Autonomic regulation and comorbid symptoms in children with attention deficit hyperactivity disorder.

OBJECTIVE: Vagally-mediated heart rate variability (vmHRV) is regarded as transdiagnostic marker of emotion regulation and cognitive control capacity. We analysed vmHRV of children with attention deficit/hyperactivity disorder (ADHD). Based on previous research, we expected to find comorbid symptom dimensions (i.e. internalizing symptoms, conduct problems (CP), and callous unemotional (CU) traits) to relate to vmHRV measures. METHODS: The sample comprised 100 (70 boys) medication naïve children with ADHD. Children were 6 to 11 years old. High frequency HRV (HF-HRV) was measured at rest and during a delay of gratification task. Additionally, sympathetic reactivity was assessed via skin conductance responses (SCR). Comorbid symptoms were assessed by parent-report questionnaires and clinical interviews. RESULTS: The multiple correlation between CU traits and the HF-HRV scores proved statistically significant. Higher CU traits were associated with higher HRV resting-state and response scores. CP were positively associated with the SCR score. CONCLUSION: In children with ADHD, increased CU traits might point to a comparatively less impaired self-regulation capacity in the reward-related context. The result corresponds to findings from previous studies. In the future, CU traits should be considered in analyses of autonomic regulation in ADHD.

Reduced prosocial motivation and effort in adolescents with conduct problems and callous-unemotional traits.

BACKGROUND: Prosocial behaviours - acts that benefit others - are of crucial importance for many species including humans. However, adolescents with conduct problems (CP), unlike their typically developing (TD) peers, demonstrate markedly reduced engagement in prosocial behaviours. This pattern is particularly pronounced in adolescents with CP and high levels of callous-unemotional traits (CP/HCU) who are at increased risk of developing psychopathy in adulthood. While a substantial amount of research has investigated the cognitive-affective mechanisms thought to underlie antisocial behaviour, much less is known about the mechanisms that could explain reduced prosocial behaviours in adolescents with CP. METHODS: Here we examined the willingness to exert effort to benefit oneself (self) and another person (other, prosocial condition) in children with CP/HCU, CP and lower levels of CU traits (CP/LCU) and their TD peers. The task captured both prosocial choices, and actual effort exerted following prosocial choices, in adolescent boys aged 11-16 (27 CP/HCU; 34 CP/LCU; 33 TD). We used computational modelling to reveal the mechanistic processes involved when choosing prosocial acts. RESULTS: We found that both CP/HCU and CP/LCU groups were more averse to initiating effortful prosocial acts than TD adolescents - both at a cognitive and at a behavioural level. Strikingly, even if they chose to initiate a prosocial act, the CP/HCU group exerted less effort following this prosocial choice than other groups. CONCLUSIONS: Our findings indicate that reduced exertion of effort to benefit others may be an important factor that differentiates adolescents with CP/HCU from their peers with CP/LCU. They offer new insights into what might drive low prosocial behaviour in adolescents with CP, including vulnerabilities that may particularly characterise those with high levels of CU traits.

Callous-unemotional traits and pre-ejection period in response to reward.

Callous-unemotional (CU) traits have important utility in distinguishing individuals exhibiting more severe and persistent antisocial behavior, and our understanding of reward processing and CU traits contributes to behavioral modification. However, research on CU traits often investigated reward alongside punishment and examined solely on average reward reactivity, neglecting the reward response pattern over time such as habituation. This study assessed individuals' pre-ejection period (PEP), a sympathetic nervous system cardiac-linked biomarker with specificity to reward, during a simple reward task to investigate the association between CU traits and both average reward reactivity and reward response pattern over time (captured as responding trajectory). A heterogeneous sample of 126 adult males was recruited from a major metropolitan area in the US. Participants reported their CU traits using the Inventory of Callous-Unemotional Traits and completed a simple reward task while impedance cardiography and electrocardiogram were recorded to derive PEP. The results revealed no significant association between average PEP reward reactivity and CU traits. However, CU traits predicted both linear and quadratic slopes of the PEP reactivity trajectory: individuals with higher CU traits had slower habituation initially, followed by a rapid habituation in later blocks. Findings highlight the importance of modeling the trajectory of PEP reward response when studying CU traits. We discussed the implications of individuals with high CU traits having the responding pattern of slower initial habituation followed by rapid habituation to reward and the possible mechanisms.

The amygdala volume moderates the relationship between childhood maltreatment and callous-unemotional traits in adolescents with conduct disorder.

