Comparing Different Approaches for Subtyping Children with Conduct Problems: Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct

Future Directions for Conduct Disorder and Psychopathic Trait Specifiers

Conduct disorder (CD) is a psychiatric diagnosis characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social norms or rules are violated. This article presents information on CD with an emphasis on a new multispecifier personality model that could offer a valuable new perspective on CD by refining the way we specify CD. The multispecifier model may have the potential to clarify the considerable confusion that has occurred over past decades and improve our understanding of prevalence, etiology, course, and treatment of youth with conduct problems. In this paper, we present a new structure for CD designed to inspire new lines of research that may be needed to help the field more fully capitalize on this innovation. With additional research, it is hoped that the new multispecifier model will eventually buy clinicians additional information that cannot be gleaned from current diagnostic criteria and will help clinicians and researchers further uncover the factors that promote or protect against the development of CD. This paper delineates the areas of research that will be needed to fully realize the potential of a multispecifier model and ultimately to improve clinical care for children and adolescents with CD.

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.

Primary and Secondary Variants of Callous-Unemotional Traits in Children with Conduct Problems: A Longitudinal Follow-up During Adolescence

Recent empirical work has suggested that youths with conduct problems and presenting high levels of callous-unemotional (CU) traits can be divided in two variants (i.e., primary, secondary) presenting specific characteristics and needs, but studies examining outcomes associated longitudinally with variants memberships remain scarce. Building on a previous investigation in which we identified variants of CU traits among children with conduct problems, we examined differences between groups on a wide range of behavioral/psychological, relational/social, and educational outcomes assessed during adolescence (n = 309, mean age = 17.4, SD = 0.96). When compared to those from the primary variant, youths from the secondary variant reported higher levels of conduct, opposition, attention deficit/hyperactivity and anxiety problems, had lower teacher-reported academic performance, experienced more conflictual relationships with their teachers, and were at higher risk of being victimized by their intimate partner. These results shed light on the specific clinical characteristics of children from the secondary variant that are likely to persist until adolescence. Providing these children with intensive preventive interventions targeting these long-term consequences could be particularly beneficial.

Utility of Multiple Specifiers for Subtyping Oppositional Defiant Problems: Investigating Multiple Psychopathy Dimensions as Specifiers

Past research has speculated that using grandiose-manipulative (GM) and daring-impulsive (DI) traits, rather than solely callous-unemotional (CU) traits, could better inform subtyping youths with behavioral problems. However, this approach remains largely untested. To further enhance our understanding of this matter, the current study utilized self-report (n = 2,381) and parent-report (n = 1,846) data to examine the utility of three psychopathic dimensions as specifiers for oppositional defiant problems (ODP). Findings showed that ODP was a significant predictor of negative outcomes, while the GM, CU, and DI traits emerged as significant predictors of theoretically and clinically relevant external variables (e.g., conduct problems and proactive aggression), independent of ODP (and age, gender, and socioeconomic status), forming the potential foundation for the development of specifiers for ODP. Furthermore, children presenting ODP alongside heightened levels of the three psychopathic traits demonstrated notably higher scores in important external variables compared to other groups, including but not confined to the subgroup of children with ODP and high CU trait levels. Findings provide preliminary support for employing GM and DI traits as specifiers for ODP. However, more comprehensive evaluations of these specifiers' utility would help inform ongoing discussions before definitively concluding they should be included in diagnostic manuals.

The Prognostic Usefulness of Multiple Specifiers for Subtyping Conduct Problems in Early Childhood

OBJECTIVE

To better describe and treat children with conduct problems (CP), grandiose-manipulative and daring-impulsive traits are proposed for subtyping CP, instead of using only a callous-unemotional specifier. However, the acclaimed benefits of having multiple specifiers for CP remain largely untested and therefore highly speculative. To fill this gap, this study tested longitudinal relations between these 3 specifiers and developmental outcomes in childhood and adolescence, independent of early childhood CP.

METHOD

Longitudinal data from 2 community studies were used. Teacher ratings were used to measure CP and the specifiers in 3- to 5-year-olds from Sweden (n = 2,064) and Spain (n = 2,055). Developmental outcomes were assessed by multiple informants (ie, teachers, parents, and children) 1 to 8 years later.

RESULTS

Early childhood CP were predictive of all outcomes. Callous-unemotional traits predicted low levels of social competence and prosocial behavior, independent of CP (and age, sex, and socioeconomic status). Grandiose-manipulative and daring-impulsive traits were predictive of aggression and violent delinquency, respectively, independent of CP, but also of higher levels of prosocial behavior or social competence.

CONCLUSION

The 3 specifiers are predictive of different outcomes, independent of CP, which is thought to form the basis for developing specifiers for CP. Findings tentatively challenge the centrality of callous-unemotional traits for subtyping CP, but it is premature to conclude that grandiose-manipulative and daring-impulsive specifiers are needed in future revisions of DSM and ICD. Efforts to systematically evaluate the utility of these specifiers should be welcomed to inform ongoing debates on this matter.

