Greater fear reactivity and psychophysiological hyperactivity among infants with later conduct problems and callous-unemotional traits

Why Should I? Examining How Childhood Callous-Unemotional Traits Relate to Prosocial and Affiliative Behaviors and Motivations

Childhood callous-unemotional (CU) traits are characterized by low empathy, limited prosocial behavior, and restricted social affiliation. However, few studies have investigated whether CU traits are associated with different subtypes of prosocial and affiliative behavior or the specific motivational difficulties underlying these behaviors. We addressed these questions using data from 135 young children (M = 5.48 years old; 58% female) who viewed depictions of adults or children in instrumental need, emotional need, or neutral situations. We assessed recognition, suggested initiation of, and motivation for prosocial or affiliative behavior in response to each depiction. We distinguished between subtypes of prosocial (instrumental and emotional) and affiliative (parallel, cooperative, associative) behavior, as well as self- versus other-orientated motivations. Parents reported on child CU traits and conduct problems. Overall, children accurately recognized prosocial and neutral situations, offered help, and expressed other-orientated motivations for prosocial behavior and social motivations for affiliative behavior. Higher CU traits were related to lower overall recognition accuracy, which was more pronounced for emotional need. Higher CU traits were also related to fewer offers of help and more denial of prosocial behavior, particularly for instrumental need. Finally, CU traits were related to lower probability of initiating affiliative behavior. CU traits were not differentially related to self- versus other-orientated motivations for prosocial or affiliative behavior. Findings demonstrate difficulties of children with CU traits in recognizing need and offering help. Interventions for CU traits could include modules that explicitly scaffold and shape prosociality and social affiliation.

Evaluating the sensitivity to threat and affiliative reward (STAR) model in relation to the development of conduct problems and callous-unemotional traits across early adolescence

BACKGROUND

The Sensitivity to Threat and Affiliative Reward (STAR) model proposes low threat sensitivity and low affiliation as risk factors for callous-unemotional (CU) traits. Preliminary evidence for the STAR model comes from work in early childhood. However, studies are needed that explore the STAR dimensions in late childhood and adolescence when severe conduct problems (CP) emerge. Moreover, it is unclear how variability across the full spectrum of threat sensitivity and affiliation gives rise to different forms of psychopathology beyond CU traits.

METHODS

The current study addressed these gaps using parent- and child-reported data from three waves and a sub-study of the Adolescent Brain Cognitive Development Study® of 11,878 youth (48% female; ages 9-12).

RESULTS

Consistent with the STAR model, low threat sensitivity and low affiliation were independently related to CU traits across informants and time. Moreover, there was significant interaction between the STAR dimensions, such that children with lower sensitivity to threat and lower affiliation had higher parent-reported CU traits. Unlike CU traits, children with higher threat sensitivity had higher parent-reported CP and anxiety. Finally, children with lower affiliation had higher parent-reported CP, anxiety, and depression. Results largely replicated across informants and time, and sensitivity analysis revealed similar findings in children with and without DSM-5 defined CP.

CONCLUSIONS

Results support the STAR model hypotheses as they pertain to CU traits and delineate threat sensitivity and affiliation as independent transdiagnostic risk factors for different types of psychopathology. Future research is needed to develop fuller and more reliable and valid measures of affiliation and threat sensitivity across multiple assessment modalities.

The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits

Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.

Risk for internalizing symptom development in young children: Roles of child parasympathetic reactivity and maternal depression and anxiety exposure in early life

Intergenerational transmission of internalizing disorders (anxiety and depression) is well documented, but the responsible pathways are underspecified. One possible mechanism is via programming of the child's parasympathetic nervous system (PNS). For example, maternal depression and anxiety, via multiple pathways, may heighten child PNS reactivity, which has been linked to increased risk for internalizing disorders. Heightened PNS reactivity also may sensitize a child to their environment, increasing the vulnerability to developing psychopathology when exposed to stressors, such as maternal psychopathology. In a prospective longitudinal study of mother-child dyads (N = 446), we examined relations among maternal depression and anxiety symptoms when children were infants and aged 3 and 5 years, child respiratory sinus arrythmia (RSA) reactivity (measure of PNS reactivity) at 3 years, and child internalizing symptoms at age 5 years. Consistent with an adaptive calibration perspective, analyses tested the roles of child RSA reactivity as both a mediator and a moderator of associations between maternal and child symptoms. Greater child RSA reactivity in response to a fearful video predicted higher internalizing symptoms among children exposed to higher levels of maternal depression or anxiety symptoms at age 5 years (moderation effects). Child RSA reactivity did not mediate relations between maternal depression or anxiety symptoms in infancy and child internalizing symptoms at age 5 years. The results suggest that heightened PNS reactivity may represent a biological vulnerability to stressful environments early in life: When coupled with maternal depression or anxiety exposure, child PNS reactivity may promote the development of internalizing psychopathology in 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.

How much maternal sensitivity is adaptive: Fear temperament, high-intensity fear, and preschooler's behavioral problems

BACKGROUND

The current study focused on the role of temperament and parenting in contributing to high-intensity fear during toddlerhood and its impact on behavioral problems in the preschool age.

METHODS

A sample of 1292 low-income rural families were recruited, where infant fear temperament at 6 months old and toddler's fear expressions at 15 months old were observed and assessed. Maternal sensitivity was also observed and assessed at both time points. Mothers rated their children's behavioral problems at 36 months old.

