Adolescents with Elevated Psychopathic Traits are Associated with an Increased Risk for Premature Mortality.

The mortality rate among adolescents has been steadily increasing in recent years. Researchers have previously identified forms of externalizing psychopathology measured during adolescence associated with an increased risk for premature mortality, including attention-deficit/hyperactivity disorder (ADHD), substance use disorders (SUDs), oppositional defiant disorder (ODD), and conduct disorder (CD). The current study investigated whether additional personality traits (i.e., adolescent psychopathic traits, assessed via the Hare Psychopathy Checklist: Youth Version [PCL:YV]) were also associated with premature mortality risk among maximum-security incarcerated adolescents (N = 332). During a follow-up period ranging from 10 to 14 years, premature mortality was observed in n = 33 participants (9.94%), a mortality rate nearly ten times higher than population norms. We observed that adolescents scoring the highest on PCL:YV total scores exhibited significantly higher rates of premature mortality compared to adolescents scoring lower on PCL:YV total scores via Fisher's exact tests. Additionally, through univariate Cox proportional hazard regression analyses, PCL:YV total, Factor 2 (measuring lifestyle/behavioral and antisocial/developmental psychopathic traits), Facet 1 (measuring interpersonal psychopathic traits), and Facet 3 (measuring lifestyle/behavioral psychopathic traits) scores were associated with faster time to premature mortality. In supplemental analyses performed, we observed that adolescents meeting criteria for externalizing psychopathology (i.e., ADHD, SUDs, ODD, and CD) did not exhibit higher rates of premature mortality compared to control participants. The current study therefore identifies additional maladaptive personality traits to consider in relation to premature mortality risk (i.e., psychopathic traits) among a high-risk sample of incarcerated adolescents.

Striatal brain volume linked to severity of substance use in high-risk incarcerated youth.

Substance use disorders among juveniles are a major public health concern and are often intertwined with other psychosocial risk factors including antisocial behavior. Identifying etiological risks and mechanisms promoting substance use disorders remains a high priority for informing more focused interventions in high-risk populations. The present study examined brain gray matter structure in relation to substance use severity among n = 152 high-risk, incarcerated boys (aged 14-20). Substance use severity was positively associated with gray matter volume across several frontal/striatal brain regions including amygdala, pallidum, putamen, insula, and orbitofrontal cortex. Effects were apparent when using voxel-based-morphometric analysis, as well as in whole-brain, data-driven, network-based approaches (source-based morphometry). These findings support the hypothesis that elevated gray matter volume in striatal reward circuits may be an endogenous marker for vulnerability to severe substance use behaviors among youth.

Psychopathy Scores Predict Recidivism in High-risk Youth: A Five-year Follow-up Study.

Psychopathic traits have been associated with rearrest in adolescents involved in the criminal legal system. Much of the prior work has focused on White samples, short follow-up windows, and relatively low-risk youth. The current study aimed to evaluate the utility of the Hare Psychopathy Checklist: Youth Version (PCL:YV) for predicting general and violent felony recidivism in a large sample of high-risk, predominantly Hispanic/Latino, male adolescents (n = 254) with a five-year follow-up period. Results indicated higher PCL:YV scores and lower full-scale estimated IQ scores were significantly associated with a shorter time to felony and violent felony rearrest. These effects generalized to Hispanic/Latino adolescents (n = 193)-a group that faces disproportionate risk of being detained or committed to juvenile correctional facilities in the U.S. These results suggest that expert-rated measures of psychopathic traits and IQ are reliable predictors of subsequent felony and violent felony rearrest among high-risk male adolescents.

Examining the Association between Psychopathic Traits and Fearlessness among Maximum-Security Incarcerated Male Adolescents.

