention targeting conduct problems. We examined cross-sectional associations between emotion dysregulation or CU traits and cortical thickness (anterior cingulate cortex [ACC] and insula) and amygdala volume at baseline. We then examined whether the pre-treatment brain-behaviour relationships were linked to reduction in conduct problems post-treatment.

RESULTS

Lower ACC and insula thickness as well as amygdala volume was associated with greater levels of emotion dysregulation and CU traits at baseline (pre-treatment, r = |0.36-0.61|). There was a significant three-way interaction between emotion dysregulation/CU traits, left insula/right rostral ACC, and treatment (pre/post; β = -1.01 to 3.6). Overall, greater baseline insular and rostral ACC thickness was related to reductions in conduct problems following group-based psychosocial intervention regardless of baseline emotion dysregulation and CU trait levels.

CONCLUSIONS

The results provide preliminary evidence of shared neural signatures underlying both emotion dysregulation and CU traits. Additionally, alterations in frontolimbic brain structure may be useful predictors of pre-treatment associations with externalizing psychopathology dimensions and post-treatment behavioural outcomes.

Investigating cross-sectional and longitudinal relationships between brain structure and distinct dimensions of externalizing psychopathology in the ABCD sample

Externalizing psychopathology in childhood is a predictor of poor outcomes across the lifespan. Children exhibiting elevated externalizing symptoms also commonly show emotion dysregulation and callous-unemotional (CU) traits. Examining cross-sectional and longitudinal neural correlates across dimensions linked to externalizing psychopathology during childhood may clarify shared or distinct neurobiological vulnerability for psychopathological impairment later in life. We used tabulated brain structure and behavioural data from baseline, year 1, and year 2 timepoints of the Adolescent Brain Cognitive Development Study (ABCD; baseline n = 10,534). We fit separate linear mixed effect models to examine whether baseline brain structures in frontolimbic and striatal regions (cortical thickness or subcortical volume) were associated with externalizing symptoms, emotion dysregulation, and/or CU traits at baseline and over a two-year period. The most robust relationships found at the cross-sectional level was between cortical thickness in the right rostral middle frontal gyrus and bilateral pars orbitalis was positively associated with CU traits (β = |0.027-0.033|, pcorrected = 0.009-0.03). Over the two-year follow-up period, higher baseline cortical thickness in the left pars triangularis and rostral middle frontal gyrus predicted greater decreases in externalizing symptoms ((F = 6.33-6.94, pcorrected = 0.014). The results of the current study suggest that unique regions within frontolimbic and striatal networks may be more strongly associated with different dimensions of externalizing psychopathology. The longitudinal findings indicate that brain structure in early childhood may provide insight into structural features that influence behaviour over time.

The amygdala volume moderates the relationship between childhood maltreatment and callous-unemotional traits in adolescents with conduct disorder

CU traits, characterized by shallow affect, lack of fear, and absence of remorse, have been moderately associated with childhood maltreatment in a recent meta-analysis. However, the potential impact of brain structures remains undetermined. This paper examines the relationship between callous-unemotional (CU) traits, childhood maltreatment, and amygdala volumes. In this study, we used a region-of-interest (ROI) analysis to explore the interaction between the volumes of the amygdala, childhood maltreatment, and the manifestation of CU traits in adolescents diagnosed with conduct disorder (CD, N = 67), along with a comparison group of healthy-control youths (HCs, N = 89). The ROI analysis revealed no significant group differences in the bilateral amygdalar volumes. Significant positive correlation was discovered between all forms of child maltreatment (except for physical neglect) and CU traits across subjects. But the interaction of physical abuse and amygdala volumes was only significant within CD patients. Notably, a sensitivity analysis suggested that gender significantly influences these findings. These results contribute critical insights into the etiology of CU traits, emphasizing the need for customized clinical assessment tools and intervention strategies.

Vocally-Encoded Emotional Arousal as a Marker of Callous-Unemotional Traits in a Sample of Justice-Involved Adolescents

Callous-unemotional (CU) traits are associated with severe and persistent juvenile offending. CU traits are also associated with dampened emotional arousal, which suggests that fundamental frequency (f0), a measure of vocally-encoded emotional arousal, may serve as an accessible psychophysiological marker of CU traits in youth. This study investigated the associations between f0 range measured during an emotionally evocative task, CU traits, and emotion dysregulation in a mixed-gender sample of 168 justice-involved youth. For boys, after controlling for covariates, wider f0 range-indicating greater emotional arousal-was negatively associated with CU traits and positively associated with emotion dysregulation. For girls, no significant associations with f0 range emerged; however, CU traits were positively associated with emotion dysregulation. Findings suggest that f0 range may serve as a valid indicator of CU traits in JJ-involved boys, and that detained boys and girls with high CU traits are characterized by different profiles of emotion dysregulation.

