A neurocognitive model of early onset persistent and desistant antisocial behavior in early adulthood.

It remains unclear which functional and neurobiological mechanisms are associated with persistent and desistant antisocial behavior in early adulthood. We reviewed the empirical literature and propose a neurocognitive social information processing model for early onset persistent and desistant antisocial behavior in early adulthood, focusing on how young adults evaluate, act upon, monitor, and learn about their goals and self traits. Based on the reviewed literature, we propose that persistent antisocial behavior is characterized by domain-general impairments in self-relevant and goal-related information processing, regulation, and learning, which is accompanied by altered activity in fronto-limbic brain areas. We propose that desistant antisocial development is associated with more effortful information processing, regulation and learning, that possibly balances self-relevant goals and specific situational characteristics. The proposed framework advances insights by considering individual differences such as psychopathic personality traits, and specific emotional characteristics (e.g., valence of social cues), to further illuminate functional and neural mechanisms underlying heterogenous developmental pathways. Finally, we address important open questions and offer suggestions for future research to improve scientific knowledge on general and context-specific expression and development of antisocial behavior in early adulthood.

Through the looking glass: the neural basis of self-concept in young adults with antisocial trajectories.

Self-concept is shaped by social experiences, but it is not yet well understood how the neural and behavioral development of self-concept is influenced by a history of antisocial behavior. In this pre-registered study, we examined neural responses to self-evaluations in young adults who engaged with antisocial behavior in childhood and either desisted or persisted in antisocial behavior. A self-concept task was performed by 94 young adults (age range 18-30 years). During the task, participants with a persistent or desistent antisocial trajectory (n = 54) and typically developing young adults (n = 40) rated whether positive and negative traits in different domains (prosocial and physical) described themselves. We examined both the effects of a history of antisocial behavior as well as current heterogeneity in psychopathic traits on self-concept appraisal and its neural underpinnings. Participants endorsed more positive trait statements than negative across domains, which did not differ between antisocial-history groups. However, current psychopathic traits were negatively associated with prosocial self-concept and medial prefrontal cortex activity during self-evaluation. Together, these findings suggest that antisocial tendencies might indeed be reflected in self-concept development of young adults, specifically in the prosocial domain.

Neurobiological correlates of antisociality across adolescence and young adulthood: a multi-sample, multi-method study.

BACKGROUND: Antisociality across adolescence and young adulthood puts individuals at high risk of developing a variety of problems. Prior research has linked antisociality to autonomic nervous system and endocrinological functioning. However, there is large heterogeneity in antisocial behaviors, and these neurobiological measures are rarely studied conjointly, limited to small specific studies with narrow age ranges, and yield mixed findings due to the type of behavior examined. METHODS: We harmonized data from 1489 participants (9-27 years, 67% male), from six heterogeneous samples. In the resulting dataset, we tested relations between distinct dimensions of antisociality and heart rate, pre-ejection period (PEP), respiratory sinus arrhythmia, respiration rate, skin conductance levels, testosterone, basal cortisol, and the cortisol awakening response (CAR), and test the role of age throughout adolescence and young adulthood. RESULTS: Three dimensions of antisociality were uncovered: 'callous-unemotional (CU)/manipulative traits', 'intentional aggression/conduct', and 'reactivity/impulsivity/irritability'. Shorter PEPs and higher testosterone were related to CU/manipulative traits, and a higher CAR is related to both CU/manipulative traits and intentional aggression/conduct. These effects were stable across age. CONCLUSIONS: Across a heterogeneous sample and consistent across development, the CAR may be a valuable measure to link to CU/manipulative traits and intentional aggression, while sympathetic arousal and testosterone are additionally valuable to understand CU/manipulative traits. Together, these findings deepen our understanding of the fundamental mechanisms underlying different components of antisociality. Finally, we illustrate the potential of using current statistical techniques for combining multiple datasets to draw robust conclusions about biobehavioral associations.

The neurobiology of antisocial behavior in adolescence; current knowledge and relevance for youth forensic clinical practice.

Antisocial behavior in adolescents is generally seen as a neurodevelopmental problem; however, in spite of increasing knowledge on the neurobiology of persistent antisocial behavior, conduct disorders, and psychopathic traits, this knowledge is hardly used in clinical practice. The aim of this review is to give an overview of current research on the neurobiology of antisocial behavior in adolescents and to discuss how this knowledge can be translated to youth forensic clinical practice. First, an overview of recent literature on genetics, neuroimaging, neuropsychology, neurophysiology/neuroendocrinology, and antisocial behavior in adolescents is given. Second, implications for diagnostics, risk taxation, and treatment are discussed. Finally, an integrated biopsychosocial approach for future research regarding translational forensic child and adolescent psychology and psychiatry is advocated.