RESULTS

A path model revealed quadratic effects of maternal sensitivity on the development of high-intensity fear at 15 months, in that a moderate level of maternal sensitivity was linked with higher high-intensity fear for children with extra high temperamental fear, while high and low levels of maternal sensitivity were linked with higher high-intensity fear for those with extra low temperamental fear. A quadratic effect was also found, where high maternal sensitivity channeled toddlers with low normal fear towards internalizing behaviors at 36 months. Finally, a quadratic effect suggested that high maternal sensitivity increased the risks for externalizing behaviors at 36 months for toddlers with high versus low levels of high-intensity fear.

LIMITATIONS

The low-income, rural community sample limited study generalizability.

CONCLUSIONS

These findings speak to the complexity of person-environment interactions in the development of fear and associated behavioral problems, with implications for future research and intervention efforts.

Behavioral inhibition as an early life predictor of callous-unemotional traits

Callous-unemotional (CU) traits predict behavioral problems in adolescence. But little is known about early modulatory factors. Behavioral Inhibition (BI) in particular has been suggested to protect against the development of CU-traits. This temperamental predisposition is characterized by heightened environmental sensitivity. The current prospective longitudinal study examined whether BI at 15 months of age predicted lower CU-traits across development to age 21. A longitudinal sample of normatively developing children ( n = 125) was used. BI was assessed at 15 months using a standard stranger/robot paradigm. CU-traits were assessed at 2, 5, 9, 12, 14, 17, and 21 years with parent, teacher, and self-reports. Developmental pathways across all available data points were examined using Bayesian mixed models and k-means cluster analysis. Infant BI predicted lower CU-traits across development for girls, suggesting that BI buffers the long-term development of CU-traits for girls. CU-traits peaked in early adulthood. Boys scored higher and showed higher increases in CU-traits than girls from childhood onward. There was no gender difference regarding infant BI. Together, the findings demonstrated gender differences in the development of CU-traits, with a protective role of BI for girls. These results shed new light on the developmental trajectories and protective factors of CU-traits and provide starting points for interventions aiming at increasing children’s responsiveness to external cues to prevent antisocial traits and conduct problems.

Examining Links Between Infant Parasympathetic Regulation during the Still-Face Paradigm and Later Callous-Unemotional Traits

Although research suggests that callous-unemotional (CU) traits are underpinned by deficits in social affiliation and reduced sensitivity to threat, there has been little investigation of the biophysiological regulatory mechanisms underlying these processes in infancy. The current study uses data from the Durham Child Health and Development Study (DCHD; n = 206) to examine whether and how the combination of infants' behavioral reactivity and levels of respiratory sinus arrhythmia (RSA), an indicator of parasympathetic nervous system functioning, during the still-face episode of the still-face paradigm at 6 months differentiates risk for CU traits and oppositional defiant behaviors (ODD) at age 3 years, as well as whether these relations vary by children's attachment security. Results indicate that reduced negative affect during the still-face episode at 6 months predicts higher CU traits (B = -0.28, β = -0.27, p = 0.003) and ODD (B = -0.35, β = -0.24, p = 0.007) at 3 years. Results also show that comparatively lower RSA, i.e. engaged parasympathetic system, predicts higher CU traits (B = -0.10, β = -0.34, p = 0.013), but not ODD. Tests of moderation suggest the combination of blunted negative affect but comparatively lower RSA levels during a social stressor constitutes risk for later CU traits for children who are also insecurely attached (simple slope = -0.70, t = 2.88, p = 0.006 at -1 SD). Findings contribute to our understanding of the complex and interactive risk processes which precede the development of CU traits.

Social Fear in US Infants: The Roles of Hair and Salivary Cortisol

Elevated social fear in infancy poses risk for later social maladjustment and psychopathology. Hair cortisol concentration (HCC), an index of cumulative cortisol exposure, and diurnal salivary cortisol slope, a biomarker of acute stress regulation, have been associated with social fear behaviors in childhood; however, no research has addressed their relations in infancy. Elucidating potential biomarkers of infant social fear behaviors, as well as environmental factors associated with these biomarkers, may grant insights into the ontogeny of fear behaviors that increase risk for internalizing and externalizing psychopathologies later in life. The current study used multiple linear regression to examine if infant HCC, infant diurnal cortisol slope, and income-to-needs ratios (ITN) were differentially associated with observed social fear responses to a Stranger Approach task at 12 months. Using a sample of 90 infants (M _age = 12.26m, SD = 0.81m, 50% female), results indicated that increased infant HCC was associated with increased distress vocalizations during the Stranger Approach task, while steeper diurnal cortisol slope was associated with fewer distress vocalizations. Ordinary least squares path analyses did not reveal group differences between economically strained and non-strained infants in how cortisol measures and social fear responses related. Findings underscore very early psychobiological correlates of fearfulness that may increase risk for fear-related disorders and adverse mental health symptomology across childhood.