Primary and Secondary Callous-Unemotional Childhood Variants in a Korean Community Sample

Despite the growing support for the multiple developmental pathways to phenotypic callous-unemotional (CU) traits (i.e., primary, and secondary CU variants), there remains limited research on childhood manifestations of CU variants in non-Western, community samples. Using a latent profile analysis with data sourced from the longitudinal, nationwide Korean sample (N = 1597, 48.7% girls), we discerned heterogeneous groups of children, based on externalizing problems, CU traits, and emotional reactivity level. The optimal five-profile solution identified distinct subgroups: low-risk, primary CU (characterized by low emotional reactivity and externalizing problem), reactive (low CU/moderate emotion reactivity and externalizing problem), and two secondary CU groups (i.e., secondary-high CU and secondary-moderate CU; both high in emotional reactivity and externalizing problems). The two secondary CU variants demonstrated differences from the primary CU variants, in that both are high in preschool externalizing problems (age 6) and school-age conduct problems (age 11). However, the secondary-moderate CU group displayed greater levels of anxiety at age 11 compared to secondary-high CU, indicating divergent developmental trajectories of secondary CU variants. These findings expand our understanding of CU variants among Korean preschoolers and highlight the role of emotional reactivity in distinguishing such subtypes and identifying their developmental outcomes across time.

Environmental Predictors of Within-Person Changes in Callous-Unemotional Traits among Justice-Involved Male Adolescents

OBJECTIVE

Youth who display elevated callous-unemotional (CU) traits are at risk for negative developmental outcomes. Previous studies demonstrate that environmental conditions contribute to elevated levels of CU traits, but the majority of this work focuses on a single source of environmental influence. To better understand how environmental conditions contribute to changes in CU traits during adolescence, the current study examined the time-varying relation between CU traits, parent, peer, and community conditions.

METHOD

Using data from the longitudinal Pathways to Desistance study (N = 1,026 males, Mage = 15.98, SD = 1.16; 40.94% Black, 34.11% Latino, 20.66% White, 4.29% Other), full-factorial fixed effect regression models were implemented to examine how parental hostility, antisocial peers, community violence, and neighborhood disorder are individually and interactively associated with within-person changes in CU traits during adolescence (15-21 years).

RESULTS

Results indicated that proximal conditions (i.e., negative parenting, antisocial peers) had more consistent associations with CU traits than distal conditions (i.e., neighborhood disorder, community violence). Affiliation with antisocial peers was not significantly related to CU traits when youth were simultaneously exposed to high community violence and low neighborhood disorder. Further, the association between CU traits and impact of living in high disordered, high violence neighborhoods was stronger for younger youth.

CONCLUSION

Results indicate that the association among parents, peers, and CU trait development is more nuanced than previously suggested, such that the risk that each environmental condition poses is moderated by a youth's age and their exposure to distal conditions.

Resting heart rate moderates the relationship between parental emotion socialization and callous-unemotional traits in children

Although empirical findings have indicated that both familial and neurobiological risk factors contribute to the development of callous-unemotional (CU) traits in children, relatively few studies have investigated how these two factors interact to influence these traits. The current study focused on the combined effects of parental emotion socialization and child's resting heart rate on CU traits. Parents of Chinese children (N = 166) completed the Coping with Children's Negative Scale when children were 9.39 years old (SD = 0.92), while children's resting heart rate data were collected when they were 10.21 years old (SD = 0.72). When they were 11.15 years old (SD = 0.67), parents completed the Inventory of Callous-Unemotional Traits Short-Form. Results showed that parental supportive emotion socialization was negatively associated with CU traits and Callous behaviors in particular. In addition, resting heart rate moderated the relationship between parental emotion socialization and child's CU traits. Findings provide further evidence that an interdisciplinary approach that combines both psychosocial and biological factors is essential to further our understanding of CU traits in youth.

Emotion Identification for Self and Other Associated with Callous-Unemotional Traits and Sex Differences in Early Adolescents

Callous-unemotional traits (CU) associates with impairments in emotional responsivity. However, there is less evidence on associations with specific emotions and sex differences utilizing both self and other oriented emotional stimuli. Given that the nuance of associations with specific emotions (including sex effects) is critical for understanding core impairments of this antisocial phenotype, the current study employed a behavioral paradigm with both self and other emotional stimuli for specific emotions (happy, sad, anger, fear, neutral) with a sample of male and female early adolescents (females = 51%, age = 12.86 ± 0.75). We examined accuracy and reaction times on this task, along with moderating effects of sex, in relation to CU traits. Results indicate CU traits associated with overall self-emotions negatively and sex moderated CU traits negative association with recognizing others overall emotions. CU traits negatively associated with accurate identification of both self and other emotions (happy, sad, and fear). Sex moderated all other emotion identification but only sad emotions for self. No reaction time differences were found. These findings evidence important nuance in CU traits and sex effects with identifying self and other emotions. Results have important implications for clinical understanding of sex differences in CU traits that require further consideration.

