Research Review: What do we know about psychopathic traits in children?

Affective theory of mind impairments linked with callous-unemotional traits implicate cognitive control: A pre-registered double-blind randomized controlled trial with a dual-task paradigm

INTRODUCTION

Youth antisocial behavior strongly associates with conduct problems (CP) and callous-unemotional (CU) traits. While CP has links to broad cognitive impairments, CU traits have specific links with cognitive control and affective theory of mind (ToM) difficulties. Evidence suggests cognitive control limitations impact affective processing in ToM amongst youth with elevated CU traits. Here we sought to improve on those initial findings by leveraging a randomized dual-task (within-trial) design to replicate and extend prior findings.

METHODS

In this double-blind, randomized controlled trial, 85 participants (47 % female) were stratified by sex and CU trait severity. The study employed a ToM task with cognitive, affective, and physical conditions, combined with an inhibitory processing task to tax cognitive control. Participants completed single and dual-task trials, counterbalanced to test within-subject effects. Primary hypotheses were tested with both CP and CU traits in the same model using repeated measure mixed effects to examine changes in accuracy and reaction time.

RESULTS

CU traits were uniquely associated with greater impairments in affective ToM under dual-task conditions, reflecting increased difficulty integrating affective information when cognitive demands were increased. CP associated with lower single ToM performance but no change during dual-task trials. Notably, participants resilient to dual-task effects reported fewer antisocial behaviors, even with elevated CU traits.

LIMITATIONS

While appropriately powered for study aims, the sample was underpowered to detect any potential primary and secondary variant interactions on study outcomes.

CONCLUSIONS

These findings support a CU trait specific cognitive-affective interaction as a mechanism critical for understanding youth antisocial behavior.

Adolescent psychopathic traits and adverse environments: Associations with socially adaptive outcomes

Researchers have suggested that psychopathic traits among adults may be, at least in part, an adaptive and/or a learned response for securing socially adaptive outcomes in adverse environments, but there is a lack of developmental evidence supporting this hypothesis among adolescents. Therefore, we examined the indirect links from self-perceived adverse environments (parental neglect, socioeconomic status, school competition, neighborhood violence) to evolutionarily relevant social outcomes (social power, dating behavior) through psychopathic traits. A community sample of 396 adolescents completed measures for the study (Mage = 14.64, SD = 1.52). As predicted, there were significant indirect effects from higher levels of parental neglect, school competition, and neighborhood violence to both forms of socially adaptive outcomes through psychopathic traits, but unexpectedly, there were no indirect effects with socioeconomic status. There were also direct effects between environment and socially adaptive outcomes. Results support the hypothesis that psychopathic traits may be, in part, an adaptive and/or learned response to cues from adverse social environments as a means to acquire evolutionarily relevant social outcomes. Interventions could be designed to target the adverse social issues that might be facilitating the development of psychopathy and should be sensitive to the social outcomes adolescents may acquire from these traits.

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.

A Multi-Dimensional, Multi-Informant Examination of Adolescent Psychopathy and its Links to Parental Monitoring: The Moderating Role of Resting Arousal

Recent work indicates clinically meaningful differences in domains of psychopathic personality - such as grandiose-manipulative (GM), callous-unemotional (CU), and daring-impulsive (DI) traits - and parenting factors. Yet, different domains of parenting and reports from multiple informants may vary in their associations to psychopathic traits. This study examined psychopathic traits and their links with parental monitoring behaviors, parental knowledge, and adolescent disclosure. Further, we evaluated whether adolescents' self-reported resting arousal moderated these associations. A mixed clinic-referred/community sample of 134 adolescent-parent dyads (Mage = 14.49; SD = 0.50; 66.4% female) completed multi-dimensional measures of psychopathy, parental monitoring behaviors, parental knowledge, and adolescent disclosure; adolescents also self-reported on their resting arousal. Results indicated links between: (a) increased parent-reported GM traits and decreased parent-reported parental knowledge, and (b) increased parent-reported DI traits and lower parent-reported monitoring behaviors, which were attenuated at high levels of adolescent-reported resting arousal. Associations between elevated dimensions of psychopathic traits and lower levels of parental monitoring behaviors, parental knowledge, and adolescent disclosure were most consistent within-informants, with some cross-informant associations identified for links between elevated GM and DI and lower levels of parental monitoring behaviors and parental knowledge. These findings have important implications for our understanding of how to assess and prevent psychopathy and associated externalizing problems, and suggest that targeting modifiable environmental and psychophysiological factors may be particularly important.