CU traits, characterized by shallow affect, lack of fear, and absence of remorse, have been moderately associated with childhood maltreatment in a recent meta-analysis. However, the potential impact of brain structures remains undetermined. This paper examines the relationship between callous-unemotional (CU) traits, childhood maltreatment, and amygdala volumes. In this study, we used a region-of-interest (ROI) analysis to explore the interaction between the volumes of the amygdala, childhood maltreatment, and the manifestation of CU traits in adolescents diagnosed with conduct disorder (CD, N = 67), along with a comparison group of healthy-control youths (HCs, N = 89). The ROI analysis revealed no significant group differences in the bilateral amygdalar volumes. Significant positive correlation was discovered between all forms of child maltreatment (except for physical neglect) and CU traits across subjects. But the interaction of physical abuse and amygdala volumes was only significant within CD patients. Notably, a sensitivity analysis suggested that gender significantly influences these findings. These results contribute critical insights into the etiology of CU traits, emphasizing the need for customized clinical assessment tools and intervention strategies.

Deficits in emotion recognition and processing in children with high callous-unemotional traits: the role of the MAOA gene.

Children with high Callous-Unemotional (CU) traits show deficits in recognizing and processing facial expressions. Alterations in emotion recognition have been linked to a higher synaptic concentration of monoaminergic neurotransmitters. The current study investigated the relationship between the MAOA-Low-activity alleles and the ability to recognize and process facial expressions in 97 male children (8-12 years old) diagnosed with disruptive behavior disorder. Participants completed a computerized emotion-recognition task while an eye-tracking system recorded the number (Fixation Count, FC) and length (Fixation Duration, FD) of fixations to the eye region of the emotional stimuli. Children with high CU traits exhibited lower scores in recognition of sadness and anger, and lower FC and FD for sadness and fear than children with low CU traits. Children carrying the MAOA-Low-activity alleles displayed lower FD for sadness, and FD and FC for fear than those carrying the MAOA-High-activity alleles. These genetic effects appeared even stronger in children with CU traits. Moderation analysis revealed that CU traits were associated with lower FC and FD for fear, and lower FD for sadness, probably due to the MAOA-Low-activity alleles. Our findings, although to be replicated, suggest MAOA-Low-activity alleles as potential genetic biomarkers to identify CU children in need of training focused on emotion processing.

Resting heart rate moderates the relationship between parental emotion socialization and callous-unemotional traits in children.

Although empirical findings have indicated that both familial and neurobiological risk factors contribute to the development of callous-unemotional (CU) traits in children, relatively few studies have investigated how these two factors interact to influence these traits. The current study focused on the combined effects of parental emotion socialization and child's resting heart rate on CU traits. Parents of Chinese children (N = 166) completed the Coping with Children's Negative Scale when children were 9.39 years old (SD = 0.92), while children's resting heart rate data were collected when they were 10.21 years old (SD = 0.72). When they were 11.15 years old (SD = 0.67), parents completed the Inventory of Callous-Unemotional Traits Short-Form. Results showed that parental supportive emotion socialization was negatively associated with CU traits and Callous behaviors in particular. In addition, resting heart rate moderated the relationship between parental emotion socialization and child's CU traits. Findings provide further evidence that an interdisciplinary approach that combines both psychosocial and biological factors is essential to further our understanding of CU traits in 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.

Is childhood lying shaped by callous-unemotional traits or does lie-telling make children more callous-unemotional? A longitudinal between- and within-person perspective.

The current study aims to advance knowledge on the causal interrelationship between childhood CU traits and lying both at a between- and a within-person perspective across a significant developmental period of mid-childhood to mid-adolescence. Cross-lagged panel models and Random-intercept cross-lagged panel models were used to investigate the prospective associations between lying and the distinct subcomponents of CU traits, including Callousness, Uncaring, and Unemotional in a sample of 719 children (T1; Mage = 10.73 years, SDage = 1.38, range = 7-15 years, 54.4% girls) across four assessment points. Results supported large vulnerability effects at the between-person level across time, indicating that CU traits predominantly influence the subsequent development of lying, with Callousness and Uncaring showing most profound effects on subsequent developmental processes of lying. At the within-person level, fluctuations in CU traits and lying were overall meaningfully related, but no causal relationship could be empirically determined. These findings provide a differentiated etiological viewpoint on the intertwinement of CU traits and lying at a young age, and underscore the importance of an early identification of children with callous and uncaring tendencies in order to prevent more persistent lying in adolescence.

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.

Callous-unemotional traits moderate the association between inhibitory control and disruptive behavior problems.