Heart-wired to be cold? Exploring cardiac markers of callous-unemotional traits in incarcerated offenders

Elevated callous-unemotional (CU) traits have been repeatedly identified in a subgroup of offenders that displays severe antisocial behavior; establishing physiological markers may help improve early identification and treatment efforts. This study examines to what extent baseline-resting heart rate (HR) and heart rate variability (HRV) can be used as markers of CU in incarcerated juvenile and adult offenders. CU traits were assessed using the Inventory of Callous-Unemotional traits. Results of the multiple hierarchical regression tests indicated that there was a small yet significant positive association between baseline HR and CU and negative association between HRV and CU in juvenile offenders with medium model effect sizes (R² = 0.115 for HR-CU; R² = 0.126 for HRV-CU). The cardiac markers were unrelated to CU in adult offenders. These findings are important because they demonstrate that impaired cardiac autonomic activity is related to CU traits in juveniles, suggesting that socioemotional processing difficulties should be considered in understanding these deficits. Future research should be conducted in large samples, under reactive and static conditions, while including cardiac covariates, to get more clarity on the interplay between biological systems and behavioral expression.

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.

Autonomic Nervous System Inflexibility During Parent-child Interactions is Related to Callous-unemotional Traits in Youth Aged 10-14 Years Old

Youth with callous-unemotional (CU) traits are at high risk for aggression and antisocial behavior. Extant literature suggests that CU traits are related to abnormal autonomic responses to negatively-valenced emotional stimuli, although few studies have tested autonomic responding specifically during social interactions. To address this knowledge gap, the current study tested whether CU traits were related to autonomic activity, assessed via respiratory sinus arrhythmia (RSA), during several parent-child interaction tasks designed to provoke negative emotion. The sample was 162 clinically referred youth (M age = 12.03, SD = .92; 47% female). Using piecewise latent growth models, we estimated individual differences in RSA during three semi-structured social interaction tasks (reading aloud to a parent and research assistant; a recovery period from the reading task; and a parent-child conflict discussion) and tested whether CU traits were related to patterns of RSA responding across tasks. Overall, youth showed expected RSA decreases during the reading period, increases in RSA during recovery, and further decreases during the conflict discussion. However, youth with clinically-elevated CU traits had a different pattern of RSA change across tasks, such that CU traits were related to significantly less RSA change during reading and recovery. Findings suggest that less RSA engagement during social interactions and less RSA recovery may be a biomarker of CU traits. Future research is needed to examine whether this inflexibility contributes to the development of CU traits beginning early in childhood.

Development of Infant High-Intensity Fear and Fear Regulation from 6 to 24 Months: Maternal Sensitivity and Depressive Symptoms as Moderators

This study tested bidirectional relations between infant high-intensity fear and fear regulation over 1.5 years, and maternal sensitivity and depressive symptoms as moderators. Participants were 1,292 mother-infant pairs prospectively assessed at three times when infants were 6, 15, and 24 months old. Infant high-intensity fear and fear regulation (avoidance, orienting to mother, attention regulation, and self-soothing) were observed during the Mask Task at each of these time points. Likewise, mothers reported their depressive symptoms, and their sensitivity was observed in a separate mother-child interaction task at each time point. Conditional multilevel growth models revealed that highly avoidant infants exhibited less initial high-intensity fear, but faster growth in high-intensity fear over time. Furthermore, highly avoidant infants exhibited more concurrent high-intensity fear when their mothers demonstrated low sensitivity. Unexpectedly, when their mothers were highly depressed, infants who used more attention regulation demonstrated more rapid growth of high-intensity fear over time. Finally, when their mothers were not depressed, infants exhibiting more high-intensity fear oriented more to their mothers concurrently. When their mothers reported high depressive symptoms over time, infants with more high-intensity fear initially oriented less to their mothers but more rapidly increased orienting to their mothers over time. Findings reveal the interplay between infant and maternal factors over time in development of infant high-intensity fear. In particular, maternal sensitivity protected highly fearful infants by rapidly reducing fear reactivity despite infant avoidance. In contrast, high maternal depressive symptoms introduced both immediate and enduring risks for infant fear development. Clinical implications are discussed.

Associations between multisystem stress reactivity and peer nominated aggression in early childhood vary by sex

There is emerging evidence that the development of problematic aggression in childhood may be associated with specific physiological stress response patterns, with both biological overactivation and underactivation implicated. This study tested associations between sex-specific patterns of stress responses across the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis and peer nominations of aggression among 271 kindergarten children (Mean age = 5.32 years; 52% Female; 44% White). Upon entry to kindergarten, children participated in a multidomain standardized stress paradigm. Changes in pre-ejection period (PEP) and salivary cortisol were assessed. On a separate day, children provided peer ratings of physical and relational aggression in a standardized interview. As expected, there was a significant three-way interaction between PEP, cortisol reactivity, and sex, but only for physical aggression. Among boys, cortisol reactivity was positively associated with physical aggression only for those with higher SNS reactivity. Findings suggest that for boys, asymmetrical and symmetrical HPA/SNS reactivity may be associated with lower and higher risk for peer-directed physical aggression, respectively. Understanding the complex associations between multisystem physiology, child sex and peer-directed aggression in early childhood may offer insight into individual differences underlying the emergence of behavioral dysregulation in early peer contexts.