Gender Differences in Co-developmental Trajectories of Internalizing and Externalizing Problems: A 7-Year Longitudinal Study from Ages 3 to 12

The co-occurrence of externalizing and internalizing problems is acknowledged, but gender differences remain unclear. The present study examines gender differences in the longitudinal relationships between conduct and emotional problems throughout childhood. The sample, drawn from the ELISA project, included 2368 children (48.1% girls; ages 3-12). Latent growth curve models were employed to analyze the trajectories of parent-reported conduct problems and emotional symptoms separately, while parallel process latent growth curve models were utilized to compare joint trajectories. The decrease in conduct problems was consistent for girls, but not for boys. High initial emotional symptoms predicted a slower increase in emotional symptoms over time for girls. Parental positivity was a protective factor for conduct problems in girls. Grandiose-deceitful traits were more related to conduct problems in girls, while callous-unemotional traits were related to emotional symptoms in boys. This study highlights the importance of considering gender in childhood conduct and emotional problems.

Do Children with High Callous-Unemotional Traits Have Attentional Deficits to Emotional Stimuli? Evidence from a Multi-Method and Multi-Informant Study

Callous-unemotional (CU) traits in children and adolescents are linked to severe and persistent antisocial behavior. Based on past empirical research, several theoretical models have suggested that CU traits may be partly explained by difficulties in correctly identifying others' emotional states as well as their reduced attention to others' eyes, which could be important for both causal theory and treatment. This study tested the relationships among CU traits, emotion recognition of facial expressions and visual behavior in a sample of 52 boys referred to a clinic for conduct problems (Mage = 10.29 years; SD = 2.06). We conducted a multi-method and multi-informant assessment of CU traits through the Child Problematic Traits Inventory (CPTI), the Inventory of Callous-Unemotional (ICU), and the Clinical Assessment of Prosocial Emotions-Version 1.1 (CAPE). The primary goal of the study was to compare the utility of these methods for forming subgroups of youth that differ in their emotional processing abilities. An emotion recognition task assessed recognition accuracy (percentage of mistakes) and absolute dwell time on the eyes or mouth region for each emotion. Results from repeated measures ANOVAs revealed that low and high CU groups did not differ in emotion recognition accuracy, irrespective of the method of assessing CU traits. However, the high CU group showed reduced attention to the eyes of fearful and sad facial expressions (using the CPTI) or to all emotions (using the CAPE). The high CU group also showed a general increase in attention to the mouth area, but only when assessed by the CAPE. These findings provide evidence to support abnormalities in how those elevated on CU traits process emotional stimuli, especially when assessed by a clinical interview, which could guide appropriate assessment and more successful interventions for this group of youth.

Callous-Unemotional Traits and Conduct Problems in Children: The Role of Strength and Positive Characteristics

In recent decades, many researchers have focused on the development of Conduct Problems from childhood to adolescence. Understanding behavior problems also requires an understanding of well-regulated characteristics. Focusing our assessment on strengths makes it possible, on the one hand, to help children or adolescents with deficits in important areas (e.g., socio-emotional deficits) to develop emotional regulation skills and adapt their responses to different contexts. This study aims to understand the role of self-competence, self-regulation, empathy, and responsibility (strength variables) in the relationship between Callous Unemotional characteristics and Conduct Problems, with a sample of 236 children aged between 3 and 10 years (M = 7.51, SD = 1.63), through mediation analysis. In general, our findings suggest that self-regulation significantly explains the relationship between the callous dimension of the Inventory of Callous-Unemotional Traits and Conduct Problems, pointing out that this strength variable seems to act as a protective factor against the development of behavior problems. No other mediation effects were found, and these results are considered in light of some limitations.

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.

