Predictive Validity of Adolescent Callous-Unemotional Traits and Conduct Problems with Respect to Adult Outcomes: High- and Low-Risk Samples.

Current understanding of the predictive validity of callous-unemotional (CU) traits is limited by (a) the focus on externalizing psychopathology and antisocial behaviors, (b) a lack of long-term prospective longitudinal data, (c) samples comprised of high-risk or low-risk individuals. We tested whether adolescent CU traits and conduct problems were associated with theoretically relevant adult outcomes 12-18 years later. Participants were drawn from two studies: higher-risk Fast Track (FT; n = 754) and lower-risk Child Development Project (CDP; n = 585). FT: conduct problems positively predicted externalizing and internalizing psychopathology and partner violence, and negatively predicted health, wellbeing, and education. Three conduct problems × CU traits interaction effects were also found. CDP: CU traits positively predicted depression and negatively predicted health and education; conduct problems positively predicted externalizing and internalizing psychopathology and substance use, and negatively predicted wellbeing. CU traits did not provide incremental predictive validity for multiple adult outcomes relative to conduct problems.

The comparative and cumulative impact of different forms of violence exposure during childhood and adolescence on long-term adult outcomes.

Violence exposure during childhood and adolescence is associated with a range of negative psychosocial outcomes. Research examining the impact of violence exposure has been limited by the compartmentalization into separate bodies of research (e.g., community violence, domestic violence). There is also a paucity of research examining long-term adult outcomes. Using a large and racially diverse sample (n = 754; male = 58%; Black = 46%), the current longitudinal study aimed to elucidate the comparative and cumulative effect of different types of violence exposure (witnessing vs. victimization) across different locations (home, school, neighborhood) in childhood and adolescence (lifetime through Grade 8) on long-term internalizing, externalizing, and attention problems; substance use; and intimate partner violence in adulthood (age 25). Victimization, but not witnessing violence, predicted all five adult outcomes. Specifically, being victimized at home was associated with the widest range of negative outcomes (internalizing, externalizing, and attention problems), while school victimization was associated with substance use. Further, when youth experienced multiple types of violence across multiple locations (cumulative violence exposure), they experienced a more diverse range of negative outcomes in adulthood (composite score). The current study highlights the stronger effects of violence exposure in more proximal contexts, and how these locations are important for emotional and behavioral development.

Capturing Parenting as a Multidimensional and Dynamic Construct with a Person-Oriented Approach.

Although parenting is one of the most commonly studied predictors of child problem behavior, few studies have examined parenting as a multidimensional and dynamic construct. This study investigated different patterns of developmental trajectories of two parenting dimensions (harsh discipline [HD] and parental warmth [PW]) with a person-oriented approach and examined the associations between different parenting patterns and child externalizing problems and callous-unemotional traits. Data were drawn from the combined high-risk control and normative sample (n = 753) of the Fast Track Project. Parent-reported HD and observer-reported PW from kindergarten to grade 2 were fit to growth mixture models. Two subgroups were identified for HD (low decreasing, 83.0 %; high stable, 17.0 %) and PW (high increasing, 78.7 %; low increasing, 21.3 %). The majority of parents (67.0 %) demonstrated the low decreasing HD and high increasing PW pattern, while the prevalence of the high stable HD and low increasing PW pattern was the lowest (6.8 %). Parenting satisfaction, parental depression, family socioeconomic status, and neighborhood safety predicted group memberships jointly defined by the two dimensions. Children from the high stable HD and low increasing PW pattern showed the highest levels of externalizing problems in grades 4 and 5. Children from the low decreasing HD and low increasing PW pattern showed the highest levels of callous-unemotional traits in grade 7. These findings demonstrate the utility and significance of a person-oriented approach to measuring parenting as a multidimensional and dynamic construct and reveal the interplay between HD and PW in terms of their influences on child developmental outcomes.

Effects of Treatment Setting on Outcomes of Flexibly-Dosed Intensive Cognitive Behavioral Therapy for Pediatric OCD: A Randomized Controlled Pilot Trial.

Introduction: Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority. Methods: Youth were randomized to receive intensive CBT at a hospital clinic (n = 14) or within their home (n = 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed. Results: Families' satisfaction with the treatment program was high. Of study completers (n = 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment). Discussion: Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant. Clinical Trial Registration: www.ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03672565, identifier: NCT03672565.

Violence Exposure Subtypes Differentially Mediate the Relation between Callous-Unemotional Traits and Adolescent Delinquency.

Research with children and adolescents has established a link between callous-unemotional (CU) traits and delinquency, as well as a link between violence exposure (witnessing and direct victimization) and diverse negative and antisocial outcomes. Little attention has been paid to investigating the association among CU traits, violence exposure, and various forms of delinquency. Using a sample of 753 adolescents (male =58%; African American =46%), the current study aimed to elucidate the mediating role of violence exposure (measured in grades 7, 8, 10, 11) on the relationship between CU traits measured in grade 7 and later delinquency (i.e., property, violent, drug, and sexual) assessed in grade 12. Total violence exposure (witnessing and direct victimization) mediated the association between CU traits and all forms of delinquency. When looking at witnessing and direct victimization separately, however, only witnessing violence mediated the relationship between CU traits and all forms of delinquency. These results highlight the importance of violence exposure in the CU-delinquency link, and showed the differential roles of indirect and direct forms of violence exposure on the association. Witnessing and direct victimization may involve different underlying mechanisms influencing developmental outcomes in youth. These findings have important implications for understanding developmental models of violence exposure, CU traits, and delinquency, as well as interventions for youth who have experienced both indirect and direct forms of violence.