Studies have reported positive associations between youth psychopathy scores and measures of 'fearlessness'. However, prior studies modified fearlessness items to be age appropriate, shifting from assessing hypothetical, extreme forms of physical risk-taking (e.g., flying an airplane) to normative risk-taking (e.g., riding bicycles downhill). We hypothesize that associations between youth psychopathy scores and alternative forms of sensation seeking (i.e., Disinhibition) have been conflated under a false fearlessness label. We tested this hypothesis among incarcerated male adolescents, investigating whether youth psychopathy scores were significantly associated with two different forms of sensation seeking: Disinhibition and Thrill and Adventure Seeking (TAS). Youth psychopathic traits were assessed using the Psychopathy Checklist: Youth Version (PCL:YV), Antisocial Process Screening Device (APSD), Child Psychopathy Scale (CPS), Inventory of Callous and Unemotional Traits (ICU), and Youth Psychopathic Traits Inventory (YPI). Disinhibition and fearlessness (i.e., TAS) were assessed using an unmodified version of the Zuckerman Sensation Seeking Scales (SSS). Consistent with hypotheses, youth psychopathy scores were associated with higher Disinhibition and lower TAS scores. Our results contribute to a growing body of literature suggesting that psychopathic traits, including among adolescents, are not concomitant with physical risk-taking and descriptions of psychopathy including fearlessness distort a precise understanding of psychopathy's core features.

Automated patterns of head dynamics are associated with psychopathic traits in incarcerated women.

Men with elevated psychopathic traits have been characterized by unique patterns of nonverbal communication, including more fixed and focused head positions during clinical interviews, compared to men scoring low on measures of psychopathy. However, it is unclear whether similar patterns of head dynamics help characterize women scoring high on psychopathic traits. Here, we utilized an automated detection algorithm to assess head position and dynamics during a videotaped clinical interview (i.e., the Psychopathy Checklist - Revised [PCL-R]) in a sample of n = 213 incarcerated women. PCL-R Total, Factor 1 (i.e., interpersonal and affective psychopathic traits), and Factor 2 (i.e., lifestyle/behavioral and antisocial/developmental psychopathic traits) scores were associated with a pattern of head dynamics indicative of a rigid head position. The current study extends analyses of nonverbal behavior studies in men to women and highlights how individuals with elevated psychopathic traits demonstrate unique nonverbal behaviors relative to individuals who score low on psychopathic traits. The implications and clinical value of these findings are discussed.

Psychometric properties of the Trauma Checklist 2.0 and its predictive utility of felony re-offending among high-risk juvenile offenders.

BACKGROUND: Incarcerated youth are characterized by particularly high rates of childhood trauma, a significant risk factor for outcomes including risky behaviors and recidivism. Trauma-based interventions can ameliorate the negative effects of childhood trauma; however, a critical part of success is careful trauma screening. Due to the limitations associated with commonly used self-report trauma assessments, our team developed the Trauma Checklist (TCL), a trained-rater assessment of childhood trauma specifically created for use with forensic populations. The TCL is designed to provide a more comprehensive assessment of trauma, incorporating categories that are of specific relevance for incarcerated individuals (e.g., traumatic loss). Here, we discuss the continued development made to our original trauma assessment and explore the psychometric properties of this expanded assessment (herein termed the TCL 2.0). METHOD: We examined relationships between TCL 2.0 scores, measures of psychopathology, and psychopathic traits in a sample of incarcerated male juvenile offenders (n = 237). In addition, we examined whether TCL 2.0 scores were associated with time to felony re-offense via Cox proportional-hazard regression analyses. RESULTS: We examined dimensionality of the TCL 2.0 using a principal component analysis (PCA), the results of which were confirmed via exploratory structural equation modeling; the PCA yielded a two-component solution (i.e., PC1 and PC2). We observed that PC1 (Experienced Trauma) scores were positively correlated with mood disorder diagnoses. TCL 2.0 total scores were positively correlated with post-traumatic stress disorder symptomatology and psychopathic traits. Finally, higher PC2 (Community Trauma) scores were associated with faster time to felony re-offending. CONCLUSIONS: These results suggest that the TCL 2.0 may be a beneficial screening tool to provide high-risk youth with appropriate trauma-informed treatment.

Psychopathic traits and altered resting-state functional connectivity in incarcerated adolescent girls.