Mapping neural activity patterns to contextualized fearful facial expressions onto callous-unemotional (CU) traits: intersubject representational similarity analysis reveals less variation among high-CU adolescents

Callous-unemotional (CU) traits are early-emerging personality features characterized by deficits in empathy, concern for others, and remorse following social transgressions. One of the interpersonal deficits most consistently associated with CU traits is impaired behavioral and neurophysiological responsiveness to fearful facial expressions. However, the facial expression paradigms traditionally employed in neuroimaging are often ambiguous with respect to the nature of threat (i.e., is the perceiver the threat, or is something else in the environment?). In the present study, 30 adolescents with varying CU traits viewed fearful facial expressions cued to three different contexts ("afraid for you," "afraid of you," "afraid for self") while undergoing functional magnetic resonance imaging (fMRI). Univariate analyses found that mean right amygdala activity during the "afraid for self" context was negatively associated with CU traits. With the goal of disentangling idiosyncratic stimulus-driven neural responses, we employed intersubject representational similarity analysis to link intersubject similarities in multivoxel neural response patterns to contextualized fearful expressions with differential intersubject models of CU traits. Among low-CU adolescents, neural response patterns while viewing fearful faces were most consistently similar early in the visual processing stream and among regions implicated in affective responding, but were more idiosyncratic as emotional face information moved up the cortical processing hierarchy. By contrast, high-CU adolescents' neural response patterns consistently aligned along the entire cortical hierarchy (but diverged among low-CU youths). Observed patterns varied across contexts, suggesting that interpretations of fearful expressions depend to an extent on neural response patterns and are further shaped by levels of CU traits.

The relationship between resting heart rate and aggression in males is racially variant

Although resting heart rate is thought to be a generalizable risk factor for aggression, very little research has examined whether this relationship varies by race. We addressed this limitation using longitudinal data from the Pittsburgh Youth Study. Current data are from 197 men who participated in a teenage biosocial study (mean age = 15.7 years) and adult follow-up study (mean age = 32.1 years). Teenage resting heart rate interacted with race to predict teenage and adult aggression. The relationship between heart rate and aggression was significant in White, but not in Black males. To our knowledge, this is the first study to find that the relationship between resting heart rate and aggression is racially variant, suggesting that resting heart rate may not be a generalizable biomarker for conduct problems. At an intervention-level, findings could contribute to the development of more accurate risk assessment tools that take into account racial variance in risk factors.

Sex-dependent associations between maternal prenatal cortisol and child callous-unemotional traits: Findings from the Wirral Child Health and Development Study

BACKGROUND

Elevated maternal glucocorticoids during pregnancy may impact on fetal development in a sex-dependent way, leading to increased amygdala activation and increased risk for internalising disorders in females. Based on evidence implicating reduced amygdala activation in callous-unemotional (CU) traits, we predicted that elevated maternal cortisol in pregnancy would be associated with lower CU traits and elevated anxious-depressed symptoms, only in girls.

METHODS

Participants were 225 members of a stratified subsample within an epidemiological longitudinal cohort (WCHADS). Salivary cortisol was measured over two days at 32 weeks gestation (on waking, 30-min post-waking and during the evening) and the log of the area under the curve (LogAUC) was calculated as an index of diurnal cortisol. Mothers reported on child CU traits and anxious-depressed symptoms at 2.5, 3.5 and 5.0 years of age.

RESULTS

As predicted there was a sex of child by cortisol interaction (p < .001) whereby elevated maternal cortisol was associated with lower child CU traits, explaining 25% of the variance, in girls, but not in boys. This effect remained when controlling for relevant confounders and anxious-depressed symptoms. By contrast, elevated maternal cortisol did not predict higher anxious-depressed symptoms in girls.

CONCLUSIONS

The study adds to growing evidence for sex-dependent effects of elevated maternal cortisol during pregnancy on early child psychopathology, consistent with mediation by elevated amygdala activation. The conditions under which, in girls, this is associated with heightened responsiveness to others' distress characteristic of low CU traits, or with increased affective symptoms, require further study.

The Sensitivity to Threat and Affiliative Reward (STAR) model and the development of callous-unemotional traits

Research implicates callous-unemotional (CU) traits (i.e., lack of empathy, prosociality, and guilt, and reduced sensitivity to others' emotions) in the development of severe and persistent antisocial behavior. To improve etiological models of antisocial behavior and develop more effective treatments, we need a better understanding of the origins of CU traits. In this review, we discuss the role of two psychobiological and mechanistic precursors to CU traits: low affiliative reward (i.e., deficits in seeking out or getting pleasure from social bonding and closeness with others) and low threat sensitivity (i.e., fearlessness to social and non-social threat). We outline the Sensitivity to Threat and Affiliative Reward (STAR) model and review studies that have examined the development of affiliative reward and threat sensitivity across animal, neuroimaging, genetic, and behavioral perspectives. We next evaluate evidence for the STAR model, specifically the claim that CU traits result from deficits in both affiliative reward and threat sensitivity. We end with constructive suggestions for future research to test the hypotheses generated by the STAR model.

Infant regulatory function acts as a protective factor for later traits of autism spectrum disorder and attention deficit/hyperactivity disorder but not callous unemotional traits

Background

Reduced executive functions (EF) are commonly associated with developmental conditions (e.g., autism spectrum disorder, ASD; attention deficit/hyperactivity disorder, ADHD), although EF seems to be typical in children with callous unemotional (CU) traits. Regulatory function (RF) is a proposed infant precursor that maps on onto factors driving later EF. Here, we first test whether RF is specifically and negatively associated with ASD and ADHD traits, but not CU traits. Second, we test whether RF can act as a protective factor, by moderating the association between infant markers and subsequent ASD and ADHD traits.

Methods

Participants were 79 infants at high (N = 42) and low (N = 37) familial risk for ASD. Data come from the 14-month infant visit (Autism Observational Scale for Infants; AOSI; activity level and RF from the Infant Behavior Questionnaire; IBQ) and the 7-year visit (ASD traits: Social Responsiveness Scale, SRS; ADHD traits: Conners 3, CU traits: Inventory of Callous Unemotional Traits).

