Ten recommendations for reducing the long-term costs of conduct problems: A commentary on the economic analysis of Goulter et al. (2023).

The economic analysis of Goulter et al. (2023) identifies the long-term financial costs arising from conduct problems in the kindergarten period, including those associated with later criminal activity, lost offender productivity, victim costs and government and medical services. These costs are substantial and provide policymakers with a compelling argument for investing in early intervention and prevention of conduct problems. The ultimate goal of reducing the long-term costs of early conduct problems is likely to be achieved only through the coordinated efforts of many stakeholders and diverse courses of action. Outlined here are 10 recommendations for investment that in my view would support progress towards this outcome.

Commentary: Early intervention for conduct problems as a child protection strategy - reflections on Nobakht et al. (2023).

Adverse childhood experiences (ACEs), including child maltreatment and interparental aggression, are known to have far-reaching consequences for mental health across the lifespan. Emerging evidence, such as that reported by Nobakht et al. (Journal of Child Psychology and Psychiatry, 2023), indicates that child conduct problems (e.g. oppositional defiant disorder, conduct disorder) may not only result from adversity but also contribute to it through transactional cascades that amplify risk for adversity over time. This commentary addresses some of the key implications of this evidence for translation into practice. It is argued that child conduct problems can be viewed as modifiable determinants of adversity and that the early identification and treatment of child conduct problems may allow for the early identification and reduction of risk for numerous ACEs.

Practitioner Review: A core competencies perspective on the evidence-based treatment of child conduct problems.

BACKGROUND: The effective treatment of child conduct problems is understood to rely on a range of therapist competencies, yet these have rarely been an explicit focus of research. In this practitioner review, we examine core competencies for the delivery of evidence-based parenting interventions for conduct problems in early-to-middle childhood. These are examined in light of research into the common elements shared by these interventions, literature regarding common challenges in these interventions, and conceptualisations of such competencies in other fields of mental health. METHODS: We report on the development of a novel consensus-based model of core competencies for evidence-based practice in this field, based on consultation with an international expert panel. This includes competencies as they apply to complex presentations of conduct problems. RESULTS: Despite considerable variation among widely disseminated programmes in terms of content, format and skills-training practices, there is strong consensus among practitioners regarding core competencies. These relate to three broad domains: (a) generic therapeutic competencies; (b) parenting intervention competencies; (c) specific parenting skills/techniques. CONCLUSIONS: Practitioners working with conduct problems, particularly complex presentations thereof, require competencies for engaging not only mothers, but fathers and diverse/non-traditional caregivers and other stakeholders, in evidence-based parenting interventions. Moreover, the successful delivery of these interventions necessitates competencies that extend beyond behaviour management and encompass broader aspects of the family system and the wider ecology of the child.

Cognitive and affective perspective taking amongst adolescent offenders with variants of callous-unemotional traits.

Evidence suggests that associations between antisocial behaviour, callous-unemotional (CU) traits and cognitive empathy (e.g. perspective taking) vary depending on more fine-grained dimensions of these constructs. This study examined associations between adolescent antisocial behaviour and individual differences in cognitive and affective perspective taking ability. Based on current theory regarding distinct variants of CU traits, we further tested whether the correlates of CU traits differed amongst youth with high versus low levels of anxiety. Participants were 130 male adolescents (81 youth offenders; 49 non-offenders) aged 13-20 years, of predominantly Caucasian and Aboriginal Australian ethnicity. Perspective taking skills were indexed using performance-based testing, and self-report data was collected on CU traits and anxiety in a cross-sectional design. Offender status was associated with poorer cognitive and affective perspective taking. In addition, associations between CU traits and perspective taking skills were moderated by anxiety. Specifically, CU traits were associated with poorer skills for second-order cognitive perspective taking amongst high-anxiety youth, whereas CU traits were associated with better cognitive and affective perspective taking skills amongst low-anxiety youth. More fine-grained assessment of such factors stands to enhance understanding of, and effective intervention for, antisocial youth.

Core features of callous-unemotional traits: a cross-cultural comparison of youth in four countries.

