Possible Interventions for Preventing the Development of Psychopathic Traits among Children and Adolescents?

Individuals with the combination of psychopathy and severe conduct disorder often get in a lot of trouble from their early childhood, and can cause great suffering and problems for other people and their immediate environment. Their antisocial behaviour has a tendency to develop into a chronic pattern early in life, and the treatment prognosis in adulthood is poor. A large proportion of serious violent crimes in society can be attributed to this group of perpetrators. Until recently, it has been unclear whether traits of this type can be prevented or changed, so that these individuals and their surroundings can benefit from targeted treatments at an early stage. To reduce serious crime in a society, it is very important to develop effective measures for this particular group. A lack of empathy, indifference to others, and a lack of concern about their own performance appear to be key early signs in children and adolescents with persistent behavioural problems and more serious norm violations who continue into a criminal career upon reaching adulthood. These characteristics have been termed callous−unemotional (CU) traits, and they are considered to be a precursor to psychopathic traits in adulthood. In recent years, several studies have evaluated the degree to which treatments that have been proved effective for children and adolescents with severe behavioural problems also show effectiveness for children and adolescents with CU traits. Interventions specifically tailored to children with CU traits have also been developed with the aim of directly changing the ongoing development of this precursor to psychopathy. In this paper, we will address the extent to which current evidence-based treatment methods developed for children and adolescents with behavioural difficulties are equally effective when a child has CU traits. We will also take a closer look at the effects of interventions designed to change this trait. There will be a discussion regarding what seems relevant for a change in the trait itself, as well as a change in their antisocial behaviour.

Callous-Unemotional Traits Moderate the Relationship Between Irritability and Threatening Responding

Background: Irritability and callous-unemotional (CU; reduced guilt/empathy) traits vary dimensionally in the typically developing population but may be particularly marked in youth with conduct disorder (CD). While these dimensional traits are positively correlated, they have been associated with divergent forms of dysfunction, particularly with respect to threat processing (i.e., irritability with increased, and CU traits with decreased, threat responsiveness). This suggests that interactions between these two dimensions may be complex at the neurobiological level. However, this issue has received minimal empirical attention.Methods: The study included 105 adolescents (typically developing and cases with CD; N = 59). They were scanned with fMRI during a looming threat task that involved images of threatening and neutral human faces or animals that appeared to be either looming or receding.Results: Significant irritability-by-CU traits-by-Direction-by-Emotion interactions were seen within right thalamus/PAG, left lingual gyrus and right fusiform gyrus; irritability was positively associated with the BOLD response for Looming Threatening vs. Receding Threatening trials, particularly for youth with low CU traits. In contrast, CU traits were negatively associated with the same differential BOLD response but particularly for youth showing higher levels of irritability. Similar findings were seen within left ventral anterior and posterior cingulate cortices, though the addition of the interaction with CU traits was only seen at slightly more lenient thresholds.Conclusions: The results support previous work linking irritability to increased, and CU traits to reduced, threat responsiveness. However, for adolescents with high irritability, if CU traits are also high, the underlying neuropathology appears to relate to reduced, rather than increased, threat responsiveness.

Dimensional Latent Structure of Callous-Unemotional Traits in German Adolescents: Results from Taxometric Analyses

A large amount of research has addressed the issue of the latent status of psychiatric disorders and related phenomena. We used a new taxometric approach developed by Ruscio to examine the latent status of callous-unemotional (CU) traits in a large representative study of German ninth graders (N = 3,878). Rather than estimating a putative taxon base rate and using that estimate to generate the taxon comparative data, we estimated CCFI profiles with each base rate estimate between 2.5% and 97.5% in increments of 2.5%. Results of different indicator sets clearly suggested a dimensional solution. This finding is consistent with different studies showing the dimensionality of psychopathy in adolescents. In summary, the results of this study point to the need for critical reflection in defining a high-risk-group in the context of CU traits. However, further studies are necessary to substantiate this result in different samples using different measurement approaches.