[Externalizing problem behavior with friends in adolescence: What role do factors of callous-unemotional traits play?]

INTRODUCTION

Affective impairments/disorders are one explanation as to why adolescents exhibit externalizing problem behavior (rule-breaking and dissocial behavior). Impaired affect is a core feature of callous-unemotional traits (CU traits). CU traits are composed of three factors: Callousness (lack of empathy and remorse), Uncaring (indifferent attitude toward task performance and the feelings of others), and Unemotional (superficial or flattened affect). Externalizing problem behaviors mostly occur in groups during adolescence. Therefore, it is important to consider the relationship between CU traits and externalizing problem behaviors that are exhibited explicitly in collaboration with or in the presence of friends. This perspective has been lacking in research on CU traits. The present study aims to fill this research gap.

METHODS

Self-report data were collected between June 2021 and March 2023 from N = 169 adolescents (54% female; M = 14.95 years) using a set of questionnaires that could be completed online or as a paper-pencil version. In addition to CU traits (ICU) the set of questionnaires included assessments of rule-breaking and dissocial behavior with friends (CBCL: YSR 11-18 R).

RESULTS

Only the subscale Callousness contributes to the explanation of externalizing problem behaviors with friends (6% variance explained).

DISCUSSION

The results indicate that the three factors of CU-traits should be considered separately. In addition, when examining externalizing problem behavior, one should consider whether it is exhibited alone or together with or in the presence of friends. Limitations of the study, ideas for further research, and practical implications are discussed.

Emotion Recognition Deficits in Children and Adolescents with Psychopathic Traits: A Systematic Review

Children and adolescents with psychopathic traits show deficits in emotion recognition, but there is no consensus as to the extent of their generalizability or about the variables that may be moderating the process. The present Systematic Review brings together the existing scientific corpus on the subject and attempts to answer these questions through an exhaustive review of the existing literature according to PRISMA 2020 statement. Results confirmed the existence of pervasive deficits in emotion recognition and, more specifically, on distress emotions (e.g., fear), a deficit that transcends all modalities of emotion presentation and all emotional stimuli used. Moreover, they supported the key role of attention to relevant areas that provide emotional cues (e.g., eye-region) and point out differences according to the presence of disruptive behavior and based on the psychopathy dimension examined. This evidence could advance the current knowledge on developmental models of psychopathic traits. Yet, homogenization of the conditions of research in this area should be prioritized to be able to draw more robust and generalizable conclusions.

An 'embedded brain' approach to understanding antisocial behaviour

Antisocial behaviour (ASB) incurs substantial costs to the individual and society. Cognitive neuroscience has the potential to shed light on developmental risk for ASB, but it cannot achieve this potential in an 'essentialist' framework that focuses on the brain and cognition isolated from the environment. Here, we present the case for studying the social transactional and iterative unfolding of brain and cognitive development in a relational context. This approach, which we call the study of the 'embedded brain', is needed to fully understand how risk for ASB arises during development. Concentrated efforts are required to develop and unify methods to achieve this approach and reap the benefits for improved prevention and intervention of ASB.

The "Measure of Empathy in Early Childhood": Psychometric Properties and Associations with Externalizing Problems and Callous Unemotional Traits

Empathy is crucial to the development of socio-emotional skills in youth and empathy development is central to understanding and subtyping youth with externalizing problems. This study explored for the first time the psychometric properties of the Measure of Empathy in Early Childhood (MEEC) in a sample of 652 Italian children aged 6 to 8 years. The gender invariance of MEEC scores and their associations with other measures of empathy and prosocial behavior, and children's externalizing problems and callous-unemotional (CU) traits were also evaluated. Results indicated that with some modifications, a 5-factor structure of the Italian version of MEEC scores fitted the data and was invariant across gender. Results further supported the reliability and validity of MEEC total and subscale scores. Practical implications of these results are discussed.

Examining the relation among callous-unemotional traits and cortisol, alpha-amylase, and testosterone reactivity in legal system involved young men