Proposed Specifiers for Conduct Disorder (PSCD) scale: A Latent Profile Analysis with At-Risk Adolescents

The Proposed Specifiers for Conduct Disorder (PSCD; Salekin in Pers Disord: Theory Res Treat 7:180-191, 2016) scale was designed to assess interrelated psychopathic trait domains in conjunction with symptoms of Conduct Disorder (CD) in children and adolescents (i.e., grandiose-manipulative, callous-unemotional, daring-impulsive). Variable-centered studies have provided support for a four-factor PSCD structure (Salekin et al. in Psychol Assess 34(10):985-992, 2022) in line with other adolescent and adult studies. The current person-centered study used latent profile analysis of the PSCD domains to examine whether theoretically meaningful and empirically robust PSCD subtypes emerged from a diverse sample (70.9% White, 20.1% Black, 3.6% Hispanic, and 5.4% other) of adolescents (modal age = 17) in a military style residential facility (N = 409; Males = 80.6%). As hypothesized, a four-class solution was best, consistent with adult psychopathy subtyping research (Hare et al. in Handbook of Psychopathy 39-79, 2018; Roy et al. in Pers Disord: Theory Res Treat, in press). The PSCD subtype profiles were uniform across sex and race/ethnicity. Adolescents evincing a psychopathic trait propensity profile (elevated on all four PSCD domains) displayed the greatest number of arrests and higher overall externalizing psychopathology, compared to the other three latent classes, as well as higher internalizing psychopathology compared to adolescents with general delinquency. The PSCD provides a sound measure of psychopathic trait propensities in youth and our results offer investigators and clinicians a means for understanding person-centered psychopathic traits versus antisocial profiles among at-risk adolescents. Taken together, the current results may offer a viable approach for examining specific treatment targets based on PSCD subtype profiles.

Dimensions of Warm Parenting Attributions Differentiate Conduct Problem Subtypes in Young Children

Understanding the developmental psychopathology of child conduct problems (CP) has been advanced by differentiating subtypes based on levels of internalizing problems (INT) and/or callous-unemotional (CU) traits (i.e., low empathy/guilt, poor motivation, shallow/deficient affect). The current study sought to elucidate prior inconsistencies in the role of warm/positive and harsh/negative parenting subcomponents in CP by differentiating subtypes on the basis of INT and CU traits. Parents of 135 young children (M age = 4.21 years, SD = 1.29) referred to specialty clinics for the treatment of CP completed pre-treatment measures of parenting and rated their child's levels of CP, INT, and CU traits. Results of planned comparisons revealed that mothers of children classified as secondary CU variants (high CU/ high INT) reported fewer overall warm attributions toward their child, compared with CP-only (low CU) children. They also reported a more negative dyadic relationship characterized by feelings of anger/hostility, active avoidance and/or a desire to do harm to their child relative to primary CU variants (high CU/ low INT). Mothers of primary CU variants attributed fewer good and altruistic intentions towards others in their child, relative to CP-only children. Subtypes were undifferentiated on observed positive and negative parenting behaviors, indicative of a disconnect between parenting behaviors and cognitions for mothers of children high on CU traits. Findings are discussed in relation to their theoretical and practice implications, and in guiding future research.

The Proposed Specifiers for Conduct Disorder (PSCD) in Iranian School-Attending Adolescents: A Multi-Informant Validation Study of the PSCD Parent- and Youth Self-Report Versions

The Proposed Specifier for Conduct Disorder (PSCD) was developed to measure the broad psychopathy construct with grandiose-manipulative, callous-unemotional, daring-impulsive, and conduct disorder subscales. This study tested the psychometric properties of Persian parent-and-child self-report PSCD versions with 974 parents (86% mothers) and children/adolescents (46.5% boys) dyads. Results showed that with some modifications the proposed hierarchical four-factor structure for both PSCDs was confirmed and was found to be invariant across gender. Across versions, all PSCD scores were internally consistent and demonstrated expected correlations with parent-reported externalizing problems, anxiety/depression, and poor school performance, supporting the PSCDs scores' validity. This study also is the first to examine and establish acceptable to excellent parent-child agreement of PSCD scores. Finally, all PSCD child-report scores offered small though significant incremental validity over their corresponding PSCD parent-version scores in predicting parent-reported conduct problems and proactive aggression. Findings indicated that both Persian PSCDs may hold promise for assessing psychopathy components in Iranian school-attending adolescents and generating additional research on this topic.

Limited prosocial emotions (LPE) specifier in conduct disorder and offending behavior: findings from a 10-year prospective longitudinal study of juveniles in residential care

BACKGROUND

Since the introduction of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, a limited prosocial emotion (LPE) specifier has been added to the conduct disorder (CD) diagnosis in addition to the age of onset specifier. It was suggested that this would identify a subgroup with severe antisocial and/or aggressive behavior with serious current and future (mental health) impairment. Research in recent years has shown that this is indeed a subgroup with severe antisocial behavior; however, mental health problems do not appear to differ from those of youth with CD without LPE. Most research to date has been cross-sectional. However, longitudinal research is urgently needed to better understand the predictive value of the LPE specifier. The aim of the current longitudinal study is to examine future offending behavior of youth with CD with compared to youth without the LPE specifier. In addition, the predictive value of the categorical LPE specifier and the dimensional LPE score will be examined beyond factors that are strongly associated with future offending (i.e., gender, age, and prior offending).

METHODS

Adolescents and young adults (12-25) with CD (assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]) with (N = 61) and without (N = 75) the LPE specifier (assessed with the Callous-Unemotional [CU] dimension of the Youth Psychopathic traits Inventory [YPI]) (in line with Jambroes et al., 2016) were compared on sociodemographic characteristics, mental health problems and offending behavior. Future (general and violent) offending was based on official conviction data.

RESULTS

Our results showed that youth with CD with and without the LPE specifier did not differ in self-reported and informant-reported mental health problems. However, youth with CD with the LPE specifier showed more offending behavior and personality pathology at baseline. In addition, the categorical LPE specifier was associated with future general offending, but not with future violent offending. The dimensional LPE score was associated with both future general and violent offending. However, after adjustment for gender, age, and prior delinquency, these associations disappeared, with the exception of the association between the dimensional LPE score and violent offending, which remained significant even after controlling for gender, age, and prior violent offending.

DISCUSSION

In conclusion, there seems to be evidence of a relationship between limited prosocial emotions and future offending behavior in youth with CD. This relationship, however, should not be overestimated, as there are other (static) factors (e.g. gender and prior offending behavior) that also have a strong influence on future (violent) offending behavior. Still, from a clinical point of view, a dynamic factor like prosocial emotional skills is a good focus for reducing the risk of future offending behavior.