Results

Infant RF was negatively associated with later traits of ASD (B = − 0.5, p = 0.01) and ADHD inattention (B = − 0.24, p = 0.02) but not hyperactivity (B = − 0.25, p = 0.10) or CU traits (B = 0.02, p = 0.86). RF moderated the association between infant AOSI score and ASD traits, with a significant effect in those with low RF (B = 0.10, p = 0.006), not high RF (B = 0.01, p = 0.78). Similarly, for ADHD, infant activity level was associated with later ADHD inattention in those with low (B = 0.17, p = 0.04) but not high RF (B = 0.07, p = 0.48). For ADHD hyperactivity symptoms, activity level was predictive at both high and low levels of RF.

Conclusions

Strong RF may allow children to compensate for other atypicalities, thus attenuating the association between infant markers and later disorder traits. Whilst infant RF was associated with both ASD and ADHD inattention traits, there was no association with ADHD hyperactivity or CU traits. This suggests that any protective effect may not be universal and emphasises the need for a better understanding of the underlying moderating mechanisms.

Electronic supplementary material

The online version of this article (10.1186/s11689-019-9274-0) contains supplementary material, which is available to authorized users.

A Unique Path to Callous-Unemotional Traits for Children who are Temperamentally Fearless and Unconcerned about Transgressions: a Longitudinal Study of Typically Developing Children from age 2 to 12

Despite the acknowledged significance of callous-unemotional (CU) traits in developmental psychopathology, few studies have examined their early antecedents in typically developing children, in long-term longitudinal designs, using observational measures. In 102 community mothers, fathers, and children (N = 51 girls), we examined main and interactive effects of children's fearless temperament and low concern about transgressions from toddler to early school age as predictors of CU traits in middle childhood and early preadolescence. In laboratory paradigms, we observed children's concern about breaking valuable objects (twice at each age of 2, 3, 4.5, 5.5, and 6.5 years) and about hurting the parent (twice at each age of 2, 3, and 4.5 years). We observed fearless temperament during scripted exposure to novel and mildly threatening objects and events (twice at each age of 2, 3, 4.5, and 5.5 years). Mothers and fathers rated children's CU traits and externalizing behavior problems at ages 8, 10, and 12. Children's low concern about both types of transgressions predicted CU traits, but those effects were qualified by the expected interactions with fearless temperament: Among relatively fearless children, those who were unconcerned about transgressions were at the highest risk for CU traits, even after controlling for the strong overlap between CU traits and externalizing problems. For fearful children, variation in concern about transgressions was unrelated to CU traits. Those interactions were not significant in the prediction of externalizing problems. The study highlights a potentially unique etiology of CU traits in early development.

Parenting and Cortisol in Infancy Interactively Predict Conduct Problems and Callous-Unemotional Behaviors in Childhood

This study examines observed maternal sensitivity, harsh-intrusion, and mental-state talk in infancy as predictors of conduct problems (CP) and callous-unemotional (CU) behaviors in middle childhood, as well as the extent to which infants' resting cortisol and cortisol reactivity moderate these associations. Using data from the Family Life Project (n = 1,292), results indicate that maternal sensitivity at 6 months predicts fewer CP at first grade, but only for infants who demonstrate high levels of cortisol reactivity. Maternal harsh intrusion predicts fewer empathic-prosocial behaviors, a component of CU behaviors, but only for infants who demonstrate high resting cortisol. Findings are discussed in the context of diathesis-stress and differential susceptibility models.

Early life predictors of callous-unemotional and psychopathic traits

Psychopathy is a disorder that occurs primarily in males. Offenders with psychopathic traits are responsible for a disproportionate amount of crime in society, particularly violent crime. Early childhood is a time when individual differences in empathy and guilt-key indicators of the construct of psychopathy-are first evident. A growing number of longitudinal studies have begun to investigate how factors in infancy and early childhood predict psychopathic-like traits in later childhood, adolescence, and adulthood. These studies have suggested that parenting styles during infancy (parental sensitivity, maternal harsh intrusion, commenting on the emotional state of the child) as well as attachment styles are predictive of later psychopathic-like traits. In addition, child characteristics such as temperament and the functioning of biological systems such as the autonomic nervous system and hypothalamic-pituitary-adrenal axis are predictive. Overall, studies have suggested that at least some of the origins of psychopathic traits are present in infancy and early childhood, which is consistent with the perspective of psychopathy as a neurodevelopmental disorder. A recent evolutionary-developmental model provides hypotheses regarding how psychopathy may develop and why it is more common in males than females. This model, and its implications for intervention, is discussed in the context of the longitudinal studies that have been conducted on psychopathy.