The presence of callous-unemotional (CU) traits may not be unique to conduct disorder (CD) but also extend to oppositional defiant disorder (ODD). While a distinct neurocognitive profile characterizes CU traits, it remains unclear whether this CU-related neurocognitive profile differs between youth with CD and ODD. This study investigated whether CU traits moderate the relationship between inhibitory control and CD or ODD symptoms. We leveraged computational modeling to decompose task-based inhibitory control in a sample of 200 children (59.5% boys, 86.5% Caucasian), aged 8 to 15 years (M = 10.10, SD = 1.88), referred to an outpatient child diagnostic clinic focused on externalizing problems. Analyses examined whether CU traits moderated the relationship between inhibitory control and CD or ODD symptoms while controlling for ADHD symptoms and child demographics. The results indicated that the strength of the relationship between inhibitory control and CD and ODD symptoms varies as a function of CU traits. Specifically, CD was linked to a more cautious decision-making style when elevated CU traits were present, whereas ODD was associated with more efficient decision making. These findings suggest distinct neurocognitive profiles based on CU traits, which vary between CD and ODD. Clinically, this underscores the importance of tailoring interventions for CD-CU and ODD-CU, focusing on decision making processes rather than merely addressing impulsivity. This research contributes to a more nuanced understanding of the interaction between neurocognitive processes and disruptive behavior, with significant implications for both theoretical models and treatment approaches.

Daily Associations between Parental Warmth and Discipline and Adolescent Conduct Problems and Callous-Unemotional Traits.

Past longitudinal research has demonstrated links between parenting behaviors and adolescent conduct problems (CP) and callous-unemotional (CU) traits on macro timescales (e.g., years). Less is known about daily fluctuations in parenting behaviors and adolescent CP and CU traits, as well as their daily associations on a micro timescale. This study investigated the daily reciprocal associations between three key dimensions of parenting behaviors-parental warmth, inconsistent discipline, and non-harsh discipline-and adolescent CP and CU traits, and explored potential moderating effects of person-mean levels of these parenting behaviors on within-person cross-day links. Participants included an ethnically-racially diverse low risk community sample of 86 adolescents (Mage = 14.5 years, 55% female, 45% non-White) who completed daily reports over 1 month regarding their perceived parenting behaviors and their own levels of CP and CU traits (2056 total observations). Results from dynamic structural equation modeling showed that at the within-person level, higher than average levels of inconsistent discipline were linked to higher than average levels of CU traits the next day. Among adolescents with higher person-mean levels of parental warmth and non-harsh discipline, daily parental warmth and non-harsh discipline were protective against CU traits. Moreover, among adolescents with higher person-mean levels of parental warmth, adolescent CU traits also evoked lower parental warmth the next day. These findings have significant implications for understanding daily fluctuations in parenting behaviors and adolescent CP and CU traits, and inform novel parenting-based interventions that capitalize on recent advances in mobile and other technology.

A systematic review of callous-unemotional traits and attachment in children and adolescents.

METHODS: The systematic review and meta-analysis included 17 research articles from 1994 to 2022. Results were summarized by developmental periods. RESULTS: Attachment insecurity was associated with CU traits across development (r = .17). This association was marginally stronger for high-risk samples (e.g., clinical, justice) and for continuous attachment measures versus coding schemes. From early to middle childhood, attachment disorganization was associated with CU traits (r = .17). IMPLICATIONS: Research on attachment and CU traits in childhood is still in its infancy. Changes in attachment measures from childhood to adolescence make developmental comparisons difficult. Results suggest attachment as a potential developmental mechanism for youth with CU traits, however, the area requires more research.

The "Measure of Empathy in Early Childhood": Psychometric Properties and Associations with Externalizing Problems and Callous Unemotional Traits.

Empathy is crucial to the development of socio-emotional skills in youth and empathy development is central to understanding and subtyping youth with externalizing problems. This study explored for the first time the psychometric properties of the Measure of Empathy in Early Childhood (MEEC) in a sample of 652 Italian children aged 6 to 8 years. The gender invariance of MEEC scores and their associations with other measures of empathy and prosocial behavior, and children's externalizing problems and callous-unemotional (CU) traits were also evaluated. Results indicated that with some modifications, a 5-factor structure of the Italian version of MEEC scores fitted the data and was invariant across gender. Results further supported the reliability and validity of MEEC total and subscale scores. Practical implications of these results are discussed.

Assessing Callous-Unemotional Traits Across Early Adolescence: Further Evaluation of Short Versions.