Editorial: Conduct Disorder and Its 70-Year History: Lessons From Hervey Cleckley and Lee Robins

If Cleckley1,2 and Robins3 were alive today, it is conceivable that they may argue about whether conduct disorder (CD) should be measured primarily with personality traits or behavioral characteristics. However, these strict demarcations may not be needed, or most helpful, for understanding youth with conduct problems. Recently, I proposed that CD might be best specified with 3 personality dimensions including grandiose-manipulative (GM), callous-unemotional (CU), and daring-impulsive (DI) traits.4 These traits are observable from an early age, appear to have a genetic basis, and have distinct correlates suggesting potentially differing etiologies relevant to understanding CD. Importantly, each domain is also related to conduct problems and delinquency.5.

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.

The Affective Side of Disruptive Behavior: Toward Better Understanding, Assessment, and Treatment

Historically, much of the progress made in youth mental health research can be classified as focusing on externalizing problems, characterized by disruptive behavior (e.g. aggression, defiance), or internalizing problems, characterized by intense negative affect (e.g. depression, anxiety). Until recently, however, less attention has been given to topics that lie somewhere in between these domains, topics that we collectively refer to as the affective side of disruptive behavior. Like the far side of the moon, the affective side of disruptive behavior captures facets of the phenomenon that may be less obvious or commonly overlooked, but are nonetheless critical to understand. This affective side clarifies socially disruptive aspects of traditionally "externalizing" behavior by elucidating proximal causation via intense negative affect (traditionally "internalizing"). Such problems include irritability, frustration, anger, temper loss, emotional outbursts, and reactive aggression. Given a recent explosion of research in these areas, efforts toward integration are now needed. This special issue was developed to help address this need. Beyond the present introductory article, this collection includes 4 empirical articles on developmental psychopathology topics, 4 empirical articles on applied treatment/assessment topics, 1 evidence base update review article on measurement, and 2 future directions review articles concerning outbursts, mood, dispositions, and youth psychopathology more broadly. By deliberatively investigating the affective side of disruptive behavior, we hope these articles will help bring about better understanding, assessment, and treatment of these challenging problems, for the benefit of youth and families.

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

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

Proposed Specifiers for Conduct Disorder (PSCD) self-report: Factor structure and validation in a community sample of Belgian youth

The current study examined the psychometric properties of the Proposed Specifiers for Conduct Disorder (PSCD) in a sample of school-attending adolescent Belgian youth (N = 599; M age = 16.51 years, SD = 1.27). Given the recent interest in the PSCD-Short Version (PSCD-SV), this study focused on the 13-item variant of the PSCD. Study findings showed that the PSCD-SV had a hierarchical four-factor structure including the components of grandiose-manipulative (GM), callous-unemotional (CU), daring-impulsive (DI), and conduct disorder (CD). These interrelated factors were found to be internally consistent. The study also showed that the PSCD-SV total score was positively and significantly related to an alternate measure of psychopathy. Further, the study revealed the PSCD-SV was meaningfully related to the five-factor personality domains (i.e., extraversion, conscientiousness, agreeableness) as well as peer functioning and prosocial behavior. Bivariate correlations demonstrated that the dimensions differed in their associations with external correlates (e.g., peer functioning). Regression analyses showed that the GM, CU, and CD components of the PSCD-SV were uniquely associated to externalizing difficulties, whereas only the GM and CU components of the PSCD-SV were associated with low prosocial behaviors. These findings shed light on the conceptual and developmental models for the consideration of psychopathy and conduct problems. The use of the broader psychopathy condition as well as its underpinning dimensions may have important implications for assessment, treatment, and diagnostic manuals. The implications of the current study are further discussed.

