Elemental psychopathology: distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5.

BACKGROUND: The DSM-5 features hundreds of diagnoses comprising a multitude of symptoms, and there is considerable repetition in the symptoms among diagnoses. This repetition undermines what we can learn from studying individual diagnostic constructs because it can obscure both disorder- and symptom-specific signals. However, these lost opportunities are currently veiled because symptom repetition in the DSM-5 has not been quantified. METHOD: This descriptive study mapped the repetition among the 1419 symptoms described in 202 diagnoses of adult psychopathology in section II of the DSM-5. Over a million possible symptom comparisons needed to be conducted, for which we used both qualitative content coding and natural language processing. RESULTS: In total, we identified 628 distinct symptoms: 397 symptoms (63.2%) were unique to a single diagnosis, whereas 231 symptoms (36.8%) repeated across multiple diagnoses a total of 1022 times (median 3 times per symptom; range 2-22). Some chapters had more repetition than others: For example, every symptom of every diagnosis in the bipolar and related disorders chapter was repeated in other chapters, but there was no repetition for any symptoms of any diagnoses in the elimination disorders, gender dysphoria or paraphilic disorders. The most frequently repeated symptoms included insomnia, difficulty concentrating, and irritability - listed in 22, 17 and 16 diagnoses, respectively. Notably, the top 15 most frequently repeating diagnostic criteria were dominated by symptoms of major depressive disorder. CONCLUSION: Overall, our findings lay the foundation for a better understanding of the extent and potential consequences of symptom overlap.

Dimensions of Warm Parenting Attributions Differentiate Conduct Problem Subtypes in Young Children.

Understanding the developmental psychopathology of child conduct problems (CP) has been advanced by differentiating subtypes based on levels of internalizing problems (INT) and/or callous-unemotional (CU) traits (i.e., low empathy/guilt, poor motivation, shallow/deficient affect). The current study sought to elucidate prior inconsistencies in the role of warm/positive and harsh/negative parenting subcomponents in CP by differentiating subtypes on the basis of INT and CU traits. Parents of 135 young children (M age = 4.21 years, SD = 1.29) referred to specialty clinics for the treatment of CP completed pre-treatment measures of parenting and rated their child's levels of CP, INT, and CU traits. Results of planned comparisons revealed that mothers of children classified as secondary CU variants (high CU/ high INT) reported fewer overall warm attributions toward their child, compared with CP-only (low CU) children. They also reported a more negative dyadic relationship characterized by feelings of anger/hostility, active avoidance and/or a desire to do harm to their child relative to primary CU variants (high CU/ low INT). Mothers of primary CU variants attributed fewer good and altruistic intentions towards others in their child, relative to CP-only children. Subtypes were undifferentiated on observed positive and negative parenting behaviors, indicative of a disconnect between parenting behaviors and cognitions for mothers of children high on CU traits. Findings are discussed in relation to their theoretical and practice implications, and in guiding future research.

Clinical utility of diagnosing limited prosocial emotions in young children using the Clinical Assessment of Prosocial Emotions (CAPE).

This study evaluated the interrater reliability, convergent and divergent validity, incremental validity, and clinical prognostic utility of the Clinical Assessment of Prosocial Emotions (CAPE; Frick, 2013) for assessing limited prosocial emotions (LPE). Participants were 232 young children (Mage = 3.94 years, SD = 1.46, range = 2-8; 74.6% boys) clinic-referred for conduct problems. We scored the CAPE using binary and dimensional scoring approaches and measured outcomes using parent-report and child laboratory measures. CAPE LPE symptom ratings had good interrater reliability. Children diagnosed with pretreatment LPE had more severe externalizing problems and lower empathy than children without LPE but did not differ in emotion recognition accuracy or anxiety. Dimensional CAPE symptom sum scores were associated with criterion variable scores in expected ways and offered incremental validity beyond scores on the parent-report Inventory of Callous-Unemotional Traits for predicting conduct problem severity, aggression, empathy deficits, and global emotion recognition accuracy. Among children who completed parent management training (n = 44), those diagnosed with LPE ended treatment with more severe aggressive behavior than those without LPE. Overall, children diagnosed with CAPE LPE have severe externalizing problems and achieve reduced benefits from standard parent management training, supporting the need for tailored and intensive interventions to maximize treatment outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits.

OBJECTIVE: Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems. METHOD: Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes. RESULTS: Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits. CONCLUSIONS: Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).