Proposed Specifiers for Conduct Disorder-Short Version (PSCD-SV): Psychometric Properties, Concurrent Correlates and Parenting Predictors

The present study aims to further examine the four-factor model of psychopathy in adolescence with a new alternate model for the assessment of psychopathic traits and conduct disorder (CD): The Proposed Specifiers for Conduct Disorder-Short version (PSCD-SV). Data were collected in a sample of 414 adolescents (49.2% females) aged 12-15 at the first assessment who were then followed-up 2 years later. Results supported the usefulness of the PSCD-SV to assess the broader construct of psychopathy showing good psychometric properties, including adequate reliability and validity, while accounting for all its dimensions. In addition, the study showed close associations between psychopathic traits and adolescent behavioral, emotional and psychosocial maladjustment. Finally, the findings elucidated the PSCD's connection to parental support and psychological control, and reinforced the potential role of parenting practices as predictors that can act as mechanisms of change in the development of psychopathy. Overall, current findings shed light on conceptual and developmental models of psychopathy that may have implications for assessment, diagnostic classification, prevention, and intervention.

What is the Best Source of Information for Psychopathic Traits in Youth? A Review and Meta-analysis of Self- and Other-Reported Psychopathic Traits and Their Association with Negative Outcomes

Child psychopathic traits appear to be associated with negative outcomes. Despite the study of youth psychopathy often relying on multiple reporters (e.g., child, caregivers, teachers), there is limited insight into how much information these various sources contribute and moreover, how this information is integrated. The present study sought to address this gap in the literature by examining the magnitude of relationships between self- and other-reported youth psychopathy and negative outcomes (e.g., delinquency, aggression) using a meta-analytic approach. Results revealed a moderate association between psychopathic traits and negative outcomes. Moderator analyses showed a greater relationship for other- than self-reported psychopathy, although not to a substantive extent. Results further indicated the magnitude of the overall psychopathy-negative outcomes association was stronger for externalizing than internalizing outcomes. Study findings can inform improvements in the assessment of youth psychopathy across research and practice, in addition to advancing our understanding of the utility of psychopathic traits in the prediction of clinically relevant outcomes. This review also provides guidance for future multisource raters and source-specific information in the study of psychopathy in youth.

Contemporary diagnosis and treatment of conduct disorder in youth

INTRODUCTION

Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories.

AREAS COVERED

The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators.

EXPERT OPINION

Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.

Psychopathic Traits and Parental Practices in Greek-Cypriot Community and Dutch Clinical Referred Samples

Parental practices are associated with psychopathic traits across several developmental stages. However, the majority of available studies focused mainly on the affective dimension of psychopathy, namely callous-unemotional traits, disregarding the grandiose-deceitful and impulsivity-need for stimulation dimensions. The current study examines the distinct associations between all three dimensions with parental practices (parental involvement, poor monitoring, inconsistent discipline, and corporal punishment) after considering the effect of conduct problems (CPs) and sex in a Greek-Cypriot primary school sample (N = 792, Mage = 6.93, SD = 0.72) and a Dutch clinical-referred sample (N = 217, Mage = 9.55, SD = 1.79) of children. In the community sample, hierarchical multiple regression analysis revealed that parents of children with high levels of callous-unemotional traits were more likely to engage in inconsistent discipline but less in positive parental practices. In contrast, high levels of impulsivity-need for stimulation were related to inconsistent discipline. In the clinical sample, callous-unemotional traits were associated with less parental involvement and grandiose-deceitful dimension with high levels of inconsistent discipline. These findings suggest that the three psychopathy dimensions have unique relations with parental practices above and beyond CPs, proposing that parental practices may be influenced more strongly by psychopathic traits than by antisocial behavior.

Pharmacological strategies for the management of the antisocial personality disorder

INTRODUCTION

Antisocial personality disorder (AsPD) is a pervasive pattern of violation of others' rights, related to the concept of psychopathy. AsPD is stable over time from adolescence, with evidence of conduct disorder (CD) before 15 years. DSM-5 included a specifier 'with limited prosocial emotions' (LPE), which characterizes adolescents with higher developmental vulnerability to develop AsPD. Despite being relatively frequent with considerable societal impact, AsPD is a difficult-to-treat condition with high comorbidity rates and poor evidence for effective pharmacological interventions.

AREAS COVERED

We conducted a narrative review and searched PubMed up to September 2022. We included RCTs and naturalistic studies evaluating pharmacological interventions on AsPD in adults, including those with comorbid substance use disorder or psychopathic traits. Evidence in youths with CD, callous-unemotional (CU) traits and aggression were also reviewed, exploring the role of CU traits as moderators of response.

EXPERT OPINION

Psychosocial interventions are the first option, with possible improvement of CU traits, beyond behavioral and affective symptoms, particularly if implemented early during development. Limited information, based on low-quality studies, supports the pharmacological options. Second-generation antipsychotics, lithium, anti-epileptic drugs, and stimulants are first-line medications, according to different target symptoms. Developmental pathways including ADHD suggest a specific role of psychostimulants.