In Search of Conceptual Clarity About the Structure of Psychopathic Traits in Children: A Network-Based Proposal

Psychopathic traits in childhood have been revealed as potential identifiers of risk, being predictive of later forms of behavioral maladjustment. Yet, it is still under debate how psychopathic traits in children should be best conceptualized and which are the core dimensions for construct definition and prediction. The present study aims to examine the structure of psychopathic traits in childhood, and its predictive value, by using a combination of traditional factor analysis and more recent network-based methods. Data on psychopathic traits, as measured by the Child Problematic Traits Inventory (CPTI), were collected in a large sample of children (n = 2454; 48.2% girls), aged 3 to 6 at the onset of the study (Mage = 4.26; SD = 0.91), who were followed-up one and two years later using parent- and teacher-reports. Results showed that psychopathic traits measured via CPTI are best conceptualized as five latent factors encompassing grandiosity, deceitfulness, callousness, impulsivity and need of stimulation, a result that converged across informants and time. Callousness and grandiosity emerged as central traits using network analysis of parent-reports, while deceitfulness was most central using teacher-reports. Finally, callousness, impulsivity and deceitfulness emerged as the best predictors of concurrent, prospective and stable conduct problems. These results provide a refined structure of psychopathic traits in children that better accounts for the core elements of the construct. Additional theoretical and practical implications will be discussed in terms of assessment, diagnostic classification and tailored prevention/intervention.

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.

The association between callous-unemotional traits and substance use in childhood and adolescence: A systematic review and meta-analysis

Callous-unemotional (CU) traits are characterized by a lack of guilt and empathy, restricted affect, and low concern about performance, and are increasingly recognized as co-occurring with substance use in youth. However, there is mixed evidence concerning whether they make a unique contribution to substance use. This systematic review and meta-analysis sought to quantify the association between CU traits and substance use in childhood, accounting for potential moderators including sample characteristics (age, gender, community versus clinical/forensic samples), CU traits measure and informant, and study design (cross-sectional or longitudinal). Separate meta-analyses were conducted for alcohol, cannabis, and a substance use composite. Small, significant associations were found between CU traits and alcohol (θ = 0.17), cannabis (θ = 0.17) and the substance use composite (θ = 0.15), which were present in both community and clinical/forensic samples. Findings suggest that CU traits co-occur with a range of substance use problems, and that CU traits should be considered in assessments of youth presenting with substance use problems regardless of the nature of the setting.

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.

Cognitive Mechanisms Underlying Prosocial Decision Making in Callous-Unemotional Traits

Callous-unemotional (CU) traits are characterized by a lack of prosocial emotions, which has been demonstrated with prosocial behavior paradigms. While shaping our understanding of prosocial behavior in youth with CU traits, most of this work relies on outcomes that don't reliably capture cognitive processes during prosocial behavior. Examining prosocial cognitive processes can cue researchers into cognitive mechanisms underlying core impairments of CU traits. Drift diffusion modeling is a valuable tool for elucidating more precise outcomes of latent cognitive processes during forced choice tasks such as drift rate (information accumulation toward a decision boundary) and threshold separation (amount of information considered) as well as metrics outside of the decision-making processing including bias (starting point in decision process) and non-decision time (cognitive processes outside of choice). In a sample of 87 adolescents (12-14, 49% female) we applied diffusion modeling to a prosocial behavior task in which participants either accepted or rejected trials where a real monetary value was given to them and taken away from a charity (self-serving trial) or money was given to a charity and taken from them (donation trial). Results revealed that CU traits associated with information accumulation toward accepting self-serving trials. Exploratory sex differences suggested males trended toward rejecting donation trials and females considered more information during self-serving trials. CU trait associations were independent of conduct problems. Results suggest a unique cognitive profile that are differentiated by sex at higher CU traits when making prosocial decisions involving knowledge accumulation toward self-serving decisions.

Psychopathic Traits, Externalizing Problems, and Prosocial Behavior: The Role of Social Dominance Orientation

Psychopathic traits in community and referred youths are strongly associated with severe externalizing problems and low prosocial behavior. However, less is known about the mechanisms that may link youth psychopathy and these outcomes. Social dominance orientation (SDO), defined as the general individual orientation toward unequal and dominant/subordinate relationships, might represent a valuable construct to explore to better understand the association between psychopathic traits, externalizing problems, and prosocial behavior. Based on this, the current study aimed to investigate the relationship between psychopathic traits, SDO, externalizing problems, and prosocial behavior in a community sample (N = 92, 45.57% females, mean age = 12.53, and SD = 0.60) and in a clinical (N = 29, 9% female, mean age = 12.57, and SD = 0.57) samples of adolescents with Oppositional Defiant Disorder or Conduct Disorder. Results showed that SDO mediated the relationship between psychopathic traits and externalizing problems and between psychopathic traits and prosocial behavior only in the clinical sample. These findings can provide valuable information on psychopathic trait correlates in youths with aggressive behavior disorders; treatment implications are discussed.