Resisting aggression in social contexts: The influence of life-course persistent antisocial behavior on behavioral and neural responses to social feedback.

Early adulthood has long been recognized as a potential turning point for the development of antisocial behavior, due to changes in social contexts and ongoing psychological and neurobiological maturation. However, it remains unclear how different developmental trajectories of antisocial behavior, their neural underpinnings, and individual differences in psychopathic traits may help explain the distinct developmental outcomes of individuals who persist in or desist from antisocial behavior in early adulthood - such as how they respond to others in social contexts. Therefore, in the current study, young adults (aged 18-30, 68% male) with a persistent or desistant antisocial trajectory (N = 54), as well as healthy controls (N = 39), completed the Social Network Aggression Task, during which they received positive, neutral, or negative feedback on a personal profile and got the opportunity to retaliate by blasting a loud noise. On a behavioral level, results indicated that in all groups, negative peer feedback evoked higher retaliatory aggression, compared to positive and neutral feedback. On a neural level, when receiving social feedback, individuals with persistent or desistent trajectories showed both similar and dissociable patterns of neural activity; desisting and persisting trajectory groups showed higher activity in the Insula, and the desisting trajectory group showed higher activity in dlPFC. Finally, when participants retaliated, they showed increased dlPFC and ACC activity following positive relative to neutral and negative feedback, where ACC activity correlated most strongly with inhibition of retaliatory responses in the desisting trajectory group. Together, these findings provide novel insights in dissociable patterns of brain activity that may increase our understanding of the mechanisms underlying different developmental trajectories of antisocial behavior.

Neuroendocrine Stress Response in Female and Male Youths With Conduct Disorder and Associations With Early Adversity.

OBJECTIVE: Conduct disorder (CD) involves aggressive and antisocial behavior and is associated with blunted cortisol stress response in male youths. Far less is known about cortisol stress responsivity in female youths with CD or other neuroendocrine responses in both sexes. Although CD is linked to early adversity, the possibility that neuroendocrine alterations may mediate the relationship between early adversity and CD has not been systematically investigated. METHOD: Within the European FemNAT-CD multi-site study, salivary cortisol, testosterone, the testosterone/cortisol ratio, oxytocin, and psychological stress response to a standardized psychosocial stress test (the Trier Social Stress Test [TSST]), together with common pre- and postnatal environmental risk factors, were investigated in 130 pubertal youths with CD (63% female, 9-18 years of age) and 160 sex-, age-, and puberty-matched healthy controls (HCs). RESULTS: The TSST induced psychological stress in both CD and HCs. In contrast, female and male youths with CD showed blunted cortisol, testosterone, oxytocin, and testosterone/cortisol stress responses compared to HCs. These blunted stress responses partly mediated the relationship between environmental risk factors and CD. CONCLUSION: Findings from this unique sample, including many female youths with CD, provide evidence for a widespread attenuated stress responsivity of not only stress hormones, but also sex hormones and neuropeptides in CD and its subgroups (eg, with limited prosocial emotions). Results are the first to demonstrate blunted neuroendocrine stress responses in both female and male youths with CD. Early adversity may alter neuroendocrine stress responsivity. Biological mechanisms should be investigated further to pave the way for personalized intervention, thereby improving treatments for CD.

Integrating Cognitive Developmental Neuroscience in Society: Lessons Learned From a Multidisciplinary Research Project on Education and Social Safety of Youth.