Literature on the Inventory of Callous-Unemotional (ICU) traits has suggested different versions of the instrument for assessing these traits during development. However, consensus on the instrument version and the best factorial solution remains a matter of debate, with only a few studies having validated ICU versions from a longitudinal perspective. The current study aims to contribute to the literature by comparing ICU models in a longitudinal sample of early adolescents (N = 739; 70.6% of eligible subjects, 371 females and 368 males, in the 6th grade at baseline assessment and in the 8th grade at the second assessment). We tested the validity of various versions of the ICU scales and their respective dimensions by conducting a series of confirmatory factor analyses to verify the factor structure, alongside assessments of internal consistency. For the best-fitting structure, we then analyzed gender and longitudinal invariance in addition to construct and predictive validity, using internalizing and externalizing criteria as well as prosocial behavior. From the comparative analysis, it emerged that the abbreviated 11-item ICU scale version displayed overall better data fit than the full 24-item version. Moreover, its confirmed gender invariance underscores its applicability across genders within the studied age group. With regard to longitudinal invariance, our findings advise caution when comparing ICU scores across early adolescence. Practical implications are discussed.

Adolescents High in Callous-Unemotional Traits are Prone to be Bystanders: The Roles of Moral Disengagement, Moral Identity, and Perceived Social Support.

Bystanders are the most common role that adolescents play in bullying episodes, they have considerable influence on the formation of the victim's experience and the perpetrator's behavior. Based on the social-cognitive model, the current study examined the mediating role of moral disengagement in the association between callous-unemotional traits and bystander behavior and the moderating roles of moral identity and perceived social support. Participants included 2,286 Chinese adolescents aged 11-16 years (49.3% boys; Mage = 13.46, SDage = 0.93). The study showed callous-unemotional traits were significantly and positively associated with bystander behavior and this relation was partially mediated by moral disengagement. Moral identity moderated the relation between callous-unemotional traits and moral disengagement as well as callous-unemotional traits and bystander behavior. Perceived social support moderated in the direct and indirect associations between callous-unemotional traits and bystander behavior via moral disengagement. The relation between callous-unemotional traits and moral disengagement and the relation between callous-unemotional traits and bystander behavior became weaker for adolescents with high perceived social support. Surprisingly, the relation between moral disengagement and bystander behavior became stronger for adolescents with a high level of perceived social support. The results supported two specific patterns of perceived social support: stress-buffering and reverse stress-buffering. The present study contributes to our understanding of the key mechanisms underlying the association between callous-unemotional traits and adolescents' bystander behavior.

An Examination of the Relations Between Effortful Control in Early Childhood and Risk for Later Externalizing Psychopathology: A Bi-factor Structural Equation Modeling Approach.

Deficits in effortful control (EC) contribute to patterns of maladaptation across development; however, little is known about how specific subfactors of EC differentially predict children's externalizing psychopathology. Using a longitudinal sample of 206 children (47.8% female, 42.6% Caucasian), the current study employed a bi-factor structural equation modeling approach to examine the concurrent and longitudinal associations between EC and its subfactors (i.e., attentional focusing, low-intensity pleasure, perceptual sensitivity, inhibitory control) and conduct problems, attention deficit disordered behaviors (ADD), and callous-unemotional (CU) traits at 36 and 84 months, respectively. Results indicated that increased general EC at 36 months predicted reduced CU traits and ADD at 84 months. Attentional focusing was the only subfactor to uniquely predict later CU traits, suggesting that strong attentional abilities attenuate risk for CU trait development. The implications for research and practice are discussed.

Do autism and psychopathy co-occur? A systematic review and clinical discussion.

BACKGROUND: Although the prevalence is unknown, psychopathy can be a possible co-occurring condition associated with autism especially among forensic populations. However, the relationship between these two conditions remains poorly understood. AIMS: To carry out a systematic review of the available literature exploring the relationship between autism and psychopathy. METHODS: A systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using terms for autism and psychopathy to search the literature databases Scopus, Pubmed, Web of Science, ASSIA, APA Psych Info, Medline and EMBASE from 1980 to March 2024. For inclusion, we required that a recognised measure of autism and psychopathy or associated features of the latter had been used. RESULTS: Of the 4230 potential articles identified, 37 met the selection criteria. Insufficient and inconsistent methodologies for data pooling meant that a narrative analysis was used. Although there is some overlap, four broad themes emerged relating to (1) assessment and frequency of co-occurrence, (2) behavioural and neurophysiological expressions of empathy, (3) behavioural contagion effects, mirroring, mimicry and other linking mechanisms and (4) emotional face perception and theory of mind characteristics. Within these areas there are some specific differences between the two conditions. However, the research to date examining the relationship between autism and psychopathy has mostly been with children and males, carried out with non-clinical non-forensic populations, as well as using self-report measures and parental ratings. Prior research has also largely focused on looking for differences between these conditions rather than co-occurrence. CONCLUSION: This review outlines a case for considering autism and psychopathy as distinct, but potentially co-occurring conditions and highlights the need for more research into how the two conditions interact with clinical populations. There also appears to be a need for guidelines on when and how to assess psychopathy with autistic individuals and a better understanding of the therapeutic needs and factors influencing the long-term outcomes of autistic individuals who may also present with co-occurring psychopathy.