Elevated callous-unemotional (CU) traits (e.g., lack of empathy, deficient guilt/remorse, and shallow affect) are associated with increased antisociality and distinct patterns of cognitive and emotional functioning. Previous investigations have suggested that deficits in physiological stress responses may underlie these associations, yet few studies simultaneously examine the multiple physiological systems responsible for mounting a stress response. To clarify how individuals with and without elevated CU traits respond to acute stress, the current study examined the association between CU traits and hormones released by three systems: cortisol from the hypothalamic-pituitary-adrenal (HPA) axis, alpha-amylase from the sympathetic nervous system (SNS), and testosterone from hypothalamic-pituitary-gonadal (HPG) axis. Specifically, we used fixed effect regression modeling to examine within-individual changes in each biomarker across the administration of a standardized laboratory stressor (Trier Social Stress Test) in a sample of 55 justice-involved young men (Mage= 22.84). Results indicated significant within-individual changes in cortisol, alpha-amylase, and testosterone following the stressor among those with low or average CU traits. However, those with high levels of CU exhibited no significant changes in their cortisol and testosterone levels. Furthermore, individuals with high CU traits exhibit an asymmetric stress response, such that alpha-amylase and testosterone levels were not associated with changes in cortisol levels. In sum, elevated CU traits were associated with blunted cortisol and testosterone reactivity and asymmetric response to stress. Additional work is needed to determine the behavioral and treatment implications of this distinct stress response.

Morality in middle childhood: the role of callous-unemotional traits and emotion regulation skills

BACKGROUND

The development of morality is vital for fostering prosocial behavior and enhancing both individual and societal well-being. Clarifying what contextual and individual factors play a role in moral processes during childhood can contribute to our understanding of the development of morality. Given the previous acknowledgment of importance, yet lack of existing empirical findings, the study focused on the significance of callous-unemotional traits (i.e., an affective-interpersonal personality trait, related to psychopathy in adulthood) and emotion regulation (i.e., an essential part of socio-emotional competence, and a transdiagnostic factor in the development of psychopathology) for moral emotions and cognitions during middle childhood. The concrete aim was to examine direct and indirect effects of callous-unemotional trait dimensions (callousness, uncaring, unemotionality) onto immoral emotional attribution (i.e., feeling good after immoral decisions) and admissibility of immoral actions (i.e., evaluating immoral actions as being okay) via emotion regulation skills.

METHODS

A cross-sectional study was conducted with 194 children attending Grades 1 to 4, and their primary caregivers. The children completed the Inventory of Callous-Unemotional Traits and caregivers completed the Emotion Regulation Checklist. The children were also presented with a set of moral dilemma vignettes, and asked about the emotions of protagonists who acted immoral, and the admissibility of their actions.

RESULTS

Path-model analysis revealed (1) negative direct effects of emotion regulation skills onto immoral emotional attribution and admissibility of immoral actions, (2) positive direct effects of the dimensions callousness and uncaring onto immoral emotional attribution and admissibility of immoral actions, and (3) negative direct effects of dimensions callousness and uncaring onto emotion regulation skills. Indirect effects, indicating that emotion regulation skills mediate the association between the callous-unemotional trait dimensions and morality, were also found.

CONCLUSION

The findings address a knowledge gap and indicate that emotion regulation skills, callousness, and uncaring play an important role in morality in middle childhood and should be included in frameworks of moral decision-making and development.

Dissociating cognitive and affective empathy across psychopathy dimensions: The role of interoception and alexithymia

This study examined the associations between psychopathy dimensions (triarchic phenotypes and classical factors), empathy domains (cognitive and affective), and interoception (interoceptive attention and accuracy) while accounting for the putative role of alexithymia. A community sample (n = 515) completed an online survey encompassing: Triarchic Psychopathy Measure (boldness, meanness, disinhibition); Levenson Self-Report Psychopathy Scale (primary and secondary psychopathy); Body Perception Questionnaire (interoceptive attention); Interoceptive Accuracy Scale; Toronto Alexithymia Scale. Hierarchical linear regression models were implemented for hypothesis-driven analyses examining the associations between psychopathy, empathy, and interoception while controlling for sex, age, and alexithymia. Exploratory path models were employed to investigate alexithymia and/or cognitive empathy as mediators between interoception and psychopathy. Our results largely confirmed the postulated empathy profiles across psychopathy dimensions, as meanness and primary psychopathy displayed a broad empathy impairment, while disinhibition and secondary psychopathy were only associated with diminished cognitive empathy. Importantly, boldness displayed a unique pattern (enhanced cognitive empathy and reduced affective empathy), further reinforcing its importance within the constellation of psychopathy traits. Contrary to our hypotheses, self-perceived interoceptive attention and accuracy were not associated with either psychopathy dimension after controlling for alexithymia. However, interoceptive accuracy and alexithymia were associated with cognitive empathy, while alexithymia was also positively related to all psychopathy dimensions (as expected), despite the unexpected strong and negative association with boldness. Exploratory analyses suggested significant indirect effects (mediation) between interoceptive accuracy and psychopathy via alexithymia and/or cognitive empathy. These mediating effects must be interpreted with caution and future studies should be designed to formally test this model.