The Relative Importance of Psychopathy Features as Predictors of Externalizing Behaviors in Youth: A Multimethod Examination

Research in youth psychopathy has focused heavily on the affective features (i.e., callous-unemotional [CU] traits) given robust links to severe and chronic forms of externalizing behaviors. Recently, there have been calls to expand the scope of work in this area to examine the importance of other interpersonal (i.e., antagonism) and behavioral (i.e., disinhibition) features of psychopathy. In the present study, we apply an under-utilized statistical approach (i.e., dominance analysis) to assess the relative importance of CU traits, antagonism, and disinhibition in the prediction of externalizing behaviors in youth, cross-sectionally and at 9-month follow-up. Using a multi-informant (youth- and parent-report), multi-method (questionnaire, ecological momentary assessment [EMA]) preregistered approach in a diverse sample of clinically referred youth (Mage = 12.60 years, SD = .95 years, 47% female; 61% racial/ethnic minority), we found youth- and parent-reported psychopathy features accounted for a significant proportion of variance in externalizing behavior cross-sectionally and longitudinally. However, results provided limited support for our preregistered hypotheses. While antagonism and disinhibition had larger general dominance weights relative to CU traits for both youth- and parent-report, most differences were non-significant. Thus, the interpersonal, affective, and behavioral psychopathy features could not be distinguished from one another in terms of their importance in the prediction of externalizing behavior, assessed cross-sectionally or longitudinally. Taken together, the results highlight promising avenues for future research on the relative importance of youth psychopathy features.

Some critical comments on the paper titled "Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders"

Frick (2022) presented a narrative review of some literature and made several critical comments regarding the extension of the full psychopathy construct to research and classification of childhood disruptive behavior disorders (DBDs). His arguments cautioned against the use of the multicomponent concept of psychopathy for specification of DBDs for several reasons including definitional issues, symptom sequencing, specifier versus risk factor considerations, potential overlap with other disorders and criteria (e.g., ADHD), and concerns regarding harm. While I agree with Frick (2022) that we need to be cautious when extending personality constructs to the DBDs, the remaining arguments in his paper fall short of calling for the exclusion of psychopathy components in the examination of DBDs. Rather, the counterpoints in this paper further convince that the multidimensional model of psychopathy, when applied to the DBDs, could better facilitate understanding of the etiology and mechanisms for Conduct Disorder (CD), and, it may help us to predict the prognosis and treatment outcomes of children with various forms of DBDs such as CD and Oppositional Defiant Disorder (ODD). To have the most informative designs, future research should examine the broad construct to glean a better understanding of psychopathy and the DBDs. Further, research should continue to examine sequencing and external correlates at the component level and to test the incremental value of the multicomponent model of psychopathy to help us better comprehend how each component may facilitate our understanding of the types and severity of conduct problems exhibited by youth with DBDs (i.e., CD, ODD).

Validation of the Proposed Specifiers for Conduct Disorder (PSCD) Self-Report Version in Iranian School-Attending Adolescents

The Proposed Specifiers for Conduct Disorder (PSCD) scale was developed to advance the study of child and adolescent psychopathy, especially as it relates to conduct disorder. This study is the first to test the factor structure, measurement invariance, internal consistency, and validity of the Persian PSCD self-report version in a gender-mixed sample of 1,506 school-attending 11 to 18 years old youth (M age = 15.23; SD = 1.83; 49.60% boys). Confirmatory factor analysis supported the proposed four-factor hierarchical structure of the PSCD, though with 19 items loaded on grandiose-manipulative, callous-unemotional, daring-impulsive, and conduct disorder components. This factor structure was also invariant across gender. The PSCD total and four components scores were internally consistent and exhibited the expected relations with proactive aggression, externalizing problems, anxiety and depression, and poor school performance, supporting the PSCD scores' convergent, discriminant, and criteria validity. The findings indicated that with some modifications, the Persian PSCD might hold promise for assessing psychopathy components in Iranian school-attending adolescents and may spark additional research in a variety of settings.

Understanding the Social Relationships of Youth with Callous-Unemotional Traits Using Peer Nominations

OBJECTIVE

The current study investigated the social and interpersonal correlates of callous-unemotional (CU) traits using peer nominations.

METHOD

Participants (N = 289) were children in Grades 3, 6, and 8 (Mage = 11.47 years, 40.1% male, 64.7% self-identified racial/ethnic minority) from two public school systems in the southern United States. Participants were asked to identify peers they believed fit a number of different characteristics hypothesized to be related to CU traits, in addition to individuals they "liked most" and "liked least." We also obtained self- and teacher ratings of CU traits and parent and teacher ratings of conduct problems (CP).

RESULTS

Factor analyses extracted three dimensions from peer nominations developed from past research describing social characteristics related to CU traits-being mean and aloof (Mean/Cold), untrustworthy and not nice (Not Nice), and dominant and manipulative (Desire for Dominance). Results indicated that CU traits were significantly associated with fewer "liked most" and greater "liked least" nominations, but not after controlling for CP. In contrast, both CP and CU traits were significantly independently associated with Mean/Cold nominations, and only CU traits were associated with Not Nice nominations when controlling for CP.

CONCLUSIONS

The findings from the current study suggest that CU traits are largely associated with traditional indices of peer rejection because of their level of CP. However, they contribute independently to perceptions of being mean, aloof, and untrustworthy. Thus, interventions focused on strengthening the social skills of children with elevated CU traits should consider ways to change these negative peer perceptions.

Psychopathic Personality Configurations in Early Childhood: A Response to Dvoskin et al. (2022)

Dvoskin et al. (2022) offered a cautionary comment on an article published in the Journal of Personality Disorders (López-Romero et al., 2021). This comment was focused on the scientific and policy grounds of our study, and cautioned against the use of the "putative psychopathic personality" label for applied purposes. While we agree with most of their concerns and cautions, we aim to provide additional clarification on the raised concerns, noting that the purpose of our study is purely exploratory, and that its findings are not intended for applied purposes. We do expect that our study and this commentary will further clarify the importance of examining psychopathic personality from a developmental perspective, opening new ways of discussion regarding how to best conceptualize and study a construct that, while waiting for additional longitudinal research, has been shown as relevant in identifying a group of children and adolescents at increased risk for maladjustment.