Integrating fundamental science in society, with the goal to translate research findings to daily practice, comes with certain challenges. Successfully integrating research projects into society requires (1) good collaboration between scientists and societal stakeholders, (2) collaboration partners with common expectations and goals, and (3) investment in clear communication. Here we describe an integrative research project conducted by a large Dutch consortium that consisted of neuroscientists, psychologists, sociologists, ethicists, teachers, health care professionals and policy makers, focusing on applying cognitive developmental neuroscience for the benefit of youth in education and social safety. We argue that to effectively integrate cognitive developmental neuroscience in society, (1) it is necessary to invest in a well-functioning, diverse and multidisciplinary team involving societal stakeholders and youth themselves from the start of the project. This aids to build a so-called productive interactive network that increases the chances to realize societal impact in the long-term. Additionally, we propose that to integrate knowledge, (2) a different than standard research approach should be taken. When focusing on integration, the ultimate goal of research is not solely to understand the world better, but also to intervene with real-life situations, such as education or (forensic) youth care. To accomplish this goal, we propose an approach in which integration is not only started after the research has been conducted, but taken into account throughout the entire project. This approach helps to create common expectations and goals between different stakeholders. Finally, we argue that (3) dedicating sufficient resources to effective communication, both within the consortium and between scientists and society, greatly benefits the integration of cognitive developmental neuroscience in society.

Overlapping and distinct neural correlates of self-evaluations and self-regulation from the perspective of self and others.

Prior research has implicated the medial and lateral prefrontal cortex (PFC) in processing evaluations from the perspective of self (self-traits) and evaluations from others (peer feedback), suggesting that these areas form a neural substrate that serves an intertwined function in monitoring self in relation to others. To test this possibility, we examined neural activation overlap in medial and lateral PFC after processing self- and other-informed evaluations. Young adults (age range 18-30-yrs, n = 40) performed two fMRI tasks. The self-concept task involved rating whether positive and negative traits described themselves. The Social Network Aggression Task involved processing positive, neutral or negative feedback from others, with the possibility to retaliate by blasting a loud noise following feedback. The results show that rating positive self traits and receiving positive peer feedback was associated with increased activity in an overlapping region in medial PFC. There were no significant correlations on a behavioral level and medial PFC activity for self-versus-other evaluations. The study further replicated the finding from previous research showing that higher activity in dorsolateral PFC (dlPFC) when receiving negative social feedback was associated with reduced noise blast aggression. Finally, during retaliatory responses after receiving positive feedback, participants showed increased activity in the dlPFC. Together these findings suggest that medial PFC is more strongly involved in protecting positive self-views from both internal (self traits) and external (peer feedback) points of view, whereas dlPFC is more strongly involved in regulating retaliatory responses following social rejection, and actively inhibiting aggressive behavior after receiving positive peer feedback.

Improvement of group climate in a residential setting for juveniles with mild intellectual disability through training of staff in Non-Violent Resistance.

BACKGROUND: An open group climate is essential in successful residential care for juveniles with mild intellectual disability (MID). This study examined whether non-violent resistance, adapted for MID (NVR-MID), stimulates an open group climate in time. METHOD: NVR-MID was implemented in three residential settings in The Netherlands, in a quasi-experimental stepped wedge design. In total, 124 clients with MID (Mage  = 16.39 [SD = 4.95], 49.9% male) participated. Group climate was assessed seven times with the Group Climate Inventory for Children or the Group Climate Inventory-Revisited (GCI-R), during a total of 20 months. RESULTS: Open group climate scores increased in all three institutions; effect size was medium. Clients with lower IQs experienced group climate as more positive compared to clients with higher IQs. Effects were similar for both groups. CONCLUSIONS: As NVR-MID appeared to contribute to a positive experienced group climate, it might be advisable to implement NVR-MID on larger scale.

Maturation of the Cardiac Autonomic Nervous System Activity in Children and Adolescents.

Background Despite the increasing interest in cardiac autonomic nervous activity, the normal development is not fully understood. The main aim was to determine the maturation of different cardiac sympathetic-(SNS) and parasympathetic nervous system (PNS) activity parameters in healthy patients aged 0.5 to 20 years. A second aim was to determine potential sex differences. Methods and Results Five studies covering the 0.5- to 20-year age range provided impedance- and electrocardiography recordings from which heart rate, different PNS-parameters (eg, respiratory sinus arrhythmia) and an SNS-parameter (pre-ejection period) were collected. Age trends were computed in the mean values across 12 age-bins and in the age-specific variances. Age was associated with changes in mean and variance of all parameters. PNS-activity followed a cubic trend, with an exponential increase from infancy, a plateau phase during middle childhood, followed by a decrease to adolescence. SNS-activity showed a more linear trend, with a gradual decrease from infancy to adolescence. Boys had higher SNS-activity at ages 11 to 15 years, while PNS-activity was higher at 5 and 11 to 12 years with the plateau level reached earlier in girls. Interindividual variation was high at all ages. Variance was reasonably stable for SNS- and the log-transformed PNS-parameters. Conclusions Cardiac PNS- and SNS-activity in childhood follows different maturational trajectories. Whereas PNS-activity shows a cubic trend with a plateau phase during middle childhood, SNS-activity shows a linear decrease from 0.5 to 20 years. Despite the large samples used, clinical use of the sex-specific centile and percentile normative values is modest in view of the large individual differences, even within narrow age bands.