With considerable debate concerning the impact of culture on the expression of callous-unemotional (CU) traits, it is unclear whether the core features of CU traits generalize to youth across cultures. This study aimed to examine whether cultural differences are reflected in the core features of CU traits and the associations among these features. Network analysis was employed to identify the core features and to examine the network structure of CU traits operationalized by the Inventory of Callous Unemotional traits (ICU) in four community youth samples from different nations (Australia, N = 190; the UK, N = 437; the USA, N = 330; China, N = 503). The item "Apologizes to people" was identified as a cross-cultural core feature in the ICU network with a greater centrality of this item compared to others in all four samples. In addition, some items were identified as culture-specific core features in the network, differing in their centrality across samples. The network structures of the youth self-report ICU items were moderately similar across samples, while the structures of parent-report items showed substantial differences. These findings have important implications for cross-cultural research on CU traits as well as practical implications for screening and treatment. The core features of ICU appear to be generalizable in youth across cultures, although cultural-specific manifestations should be noted.

Universal Child Mental Health Screening for Parents: a Systematic Review of the Evidence.

Childhood represents a critical window for the emergence and treatment of mental health disorders, yet many are not being identified, or are identified too late to receive adequate intervention. This systematic review (Prospero registration: CRD42022299560) aimed to determine the effectiveness and acceptability of parent reported universal mental health screening (UMHS) to improve the early identification of children at-risk of mental health difficulties, and to identify barriers and enablers that may influence parental engagement. Six databases were searched in February 2022 for peer-reviewed, primary research. Studies conducted in targeted populations, evaluating psychometric properties, or focused on screening non-psychological problems were excluded. Ten studies examined parent reported (n = 3,464 parents) UMHS for children from birth to 18 years, suggesting an overall scarcity of research. Findings are presented in a table of study characteristics and a narrative summary of acceptability, effectiveness, barriers, and enablers. Quantitative findings indicated that parents generally support and accept UMHS. Research assessing effectiveness was limited, although two studies indicated increased referrals and referral adherence following positive screens. Confidentiality and stigma were commonly identified barriers. Quality assessment using the Mixed Methods Appraisal Tool indicated that studies varied in quality, meeting four to seven of the seven quality criteria. Understanding and addressing parent attitudes to UMHS across settings is necessary for the successful implementation of screening and improvement of child mental health outcomes. More high-quality research studies, including randomized controlled trials are therefore needed to examine the acceptability and effectiveness of UMHS for parents and their children.

Commentary: Global perspectives on resilience and callous-unemotional traits - a reflection on Obando et al. (2022).

Obando, Wright and Hill's (Journal of Child Psychology and Psychiatry, 2022) study of young children exposed to community violence in Colombia is a most welcome addition to the literature on risk and protective pathways related to callous and unemotional (CU) traits. The key contributions of this study can be viewed in light of calls for a new wave of global research into resilience in children and youth. These contributions also highlight the need for further research into CU traits in diverse sociocultural contexts, and in particular, research addressing questions concerning (a) multiple pathways to CU traits; (b) community violence and other forms of adversity; and (c) the developmental timing of adversity.

Facial reactions to emotional films in young children with conduct problems and varying levels of callous-unemotional traits.

BACKGROUND: Elevated levels of callous-unemotional (CU) traits have proven useful for identifying a distinct subgroup of children whose conduct problems (CP) are early emerging, severe, persistent, and underpinned by aberrant emotional processing. The early childhood emotional experiences and expressions of CP subtypes are poorly understood, despite their importance to understanding the problematic attachments and atypical social affiliation experienced by children with elevated CU traits. The current study aimed to test for differences in facial emotional reactions to mood-inducing film clips in children with CP and varying levels of CU traits. METHOD: We compared facial emotional reactions during a developmentally appropriate mood induction task in a mixed-sex sample of clinic-referred preschool children (Mage = 3.64 years, SD = 0.63, 66.9% male) classified as CP with elevated levels of CU traits (CP + CU; n = 25) versus low CU traits (CP-only; n = 47), and typically developing children (TD; n = 28). RESULTS: Relative to TD children, children with clinical CP showed less congruent and more incongruent facial emotional expressions to sad and happy film clips, controlling for child sex, age, and ethnicity. CONCLUSIONS: Consistent with older samples, young children with CP show atypical facial emotional expressions in response to positive and negative emotional stimuli. Findings have implications for developmental models of childhood antisocial behavior and can inform the development of targeted interventions.

More than a feeling? An expanded investigation of emotional responsiveness in young children with conduct problems and callous-unemotional traits.