The Proposed Specifiers for Conduct Disorder (PSCD) Scale: Factor Structure and Validation of the Self-Report Version in a Forensic Sample of Belgian Youth

This is the first study to test the psychometric properties of the self-report version of the Proposed Specifiers for Conduct Disorder (PSCD) in detained youth. The PSCD is a measure of the broad psychopathy construct, with grandiose-manipulative, callous-unemotional, daring-impulsive, and conduct disorder (CD) components. Participants (227 males) completed the PSCD along with other measures, including a diagnostic interview to assess Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) CD. Results support the PSCD's proposed hierarchical four-factor structure. Correlations with an alternate measure of psychopathy and symptoms of CD support the convergent validity of PSCD scores. PSCD scores showed positive associations with criterion variables of emotional and regulatory functioning, aggression, substance use, and school problems. Finally, PSCD scores were unrelated to anxiety and depression, supporting the PSCD's discriminant validity. Findings indicate that the PSCD is a promising measure for assessing psychopathic traits in detained male adolescents, though its incremental validity is in need of further scrutiny.

COMT Val/Met and Psychopathic Traits in Children and Adolescents: A Systematic Review and New Evidence of a Developmental Trajectory toward Psychopathy

Psychopathic traits in youth may lead to adult criminal behaviors/psychopathy. The Val158Met polymorphism of catechol-O-methyltransferase (COMT) may influence the risk for psychopathy-related behaviors, while acting as a biomarker for predicting treatment response to dopaminergic medications. The literature shows inconsistent findings, making the interpretation of COMT's role difficult. The aims of this article are (i) to conduct a systematic review to analyze the effects of COMT Val158Met on psychopathic traits in children and adolescents, and (ii) to present new evidence on the developmental trajectory of the association of Val158Met and youth psychopathic traits. For the systematic review, a literature search was conducted using PubMed, EMBASE, OVID Medline and PsychINFO with the search terms for psychopathic traits, Val158Met and age of interest. In our genotype study, the COMT Val158Met genotype of 293 youth with European ancestry was analyzed in association with the psychopathy-related behavior scores from the Child Behavior Checklist and the Psychopathy Screening Device. To examine the potential influence of developmental changes, the sample was split into at or above and below age 13, and analyses were performed in males and females separately. The literature search yielded twenty-eight articles to be included in the systematic review, which demonstrated mixed results on the association depending on environmental factors, sex ratios, age groups and behavioral disorder diagnoses. The results from our genotype study revealed that Met homozygous youth in the below age 13 group and conversely Val carrier youth in the above age 13 group were more likely to display psychopathic traits. To our knowledge, this is the first study to systematically review the effects of COMT Val158Met on psychopathic traits in childhood and adolescence, and to provide new evidence on the changing effects of Val158Met on psychopathy-related behaviors with development. Elucidating the role of the COMT genotype in conjunction with the child versus adolescent stage of development for psychopathic traits may help predict treatment response, and may lead to early intervention and prevention strategies.

Primary and Secondary Variants of Psychopathic Traits in at-Risk Youth: Links with Maltreatment, Aggression, and Empathy

The current study examined whether two variants of psychopathic traits (PT) were identifiable in high-risk youth who had not yet been identified as antisocial, some of whom had documented histories of maltreatment (N = 167, M_age = 14.84), and then whether the variants differed in levels of aggression and empathy. High-PT youth with low anxiety and trauma (i.e., primary variant PT) and high anxiety and trauma (i.e., secondary variant PT) were differentiated. The secondary variant group was comprised largely of youth with documented histories of maltreatment. This group of youth also reported higher levels of proactive and reactive aggression than did the primary variant youth and low-PT youth. All youth reported similar levels of affective empathy and only small differences in cognitive empathy emerged: Primary variant youth reported lower cognitive empathy than low-PT youth. Findings support generalization of two variant groups of youth with psychopathic traits to diverse, high-risk samples not already identified as antisocial and have important implications for policy and practice.

Validation of the Proposed Specifiers for Conduct Disorder (PSCD) Scale in a Sample of Italian Students

This study aimed to further validate the self-reported version of the Proposed Specifiers Conduct Disorder (PSCD) scale, testing the associations between the PSCD with a scale that measures emotional/behavioral difficulties and prosocial behaviors (Strength and Difficulties Questionnaire, SDQ). A total of 536 Italian students (47.76% male; 11-14 years) completed the PSCD, while their caregivers and teachers completed the SDQ. A series of confirmatory factor analyses to test the best fitting model were run. The internal consistency of the PSCD was evaluated, and the correlations between the PSCD self-reported scores and SDQ Parent and Teacher report scores were examined. A bi-factor model was fitted with a refined 19-item version of the scale, which showed adequate fit indices. The PSCD total score was strongly associated with higher parent- and teacher-rated conduct problems, hyperactivity, and lower prosocial behavioral symptoms. In conclusion, this study indicated that the self-report PSCD shows preliminary promise as a reliable, easy-to-use tool, for measuring psychopathic traits in Italian children and young adolescents.

Validation of the Proposed Specifiers for Conduct Disorder (PSCD) Scale in a Sample of Italian Students

This study aimed to further validate the self-reported version of the Proposed Specifiers Conduct Disorder (PSCD) scale, testing the associations between the PSCD with a scale that measures emotional/behavioral difficulties and prosocial behaviors (Strength and Difficulties Questionnaire, SDQ). A total of 536 Italian students (47.76% male; 11-14 years) completed the PSCD, while their caregivers and teachers completed the SDQ. A series of confirmatory factor analyses to test the best fitting model were run. The internal consistency of the PSCD was evaluated, and the correlations between the PSCD self-reported scores and SDQ Parent and Teacher report scores were examined. A bi-factor model was fitted with a refined 19-item version of the scale, which showed adequate fit indices. The PSCD total score was strongly associated with higher parent- and teacher-rated conduct problems, hyperactivity, and lower prosocial behavioral symptoms. In conclusion, this study indicated that the self-report PSCD shows preliminary promise as a reliable, easy-to-use tool, for measuring psychopathic traits in Italian children and young adolescents.