Callous-unemotional traits and externalizing problem behaviors in left-behind preschool children: the role of emotional lability/negativity and positive teacher-child relationship

BACKGROUND

Callous-unemotional traits and emotional lability/negativity of young children have been regarded as the markers of externalizing problem behaviors. Based on the sensitivity to threat and affiliative reward model and the general aggression model, emotional lability/negativity may act as a mediator in the relationship between callous-unemotional traits and externalizing problem behaviors. Additionally, a positive teacher-child relationship could act as a buffer given the parental absence in left-behind children. However, these links remain unexplored in left-behind preschool children. Therefore, this study explored the link between callous-unemotional traits of left-behind preschool children and externalizing problem behaviors, as well as the mediating role of emotional lability/negativity and the moderating role of a positive teacher-child relationship.

METHOD

Data were collected on 525 left-behind children aged 3 to 6 years from rural kindergartens in China. Preschool teachers reported all data through an online survey platform. Moderated mediation analysis was performed to examine whether the mediated relation between callous-unemotional traits and externalizing problem behaviors was moderated by a positive teacher-child relationship.

RESULTS

The results showed callous-unemotional traits significantly predicted externalizing problem behaviors and lability/negativity acted as a mediator, while a positive teacher-child relationship acted as a protective factor in moderating the relationship between callous-unemotional traits and emotional lability/negativity. This study identified a moderated mediation effect among the four variables in left-behind preschool children in China.

CONCLUSION

The findings provide support for the advancement of theoretical foundations, and provide an avenue for further exploration to support the mental health and overall development of left-behind children during early childhood.

More than a feeling? An expanded investigation of emotional responsiveness in young children with conduct problems and callous-unemotional traits

Children with conduct problems and high callous-unemotional (CP+CU) traits are characterized by dampened emotional responding, limiting their ability for affective empathy and impacting the development of prosocial behaviors. However, research documenting this dampening in young children is sparse and findings vary, with attachment-related stimuli hypothesized to ameliorate deficits in emotional responding. Here we test emotional responsiveness across various emotion-eliciting stimuli using multiple measures of emotional responsiveness (behavioral, physiological, self-reported) and attention, in young children aged 2-8 years (M age = 5.37), with CP+CU traits (CP+CU; n = 36), CPs and low CU traits (CP-CU; n = 82) and a community control sample (CC; n = 27). We found no evidence that attachment-related stimulus ameliorated deficits in emotional responding. Rather, at a group level we found a consistent pattern of reduced responding across all independent measures of responsiveness for children with CP+CU compared to the CC group. Few differences were found between CP+CU and CP-CU groups. When independent measures were standardized and included in a regression model predicting to CU trait score, higher CU traits were associated with reduced emotional responding, demonstrating the importance of multimodal measurement of emotional responsiveness when investigating the impact of CU traits in young children.

Added value of neurotechnology for forensic psychiatric and psychological assessment

The attention for neuroscience in relation to criminal behavior is growing rapidly, and research shows that neurobiological factors have added value to the understanding of psychological and social factors in explaining delinquency. There is evidence that neurotechnology can be used in criminal justice and may be of relevance for forensic psychiatric and psychological assessment. However, the question is whether scientific knowledge of neurobiological factors is applicable in daily practice of forensic assessment. Incorporation of basic technologies, e.g., psychophysiology (heart rate, skin conductance, wearables), hormonal measures (cortisol, testosterone), and neuropsychological testing might be evident, since they can be applied relatively easy. Moreover, a body of research shows the additive value of these technologies in this field. In addition, first steps are taken to apply these technologies in individual diagnostics, treatment, and risk assessment. Complex neurotechnologies like functional MRI (e.g., brain reading) and EEG show potential to be applicable in criminal justice, once it is known what additional information these indices offer for individual cases.

Community Violence Exposure and Generalized Anxiety Symptoms: Do Callous-Unemotional Behaviors Moderate this Relation Among Urban Youth?

Community violence exposure (CVE; i.e., direct victimization and witnessed violence) is a major public health concern among youth who reside in low income, urban neighborhoods, who tend to experience CVE chronically and disproportionately. Frequent CVE is associated with generalized anxiety disorder (GAD) symptoms, such as persistent or excessive worry and difficulty concentrating. However, not all youth experiencing CVE exhibit such symptoms. One understudied factor that may moderate this relation is callous-unemotional (CU) behaviors (e.g., behaviors consistent with lack of guilt, low levels of empathy). CU behaviors are associated with lower levels of responsiveness to contextual processes; as such, CU behaviors may be associated with lower levels of GAD symptoms in the context of CVE. However, little research considers CU behaviors and GAD symptoms concurrently. To address this gap, the present study examined associations among witnessed and direct CVE, CU behaviors, and GAD symptoms among low-income, urban youth (N = 104, 50% male, Mage = 9.93 ± 1.22 years old, 95% African-American/Black). Multiple regression analyses indicated teacher-reported CU behaviors moderated the relations between CVE and caregiver-reported GAD symptoms. Post-hoc probing revealed that among youth with higher levels of CVE, higher levels of CU behaviors were associated with elevated GAD symptoms compared to their peers with lower levels of CU behaviors. Youth with lower levels of CU behaviors evidenced moderate levels of GAD symptoms regardless of their levels of CVE. Thus, low-income, urban youth who experience elevated levels of CVE may be at increased risk for co-occurring GAD and CU symptoms.