Previous work in incarcerated boys and adult men and women suggest that individuals scoring high on psychopathic traits show altered resting-state limbic/paralimbic, and default mode functional network properties. However, it is unclear whether similar results extend to high-risk adolescent girls with elevated psychopathic traits. This study examined whether psychopathic traits [assessed via the Hare Psychopathy Checklist: Youth Version (PCL:YV)] were associated with altered inter-network connectivity, intra-network connectivity (i.e., functional coherence within a network), and amplitude of low-frequency fluctuations (ALFFs) across resting-state networks among high-risk incarcerated adolescent girls (n = 40). Resting-state networks were identified by applying group independent component analysis (ICA) to resting-state fMRI scans, and a priori regions of interest included limbic, paralimbic, and default mode network components. We tested the association of psychopathic traits (PCL:YV Factor 1 measuring affective/interpersonal traits and PCL:YV Factor 2 assessing antisocial/lifestyle traits) to these three resting-state measures. PCL:YV Factor 1 scores were associated with increased low-frequency and decreased high-frequency fluctuations in components corresponding to the default mode network, as well as increased intra-network FNC in components corresponding to cognitive control networks. PCL:YV Factor 2 scores were associated with increased low-frequency fluctuations in sensorimotor networks and decreased high-frequency fluctuations in default mode, sensorimotor, and visual networks. Consistent with previous analyses in incarcerated adult women, our results suggest that psychopathic traits among incarcerated adolescent girls are associated with altered intra-network ALFFs-primarily that of increased low-frequency and decreased high-frequency fluctuations-and connectivity across multiple networks including paralimbic regions. These results suggest stable neurobiological correlates of psychopathic traits among women across development.

Machine learning classification of chronic traumatic brain injury using diffusion tensor imaging and NODDI: A replication and extension study.

Individuals with acute and chronic traumatic brain injury (TBI) are associated with unique white matter (WM) structural abnormalities, including fractional anisotropy (FA) differences. Our research group previously used FA as a feature in a linear support vector machine (SVM) pattern classifier, observing high classification between individuals with and without acute TBI (i.e., an area under the curve [AUC] value of 75.50%). However, it is not known whether FA could similarly classify between individuals with and without history of chronic TBI. Here, we attempted to replicate our previous work with a new sample, investigating whether FA could similarly classify between incarcerated men with (n = 80) and without (n = 80) self-reported history of chronic TBI. Additionally, given limitations associated with FA, including underestimation of FA values in WM tracts containing crossing fibers, we extended upon our previous study by incorporating neurite orientation dispersion and density imaging (NODDI) metrics, including orientation dispersion (ODI) and isotropic volume (Viso). A linear SVM based classification approach, similar to our previous study, was incorporated here to classify between individuals with and without self-reported chronic TBI using FA and NODDI metrics as separate features. Overall classification rates were similar when incorporating FA and NODDI ODI metrics as features (AUC: 82.50%). Additionally, NODDI-based metrics provided the highest sensitivity (ODI: 85.00%) and specificity (Viso: 82.50%) rates. The current study serves as a replication and extension of our previous study, observing that multiple diffusion MRI metrics can reliably classify between individuals with and without self-reported history of chronic TBI.

Aberrant resting-state functional connectivity associated with childhood trauma among juvenile offenders.

Individuals with history of childhood trauma are characterized by aberrant resting-state limbic and paralimbic functional network connectivity. However, it is unclear whether specific subtypes of trauma (i.e., experienced vs observed or community) showcase differential effects. This study examined whether subtypes of childhood trauma (assessed via the Trauma Checklist [TCL] 2.0) were associated with aberrant intra-network amplitude of fluctuations and connectivity (i.e., functional coherence within a network), and inter-network connectivity across resting-state networks among incarcerated juvenile males (n = 179). Subtypes of trauma were established via principal component analysis of the TCL 2.0 and resting-state networks were identified by applying group independent component analysis to resting-state fMRI scans. We tested the association of subtypes of childhood trauma (i.e., TCL Factor 1 measuring experienced trauma and TCL Factor 2 assessing community trauma), and TCL Total scores to the aforementioned functional connectivity measures. TCL Factor 2 scores were associated with increased high-frequency fluctuations and increased intra-network connectivity in cognitive control, auditory, and sensorimotor networks, occurring primarily in paralimbic regions. TCL Total scores exhibited similar neurobiological patterns to TCL Factor 2 scores (with the addition of aberrant intra-network connectivity in visual networks), and no significant associations were found for TCL Factor 1. Consistent with previous analyses of community samples, our results suggest that childhood trauma among incarcerated juvenile males is associated with aberrant intra-network amplitude of fluctuations and connectivity across multiple networks including predominately paralimbic regions. Our results highlight the importance of accounting for traumatic loss, observed trauma, and community trauma in assessing neurobiological aberrances associated with adverse experiences in childhood, as well as the value of trained-rater trauma assessments compared to self-report.