Course of disinhibited social engagement behavior in clinically referred home-reared preschool children.

BACKGROUND: Evidence supporting clinical relevance and persistence of disinhibited social engagement behavior (DSEB) pertains mostly to children reared in institutions and foster care. This study examined the course of DSEB in clinically referred home-reared children from early into middle childhood, and associations with neglect/emotional maltreatment, effortful control, Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Autism Spectrum Disorder. METHODS: Disinhibited social engagement behavior was examined in 124 children (82% boys, M = 4.06 years, SD = 0.89), referred for treatment of emotional and behavioral problems, by use of the Disturbances of Attachment Interview (DAI) with biological parents. Neglect and emotional maltreatment were assessed from case records and effortful control by use of the Child Behavior Questionnaire. At follow-up, on average 4 years later, DSEB was examined by use of DAI as well as two observational ratings: the Stranger at the Door procedure (SatD) and a structured home observation of stranger approach. Psychiatric disorders were assessed by means of the Kiddie-Schedule for Affective Disorders and Schizophrenia. RESULTS: Persistence of parent-reported DSEB was found in 57% (n = 27) of the children with DSEB at baseline (n = 47). Parent-reported DSEB at follow-up was significantly related to DSEB observed in the SatD (rpb  = .31, p = .001) and to observed stranger approach (rs  = .41, p < .001), but only stranger approach was associated with baseline DSEB. The course of DSEB was not related to neglect/emotional maltreatment, nor to the level of effortful control. There was no association between DSEB and Autism Spectrum Disorder, but course of DSEB was associated with Attention Deficit/Hyperactivity Disorder/Oppositional Defiant Disorder at follow-up (χ2  = 13.08, p = .004). CONCLUSIONS: Although explanations for the onset and course of DSEB in home-reared children remain elusive, findings suggest that DSEB is part of a complex of clinically significant problem behaviors in referred home-reared preschool children.

Implementing Non-violent Resistance, a Method to Cope with Aggression in Child and Adolescent Residential Care: Exploration of Staff Members Experiences.

Staff members in residential care for youth are frequently confronted with aggressive behaviour, which has adverse effects on their stress levels and work satisfaction. This paper describes a qualitative evaluation to find out how staff members benefit from Non-violent Resistance (NVR), a method to create an aggression mitigating residential climate. Staff members were positive about NVR and reported feeling more relaxed. Most valued aspects of this method were the focus on being a team, delayed response and giving up the illusion of control. However, training and the intention to use NVR isn't enough, high quality implementation and maintenance are crucial.

How Do Forensic Clinicians Decide? A Delphi Approach to Identify Domains Commonly Used in Forensic Juvenile Treatment Planning.

Adolescents in forensic care display wide varieties of complex psychiatric, psychological, and contextual problems. Based on large amounts of information, clinicians need to consider, integrate, and prioritize these offender characteristics to construct individual treatment trajectories. So far, scientific knowledge on how these treatment decisions take place is scarce. Current study uses a qualitative design for detecting implicit knowledge of clinicians on which offender characteristics they consider while making treatment decisions. Using the Delphi method, 34 experienced clinicians working in forensic care facilities in the Netherlands were asked about the most important domains of offender characteristics that influence their treatment planning. Eight domains were identified as being crucial in treatment planning: Mental health problems, Personal characteristics, Family, Offense, Motivation, Treatment, School/Work/Housing, and Peers/Spare time. Based on current results, focus on a broad spectrum of individual and contextual characteristics is recommended. Moreover, protective factors and comorbid problems on multiple domains should be considered.

The role of self-serving cognitive distortions in reactive and proactive aggression.