No hard feelings: maternal emotion socialization and callous-unemotional traits in children

Parents' identification and discussion of their own and their children's emotions are important emotion socialization behaviors (ESBs) that may mitigate child conduct problems (CPs). However, if parents perceive their child to be relatively unemotional, which may be the case for children with conduct problems and high callous-unemotional traits (CP + CU), these parents may be limited in their capacity to use ESBs effectively. This study tested these questions by looking at ESBs in mothers (N = 145) of children aged 2-8 years with CP + CU (n = 24), CPs and low CU traits (CP-CU; n = 94) and a non-clinical community sample (n = 27). After watching an emotional movie excerpt, mothers were asked to (1) provide ratings of their child's emotional experience and then (2) engage in a debriefing task with their child about the content. Children's expressed emotion during the excerpt and transcriptions of the debriefing task were coded by masked raters. Unexpectedly, mothers' perceptions of their children's emotion did not vary by group. Emotional ratings provided by mothers of children in the CP + CU group most closely aligned with ratings from independent observers. ESBs did not differ by group in the debriefing task. Mothers of children with CP + CU traits were shown in this study to be reliable reporters of their children's expressed emotion and showed similar rates of parental ESBs as mothers of children in the other groups. Results are discussed in reference to various models of parenting and CU traits that might account for these unexpected findings.

Is feeling bad good enough? Ethical guilt and callous-unemotional traits in childhood

Lacking the capacity for guilt is a defining characteristic of callous-unemotional (CU) traits. Although guilt is a multifaceted construct, past CU research has rarely considered the reasons underlying children's negative emotional responses to wrongdoing. The present study investigated how different forms of guilt were associated with CU traits during early and middle childhood in a Canadian community sample. We interviewed 4- and 8-year-olds (N = 300; 50% female) to assess their emotion attributions and reasoning in response to hypothetical acts of aggression. Interview responses were used to calculate variables representing undifferentiated, ethical, and non-ethical guilt ratings. Caregivers rated children's CU tendencies at baseline and again 3 years later. Higher ethical guilt was associated with lower CU scores concurrently and 3 years later. Higher non-ethical guilt was associated with higher CU scores at baseline (for older children) and 3 years later (for all children). Undifferentiated guilt was not associated with CU after controlling for demographic variables.

Factorial Structure of the Parent-Reported Version of the Inventory of Callous-Unemotional Traits Among Belgian Children: A Theory-Based Model

The factorial structure of the Inventory of Callous-Unemotional traits (ICU) is still under debate in the current literature and the published models are predominantly based on the empirical results of the statistical analyses rather than on a strong theoretical background. Aimed at overcoming these limits, the current study examined a factorial structure initiated by a theoretical framework for the parent-version of the ICU, based on a community sample of Belgian children aged 3–9 (N = 437; M age = 5.59; 54.7% boys). Further, the current study investigated measurement invariance across age and gender, and the external validity of this structure. Confirmatory factor analysis (CFA) indicated that empirical factor models from the current literature demonstrated a relatively poor fit to the data. Alternative models were built based on theory, specifically criteria from the DSM-V specifier “with limited prosocial emotions.” CFA supported an 18-item second order model with three first order factors (Lack of conscience, Unconcern about performance, Lack of emotional expression), a second order latent factor (General dimension of CU traits) and a methodological factor encompassing negatively worded items. Results supported measurement invariance across child gender, and to a lesser extent across age. As expected, the general dimension correlated with measures of aggressive behavior, attention problems, internalizing behavior and empathy. The Lack of emotional expression subfactor showed a different pattern of associations in comparison to the two other subfactors. The implications of these findings are discussed, specifically in relation to the DSM-V LPE specifier.

Moral reasoning, emotion understanding, and callous-unemotional traits in early-to-middle childhood

Relatively little is known about features of moral reasoning among young children with callous-unemotional (CU) traits (e.g., lack of guilt and empathy). This study tested associations between CU traits and emotion attributions (i.e., identification of others' emotional states) and justifications (i.e., explanations for those emotional states), across social scenarios involving discreet versus salient distress cues. The participants were boys aged 6-to-10 years (N = 50; Mage  = 7 years 7 months), who were interviewed about 12 hypothetical scenarios (eight with discreet and four with salient distress cues). Regression models indicated that CU traits, in interaction with high levels of antisocial behaviour, were associated with reduced emotion attributions of fear in discreet but not salient immoral scenarios. Higher CU traits were also associated with reduced justifications referencing others' welfare in discreet scenarios, and increased references to action-orientated justifications in salient scenarios. These findings suggest that CU traits are associated with early moral reasoning impairments and that salience of distress may be important to these processes.