Reduced structural integrity of the uncinate fasciculus in incarcerated women scoring high on psychopathy.

Both men and women scoring high on psychopathy exhibit similar structural and functional neural abnormalities, including reduced volume of the orbitofrontal cortex (OFC) and reduced hemodynamic activity in the amygdala during affective processing experimental paradigms. The uncinate fasciculus (UF) is a white matter (WM) tract that connects the amygdala to the OFC. Reduced structural integrity of the UF, measured via fractional anisotropy (FA), is commonly associated with men scoring high on psychopathy. However, only one study to date has investigated the relationship between psychopathic traits and UF structural integrity in women, recruiting participants from a community sample. Here, we investigated whether Hare Psychopathy Checklist-Revised (PCL-R) facet scores (measuring interpersonal, affective, lifestyle/behavioral, and antisocial psychopathic traits, respectively) were associated with reduced FA in the left and right UF in a sample of 254 incarcerated women characterized by a wide range of psychopathy scores. We observed that PCL-R Facet 3 scores, assessing lifestyle/behavioral psychopathic traits, were associated with reduced FA in the left and right UF, even when controlling for participant's age and history of previous substance use. The results obtained in the current study help improve our understanding of structural abnormalities associated with women scoring high on psychopathy. Specifically, reduced UF structural integrity may contribute to some of the deficits commonly associated with women scoring high on psychopathy, including emotion dysregulation.

Quantitative Head Dynamics Associated with Interpersonal (Grandiose-Manipulative) Psychopathic Traits in Incarcerated Youth.

Clinicians have long noted that individuals with elevated psychopathic traits can be characterized by unique interpersonal styles, including prolonged eye contact, invasion of interpersonal space, and frequent use of hand gestures. Such forms of nonverbal communication can be measured via hand, body, and head position and dynamics. Previous studies have developed an automated algorithm designed to capture head position and dynamics from digital recordings of clinical interviews in a sample of incarcerated adult men. We observed that higher psychopathy scores were associated with stationary head dwell time. Here, we applied a similar automated algorithm to assess head position and dynamics on videotaped clinical interviews assessing psychopathic traits from n = 242 youth housed at a maximum-security juvenile correctional facility. We observed that higher psychopathy scores (assessed via the Hare Psychopathy Checklist: Youth Version [PCL:YV]) were associated with unique patterns of head dynamics. Specifically, PCL:YV Total, Factor 1 (measuring grandiose-manipulative and callous-unemotional traits), and Facet 1 (measuring grandiose-manipulative traits) scores were associated with a higher proportion of time spent in a head dynamics pattern consisting of moderate movement away from the average head position. This study lays the groundwork for future investigations to apply quantitative methods to better understand patterns of nonverbal communication styles in clinical populations characterized by severe antisocial behavior.

Dimensions of impulsivity related to psychopathic traits and homicidal behavior among incarcerated male youth offenders.

Despite impulsivity being included as scoring criteria within several measures of youth psychopathic traits, the relationship between psychopathic traits and dimensions of impulsivity among high-risk youth is not well-understood. Here we assessed psychopathic traits via total, factor, and facet scores from the Psychopathy Checklist: Youth Version (PCL:YV) and impulsivity through total, three-factor, and six-factor model scores from the Barratt Impulsiveness Scale (BIS-11) in incarcerated male youth offenders. Correlational analyses indicated PCL:YV total, Factor 2, Facet 3, and Facet 4 scores were significantly positively correlated with BIS-11 total scores. Additionally, psychopathy scores were significantly positively correlated with specific scores from the three-factor model of the BIS-11 (e.g. Motor and Non-Planning Impulsivity scores) and the six-factor model of the BIS-11 (e.g., Attention, Self-Control, and Cognitive Complexity Impulsivity scores). Secondary analyses suggest that participants who had previously committed homicide scored higher on lifestyle/antisocial psychopathic traits and specific dimensions of impulsivity (e.g., BIS-11 Non-Planning and Self-Control Impulsivity factor scores) compared to youth who had not previously committed homicide. Our results improve our understanding of the specific forms of impulsivity significantly correlated with youth psychopathic traits and how specific factors underlying both constructs potentially characterize youth associated with severe forms of antisocial behavior.