Interaction of Psychopathic Traits Dimensions in the Prediction of Psychological and Physical Child-to-Parent Violence in Adolescents

This study examined the longitudinal relationships between three psychopathic trait dimensions (callous-unemotional, CU; grandiose-manipulative, GM; and impulsive-irresponsible, II) and their interaction in the prediction of psychological and physical child-to-parent violence (CPV). Furthermore, the study examined whether the predictive relationships were different for boys and girls. A total of 765 adolescents (463 girls), with a mean age of 15.28 years (SD = 1.04), completed measures of the psychopathic trait dimensions (CU, GM, and II) and psychological and physical CPV at the beginning of the study and six months later. At the cross-sectional level, all the psychopathic trait dimensions were related to psychological and physical CPV, although the effect sizes were small. At the longitudinal level, II predicted increased psychological CPV. A significant three-way interaction between the three psychopathic trait dimensions (CU, GM, and II) indicated that the longitudinal association between II and physical CPV was higher for adolescents with high CU and low GM. However, the predictive model did not differ for boys and girls.

Studying Configurations of Psychopathic Traits: Exploring the Viability of Psychopathic Personality in Early Childhood

The idea that very young children can manifest a constellation of personality traits that looks like psychopathy has rarely been explored. To fill this void, data from 2,247 children, aged 3-6 years (M = 4.25; SD = 0.91), from the Estudio Longitudinal para una Infancia Saludable (ELISA) were utilized. Parents and teachers completed questionnaires at baseline and at 1-year follow-up. Using three parent-rated psychopathy dimensions as indicators, the authors conducted latent profile analysis and arrived at five latent classes: Control (39.2%), Impulsive-Need for Stimulation (34.8%), Grandiose-Deceitful (16.5%), Callous-Unemotional (6.2%), and Putative Psychopathic Personality (PP, 3.3%). Children in the PP class, overall, engaged in higher levels of concurrent, future, and stable conduct problems and reactive and proactive aggression, and lower levels of prosocial behavior, as rated by parents or teachers. Findings also revealed meaningful differences between the remaining four classes. Person-oriented analyses seem to offer a fruitful avenue to identify 3-to 6-year-olds who exhibit a putative psychopathic personality and are at risk for future maladjustment.

The DSM-5 Limited Prosocial Emotions Specifier for Conduct Disorder: Comorbid Problems, Prognosis, and Antecedents

OBJECTIVE

A limited prosocial emotions (LPE) subtype of conduct disorder (CD) has been added to the DSM-5. Empirical studies on this categorically defined subtype are scarce, and existing work is predominantly cross-sectional. Hypotheses surrounding the LPE subtype that relate to comorbidity, prognosis, and developmental antecedents, and overlap with psychopathic personality, have received no or little scrutiny.

METHOD

These knowledge gaps were addressed in a community sample of 1,839 children 8 to 10 years of age who were enrolled in the study in early childhood (age 3-5 years) and were followed up in early adolescence (age 11-13 years). Parents and teachers completed questionnaires that tap theoretically and clinically relevant features.

RESULTS

Children with the LPE subtype exhibited more CD symptoms and comorbid problems, including fearlessness, and symptoms of oppositional defiant disorder and attention-deficit/hyperactivity disorder. These children were also at higher risk for future CD symptoms at the 3-year follow-up. Additionally, fearlessness, callous-unemotional traits, interpersonal traits, and harsh parenting assessed in early childhood were identified as developmental antecedents of the LPE subtype. Findings tentatively suggest that the LPE subtype is a heterogeneous group differentiated on other psychopathic personality traits.

CONCLUSION

The LPE subtype appears to identify a troubled, etiologically distinct group of children with conduct problems who are at heightened risk for future maladjustment. Findings can inform the underlying mechanisms related to the LPE subtype, and can lead to the development and improvement of prevention and intervention programs for children with conduct problems.

Psychopathic Traits in Childhood: Insights from Parental Warmth and Fearless Temperament via Conscience Development

The role of psychopathic traits in predicting more serious and persistent patterns of child conduct problems has been well documented. The jointly presence of interpersonal (grandiose-deceitful), affective (e.g., callous-unemotional), and behavioral psychopathic traits (impulsive-need of stimulation) identifies a group of children at increased risk of psychosocial maladjustment. The present study aims to disentangle the underlying mechanisms by examining how early parenting (i.e., warmth) and child temperament (i.e., fearlessness) predict later psychopathic traits, via conscience development (CD). Data were collected in a large sample of children (n = 2.266; 48.5% girls), aged 3 to 6 at the onset of the study (Mage = 4.25; SD = 0.91), who were followed up one and two years later. The results showed direct effects from fearlessness to interpersonal and behavioral psychopathic traits. Parental warmth, fearless temperament, and their interaction, predicted CD, which, in turn, showed a negative effect on psychopathic traits. The indirect effects indicated significant negative mediation effects of warmth through CD on psychopathic traits, which seem to be stronger when children present lower levels of fearlessness. Overall, these results contribute to better understand the development of child psychopathic traits and provide additional insight on effective strategies that will help to restrain the potential development of a high-risk profile in early childhood.