Development of an Empathy Rating Scale for Young Children.

Empathy is critical to young children's socioemotional development and deficient levels characterize a severe and pervasive type of Conduct Disorder (i.e., with limited prosocial emotions). With the emergence of novel, targeted early interventions to treat this psychopathology, the critical limitations of existing parent-report empathy measures reveal their unsuitability for assessing empathy levels and outcomes in young children. The present study aimed to develop a reliable and comprehensive parent-rated empathy scale for young children. This was accomplished by first generating a large list of empathy items sourced from both preexisting empathy measures and from statements made by parents during a clinical interview about their young child's empathy. Second, this item set was refined using exploratory factor analysis of item scores from parents of children aged 2 to 8 years (56.6% male), recruited online using Amazon's Mechanical Turk. A five-factor solution provided the best fit to the data: Attention to Others' Emotions, Personal Distress (i.e., Emotional Contagion/Affective Empathy), Personal Distress-Fictional Characters, Prosocial Behavior, and Sympathy. Total and subscale scores on the new "Measure of Empathy in Early Childhood" (MEEC) were internally consistent. Finally, this five-factor structure was tested using confirmatory factor analysis and model fit was adequate. With further research into the validity of MEEC scores, this new rater-based empathy measure for young children may hold promise for assessing empathy in early childhood and advancing research into the origins of empathy and empathy-related disorders.

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.

Parent Training Adapted to the Needs of Children With Callous-Unemotional Traits: A Randomized Controlled Trial.

Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.

Callous-unemotional traits linked to earlier onset of self-reported and official delinquency in incarcerated boys.

OBJECTIVE: Research shows that youth who engage in early delinquency have higher callous-unemotional (CU) traits than youth with a later start. This study extends prior research to determine the optimal delinquency onset age cutoff for identifying youth high versus low on CU traits and the average age of delinquency onset for youth with clinically significant CU traits. HYPOTHESES: We hypothesized that youth with childhood-onset delinquency would have higher CU traits than those with adolescent-onset delinquency. We hypothesized that youth with clinically significant CU traits would have an earlier delinquency onset than youth without CU traits. We explored differences in delinquency onset between antisocial youth categorized into low-anxious primary CU variant, high-anxious secondary CU variant, and low-CU/low-anxious control groups. METHOD: Participants were 456 adjudicated, incarcerated boys (M age = 16.24 years, SD = 1.33, range 12-19; 40.4% White, 39.7% Black, 13.8% Hispanic/Latino, 6.1% other race/ethnicity) in the United States. We measured age of delinquency onset using self-report and official records. RESULTS: Boys who were 11 years old or younger when they first engaged in delinquency had higher CU traits than those who were 12 years old or older (η p 2 range = .009-.012), controlling for conduct problem severity and race/ethnicity. On average, boys with clinically significant CU traits first engaged in delinquency 1 year earlier (at 7.81 years old) than those without CU traits (η p 2 = .012). Low-anxious primary CU variants were 1 year younger at their first official charge (12.65 years old) than controls (η p 2 = .026). There were no statistically significant differences between low-anxious primary and high-anxious secondary CU variants. CONCLUSIONS: Elevated CU traits were over-represented among boys who were youngest at their first legal contact, suggesting that this may be an opportune time to identify this subgroup of youth to provide nuanced intervention to prevent later serious delinquency and criminal justice involvement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating the Psychometric Effects and Assessment of Inconsistent Responding on the Psychopathic Personality Inventory-Revised in a Correctional Sample.

The current study aimed to examine the effects of inconsistent responding on Psychopathic Personality Inventory-Revised (PPI-R; Lilienfeld & Widows, 2005) scale scores and the utility of the IR scale in detecting such responding in a correctional setting. The study employed an internally controlled method of simulating inconsistent responding by inserting ascending levels of computer-generated random responses into PPI-R protocols. Participants were 218 male inmates from a medium-security prison in central Kentucky in the United States. Results indicated that psychometric properties of PPI-R scores were substantially attenuated at as low as 40% of random responding. Additionally, results indicated that an Inconsistent Responding (IR) Scale cut-off of 40 would provide the best balance between sensitivity and specificity in detecting invalid PPI-R protocols. Overall, this study highlighted the utility of the IR Scale in self-report psychopathy measures and the need to consider such response biases in research and clinical settings.