Clarifying fearlessness in psychopathy: An examination of thrill-seeking and physical risk-taking.

Fearlessness has been described among the traits associated with psychopathy; however, disparities in conceptualizations of fear and how related elements are operationalized among different measures of psychopathic traits have led to some enduring controversy. Here we address a subset of elements characterizing fearlessness represented in thrill-seeking and physical risk-taking among a large sample of incarcerated individuals (n = 688). We examine these relationships utilizing Hare's Psychopathy Checklist Revised (PCL-R), the Psychopathy Personality Inventory-Short Form (PPI-SF), and the Zuckerman Sensation Seeking Scale (SSS). Among males, the Thrill and Adventure Seeking (TAS) scale of the SSS was not related to features of the PCL-R, but was highly correlated with Fearless Dominance (FD) of the PPI-SF. Among females, TAS was only modestly correlated with PCL-R total score, but neither of the two PCL-R factors. PPI-SF FD remained a strong predictor of TAS among females. We argue for a careful consideration of the boundaries of the term "fearlessness" as it relates to diverse manifestations of behavior and varied conceptualizations of psychopathy. We also reiterate apparent differences between males and females in the presentation of psychopathic traits.

Re-wiring Guilt: How Advancing Neuroscience Encourages Strategic Interventions Over Retributive Justice.

The increasing visibility of neuroscience employed in legal contexts has rightfully prompted critical discourse regarding the boundaries of its utility. High profile debates include some extreme positions that either undermine the relevance of neuroscience or overstate its role in determining legal responsibility. Here we adopt a conciliatory attitude, reaffirming the current value of neuroscience in jurisprudence and addressing its role in shifting normative attitudes about culpability. Adopting a balanced perspective about the interaction between two dynamic fields (science and law) allows for more fruitful consideration of practical changes likely to improve the way we engage in legal decision-making. Neuroscience provides a useful platform for addressing nuanced and multifaceted deterministic factors promoting antisocial behavior. Ultimately, we suggest that shifting normative attitudes about culpability vis-à-vis advancing neuroscience are not likely to promote major changes in the way we assign legal responsibility. Rather, it helps us to shed our harshest retributivist instincts in favor of more pragmatic strategies for combating the most conspicuous patterns promoting mass incarceration and recidivism.

Youth with elevated psychopathic traits exhibit structural integrity deficits in the uncinate fasciculus.

Youth with elevated psychopathic traits represent a particularly severe subgroup of adolescents characterized by extreme behavioral problems and exhibit comparable neurocognitive deficits as adult offenders with psychopathic traits. A consistent finding among adults with elevated psychopathic traits is reduced white matter structural integrity of the right uncinate fasciculus (UF). The UF is a major white matter tract that connects regions of the anterior temporal lobe (i.e., the amygdala) to higher-order executive control regions, including the ventromedial prefrontal cortex. However, the relationship between youth psychopathic traits and structural integrity of the UF has been mixed, with some studies identifying a negative relationship between adolescent psychopathy scores and FA in the UF, and others identifying a positive relationship. Here, we investigated structural integrity of the left and right UF using fractional anisotropy (FA) in a large sample of n = 254 male adolescent offenders recruited from maximum-security juvenile correctional facilities. Psychopathic traits were assessed using the Hare Psychopathy Checklist: Youth Version (PCL:YV). Consistent with hypotheses, interpersonal and affective traits (i.e., PCL:YV Factor 1 and Facet 1 scores) were associated with reduced FA in the right UF. Additionally, lifestyle traits (i.e., PCL:YV Facet 3 scores) were associated with increased FA in the left UF. Results are consistent with previously published studies reporting reduced FA in the right UF in adult psychopathic offenders and increased left UF FA in youth meeting criteria for certain externalizing disorders.

Aberrant brain gray matter in murderers.

Homicide is a significant societal problem with economic costs in the billions of dollars annually and incalculable emotional impact on victims and society. Despite this high burden, we know very little about the neuroscience of individuals who commit homicide. Here we examine brain gray matter differences in incarcerated adult males who have committed homicide (n = 203) compared to other non-homicide offenders (n = 605; total n = 808). Homicide offenders' show reduced gray matter in brain areas critical for behavioral control and social cognition compared with subsets of other violent and non-violent offenders. This demonstrates, for the first time, that unique brain abnormalities may distinguish offenders who kill from other serious violent offenders and non-violent antisocial individuals.