Examining Psychopathic Traits in Children Using the Child Psychopathy Scale - Revised

Applying the affective dimension of psychopathy to youth has advanced understanding of conduct problems in youth, leading to suggestions that other aspects of psychopathy may do the same. This was addressed in the present study by examining the structure and validity of psychopathic traits in elementary-age children as rated by mothers and teachers on the Child Psychopathy Scale - Revised (CPS-R). Participants were 222 children (80.2% male; Mage = 8.92), the majority (71.6%) of whom met criteria for both ADHD and conduct problems. Confirmatory factor analysis supported a four-factor model consisting of prosocial-empathic (PE), grandiose-manipulative (GM), emotionally volatile (EV), and attentive-planful(AP) factors. The CPS-R demonstrated good criterion validity with well-established measures of child behavior problems and callousness. The EV and AP factors demonstrate incremental validity by moderating the relation between conduct problems and impairment. Latent profiles supported a three-profile solution for mothers and a four-profile solution for teachers, with profiles consisting of one group low, one group moderate, and one high on all measures for both informants, and a fourth group that was high on all measures except CD and limited PE. Profiles differed significantly from each other on callousness and impairment, with limited PE being the best differentiator of youth highest in antisocial behavior based on mother and teacher report. Findings suggest that mothers and teachers may be able to identify children at risk for a more negative trajectory of antisocial behavior, that it is worthwhile to examine multiple psychopathy dimensions (rather than just the affective dimension), and that the CPS-R may be useful to screen for youth who are most likely to display more severe antisocial behavior and impairment.

Disruptive Behavior Disorders and Psychopathic Traits in Adolescents: Empathy-Related Responses to Witnessing Animal Distress

Cruelty to animals is a symptom of conduct disorder and associated with psychopathic traits in childhood. One of the factors thought to contribute to animal cruelty is reduced empathy and concern for the well-being of animals. A first aim of this study was to examine empathy towards animals in distress in male adolescents with disruptive behavior disorders (DBD) and high or low psychopathic traits, and normal controls (NC). Psychopathic traits were assessed by the Antisocial Process Screening Device (APSD). Respondents were exposed to a short film clip depicting a baby bear in distress. Heart rate (HR) responses were monitored during film exposure. Afterwards, respondents were asked to report the emotions they had observed and experienced. Contrary to expectations based on research on human empathy, no group differences were found in empathy-related responses to witnessing animal distress. Both DBD groups and normal controls observed equal levels of distress in the baby bear, experienced as much empathy and sympathy, and showed similar levels of HR reduction during the most dramatic scene. Results suggest that empathy for humans does not generalize to animals, and vice versa. A second aim was to examine the associations between empathy-related responses and the broad concept of psychopathy as well as its dimensions. The relationships were different and for the most part reversed in the NC and DBD groups. Group proved to be an important moderating factor, indicating that results obtained within a sample of healthy adolescents do not generalize to adolescents with DBD, and vice versa.

Conceptualizing callous-unemotional traits in preschoolers: Associations with social-emotional competencies and aggressive behavior

BACKGROUND

Extensive empirical evidence suggests that high Callous-Unemotional (CU) traits in childhood and adolescence can reliably identify individuals at risk for antisocial outcomes. The present study addresses research gaps by investigating the factor structure of CU traits in children at preschool age.

METHODS

The sample includes 371 children (49.6% female, M age = 4.7, SD = 0.69). Using the Inventory of Callous-Unemotional-Traits (ICU), six alternative confirmatory factor analyses were conducted to find the best fitting model for our preschool sample. Children's level of emotional competence and aggressive behavior was assed using a German questionnaire, the Behavior Rating Scales for Preschoolers (Verhaltensskalen für das Kindergartenalter, VSK) in a preschool teachers' rating. Post hoc cluster analytic strategies and ANOVA were applied to identify groups of children with regard to their combination of social-emotional competences and CU traits, and to examine associations with aggressive behavior.

RESULTS

Results indicate that a two-factor model revealed the best fit to our data, including a callous and an uncaring factor using 12 of the original 24 ICU items. Cluster analytic strategies reveal a risk group of children demonstrating high rates of callousness and uncaring combined with weak emotion knowledge/empathy and social competence. ANOVA shows that children in the risk group demonstrate the highest levels of aggressive behavior.

CONCLUSIONS

Group characteristics indicate that the construct of CU traits in early childhood may be nothing other than a social-emotional developmental deficit.

A Multi-Informant Study of the Validity of the Inventory of Callous-Unemotional Traits in a Sample of Norwegian Adolescents with Behavior Problems

The Inventory of Callous-Unemotional traits (ICU) is a widely used measure of the affective aspects of psychopathy in children and adolescents. Although a 3-bifactor model of the ICU has often been supported, method-variance effects and mixed results for the Unemotional subscale raise concerns. This study applied a multi-informant design to investigate the structural and concurrent validity of the self-, parent- and teacher-versions of the ICU in a Norwegian at-risk adolescent sample (N = 160, female = 46.3%, mean age = 14.73 years, SD = 1.47). Confirmatory Factor Analysis demonstrated method-variance effects of the standard- and reverse-scored items. The best fitting model was the 12-item 2-factor ICU, comprising a Callousness and an Uncaring factor. The scale reliabilities were acceptable with Cronbach alphas ranging from .810 to .906 across respondent groups. Cross-rater reliability was poor, with Intra Class Correlations ranging from .170 to .226. The concurrent validity of the ICU12 was supported by within-rater associations to externalizing problems, aggression, and problematic alcohol use. Cross-rater associations of ICU12-scores to self-reported delinquency and lower levels of anxiety, provided additional support for the concurrent validity. The unidimensional ICU12 total score was associated both to delinquency and rule-breaking behavior as observed for the Callousness factor and to lack of anxiety and reduced fear sensitivity as observed for the Uncaring factor. The ICU items aimed at capturing lack of prosocial emotions, seem to need revision. Future research should assess the predictive validity and clinical relevance of unidimensional versus factor models of the ICU.