Individual differences in white matter of the uncinate fasciculus and inferior fronto-occipital fasciculus: possible early biomarkers for callous-unemotional behaviors in young children with disruptive behavior problems

BACKGROUND

Callous-unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to (a) explore differences in the white matter microstructure in the UF and other major fiber tracks between young typically developing (TD) children and those with a disruptive behavior disorder (DBD) and (b) explore, within the DBD group, whether individual differences in these white matter tracts relate to co-occurring CP and CU behaviors.

METHODS

Participants included 198 young children (69% boys, Mage  = 5.66 years; 80% Latinx; 48.5% TD). CU behaviors and CP were measured via a combination of teacher/parent ratings. Non-invasive diffusion-weighted imaging (DWI) was used to measure fractional anisotropy (FA), an indirect indicator of white matter properties.

RESULTS

Relative to TD children, children in the DBD group had reduced FA on four out of the five fiber tracks we examined (except for cingulum and right ILF), even after accounting for whole brain FA, sex, movement, parental income, and IQ. Within the DBD group, no associations were found between CP and reduced white matter integrity across any of the fiber tracks examined. However, we found that even after accounting for CP, ADHD symptomology, and a host of covariates (whole brain FA, sex, movement, parental income, and IQ), CU behaviors were independently related to reduced FA in bilateral UF and left inferior fronto-occipital fasciculus (IFOF) in the DBD group, but this was not the case for TD children.

CONCLUSIONS

Alterations in the white matter microstructure within bilateral UF and left IFOF may be biomarkers of CU behaviors, even in very young children.

Common functional brain networks between attention deficit and disruptive behaviors in youth

Attention deficits (AD) and disruptive behavior (DB) are highly comorbid youth externalizing behaviors. This study aimed to study reliable functional brain networks shared by AD and DB in youth aged from 8 to 21 years from the Philadelphia Neurodevelopmental Cohort (PNC). The PNC study assessed AD and DB behaviors via Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). This study employed sparse canonical correlation analysis (SCCA) to examine the correlation of AD and DB behaviors with resting-state functional connectivity maps of the brain regions identified via activation likelihood estimation (ALE) meta-analyses on attention deficit/hyperactivity disorder (ADHD) and DB disorder (DBD). Our meta-analyses identified that the middle cingulate cortex, pre-supplementary motor area (pre-SMA), and striatum had a great consensus in existing ADHD studies and the amygdala and inferior parietal lobule were consistently found in existing DBD studies. Our SCCA analysis revealed that the AD and DB behavioral items relevant to inattention and delinquency were correlated with the functional connectivity of the pre-SMA with the ventral attentional and frontoparietal networks (FPN), and the striatum with the default mode (DMN) and dorsal attentional networks. The AD and DB behavioral items relevant to inattention and irritability were associated with the functional connectivity between the amygdala and the DMN and FPN. Our findings suggest that the functional organization of the ADHD- and DBD-related brain regions provides insights on the shared neural basis in AD and DB.

Subnormal short-latency facial mimicry responses to dynamic emotional facial expressions in male adolescents with disruptive behavior disorders and callous-unemotional traits

Using still pictures of emotional facial expressions as experimental stimuli, reduced amygdala responses or impaired recognition of basic emotions were repeatedly found in people with psychopathic traits. The amygdala also plays an important role in short‐latency facial mimicry responses. Since dynamic emotional facial expressions may have higher ecological validity than still pictures, we compared short‐latency facial mimicry responses to dynamic and static emotional expressions between adolescents with psychopathic traits and normal controls. Facial EMG responses to videos or still pictures of emotional expressions (happiness, anger, sadness, fear) were measured. Responses to 500‐ms dynamic expressions in videos, as well as the subsequent 1500‐ms phase of maximal (i.e., static) expression, were compared between male adolescents with disruptive behavior disorders and high (n = 14) or low (n = 17) callous‐unemotional (CU) traits, and normal control subjects (n = 32). Responses to still pictures were also compared between groups. EMG responses to dynamic expressions were generally significantly smaller in the high‐CU group than in the other two groups, which generally did not differ. These group differences gradually emerged during the 500‐ms stimulus presentation period but in general they were already seen a few hundred milliseconds after stimulus onset. Group differences were absent during the 1500‐ms phase of maximal expression and during exposure to still pictures. Subnormal short‐latency mimicry responses to dynamic emotional facial expressions in the high‐CU group might have negative consequences for understanding emotional facial expressions of others during daily life when human facial interactions are primarily dynamic.