Developmental dynamics of autonomic function in childhood

There is a paucity of developmental data examining the stability of autonomic function during childhood, and even less is known regarding the extent of coordination between autonomic branches. To address this, autonomic measures of sympathetic (cardiac pre-ejection period, PEP; electrodermal activity, and EDA) and parasympathetic (respiratory sinus arrhythmia and RSA) function were collected from 339 children annually from kindergarten to second grade. Physiology was quantified into 31 epochs 30 s in length, across a series of baselines and emotion-inducing films. Rank-order stability was observed for all three indices, but was higher for cardiac than electrodermal measures. A series of multilevel models was used to identify the proportion of variance in psychophysiological function attributable to the individual (trait), visit (potential developmental change), or epoch (reactivity to task). Both PEP and RSA had sizeable components of individual-level variance, with PEP showing very small variance attributable to experimental task. In contrast, variance in EDA was largely attributable to task epoch. Variance decompositions of the parasympathetic-sympathetic coordination (e.g., RSA-EDA) suggest that the branches of the autonomic system are prototypically cooperative, but evidence did not indicate traitlike stability or linear developmental change. The extent of coordination was moderated by emotional context, indicating that autonomic coordination varies dynamically within individuals. These findings have implications for future work attempting to identify the contextual, experiential, and demographic factors that modulate developmental trajectories of autonomic function and coordination, and for examination of how developmental changes in autonomic psychophysiology are related to or predict behavioral trajectories across a range of psychological domains.

Immune and neuroendocrine correlates of temperament in infancy

There is now a clear focus on incorporating, and integrating, multiple levels of analysis in developmental science. The current study adds to research in this area by including markers of the immune and neuroendocrine systems in a longitudinal study of temperament in infants. Observational and parent-reported ratings of infant temperament, serum markers of the innate immune system, and cortisol reactivity from repeated salivary collections were examined in a sample of 123 infants who were assessed at 6 months and again when they were, on average, 17 months old. Blood from venipuncture was collected for analyses of nine select innate immune cytokines; salivary cortisol collected prior to and 15 min and 30 min following a physical exam including blood draw was used as an index of neuroendocrine functioning. Analyses indicated fairly minimal significant associations between biological markers and temperament at 6 months. However, by 17 months of age, we found reliable and nonoverlapping associations between observed fearful temperament and biological markers of the immune and neuroendocrine systems. The findings provide some of the earliest evidence of robust biological correlates of fear behavior with the immune system, and identify possible immune and neuroendocrine mechanisms for understanding the origins of behavioral development.

The Neurodevelopmental Basis of Early Childhood Disruptive Behavior: Irritable and Callous Phenotypes as Exemplars

The arrival of the Journal's 175th anniversary occurs at a time of recent advances in research, providing an ideal opportunity to present a neurodevelopmental roadmap for understanding, preventing, and treating psychiatric disorders. Such a roadmap is particularly relevant for early-childhood-onset neurodevelopmental conditions, which emerge when experience-dependent neuroplasticity is at its peak. Employing a novel developmental specification approach, this review places recent neurodevelopmental research on early childhood disruptive behavior within the historical context of the Journal. The authors highlight irritability and callous behavior as two core exemplars of early disruptive behavior. Both phenotypes can be reliably differentiated from normative variation as early as the first years of life. Both link to discrete pathophysiology: irritability with disruptions in prefrontal regulation of emotion, and callous behavior with abnormal fear processing. Each phenotype also possesses clinical and predictive utility. Based on a nomologic net of evidence, the authors conclude that early disruptive behavior is neurodevelopmental in nature and should be reclassified as an early-childhood-onset neurodevelopmental condition in DSM-5. Rapid translation from neurodevelopmental discovery to clinical application has transformative potential for psychiatric approaches of the millennium. [AJP at 175: Remembering Our Past As We Envision Our Future November 1938: Electroencephalographic Analyses of Behavior Problem Children Herbert Jasper and colleagues found that brain abnormalities revealed by EEG are a potential causal factor in childhood behavioral disorders. (Am J Psychiatry 1938; 95:641-658 )].

Conduct problems in youth and the RDoC approach: A developmental, evolutionary-based view

Problems related to aggression in young people are traditionally subsumed under the header of conduct problems, which include conduct disorder and oppositional defiant disorder. Such problems in children and adolescents are an important societal and mental health problem. In this paper we present an evolutionarily informed developmental psychopathology view of conduct problems inspired by the NIMH Research Domain Criteria (RDoC) initiative. We assume that while there are many pathways to conduct problems, chronic or temporary impairments in the domain of social cognition or mentalizing are a common denominator. Specifically, we conceptualize conduct problems as reflecting temporary or chronic difficulties with mentalizing, that is, the capacity to understand the self and others in terms of intentional mental states, leading to a failure to inhibit interpersonal violence through a process of perspective-taking and empathy. These difficulties, in turn, stem from impairments in making use of a normally evolutionarily protected social learning system that functions to facilitate intergenerational knowledge transmission and protect social collaborative processes from impulsive and aggressive action. Temperamental, biological, and social risk factors in different combinations may all contribute to this outcome. This adaptation then interacts with impairments in other domains of functioning, such as in negative and positive valence systems and cognitive systems. This view highlights the importance of a complex interplay among biological, psychological, and environmental factors in understanding the origins of conduct problems. We outline the implications of these views for future research and intervention.

Physiological mechanisms of prosociality

Psychophysiological perspectives can provide unique insights into the nature and motivations of children's prosociality and inform our understanding of individual differences. Here, I review current research on prosociality involving some of the most common physiological measures in developmental psychology, including cortisol, various sympathetic nervous system measures, and high-frequency heart rate variability. The literature has been quite mixed, in part because the link between physiology and prosociality is context-dependent and person-dependent. However, recent advances are refining our understanding of the basic physiological mechanisms of prosociality. Resting physiology that contributes to a balance of regulation and vigilance prepares children to effectively cope with future social challenges, like noticing and attending to the needs of others. Experiencing some arousal is an important aspect of empathy-related responding, but physiological patterns of both heightened and hypoarousal can undermine prosociality. Physiological flexibility in response to others' needs may support emotional and behavioral flexibility important for prosociality.