The Proposed Specifiers for Conduct Disorder - Parent (PSCD-P): Convergent Validity, Incremental Validity, and Reactions to Unfamiliar Peer Confederates

Youth who experience psychopathy display multiple impairments across interpersonal (grandiose-manipulative [GM]), affective (callous-unemotional [CU]), lifestyle (daring-impulsive [DI]), and potentially antisocial and behavioral features. Recently, it has been acknowledged that the inclusion of psychopathic features can offer valuable information in relation to the etiology of Conduct Disorder (CD). Yet, prior work largely focuses on the affective component of psychopathy, namely CU. This focus creates uncertainty in the literature on the incremental value of a multicomponent approach to understanding CD-linked domains. Consequently, researchers developed the Proposed Specifiers for Conduct Disorder (PSCD; Salekin & Hare, 2016) as a multicomponent approach to assess GM, CU, and DI features in combination with CD symptoms. The notion of considering the wider set of psychopathic features for CD specification requires testing whether multiple personality dimensions predict domain-relevant criterion outcomes above-and-beyond a CU-based approach. Thus, we tested the psychometric properties of parents' reports on the PSCD (PSCD-P) in a mixed clinical/community sample of 134 adolescents (M_age = 14.49, 66.4% female). Confirmatory factor analyses resulted in a 19-item PSCD-P displaying acceptable reliability estimates and a bifactor solution consisting of GM, CU, DI, and CD factors. Findings supported the incremental validity of scores taken from the PSCD-P across multiple criterion variables, including (a) an established survey measure of parent-adolescent conflict; and (b) trained independent observers' ratings of adolescents' behavioral reactions to laboratory controlled tasks designed to simulate social interactions with unfamiliar peers. These findings have important implications for future research on the PSCD and links to adolescents' interpersonal functioning.

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.

Elucidating the role of negative parenting in the genetic v. environmental influences on adult psychopathic traits

BACKGROUND

Psychopathic traits involve interpersonal manipulation, callous affect, erratic lifestyle, and antisocial behavior. Though adult psychopathic traits emerge from both genetic and environmental risk, no studies have examined etiologic associations between adult psychopathic traits and experiences of parenting in childhood, or the extent to which parenting practices may impact the heritability of adult psychopathic traits using a genetically-informed design.

METHODS

In total, 1842 adult twins from the community reported their current psychopathic traits and experiences of negative parenting during childhood. We fit bivariate genetic models to the data, decomposing the variance within, and the covariance between, psychopathic traits and perceived negative parenting into their genetic and environmental components. We then fit a genotype × environment interaction model to evaluate whether negative parenting moderated the etiology of psychopathic traits.

RESULTS

Psychopathic traits were moderately heritable with substantial non-shared environmental influences. There were significant associations between perceived negative parenting and three of four psychopathy facets (interpersonal manipulation, erratic lifestyle, antisocial tendencies, but not callous affect). These associations were attributable to a common non-shared environmental pathway and not to overlapping genetic effects. Additionally, we found that primarily shared environmental influences were stronger on psychopathic traits for individuals with a history of greater negative parenting.

CONCLUSIONS

Utilizing a genetically-informed design, we found that both genetic and non-shared environmental factors contribute to the emergence of psychopathic traits. Moreover, perceptions of negative parenting emerged as a clear environmental influence on the development of interpersonal, lifestyle, and antisocial features of psychopathy.

Perinatal and early-life factors associated with stable and unstable trajectories of psychopathic traits across childhood

BACKGROUND

This study aimed to identify perinatal and early-life factors associated with trajectories of psychopathic traits across childhood.