Children with conduct problems and high callous-unemotional (CP+CU) traits are characterized by dampened emotional responding, limiting their ability for affective empathy and impacting the development of prosocial behaviors. However, research documenting this dampening in young children is sparse and findings vary, with attachment-related stimuli hypothesized to ameliorate deficits in emotional responding. Here we test emotional responsiveness across various emotion-eliciting stimuli using multiple measures of emotional responsiveness (behavioral, physiological, self-reported) and attention, in young children aged 2-8 years (M age = 5.37), with CP+CU traits (CP+CU; n = 36), CPs and low CU traits (CP-CU; n = 82) and a community control sample (CC; n = 27). We found no evidence that attachment-related stimulus ameliorated deficits in emotional responding. Rather, at a group level we found a consistent pattern of reduced responding across all independent measures of responsiveness for children with CP+CU compared to the CC group. Few differences were found between CP+CU and CP-CU groups. When independent measures were standardized and included in a regression model predicting to CU trait score, higher CU traits were associated with reduced emotional responding, demonstrating the importance of multimodal measurement of emotional responsiveness when investigating the impact of CU traits in young children.

Sympathetic nervous system functioning during the face-to-face still-face paradigm in the first year of life.

Contemporary theories of early development and emerging child psychopathology all posit a major, if not central role for physiological responsiveness. To understand infants' potential risk for emergent psychopathology, consideration is needed to both autonomic reactivity and environmental contexts (e.g., parent-child interactions). The current study maps infants' arousal during the face-to-face still-face paradigm using skin conductance (n = 255 ethnically-diverse mother-infant dyads; 52.5% girls, mean infant age = 7.4 months; SD = 0.9 months). A novel statistical approach was designed to model the potential build-up of nonlinear counter electromotive force over the course of the task. Results showed a significant increase in infants' skin conductance between the Baseline Free-play and the Still-Face phase, and a significant decrease in skin conductance during the Reunion Play when compared to the Still-Face phase. Skin conductance during the Reunion Play phase remained significantly higher than during the Baseline Play phase; indicating that infants had not fully recovered from the mild social stressor. These results further our understanding of infant arousal during dyadic interactions, and the role of caregivers in the development of emotion regulation during infancy.

Building a National Clinical Trials Network in child and youth mental health: Growing Minds Australia.

Many fields of medicine have benefitted from the formation of clinical trials networks, whereby researchers come together on a large scale to identify high-priority questions and implement coordinated clinical trials. Clinical trials networks in the field of mental health, however, have been rare and largely absent from the Australian context. Here, we present an overview of the newly formed Growing Minds Australia Clinical Trials Network, which represents the first comprehensive clinical trials network in child and youth mental health in Australia. The 60 principal members of the Growing Minds Australia Clinical Trials Network represent teams across 19 diverse areas related to specific forms of psychopathology (e.g. internalising, externalising, neurodevelopmental disorders, early psychosis, substance use), specific research methods and processes (e.g. health economics, eHealth, implementation science) and specialised areas of practice (e.g. school-based systems, parenting interventions, Indigenous mental health, refugee families). Core functions of the Growing Minds Australia Clinical Trials Network include collaborative trial protocol development; peer review, prioritisation and endorsement of proposed trials; training; development of clinical guidelines; and consumer representation. The research by the clinical trials network will encompass the populations typically accessing youth mental health services, while placing a key emphasis on the early periods of life, and the role of parents and caregivers as critical partners in the co-design of research and the delivery of intervention and prevention strategies. The structures and processes built into the network are designed to coordinate collaboration between diverse stakeholders and ensure that provisions for translation are integrated into research from the outset. In this paper, we examine the potential for a dedicated clinical trials network to initiate fundamental improvement in child and youth mental health systems, and discuss the unique and complex challenges associated with establishing such an initiative.

Oral language skills, callous and unemotional traits and high-risk patterns of youth offending.

Extensive research has associated adolescent delinquent behavior with verbal deficits, yet for some subgroups of youth offenders better verbal ability has been associated with increased risk. This study examined associations between specific oral language skills and established markers of high-risk youth offending comprising callous and unemotional (CU) traits, early age of the first offence, and violent offending. Measures of language, CU traits, anxiety, as well as official youth justice data, were collected for adolescent male offenders and non-offenders (n = 130; aged 13-19 years; 62% youth offenders). Pragmatic language was found to be differentially associated with distinct variants of CU traits based on high/low levels of anxiety. Furthermore, among youth offenders with primary variant (low anxiety) CU traits, more violent offending was associated with better structural language skills, while earlier age of first offence was associated with better pragmatic language skills.