BACKGROUND: Aggression is often divided into reactive and proactive forms. Reactive aggression is typically thought to encompass 'blaming others' and 'assuming the worst', while proactive aggression relates to 'self-centeredness' and 'minimising/mislabelling'. AIM: Our aim was to evaluate relationships between reactive and proactive aggression and cognitive distortions and to test whether changes in these cognitions relate to changes in aggression. METHODS: A total of 151 adolescents (60% boys; mean age 15.05 years, standard deviation 1.28) were enrolled in an evidence-based intervention to reduce aggression. Due to attrition and anomalous responses, the post-intervention sample involved 80 adolescents. Correlation and linear regression analyses were used to investigate the relationship between cognitive distortions and aggression. RESULTS: Blaming others was related to reactive aggression before the intervention, while all cognitive distortions were related to proactive aggression both pre- and post-intervention. Changes in reactive aggression were uniquely predicted by blaming others, while changes in proactive aggression were predicted by changes in cognitive distortions overall. CONCLUSION: To our knowledge, this study is the first to show a relationship between changes in cognitive distortions and changes in aggression. Treatment of reactive aggression may benefit from focusing primarily on reducing cognitive distortions involving misattribution of blame to others. Copyright © 2017 John Wiley & Sons, Ltd.

Temperament Traits and Psychopathology in Young Clinically Referred Children Compared to a General Population Sample.

Evidence from general population studies shows the contribution of various temperament traits to the development of child psychopathology. Little is known about which traits are associated with internalizing and externalizing problems in young clinically referred children. The current study assessed temperament and internalizing and externalizing problems in 216 referred children (M = 4.35 years, SD 0.89, 81% boys). A comparison was made with an age and gender matched general population sample. Referred children showed less effortful control than general population children. Less effortful control and more negative affectivity were associated with more internalizing and externalizing problems across groups. Surgency, and specifically temperamental impulsivity, was more strongly associated with externalizing problems in referred children compared to general population. Less soothability, less inhibitory control and more frustration predicted (sub)clinical levels of comborbid internalizing and externalizing problems in referred children. The results can be used in diagnostic and treatment procedures in early childhood.

Examining the reactive proactive questionnaire in adults in forensic and non-forensic settings: A variable- and person-based approach.

The Reactive Proactive Questionnaire (RPQ) was originally developed to assess reactive and proactive aggressive behavior in children. Nevertheless, some studies have used the RPQ in adults. This study examines the reliability of the RPQ within an adult sample by investigating whether reactive and proactive aggression can be distinguished at a variable- and person-based level. Male adults from forensic samples (N = 237) and from the general population (N = 278) completed the RPQ questionnaire. Variable-based approaches, including factor analyses, were conducted to verify the two-factor model of the RPQ and to examine alternative factor solutions of the 23 items. Subsequently, a person-based approach, i.e., Latent Class Analysis (LCA), was executed to identify homogeneous classes of subjects with similar profiles of aggression in the observed data. The RPQ proved to have sufficient internal consistency. Multiple-factor models were examined, but the original two-factor model was statistically and theoretically considered as most solid and in line with previous research. The multi-level LCA identified three different classes of aggression severity (class 1 showed low aggressive behavior; class 2 subjects displayed modest aggression levels; and class 3 exhibited the highest level of aggressive behavior). In addition, class 1 and 2 showed more reactive than proactive aggression, whereas class 3 displayed comparable levels of reactive/proactive aggression. The RPQ appears to have clinical relevance for adult populations in the way that it can distinguish severity levels of aggression. Before the RPQ is implemented in adult populations, norm scores need to be developed. Aggr. Behav. 43:155-162, 2017. © 2016 Wiley Periodicals, Inc.

Do post-trauma symptoms mediate the relation between neurobiological stress parameters and conduct problems in girls?