METHODS

Participants were 1631 children (51.5% girls) from the Quebec Longitudinal Study of Child Development. A wide range of perinatal and early-life factors were assessed from pregnancy to age 2.5 years using medical files and mothers' reports. Psychopathic traits were assessed via teachers' reports at ages 6, 7, 8, 10, and 12 years. Latent class growth analyses and multinomial logistic regressions controlling for child sex were conducted. Two-way interaction effects between perinatal/early-life factors and child sex were explored.

RESULTS

Four trajectories of psychopathic traits were identified: High-stable (4.48%), Increasing (8.77%), Decreasing (11.46%), and Low-stable (75.29%). A few perinatal factors and most child-level and family-level early-life factors significantly increased the odds of following the High-stable v. the Low-stable trajectory. Higher levels of psychotropic exposures during pregnancy, socioeconomic adversity, child's physical aggression, child's opposition, mother's depressive symptoms, and hostile parenting increased the likelihood of following the Increasing instead of the Low-stable trajectory. Higher socioeconomic adversity, mother's depressive symptoms, and inconsistent parenting were associated with membership to the High-stable instead of the Decreasing trajectory. Most associations were not moderated by child sex.

CONCLUSIONS

These results shed light on the perinatal and early-life factors that are associated with specific pathways of psychopathic traits during childhood and suggest that different factors could be targeted to prevent the exacerbation (v. low and stable levels) or the stability at high levels (v. attenuation) of these traits.

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).

HTR1B genotype and psychopathy: Main effect and interaction with paternal maltreatment

Psychopathy is a condition characterized by atypical emotions and socially maladaptive behavioral patterns. Among incarcerated people, psychopathy has been associated with higher rates of crimes, recidivism, and resistance to treatment. Many studies have indicated significant heritability of psychopathic traits, but little is known about the specific contribution of genes and their interaction with adverse experiences in life. Considering the primary role that serotonin plays in cognition and emotion, we investigated TPH2-rs4570625, 5-HTTLPR, MAOA-uVNTR, HTR1B-rs13212041 and HTR2A-rs6314 as risk factors for psychopathy in the largest sample of institutionalized individuals studied so far, consisting of 793 US White male incarcerated adults, and in a replication sample of 168 US White male incarcerated adolescents. In a subgroup of the adult sample, the interaction between genetics and parenting style, assessed by the Measure of Parental Style (MOPS) questionnaire, was also evaluated. The HTR1B-rs13212041-T/T genotype, as compared to HTR1B-rs13212041-C allele, predicted higher psychopathy scores in both the adult and the adolescent samples. The interaction between HTR1B-rs13212041-T/T genotype and paternal MOPS scores, investigated in a subgroup of the adult sample, was an even stronger predictor of higher levels of psychopathy than either the genetics or the environment taken individually. Overall, these data, obtained in two independent samples, shed new light on neurobiological correlates of psychopathy with promising implications both at a clinical and forensic level.

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.

Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders

The recent inclusion of callous-unemotional traits in the diagnostic criteria for serious conduct problems has led to renewed interest in more comprehensive integrations of the construct of psychopathy into research and clinical classification of childhood disruptive behavior disorders. There have been a number of recent reviews of research focusing the many potential benefits for this integration. However, there are also a number of issues that could reduce these benefits and even potentially lead to harmful effects. The current paper focuses on several of these issues, some of which are common when attempting to integrate research findings across areas that have been conducted independently of each other. Other issues are more specific to the construct of psychopathy. Specifically, the current paper focuses on the lack of agreement on the necessary and sufficient dimensions needed to define psychopathy, the need to consider developmental relationships among these dimensions, the implications of the different associations among the dimensions of psychopathy with conduct problems in children and adolescents, the need to consider how these dimensions relate to existing constructs used in the classification of disruptive behavior disorders, and the potential harmful effects of labeling something "a dimension of psychopathy". These issues have several clear implications for using the construct of psychopathy to guide research on and diagnostic classification of childhood disruptive behavior disorders.

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.

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.