Global Workforce Development in Father Engagement Competencies for Family-Based Interventions Using an Online Training Program: A Mixed-Method Feasibility Study.

Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners' skills in engaging fathers in family-based interventions.

Towards Preventative Psychiatry: Concurrent and Longitudinal Predictors of Postnatal Maternal-Infant Bonding.

Maternal-infant bonding is important for children's positive development. Poor maternal-infant bonding is a risk factor for negative mother and infant outcomes. Although researchers have examined individual predictors of maternal-infant bonding, studies typically do not examine several concurrent and longitudinal predictors within the same model. This study aimed to evaluate the unique and combined predictive power of cross-sectional and longitudinal predictors of maternal-infant bonding. Participants were 372 pregnant women recruited from an Australian hospital. Data were collected from mothers at antenatal appointments (T0), following their child's birth (T1), and at a laboratory assessment when their child was 5-11-months-old (T2). Poorer bonding at T2 was predicted at T0 by younger maternal age, higher education, and higher antenatal depressive symptoms. Poorer bonding at T2 was predicted at T1 by younger maternal age, higher education, and higher postnatal depressive symptoms. Poorer bonding at T2 was predicted at T2 by younger maternal age, higher education, higher postnatal depression symptoms, higher concurrent perceived social support, and more difficult infant temperament, when controlling for child age at T2. To promote positive maternal-infant bonding, global and targeted interventions in the perinatal period may benefit from targeting maternal psychopathology, perceived lack of social support, and coping with difficult infant temperament.

Longitudinal Associations between Callous-unemotional (CU) Traits and School-based Affiliative Relationships among South Korean Children.

OBJECTIVE: Callous-unemotional traits (CU) traits are characterized by low empathy, guilt, and reduced sensitivity to others' feelings, along with a reduced drive for social affiliation. However, little is known about the relationships between CU traits and social affiliation in the school context, or the influence of gender on these associations. This study tested reciprocal associations between CU traits and school-based affiliative relationships and explored gender as a potential moderator. METHOD: The sample included South Korean children aged 10 to 12 years (N = 218, M = 11.03, SD = .65, 52% boys). Children reported on CU traits, antisocial behavior, teacher-student relationship quality, and peer affiliation. Three-wave longitudinal cross-lagged models tested reciprocal associations between CU traits and affiliation with both teachers and peers, with multi-group modeling employed to test the moderating effect of gender. RESULTS: Higher CU traits at time 1 predicted decreases in teacher affiliation at time 2 controlling for CU traits, teacher-child affiliation, and antisocial behavior at time 1, while lower teacher-child affiliation at time 2 predicted increases in CU traits at time 3 accounting for CU traits, teacher-child affiliation, and antisocial behavior at time 2. However, there were no reciprocal associations between CU traits and teacher affiliation nor significant associations between CU traits and peer affiliation. Gender did not moderate any pathways between CU traits and teacher or peer affiliation. CONCLUSIONS: Findings indicate CU traits may reduce teacher-child affiliation, potentially escalating risk for further increases in CU traits. Thus, teacher-child affiliation may represent an important target for school-based intervention for children with elevated CU traits regardless of gender.

Learning to like triangles: A longitudinal investigation of evaluative conditioning in infancy.

There is tentative evidence that infants can learn preferences through evaluative conditioning to socioemotional stimuli. However, the early development of evaluative conditioning and the factors that may explain infants' capacity to learn through evaluative conditioning are not well understood. Infants (N = 319; 50.2% boys) participated in a longitudinal study where an evaluative conditioning paradigm using socioemotional stimuli was conducted on two occasions (when infants were 7 and 14 months old, on average). We tested whether repeatedly pairing neutral stimuli (triangular and square shapes) with affective stimuli (angry and happy faces) affects infants' preferences for these shapes. At both timepoints, the majority of infants did not choose the shape that was paired with happy faces, indicating that, in general, learning through evaluative conditioning was not present. However, as expected, individual differences were evident such that infants who spent more time fixating on faces compared to shapes (face-preferrers) during the conditioning trials were significantly more likely than non-face-preferrers to choose the shape paired with happy faces, and this effect strengthened with increasing age.

Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers' parental attributions on professional help-seeking intentions.

There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers' attributions about their child's problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers' anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (ß = .19, p = .002) but not parental self-efficacy (ß = - .01, p = .865) in the general sample, while positively associated with child-responsible attributions (ß = .20, p = .009) and negatively associated with parental self-efficacy (ß = - .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.

No hard feelings: maternal emotion socialization and callous-unemotional traits in children.

Parents' identification and discussion of their own and their children's emotions are important emotion socialization behaviors (ESBs) that may mitigate child conduct problems (CPs). However, if parents perceive their child to be relatively unemotional, which may be the case for children with conduct problems and high callous-unemotional traits (CP + CU), these parents may be limited in their capacity to use ESBs effectively. This study tested these questions by looking at ESBs in mothers (N = 145) of children aged 2-8 years with CP + CU (n = 24), CPs and low CU traits (CP-CU; n = 94) and a non-clinical community sample (n = 27). After watching an emotional movie excerpt, mothers were asked to (1) provide ratings of their child's emotional experience and then (2) engage in a debriefing task with their child about the content. Children's expressed emotion during the excerpt and transcriptions of the debriefing task were coded by masked raters. Unexpectedly, mothers' perceptions of their children's emotion did not vary by group. Emotional ratings provided by mothers of children in the CP + CU group most closely aligned with ratings from independent observers. ESBs did not differ by group in the debriefing task. Mothers of children with CP + CU traits were shown in this study to be reliable reporters of their children's expressed emotion and showed similar rates of parental ESBs as mothers of children in the other groups. Results are discussed in reference to various models of parenting and CU traits that might account for these unexpected findings.

Still connecting the dots: An investigation into infants' attentional bias to threat using an eye-tracking task.

An attentional bias toward threat has been theorized to be a normative aspect of infants' threat and safety learning, and an indicator of risk for internalizing psychopathology in older populations. To date, only four studies have examined this bias using the dot-probe task in infancy and the findings are mixed. We extended the literature by examining patterns of attention to threat in a culturally and linguistically diverse sample of infants aged 5-11 months old (N = 151) using all measures previously employed in the infant dot-probe literature. Given that an attentional bias toward threat is associated with higher risk of developing anxiety disorders later in life, we also examined how negative affect-an early correlate of later anxiety disorders-is related to attentional bias toward threat in infancy. This study was the first to use a consistent measure of negative affect across the whole sample. An eye-tracking dot-probe task was used to examine attentional bias toward threat (i.e., angry faces) relative to positive (i.e., happy faces) stimuli. Results showed that an attention bias to threat was not characteristic of infants at this age, and negative affect did not moderate the putative relationship between attention and emotional faces (angry, happy). These findings therefore suggest that attention biases to socio-emotional threat may not have emerged by 11 months old.

The assessment of adverse childhood experiences in clinical settings: Practitioner competencies and perceptions.

Issues concerning the screening and assessment of adverse childhood experiences (ACEs) in healthcare settings have been subject to growing scrutiny in recent years, yet relatively little is known about practitioner perceptions and competencies related to such practices. This study examined practitioner knowledge, ability and concerns about the assessment of ACEs among parents and children in clinical settings and the acceptability of a newly validated measure (The Adverse Life Experiences Scale, ALES) for this purpose. Participants were (N = 144) healthcare practitioners (predominantly psychologists, nurses, social workers and psychiatrists). Measures were completed online, and the effects of family characteristics on practitioner perceptions were tested experimentally using case vignettes. Participants indicated moderate-to-high levels of knowledge and ability regarding the assessment of ACEs, and the ALES demonstrated high levels of acceptability across hypothetical cases involving various levels of risk. Practitioner concerns about such assessment were also found to be influenced by the level of risk indicated by case referral information. Specifically, concerns that assessment would be too upsetting or time-consuming were greater in response to a case with a high level of ACEs, compared to one with low-to-moderate ACEs (p < .05; large effect size). Practitioners demonstrated relatively high competencies regarding the assessment of ACEs and supported the use of the ALES for this purpose. Those families with the highest levels of ACEs may nonetheless be the least likely to receive such assessment in clinical settings.