Taxometric analyses and predictive accuracy of callous-unemotional traits regarding quality of life and behavior problems in non-conduct disorder diagnoses

Callous-unemotional (CU) traits have mainly been studied in relation to conduct disorder (CD), but can also occur in other disorder groups. However, it is unclear whether there is a clinically relevant cut-off value of levels of CU traits in predicting reduced quality of life (QoL) and clinical symptoms, and whether CU traits better fit a categorical (taxonic) or dimensional model. Parents of 979 youths referred to a child and adolescent psychiatric clinic rated their child's CU traits on the Inventory of Callous-Unemotional traits (ICU), QoL on the Kidscreen-27, and clinical symptoms on the Child Behavior Checklist. Experienced clinicians conferred DSM-IV-TR diagnoses of ADHD, ASD, anxiety/mood disorders and DBD-NOS/ODD. The ICU was also used to score the DSM-5 specifier 'with limited prosocial emotions' (LPE) of Conduct Disorder. Receiver operating characteristic (ROC) analyses revealed that the predictive accuracy of the ICU and LPE regarding QoL and clinical symptoms was poor to fair, and similar across diagnoses. A clinical cut-off point could not be defined. Taxometric analyses suggested that callous-unemotional traits on the ICU best reflect a dimension rather than taxon. More research is needed on the impact of CU traits on the functional adaptation, course, and response to treatment of non-CD conditions.

If You Go Down to the Woods Today: Infants' Distress During a Teddy Bear's Picnic in Relation to Peer Relations and Later Emotional Problems

Infants' emotional reactions to an unusual event were assessed at a simulated birthday party during which two costumed characters enacted a Teddy Bear's Picnic. Two hundred and fifty-eight firstborn infants in a representative British community sample were observed at a mean age of 12.8 months in the presence of their parents and other participating families, in a laboratory sitting room decorated with balloons and banners. The picnic scenario was followed by free play with the other participating infants. At a mean of 36 months of age, mothers, fathers, and another informant who knew the child well completed the Child Behaviour Check List (CBCL). The majority of infants showed no vocal distress during the picnic scenario. A minority of infants expressed strong distress, which was correlated with elevated heart rate and production of cortisol. Infants who were not distressed were more likely to direct social behavior to their peers and especially likely to use physical force against peers. In comparison with strongly distressed and nondistressed infants, those who had shown mild distress during the picnic scenario were least likely to manifest later emotional problems. This pattern was particularly marked for boys. Taken together, the findings indicate that infants' strong distress during naturalistic encounters that are meant to be entertaining can suppress sociability and might indicate risk for subsequent emotional problems.

Associations between Infant Behaviors during the Face-To-Face Still-Face Paradigm and Oppositional Defiant and Callous-Unemotional Behaviors in Early Childhood

Deficits in social orienting (i.e., gazing toward caregivers) during dyadic interactions and reactivity to stressful stimuli have been identified as behavioral correlates of oppositional defiant disorder (ODD) and callous-unemotional (CU) behaviors in older children. The goal of the current study was to investigate infants' mother-directed gaze and reactivity during the face-to-face and still-face episodes of the face-to-face stillface paradigm performed at 6 months in the prediction of ODD and CU behaviors in early childhood. Using data from the Durham Child Health and Development study (n = 206), hierarchical regression analyses revealed that infants' negative reactivity during the still-face episode and mother-directed gaze during the face-to-face episode predicted fewer ODD behaviors in early childhood. Examination of interaction effects suggested that mother-directed gaze attenuated the negative relation between reactivity and ODD and CU behaviors in early childhood. The current study is one of the first to extend downward the investigation of ODD and CU behaviors into infancy.

Dimensions of Maternal Parenting and Infants' Autonomic Functioning Interactively Predict Early Internalizing Behavior Problems

Developmental pathways to childhood internalizing behavior problems are complex, with both environmental and child-level factors contributing to their emergence. The authors use data from a prospective longitudinal study (n = 206) to examine the associations between dimensions of caregiving experiences in the first year of life and anxious/depressed and withdrawn behaviors in early childhood. Additionally, the authors examine the extent to which these associations were moderated by infants' autonomic functioning in the first year of life indexed using measures of respiratory sinus arrhythmia (RSA) and heart period (HP). Findings suggest that higher levels of maternal sensitivity in infancy are associated with fewer anxious/depressed and withdrawn behaviors at age 3 years. Negative intrusiveness was found to be positively associated with children's anxious/depressed behaviors but not withdrawn behaviors. Further, moderation analyses suggested that the link between negative intrusive parenting during infancy and subsequent anxious/depressed behaviors is exacerbated for infants with average or low baseline HP and that positive engaging parenting during infancy was negatively related to withdrawn behaviors for infants demonstrating average to high levels baseline HP. Interestingly, RSA was not found to moderate the associations between parenting in infancy and later internalizing behavior problems suggesting that, during infancy, overall autonomic functioning may have greater implications for the development of internalizing behaviors than do parasympathetic influences alone. Implications of these findings and future directions for research are discussed.