Where Should Psychopathic Traits Be Placed in a Diagnostic Framework? Evidence for a Grandiose-Manipulative Specifier for ODD

Youth exhibiting psychopathic traits are at increased risk for a more severe, persisting, and treatment-resistant course of antisocial behavior. To reflect this diagnostically, the specifier with limited prosocial emotions (LPE) was added to the criteria for conduct disorder (CD). Yet, psychopathic traits often show an earlier onset than CD symptoms and LPE may exclude important dimensions of psychopathy. This study examines grandiose-manipulative (GM) traits both dimensionally and as a diagnostic specifier for behavioral disorders.Data come from a clinic sample of 177 boys aged 7-12 followed up annually through age 17. Annual parent reports of children's GM, and symptoms of CD, oppositional defiant disorder (ODD), and attention-deficit/hyperactivity disorder (ADHD) were tested, controlling for other psychopathology and demographics. A categorical GM specifier for ODD or ADHD was also tested as a predictor of CD or ODD diagnosis.GM and ODD were significantly predictive of increases in CD. Reciprocal associations were observed between GM and ODD symptoms. The GM specifier was most commonly associated with ODD (91.9%), compared to CD (44.1%) or ADHD (67.1%), and was significantly predictive of future CD when applied to ODD. GM as a specifier for ADHD enhanced the prediction from ADHD to ODD, but not to CD. Including GM as a specifier for disorders beyond CD improves the prediction of future behavioral disorders, distinguishing youth with ODD at risk for CD, and youth with ADHD at risk for ODD. Failing to do so may miss a substantial portion of elevated GM.

Empathy, Self-control, Callous-Unemotionality, and Delinquency: Unique and Shared Developmental Antecedents

The current investigation tested childhood developmental antecedents of adolescent empathy, self-control, callous-unemotionality, and delinquency, namely difficult temperament, positive socialization experiences, and intelligence; it also tested potential mediation effects of temperament via socialization. Data were collected as part of the National Institute of Child Health and Human Development Early Child Care and Youth Development Study, which followed N = 1364 children from birth through 15 years (51% female, 80% European American). Early positive socialization (maternal sensitivity, secure attachment, and quality home environment) and temperament variables were assessed from 1 to 36 months, intelligence at age 9, and self-control, empathy, callous-unemotionality, and delinquency at age 15. Based on structural equation modeling hypothesis tests, early positive socialization positively predicted self-control and empathy, and negatively predicted callous-unemotionality and delinquency. Intelligence uniquely and positively predicted empathy. Difficult infant temperament indirectly predicted each of the four traits through early positive socialization. Important research and practical implications are discussed.

A Longitudinal Test of the Mediational Role of Delinquent Peer Association on the Link Between Psychopathy and Offending

Although prior research has found that psychopathy and delinquent peer association are predictors of delinquency, less research has assessed the dynamic role of peers in the relationship between psychopathic traits and offending. Using 10 waves of data from the Pathways to Desistance longitudinal study (n = 1,354), the current exploratory study investigates the impact of changes in delinquent peer association on the relationship between psychopathy and self-reported offending. Although the effects are small, results indicate that youth with higher Psychopathy Checklist Youth Version (PCL:YV; Forth et al.) scores report higher initial levels of delinquent peer association, which results in increases in offending over the study period. Initial levels (intercept) and change (slope) in delinquent peer association are positively associated with offending. Findings also demonstrate that initial levels and changes in delinquent peer association mediate the relationship between psychopathy and changes in offending. The findings have implications for delinquency prevention and intervention efforts for all adolescents and particularly serious offenders.

Fear Conditioning Deficits in Children and Adolescents with Psychopathic Traits: a Study in a Clinical Population