OBJECTIVE: Attenuated activity of stress-regulating systems has consistently been reported in boys with conduct problems. Results in studies of girls are inconsistent, which may result from the high prevalence of comorbid post-trauma symptoms. Therefore, the aim of the present study is to investigate post-trauma symptoms as a potential mediator in the relation between stress-regulation systems functioning and conduct problems in female adolescents. METHODS: The sample consisted of 78 female adolescents (mean age 15.4; SD 1.1) admitted to a closed treatment institution. The diagnosis of disruptive behaviour disorder (DBD) was assessed by a structured interview-the diagnostic interview schedule for children version IV (DISC-IV). To assess post-trauma symptoms and externalizing behaviour problems, self-report questionnaires, youth self report (YSR) and the trauma symptom checklist for Children (TSCC) were used. The cortisol awakenings response (CAR) measured hypothalamic-pituitary-adrenal (HPA) axis activity, whereas autonomous nervous system (ANS) activity was assessed by heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA). Independent t-tests were used to compare girls with and without DBD, while path analyses tested for the mediating role of post- trauma symptoms in the relation between stress regulating systems and externalizing behaviour. RESULTS: Females with DBD (n = 37) reported significantly higher rates of post-trauma symptoms and externalizing behaviour problems than girls without DBD (n = 39). Path analysis found no relation between CAR and externalizing behaviour problems. With regard to ANS activity, positive direct effects on externalizing behaviour problems were present for HR (standardized ß = 0.306, p = 0.020) and PEP (standardized ß = -0.323, p = 0.031), though not for RSA. Furthermore, no relation-whether direct or indirect-could be determined from post-trauma symptoms. CONCLUSIONS: Present findings demonstrate that the neurobiological characteristics of female externalizing behaviour differ from males, since girls showed heightened instead of attenuated ANS activity. While the prevalence of post-trauma symptoms was high in girls with DBD, it did not mediate the relation between stress parameters and externalizing behaviour. Clinical implications and future directions are discussed.

Childhood traumatic experiences and mental health problems in sexually offending and non-sexually offending juveniles.

OBJECTIVE: To examine the relationship between a history of childhood abuse and mental health problems in juveniles who sexually offended (JSOs) over and above general offending behavior. METHODS: A sample of 44 JSOs incarcerated in two juvenile detention centers in the Netherlands between May 2008 and March 2014 were examined for childhood abuse history (Childhood Trauma Questionnaire-Short Form) and mental health problems (Massachusetts Youth Screening Instrument-Version 2). Furthermore, the connection between childhood abuse and mental health problems in JSOs was compared to a sample of 44 propensity score matched juveniles who offended non-sexually (non-JSOs). RESULTS: In JSOs, sexual abuse was related to anger problems, suicidal ideation, and thought disturbance. These associations were significantly stronger in JSOs than in non-JSOs. CONCLUSIONS: Our results suggest that the relationship between childhood abuse and both internalizing and externalizing mental health problems is of more salience for understanding sexual offending than non-sexual offending, and should, therefore, be an important focus in the assessment and treatment of JSOs.

Sexuality and Autistic-Like Symptoms in Juvenile Sex Offenders: A Follow-Up After 8 Years.

Juveniles who have committed a sexual offense (JSOs) are thought to have abnormal sexual development, as well as increased ASD symptoms. In the current study, sexual development and behavior, as well as stability of ASD-like symptoms were assessed in a sample of 44 male JSOs (mean age 24.7 ± 1.5 years) 8 years after their sexual offence. JSOs exhibited less knowledge of sexuality, less positive attitudes towards pornography and more often reported having been a victim of verbal sexual intimidation than a matched normal population sample. ASD symptoms were relatively stable over the 8 years follow-up, indicating that social difficulties in JSOs may be part of life-long autistic-like traits. However, ASD symptoms were not related to alterations in sexual development or behavior.

The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5.

In DSM 5, conduct disorder (CD) has been expanded with a new specifier 'with Limited Prosocial Emotions' (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe antisocial subgroup of CD. However, research in clinical practice has been scarce. Therefore, the current study will examine differences in clinical symptoms between subtypes of CD, based on both subtyping schemes. Subsequently, it will investigate whether the LPE specifier explains unique variance in aggression, added to the AoO subtyping. A sample of 145 adolescents with CD (51 % male, mean age 15.0) from a closed treatment institution participated in this study. CD diagnoses and AoO subtype were assessed using a structured diagnostic interview. The LPE specifier was assessed using the callous-unemotional dimension of the Youth Psychopathy Traits Inventory (YPI). Self-reported proactive and reactive aggression, rule-breaking behavior and internalizing problems within the subtypes were compared. Youth with childhood-onset CD and LPE showed significantly more aggression than adolescent-onset CD without LPE (proactive aggression: F = 3.1, p < 0.05, reactive aggression: F = 3.7, p < 0.05). Hierarchical regression revealed that the LPE specifier uniquely explained 7 % of the variance in reactive aggression, additionally to the AoO subtyping. For proactive aggression, the interaction between AoO and the LPE added 4.5 % to the explained variance. Although the LPE specifier may help to identify a more aggressive subtype of CD in adolescents, the incremental utility seems to be limited. Therefore, clinical relevance of the LPE specifier in high-risk adolescent samples still needs to be investigated thoroughly.