Affective theory of mind impairments underlying callous-unemotional traits and the role of cognitive control: A pilot study

Affective theory of mind (aToM) impairments predict antisocial behavior above clinical rating of the youth antisocial phenotype callous-unemotional (CU) traits. Adolescents with CU traits demonstrate specific impairments in cognitive control; and cognitive control modulates aToM. Adolescents with CU traits specifically demonstrate aToM impairments during complex, but not basic, emotions, which require greater cognitive control to process. What is less understood is how cognitive control impacts complex aToM in relation to CU traits. Such investigations demonstrate promise for understanding modifiable mechanisms underlying core impairments of CU traits. To examine this, 81 participants (ages 12-14, Female = 51.8%, Male= 48.2%) were recruited to complete a behavioral paradigm that involved an initial aToM task followed by placing additional demands on cognitive control and a final repeat of the same aToM task. Results indicate higher CU traits associated with greater sensitivity to cognitive demands and that placing demands on cognitive control resulted in additional decrements in complex aToM. These preliminary results suggest that the cognitive control vulnerabilities associated with CU traits impact complex aToM. This may partially explain why youth with CU traits persist in antisocial behavior and warrants further investigation.

Reward-Related Dysfunctions in Children Developing Attention Deficit Hyperactivity Disorder—Roles of Oppositional and Callous-Unemotional Symptoms

Objectives: Neurocognitive functions might indicate specific pathways in developing attention deficit hyperactivity disorder (ADHD). We focus on reward-related dysfunctions and analyze whether reward-related inhibitory control (RRIC), approach motivation, and autonomic reactivity to reward-related stimuli are linked to developing ADHD, while accounting for comorbid symptoms of oppositional defiant disorder (ODD), and callous-unemotional (CU) traits.Methods: A sample of 198 preschool children (115 boys; age: m = 58, s = 6 months) was re-assessed at age 8 years (m = 101.4, s = 3.6 months). ADHD diagnosis was made by clinical interviews. We measured ODD symptoms and CU traits using a multi-informant approach, RRIC (Snack-Delay task, Gift-Bag task) and approach tendency using neuropsychological tasks, and autonomic reactivity via indices of electrodermal activity (EDA).Results: Low RRIC and low autonomic reactivity were uniquely associated with ADHD, while longitudinal and cross-sectional links between approach motivation and ADHD were completely explained by comorbid ODD and CU symptoms.Conclusion: High approach motivation indicated developing ADHD with ODD and CU problems, while low RRIC and low reward-related autonomic reactivity were linked to developing pure ADHD. The results are in line with models on neurocognitive subtypes in externalizing disorders.

Reflexive Gaze Shifts and Fear Recognition Deficits in Children with Callous-Unemotional Traits and Impulsivity/Conduct Problems

The ability to efficiently recognize the emotions on others’ faces is something that most of us take for granted. Children with callous-unemotional (CU) traits and impulsivity/conduct problems (ICP), such as attention-deficit hyperactivity disorder, have been previously described as being “fear blind”. This is also associated with looking less at the eye regions of fearful faces, which are highly diagnostic. Previous attempts to intervene into emotion recognition strategies have not had lasting effects on participants’ fear recognition abilities. Here we present both (a) additional evidence that there is a two-part causal chain, from personality traits to face recognition strategies using the eyes, then from strategies to rates of recognizing fear in others; and (b) a pilot intervention that had persistent effects for weeks after the end of instruction. Further, the intervention led to more change in those with the highest CU traits. This both clarifies the specific mechanisms linking personality to emotion recognition and shows that the process is fundamentally malleable. It is possible that such training could promote empathy and reduce the rates of antisocial behavior in specific populations in the future.

An examination of the relations between effortful control in early childhood and risk for later externalizing psychopathology: A bi-factor structural equation modeling approach