Clinical Utility of the Limited Prosocial Emotions Specifier in the Childhood-Onset Subtype of Conduct Disorder

OBJECTIVE

Clinicians may specify the diagnosis of conduct disorder (CD) as "with limited prosocial emotions" (LPE). This specifier is thought to identify youths with particularly severe and stable symptomatology. However, few studies have examined the clinical usefulness of the LPE specifier among children with childhood-onset CD. The current study examines whether the LPE specifier distinguishes children with particularly severe and persistent symptoms among those with childhood-onset CD. The study also aims to test whether the LPE specifier aids in identifying children with subclinical CD whose conduct problems are at risk of increasing.

METHOD

Two hundred sixty-four children showing at least one CD symptom before age 10 were divided based on the presence of CD and the specifier. Children with and without the specifier were compared on number of CD symptoms (assessed at study inception) and trajectory of conduct problems (assessed over 4 years). The analyses controlled for oppositional defiant and attention deficit hyperactivity symptomatology.

RESULTS

Compared with children with CD but without LPE, children with CD and the LPE specifier did not differ on likelihood of endorsing most symptoms nor on total numbers of symptoms. Moreover, they did not show a more stable pattern of conduct problems across the 4 years. Children with subclinical CD with and without the LPE specifier were also similar in terms of their symptoms, severity, and evolution of their problems.

CONCLUSIONS

Among youths with childhood-onset CD, the specifier appears to offer limited value in identifying those with particularly severe and stable CD symptomatology.

A Prospective Study on Self-Reported Psychopathy and Criminal Recidivism Among Incarcerated Male Juvenile Offenders

The present study examines the utility of three self-report measures of psychopathic traits in predicting recidivism among a sample of incarcerated male juvenile offenders. Participants (N = 214, M = 16.40 years, SD = 1.29 years) from seven Portuguese juvenile detention centers were followed and prospectively classified as recidivists versus non-recidivists. Area under the curve (AUC) analysis revealed that the Antisocial Process Screening Device-Self-Report (APSD-SR) presented the best performance in terms of predicting general recidivism, with the Youth Psychopathic Traits Inventory (YPI) and the Childhood and Adolescent Taxon Scale-Self-Report (CATS-SR) presenting much poorer results. However, logistic regression models controlling for past frequency of crimes and age of first incarceration found that none of these self-report measures significantly predicted 1- or 3-year recidivism, whether general or violent. Findings suggest there are limitations in terms of the incremental utility of self-report measures of psychopathic traits in predicting recidivism among juveniles.

Assessing Psychopathic Traits Among Children: The First Validation Study of the Child Problematic Traits Inventory in a Clinical Sample

This is the first study that tested the psychometric properties of the Child Problematic Traits Inventory (CPTI) in clinic-referred children (ages 6-13 years). Teachers (N = 159) and parents (N = 173) completed the CPTI and various other measures. Confirmatory factor analyses supported the CPTI's three-factor structure when teachers and parents rated the 28 CPTI items. Teacher- and parent-reported CPTI scores showed the expected relations with external correlates (e.g., conduct problems and proactive aggression). Crucially, the validity of the CPTI scores was also supported across informants (i.e., when linking teacher-reported CPTI scores to parent-reported external correlates, and vice versa) and across methods (i.e., regardless if a questionnaire or a diagnostic interview was used to measure external correlates). We conclude that the CPTI holds promise as a research tool for assessing psychopathic traits in clinic-referred children. Until our findings have been replicated and extended, the CPTI should not be used for clinical decision making.

Predictors of adult outcomes in clinically- and legally-ascertained youth with externalizing problems

Externalizing problems (EP), including rule-breaking, aggression, and criminal involvement, are highly prevalent during adolescence, but the adult outcomes of adolescents exhibiting EP are characterized by heterogeneity. Although many youths' EP subside after adolescence, others' persists into adulthood. Characterizing the development of severe EP is essential to prevention and intervention efforts. Multiple predictors of adult antisocial personality disorder (ASPD) and legal outcomes of a large sample (N = 1205) of clinically- or legally-ascertained adolescents (ages 12-19 years) with severe EP were examined. Many psychosocial predictors hypothesized to predict persistence of EP demonstrated zero-order associations with adult outcomes, but accounted for little unique variation after accounting for baseline conduct disorder symptoms (CD) and demographic factors. Baseline measures of intelligence, which explained independent variation in legal outcomes, provided the only consistent exception to this pattern, though future work is needed to parse these effects from those of socioeconomic factors. CD severity during adolescence is a parsimonious index of liability for persistence of EP into adulthood that explains outcome variance above and beyond all other demographic and psychosocial predictors in this sample.

Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct as Predictors of Various Antisocial Outcomes During Early Adolescence

The aim of this study was to compare callous-unemotional (CU) traits versus the multidimensional psychopathy construct in their ability to predict future and stable antisocial behavior. At baseline, a community sample of 996 Cypriot 12-year old adolescents (52% girls) completed measures that tap conduct problems (CP) and psychopathic traits, including CU. CP, aggression, and substance use were self-reported at 1–3 year follow-ups. Youths were assigned to six mutually exclusive groups based on their baseline levels of CP and psychopathic traits. Youth with CP scoring high on all three psychopathic traits dimensions (Psychopathic Personality + CP) showed the most robust and highest risk for future and stable CP, aggression, and substance use, followed by youth who were high on all three psychopathic traits dimensions but displayed no concurrent CP (Psychopathic Personality Only) and CP youth with low levels of psychopathic traits (CP Only). Youth with CP who merely manifested callous-unemotional traits (Callous-Unemotional + CP) were only at risk for future CP. The findings suggest that the CU traits-based approach for subtyping children with CP is less informative compared to a subtyping approach using various psychopathic traits dimensions in predicting future and stable forms of various antisocial outcomes. These findings and their consistency with prior work indicate the need for additional research to examine the various psychopathic traits dimensions rather than focusing solely on CU traits, especially for CP subtyping purposes.