Resting-state fMRI dynamic functional network connectivity and associations with psychopathy traits.

Studies have used resting-state functional magnetic resonance imaging (rs-fMRI) to examine associations between psychopathy and brain connectivity in selected regions of interest as well as networks covering the whole-brain. One of the limitations of these approaches is that brain connectivity is modeled as a constant state through the scan duration. To address this limitation, we apply group independent component analysis (GICA) and dynamic functional network connectivity (dFNC) analysis to uncover whole-brain, time-varying functional network connectivity (FNC) states in a large forensic sample. We then examined relationships between psychopathic traits (PCL-R total scores, Factor 1 and Factor 2 scores) and FNC states obtained from dFNC analysis. FNC over the scan duration was better represented by five states rather than one state previously shown in static FNC analysis. Consistent with prior findings, psychopathy was associated with networks from paralimbic regions (amygdala and insula). In addition, whole-brain FNC identified 15 networks from nine functional domains (subcortical, auditory, sensorimotor, cerebellar, visual, salience, default mode network, executive control and attentional) related to psychopathy traits (Factor 1 and PCL-R scores). Results also showed that individuals with higher Factor 1 scores (affective and interpersonal traits) spend more time in a state with weaker connectivity overall, and changed states less frequently compared to those with lower Factor 1 scores. On the other hand, individuals with higher Factor 2 scores (impulsive and antisocial behaviors) showed more dynamism (changes to and from different states) than those with lower scores.

The structural brain correlates of callous-unemotional traits in incarcerated male adolescents.

Youth with severe conduct problems impose a significant cost on society by engaging in high levels of antisocial and aggressive behavior. Within this group, adolescents with high levels of callous- unemotional traits have been found to exhibit more severe and persistent patterns of antisocial behavior than youth with severe conduct problems but normative levels of callous-unemotional traits. Existing neuroimaging studies, along with theoretical accounts of psychopathology, suggest that dysfunction within the paralimbic cortex and limbic system may underlie elevated levels of callous-unemotional traits. The present study examines this hypothesis by investigating gray matter correlates associated with callous-unemotional traits. A sample of incarcerated male adolescents (N = 269), were assessed using voxel-based morphometry. Callous-unemotional traits were assessed using the Inventory of Callous-Unemotional traits (Frick 2004). Total callous-unemotional traits were negatively correlated with anterior temporal lobe gray matter volume (GMV). Callous traits in particular exhibited a reliable negative correlation with gray matter volume in nearly every paralimbic brain region examined. Uncaring traits were positively correlated with GMV in the orbitofrontal and anterior cingulate cortices. These findings demonstrate specific neural features within the paralimbic cortex and limbic system that accompany elevated callous-unemotional traits and serves to expand our understanding of pathophysiological mechanisms that may give rise to severe conduct problems in youth.

Machine learning of brain gray matter differentiates sex in a large forensic sample.

Differences between males and females have been extensively documented in biological, psychological, and behavioral domains. Among these, sex differences in the rate and typology of antisocial behavior remains one of the most conspicuous and enduring patterns among humans. However, the nature and extent of sexual dimorphism in the brain among antisocial populations remains mostly unexplored. Here, we seek to understand sex differences in brain structure between incarcerated males and females in a large sample (n = 1,300) using machine learning. We apply source-based morphometry, a contemporary multivariate approach for quantifying gray matter measured with magnetic resonance imaging, and carry these parcellations forward using machine learning to classify sex. Models using components of brain gray matter volume and concentration were able to differentiate between males and females with greater than 93% generalizable accuracy. Highly differentiated components include orbitofrontal and frontopolar regions, proportionally larger in females, and anterior medial temporal regions proportionally larger in males. We also provide a complimentary analysis of a nonforensic healthy control sample and replicate our 93% sex discrimination. These findings demonstrate that the brains of males and females are highly distinguishable. Understanding sex differences in the brain has implications for elucidating variability in the incidence and progression of disease, psychopathology, and differences in psychological traits and behavior. The reliability of these differences confirms the importance of sex as a moderator of individual differences in brain structure and suggests future research should consider sex specific models.