Effortful control (EC) is characterized by regulatory strategies that contribute to patterns of (mal)adaptation across development. Deficits in EC pose risk for externalizing psychopathology, but whether and how subfactors of EC differentially influence children’s conduct problems (CP), attention deficit disordered behaviors (ADD), and callous-unemotional (CU) traits remains unknown. Research on EC may benefit from alternative modeling strategies that allow for comparisons of overall EC scores and its subfactors in the prediction of externalizing outcomes. The current study uses a bi-factor structural equation modeling approach to examine if general EC and its subfactors (i.e., attentional focusing, low-intensity pleasure, perceptual sensitivity, inhibitory control) at 36 months differentially predict CP, ADD, and CU traits at 84 months. Using a longitudinal sample of 206 children followed from age three to seven years (47.8% female, 42.6% European-American), results indicated that increased general EC at 36 months predicted reduced CU traits and ADD at 84 months. Attentional focusing was the only subfactor to uniquely predict later CU traits, suggesting that attentional abilities hold particular significance for buffering against psychopathy. Findings are interpreted in the context of methodological and theoretical significance for future developmental research, as well as implications for interventions targeting regulatory strategies in early childhood.

A Comparison of Parent, Teacher, and Youth Ratings on the Inventory of Callous–Unemotional Traits

The current study compared the validity of self-, parent-, and teacher-report versions of the Inventory of Callous–Unemotional Traits (ICU), a widely used measure of callous–unemotional (CU) traits, at several different ages. Participants ( N = 236, 60.6% girls) were children in Grades 3, 6, and 8 ( Mage = 11.55, SD = 2.23) from a public school system in the southern United States. We tested the association of all three ICU versions with several validators: parent- and teacher-reported conduct problems, peer nominations of characteristics associated with CU traits, and sociometric peer nominations of social preference. Results revealed an interaction between the ICU version and grade in the overall level of CU traits reported, with teacher-report leading to the highest ratings in sixth grade and being higher than parent-report in third grade. Furthermore, the validity of the different versions of the ICU varied somewhat across grades. Specifically, findings support the validity of both teacher- and self-report in third grade, but self-report was the only version to show strong validity in the eighth grade.

SLC25A24 gene methylation and gray matter volume in females with and without conduct disorder: an exploratory epigenetic neuroimaging study

Conduct disorder (CD), a psychiatric disorder characterized by a repetitive pattern of antisocial behaviors, results from a complex interplay between genetic and environmental factors. The clinical presentation of CD varies both according to the individual’s sex and level of callous-unemotional (CU) traits, but it remains unclear how genetic and environmental factors interact at the molecular level to produce these differences. Emerging evidence in males implicates methylation of genes associated with socio-affective processes. Here, we combined an epigenome-wide association study with structural neuroimaging in 51 females with CD and 59 typically developing (TD) females to examine DNA methylation in relation to CD, CU traits, and gray matter volume (GMV). We demonstrate an inverse pattern of correlation between CU traits and methylation of a chromosome 1 region in CD females (positive) as compared to TD females (negative). The identified region spans exon 1 of the SLC25A24 gene, central to energy metabolism due to its role in mitochondrial function. Increased SLC25A24 methylation was also related to lower GMV in multiple brain regions in the overall cohort. These included the superior frontal gyrus, prefrontal cortex, and supramarginal gyrus, secondary visual cortex and ventral posterior cingulate cortex, which are regions that have previously been implicated in CD and CU traits. While our findings are preliminary and need to be replicated in larger samples, they provide novel evidence that CU traits in females are associated with methylation levels in a fundamentally different way in CD and TD, which in turn may relate to observable variations in GMV across the brain.

Reflexive Gaze Shifts and Fear Recognition Deficits in Children With Callous-unemotional Traits and Impulsivity/Conduct Problems

The ability to efficiently recognize the emotions on others’ faces is something that most of us take for granted. Children with callous-unemotional (CU) traits and impulsivity/conduct problems (ICP), such as attention-deficit hyperactivity disorder, have been previously described as being “fear blind”. This is also associated with looking less at the eye regions of fearful faces, which are highly diagnostic. Previous attempts to intervene into emotion recognition strategies have not had lasting effects on participants’ fear recognition abilities. Here we present both (a) additional evidence that there is a two-part causal chain, from personality traits to face recognition strategies using the eyes, then from strategies to rates of recognizing fear in others; and (b) a pilot intervention that had persistent effects for weeks after the end of instruction. Further, the intervention led to more change in those with the highest CU traits. This both clarifies the specific mechanisms linking personality to emotion recognition and shows that the process is fundamentally malleable. It is possible that such training could promote empathy and reduce the rates of antisocial behavior in specific populations in the future.