The role of anxiety in cortisol stress response and cortisol recovery in boys with oppositional defiant disorder/conduct disorder

Children with antisocial and aggressive behaviors have been found to show abnormal neurobiological responses to stress, specifically impaired cortisol stress reactivity. The role of individual characteristics, such as comorbid anxiety, in the stress response is far less studied. Furthermore, this study extended previous studies in that not only baseline and reactivity to a psychosocial stressor were examined, but also recovery from a stressor. These three phases of cortisol could be impacted differentially in boys with oppositional defiant disorder/conduct disorder (ODD/CD) with (+ANX) and without anxiety (-ANX). The results revealed that cortisol patterns in response to psychosocial stress were different for boys with ODD/CD+ANX (n=32), ODD/CD-ANX (n=22) and non-clinical controls (NC) (n=34), with age range of 7.8-12.9 years. The ODD/CD-ANX group showed lower overall cortisol levels than the NC group. When considering the three phases of cortisol separately, the ODD/CD-ANX group had lower baseline cortisol levels relative to the other groups, whereas the ODD/CD+ANX showed an impaired cortisol recovery response. Within those with ODD/CD, callous-unemotional traits were predictive of high baseline cortisol levels. Also, anxiety predicted high baseline and recovery cortisol levels, whereas a high number of CD symptoms predicted reduced cortisol stress reactivity. These results clearly indicate that comorbid anxiety is an important factor in explaining differences in stress response profiles in boys with ODD/CD; although boys with CD/ODD are generally characterized by an impaired cortisol stress response, we found that those with comorbid anxiety showed impaired cortisol recovery, whereas those without anxiety showed reduced baseline cortisol levels.

Respiratory sinus arrhythmia and heart period in infancy as correlates of later oppositional defiant and callous-unemotional behaviors

Extant literature suggests that oppositional defiant (ODD) and callous-unemotional (CU) behaviors in childhood and adolescence are associated with distinct patterns of psychophysiological functioning and that individual differences in these patterns have implications for developmental pathways to disorder. Very little is known about the associations between psychophysiological functioning in infancy and later ODD and CU behaviors. This study examined associations between basal autonomic nervous system (ANS) functioning in infancy and ODD and CU behaviors in later childhood. Using longitudinal heart period (HP) and respiratory sinus arrhythmia (RSA) data from the Durham Child Health and Development Study (N = 206), the current study tested associations, within a structural equation modeling framework, between continuous measures of HP and RSA across the first two years of life and later ODD and CU behaviors at first grade. Results indicate that ODD and CU behaviors in childhood are associated with lower baseline RSA, but not HP, across infancy. The implications of these findings for developmental models of ODD and CU behaviors are discussed.

Punishment Insensitivity in Early Childhood: A Developmental, Dimensional Approach

Impairment in learning from punishment ("punishment insensitivity") is an established feature of severe antisocial behavior in adults and youth but it has not been well studied as a developmental phenomenon. In early childhood, differentiating a normal: abnormal spectrum of punishment insensitivity is key for distinguishing normative misbehavior from atypical manifestations. This study employed a novel measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB), to examine the distribution, dimensionality, and external validity of punishment insensitivity in a large, demographically diverse community sample of preschoolers (3-5 years) recruited from pediatric clinics (N = 1,855). Caregivers completed surveys from which a seven-item Punishment Insensitivity scale was derived. Findings indicated that Punishment Insensitivity behaviors are relatively common in young children, with at least 50 % of preschoolers exhibiting them sometimes. Item response theory analyses revealed a Punishment Insensitivity spectrum. Items varied along a severity continuum: most items needed to occur "Often" in order to be severe and behaviors that were qualitatively atypical or intense were more severe. Although there were item-level differences across sociodemographic groups, these were small. Construct, convergent, and divergent validity were demonstrated via association to low concern for others and noncompliance, motivational regulation, and a disruptive family context. Incremental clinical utility was demonstrated in relation to impairment. Early childhood punishment insensitivity varies along a severity continuum and is atypical when it predominates. Implications for understanding the phenomenology of emergent disruptive behavior are discussed.

Parenting and children's representations of family predict disruptive and callous-unemotional behaviors

Data from a large prospective longitudinal study (n = 1,239) was used to investigate the association between observed sensitive parenting in early childhood and children's representations of family relationships as measured by the Family Drawing Paradigm (FDP) in first grade as well as the extent to which these representations partially mediate the influences of early caregiving experiences on later conduct problems and callous-unemotional behaviors. A structural equation modeling approach revealed that less sensitive parenting at 24, 36, and 58 months predicts higher levels of conduct problems (CP) and callous-unemotional (CU) behaviors in first grade controlling for earlier measures of CP and CU behaviors. Results also indicated that greater dysfunctional family representations, as assessed with the FDP, are significantly associated with higher CU behaviors in the first grade, but not CP. Finally, a test of the indirect pathway suggests that children's dysfunctional family representations may, in part, account for the association between sensitive parenting and CU behaviors.

Attachment and Health-Related Physiological Stress Processes

People who are more securely attached to close partners show health benefits, but the mechanisms underlying this link are not well specified. We focus on physiological pathways that are potential mediators of the connection between attachment in childhood and adulthood and health and disease outcomes. Growing evidence indicates that attachment insecurity (vs. security) is associated with distinctive physiological responses to stress, including responses involving the HPA, SAM and immune systems, but these responses vary with type of stressor (e.g., social/nonsocial) and contextual factors (e.g., partner's attachment style). Taking this more nuanced perspective will be important for understanding the conditions under which attachment shapes health-related physiological processes as well as downstream health and disease consequences.