Deficits in fear conditioning related to psychopathy have been widely studied in adults. However, evidence in children and adolescents is scarce and inconsistent. This research aimed to expand knowledge about fear conditioning in psychopathy and its dimensions in child and early adolescent clinical populations. Participants were 45 boys (outpatients) aged 6–14 years (M = 10.59, SD = 2.04). They were assessed with the parents’ and teachers’ versions of the Child Problematic Traits Inventory (CPTI). A fear conditioning paradigm (Neumann et al., in Biological Psychology, 79(3), 337–342, 2008) for children and adolescents was used. Conditioned stimuli (CS+ and CS-) were geometric shapes and the unconditioned stimulus (US) was an unpleasant sound of metal scraping on slate (83 dB). Difference scores (CS+ minus CS-) in skin conductance responses (SCR) and self-reported cognitive and affective measures were considered as indices of fear conditioning. Results showed that: a) deficits in fear conditioning were related to some psychopathy dimensions but not to psychopathy as a unitary construct; b) the Impulsivity-Need for Stimulation dimension was a predictor of impaired fear conditioning at a cognitive level; c) the interaction of Callous-Unemotional and Impulsivity-Need for Stimulation dimensions was a significant predictor of impaired electrodermal fear conditioning; d) by contrast, the Grandiose-Deceitful dimension, was marginally associated with a greater electrodermal fear conditioning. In conclusion, psychopathy dimensions and their interactions, but not psychopathy as a whole, predicted deficits in fear conditioning as measured by SCR and cognitive indices. These findings confirm the notion that psychopathic traits are associated with deficits in fear conditioning in child and adolescent clinical populations and provide support for a multidimensional approach to youth psychopathy.

Skin Conductance Responses to a Discrete Threat in Virtual Reality: Associations with Psychopathy and Anxiety

People with high levels of psychopathic traits are often described as fearless and lacking in emotional depth, particularly when evaluating threats in their environments. Skin conductance responsivity (SCR) to negative emotional stimuli represents a robust autonomic correlate of conduct problem behavior in children (Fanti et al., in Neuroscience and Biobehavioral Reviews, 100, 98-107, 2019). However, studies that have examined threat-related processing in youth with conduct problems have tended to use a variety of negative stimuli that might induce various and unspecific negative emotions. Few studies have taken in to account the moderating effects of anxiety on the relationship of distinct psychopathic traits (e.g., narcissism, callousness, impulsivity) with SCR to a fear inducing stimulus. In this study, we examined SCR to a virtual reality rollercoaster drop - that is, a discrete fear inducing event - in a sample of 75 youths (61 males; M = 14 years, SD = 1.4) enrolled in a non-mainstream school. The rollercoaster drop was used to more clearly examine an event-related response to a discrete threat, rather than examining SCR throughout the rollercoaster ride. We used the teacher-reported Antisocial Process Screening Device (Frick & Hare, in Antisocial process screening device: APSD. Toronto: Multi-Health Systems, 2001) to examine the relations of distinct psychopathic traits with SCR and self-reported anxiety. Lower anxiety was associated with higher callousness, but only in youths with low SCR to discrete threat. These findings suggest that fear and anxiety show complex and interactive relations with distinct psychopathic traits.

Interpersonal trauma and its relation to childhood psychopathic traits: what does ADHD and ODD add to the equation?

BACKGROUND

Childhood trauma has demonstrated associations with callous-unemotional traits (e.g., reflecting lack of remorse and guilt, unconcern about own performance). Less is known about associations between trauma and multiple domains of child psychopathic traits. There has also been limited focus on the role of co-occurring disorders to psychopathy traits among children, namely, attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) and how they interact with childhood trauma.

METHODS

We examined to what degree childhood interpersonal trauma can predict parent-rated psychopathic traits in a large population based Swedish twin sample (N = 5057), using a stringent definition of interpersonal trauma occurring before age 10. Two hundred and fifty-one participants met the interpersonal trauma criteria for analysis. The study explored the additional impact of traits of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).

RESULTS

Linear regressions demonstrated statistically significant but clinically negligible effects of interpersonal trauma on total and subscale scores of parent-rated psychopathic traits. When exploring interaction effects of ADHD and ODD into the model, the effect increased. There were interaction effects between ODD and trauma in relation to psychopathic traits, suggesting a moderating role of ODD. Having been exposed to trauma before age 10 was significantly associated with higher parent rated psychopathy traits as measured by The Child Problematic Traits Inventory-Short Version (CPTI-SV), however the explained variance was small (0.3-0.9%).

CONCLUSIONS

The results challenge the notion of association between interpersonal trauma and youth psychopathic traits. They also highlight the need to gain an improved understanding of overlap between psychopathic traits, ADHD and ODD for clinical screening purposes and the underlying developmental mechanisms.