Health Service Utilization in Adolescents Following a First Arrest: The Role of Antisocial Behavior, Callous-Unemotional Traits, and Juvenile Justice System Processing.

Previous research indicates that youth exhibiting antisocial behavior are at risk for utilizing a disproportionate amount of health services compared to youth without these problems. The present study investigates whether being processed by the juvenile justice system and showing callous-unemotional (CU) traits independently predict health service utilization (medical and mental health service use and out-of-home placement) over and above the severity of antisocial behavior across adolescence. A total of 766 participants who had been arrested for the first time in adolescence provided data at ten appointments over a period of seven years. Results showed that self-reported antisocial behavior at the time of arrest predicted increased use of most health service use types over the next seven years (i.e. medicine prescriptions, tests for sexually transmitted infections, mental health service appointments, and out-of-home placements). All except prescription medication use remained significant when controlling for justice system processing and CU traits. Further, justice system processing added significantly to the prediction of medical service appointments. Whereas CU traits were associated with mental health service appointments and out-of-home placements, these did not remain significant when controlling for severity of antisocial behavior. These findings are consistent with prior research documenting the health care costs of antisocial behavior.

Dysfunction in differential reward-punishment responsiveness in conduct disorder relates to severity of callous-unemotional traits but not irritability.

BACKGROUND: Conduct disorder (CD) has been associated with dysfunction in reinforcement-based decision-making. Two forms of affective traits that reflect the components of CD severity are callous-unemotional (CU; reduced guilt/empathy) traits and irritability. The form of the reinforcement-based decision-making dysfunction with respect to CD and CU traits remains debated and has not been examined with respect to irritability in cases with CD. The goals of the current study were to determine the extent of dysfunction in differential (reward v. punishment) responsiveness in CD, and CU traits and irritability in participants with CD. METHODS: The study involved 178 adolescents [typically developing (TD; N = 77) and cases with CD (N = 101)]. Participants were scanned with fMRI during a passive avoidance task that required participants to learn to respond to (i.e. approach) stimuli that engender reward and refrain from responding to (i.e. passively avoid) stimuli that engender punishment. RESULTS: Adolescents with CD showed reduced differential reward-punishment responsiveness within the striatum relative to TD adolescents. CU traits, but not irritability, were associated with reduced differential reward-punishment responsiveness within the striatum, rostromedial, and lateral frontal cortices. CONCLUSIONS: The results suggest CD is associated with reduced differential reward-punishment responsiveness and the extent of this dysfunction in participants with CD is associated with the severity of CU traits but not irritability.

Antisocial behavior is associated with reduced frontoparietal activity to loss in a population-based sample of adolescents.

BACKGROUND: Adolescent antisocial behavior (AB) is a public health concern due to the high financial and social costs of AB on victims and perpetrators. Neural systems involved in reward and loss processing are thought to contribute to AB. However, investigations into these processes are limited: few have considered anticipatory and consummatory components of reward, response to loss, nor whether associations with AB may vary by level of callous-unemotional (CU) traits. METHODS: A population-based community sample of 128 predominantly low-income youth (mean age = 15.9 years; 42% male) completed a monetary incentive delay task during fMRI. A multi-informant, multi-method latent variable approach was used to test associations between AB and neural response to reward and loss anticipation and outcome and whether CU traits moderated these associations. RESULTS: AB was not associated with neural response to reward but was associated with reduced frontoparietal activity during loss outcomes. This association was moderated by CU traits such that individuals with higher levels of AB and CU traits had the largest reductions in frontoparietal activity. Co-occurring AB and CU traits were also associated with increased precuneus response during loss anticipation. CONCLUSIONS: Findings indicate that AB is associated with reduced activity in brain regions involved in cognitive control, attention, and behavior modification during negative outcomes. Moreover, these reductions are most pronounced in youth with co-occurring CU traits. These findings have implications for understanding why adolescents involved in AB continue these behaviors despite severe negative consequences (e.g. incarceration).