During human interactions, short‐latency facial mimicry responses occur to dynamic emotional facial expressions of others. These are preconscious, automatic responses which cannot be voluntarily controlled. They may be important for emotional understanding of others and appear to be subnormal in male adolescents with psychopathic traits.

Callous-Unemotional Traits Do Not Predict Functional Family Therapy Outcomes for Adolescents With Behavior Problems

Despite the availability of evidence-based treatment models for adolescent behavior problems, little is known about the effectiveness of these programs for adolescents with callous-unemotional (CU) traits. Defined by lack of empathy, lack of guilt, flattened affect and lack of caring, CU traits have been linked to long-term anti-social behavior and unfavorable treatment outcomes and might be negatively related to outcomes in evidence-based programs such as Functional Family Therapy (FFT). This study used a single-group pre-post evaluation design with a sample of 407 adolescents (49.1% female, mean age = 14.4 years, SD = 1.9) receiving FFT to investigate whether outcomes in FFT are predicted by CU traits and to what extent reliable changes in CU traits can be observed. The results showed that although CU traits are related to increased problem severity at baseline, they predicted neither treatment dropout nor post-treatment externalizing behavior and family functioning. CU traits were related to diminished improvement ratings, in particular with respect to parental supervision. Reductions in CU traits were observed across the time of treatment, and these were most profound among adolescents with elevated levels of CU traits at baseline. Further research should investigate whether certain evidence-based treatment components are more suited for adolescents with CU, and if the addition of specific intervention elements for reducing CU-traits could further improve outcomes for this high-risk population.

Antisocial behaviour and teacher-student relationship quality: The role of emotion-related abilities and callous-unemotional traits

BACKGROUND

Childhood antisocial behaviour has been associated with poorer teacher-student relationship (TSR) quality. It is also well-established that youth with antisocial behaviour have a range of emotion-related deficits, yet the impact of these students' emotion-related abilities on the TSR is not understood. Furthermore, the addition of the Limited Prosocial Emotions Specifier in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that understanding the role of callous-unemotional (CU) traits for youth with antisocial behaviour problems is of particular importance.

AIMS

The aim of this study was to investigate the association between antisocial behaviour difficulties and the TSR by examining the influence of emotion-related abilities and CU traits.

SAMPLE

Twelve teachers from 10 primary schools provided anonymized information on 108 children aged 6-11 years.

RESULTS

Antisocial behaviour was associated with higher teacher-student conflict (but not closeness) as well as higher emotion lability/negativity and lower emotion understanding/empathy. Emotion lability/negativity was associated with higher teacher-student conflict (but not closeness), and emotion understanding/empathy was associated with lower teacher-student conflict and higher closeness. CU traits were associated with higher teacher-student conflict and lower teacher-student closeness (controlling for antisocial behaviour more broadly). We found no evidence of a moderating effect of CU traits or emotion-related abilities on the association between antisocial behaviour and TSR quality.

CONCLUSIONS

Interventions for behaviour difficulties should consider teacher-student relationships in the classroom. Strategies which aim to improve teacher-student closeness as well as reduce teacher-student conflict may be of particular value to students with high CU traits.

Cyclothymic-hypersensitive temperament in youths: Refining the structure, the way of assessment and the clinical significance in the youth population

BACKGROUND

Although a better understanding of the prodromes of affective disorders in youth has important clinical and research implications, empirical data are still unconclusive. Cyclothymic-hypersensitive temperament (CHT) has been linked to both depression and bipolarity, as well as to suicidality. Its conceptualization is still debated, as well as a comprehensive, psychometrically sound way of assessment.

METHODS

factor structure, reliability, measurement invariance, convergent and divergent validity of the previously published CHT questionnaire (a youth version derived from Temperament Evaluation in Memphis Pisa and San Diego (TEMPS) was assessed in a school-based sample of 2959 students aged from 10 to 14 years (mean age = 11.8 ± 0.97 years). Furthermore, accuracy, sensitivity and specificity were calculated for a new cut-off score related to the presence of general psychopathology symptoms.

RESULTS

CHT is better conceptualized in a two-correlated factors model, a moodiness/hypersensitiveness factor, more associated with internalizing symptoms, and an impulsiveness/emotional dysregulation factor, more associated with externalizing symptoms. The revised 22-items version of the CHT questionnaire with a cut-off score of 15 for females and 17 for males results accurate, sensitive and specific enough for the recognition of cyclothymic adolescents with clinical symptoms.

LIMITATION

the cross sectional design and the self-report nature of the measures limit the findings.

DISCUSSION

Cyclothymic-hypersensitive temperament is a relevant concept in the realm of affective disorder and can be reliably assessed in youths. It may describe youths with the coexistence of both internalizing and externalizing symptoms that can be difficult to diagnose with a DSM perspective.