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.

Effects of neighborhood disadvantage and peer deviance on adolescent antisocial behavior: Testing potential interactions with age-of-onset.

Research has suggested that childhood-onset conduct problems (CPs) are more strongly related to individual predispositions, whereas adolescent-onset CP is more strongly associated with social factors, such as peer delinquency. Neighborhood disadvantage (ND) increases the risk for associating with deviant peers. Thus, peer delinquency could mediate the relationship between ND and adolescent-onset CP. This mediational hypothesis has not been tested previously. We tested this hypothesis in 1,127 justice-involved adolescent males using self-reported delinquency and official arrest records over 3 years after the youth's first arrest as outcomes. Predictors were self-reported and census-derived indicators of ND and self-reported peer delinquency. Age of onset moderated the associations between self-reported ND and arrests and between self-report of peer delinquency and arrests. In both cases, the association was stronger for those with adolescent-onset CP. Peer delinquency mediated all relationships between ND and CP. Our results also showed some unexpected differences in associations depending on whether self-reported ND or census-derived indicators were used as predictors. Specifically, census-derived ND was negatively related to self-reported offending, which could be due to the use of an arrested sample and the need for youth in more advantaged neighborhoods to show a more severe pattern of antisocial behavior to be arrested.

Proactive and reactive aggression: Developmental trajectories and longitudinal associations with callous-unemotional traits, impulsivity, and internalizing emotions.

Research on proactive and reactive aggression has identified covariates unique to each function of aggression, but hypothesized correlates have often not been tested with consideration of developmental changes in or the overlap between the types of aggression. The present study examines the unique developmental trajectories of proactive and reactive aggression over adolescence and young adulthood and tests these trajectories' associations with key covariates: callous-unemotional (CU) traits, impulsivity, and internalizing emotions. In a sample of 1,211 justice-involved males (ages 15-22), quadratic growth models (i.e., intercepts, linear slopes, and quadratic slopes) of each type of aggression were regressed onto quadratic growth models of the covariates while controlling for the other type of aggression. After accounting for the level of reactive aggression, the level of proactive aggression was predicted by the level of CU traits. However, change in proactive aggression over time was not related to the change in any covariates. After accounting for proactive aggression, reactive aggression was predicted by impulsivity, both at the initial level and in change over time. Results support that proactive and reactive aggression are unique constructs with separate developmental trajectories and distinct covariates.

Developing Cutoff Scores for the Inventory of Callous-Unemotional Traits (ICU) in Justice-Involved and Community Samples.

Objective: The recent addition of the callous-unemotional (CU) traits specifier, "with Limited Prosocial Emotions (LPE)," to major classification systems has prompted the need for assessment tools that aid in the identification of elevations on these traits for diagnostic purposes. The goal of the current study was to use and evaluate multiple methods for establishing cutoff scores for the multi-informant questionnaire, the Inventory of Callous-Unemotional Traits (ICU).Method: The present study compared the clinical utility of various proposed cutoff methods and scores (i.e., empirically derived cutoffs using receiver operating characteristic (ROC), normative cutoffs, and rational scoring approximations of LPE criteria) in both a longitudinal sample of justice-involved male adolescents (N = 1,216; Mage = 15.29, SD = 1.29) and a cross-sectional sample of school children (N = 289; Mage = 11.47 years; SD = 2.26).Results: Methods resulted in a range of cutoff scores with substantial diagnostic overlap and validity. Specifically, they designated justice-involved adolescents at risk for later delinquency, aggression, and rearrests, and they designated school children more likely to be rated by parents and teacher as having conduct problems and rated by peers as being rejected and mean.Conclusions: The results lead to ranges of ICU scores that have support for their validity and can help to guide clinical decisions about children and adolescents who may be elevated on CU traits.

Inventory of Callous-Unemotional Traits (ICU) Factor Structure and Measurement Invariance in an Adolescent Multinational Sample.

OBJECTIVE: The Inventory of Callous-Unemotional Traits (ICU) is a widely used, comprehensive measure of callous-unemotional (CU) traits. While the ICU total score is used frequently in research, the scale's factor structure remains highly debated. Inconsistencies in past factor structure research appear to be largely due to the use of small non-representative samples and failure to control for method variance (i.e., item wording direction). METHOD: The current study used a multitrait-multimethod (MTMM) confirmatory factor analysis (CFA) approach that considers both trait and method variance to test the factor structure of a 22-item version of the self-report ICU in a multinational community sample of 4,683 adolescents (ages 11-17). RESULTS: Results showed that a hierarchical four-factor model (i.e., one overarching CU factor, four latent trait factors) that controlled for method variance (i.e., by allowing residuals from positively worded items to covary) provided the best fit (χ2 = 2797.307, df = 160, RMSEA=.059, CFI=.922, TLI=.888, SRMR=.045). CONCLUSIONS: After controlling for method variance, the best-fitting factor structure is consistent with how the ICU was developed and corresponds to the four symptoms of Limited Prosocial Emotions (LPE) specifier in the DSM-5 criteria for Conduct Disorder (CD). In addition, measurement invariance of this factor structure across age (i.e., younger versus older adolescents) and sex was supported. As a result, mean differences in ICU total score across age and sex can be interpreted as reflecting true variations in these traits. Further, we documented that boys generally scored higher than girls on the ICU, and this sex difference was larger in later adolescence.

Longitudinal associations of parental monitoring and delinquent peer affiliation: The potential influence of parental solicitation and monitoring rules.

INTRODUCTION: Poor parental monitoring has been theorized as a key risk factor for an adolescent's association with deviant peers. However, measurements of parental monitoring often only measure parental knowledge rather than parental monitoring actions, leaving the true longitudinal associations between parental monitoring and peer delinquency unclear. METHODS: The current sample consisted of 1095 male justice-involved adolescents (13-17 years old at baseline collected between 2011 and 2013) from across the United States who provided survey data every 6 months for 3 years. Longitudinal associations between parental monitoring constructs (i.e., parental solicitation and monitoring rules) and peer delinquency were tested using random intercept cross-lagged panel models to investigate both between-individual associations and within-individual bidirectional effects. RESULTS: Although parental monitoring and peer delinquency were negatively related at a between-individual level, very few within-individual directional effects were found. The few within-individual effects present indicated that parental solicitation predicted greater peer delinquency and peer delinquency predicted fewer parental monitoring rules over time. CONCLUSIONS: Current findings indicate that, while greater overall parental monitoring is associated with less peer delinquency, there is little evidence that changes in parental monitoring lead to reductions in peer delinquency over time. Results support previous findings suggesting parental monitoring should not be the sole target of intervention for reducing peer delinquency.

Do callous-unemotional traits moderate the effects of the juvenile justice system on later offending behavior?

BACKGROUND: Research suggests that callous-unemotional (CU) traits, a recent addition to psychiatric classification of serious conduct problems, may moderate the influence of a number of contextual factors (e.g., parenting, deviant peer influence) on an adolescent's adjustment. The current study sought to replicate past research showing that formal processing through the juvenile justice system increases recidivism and tested the novel hypothesis that CU traits would moderate the relationship between processing decision and future antisocial behavior. METHODS: A diverse sample of first-time male offenders (N = 1,216; M age = 15.12, SD = 1.29) in three regions of the United States was assessed within 6 weeks of their first arrest and then at 6-month intervals for 36 months. RESULTS: Compared to those who were informally processed (i.e., diverted), adolescents formally processed through the court were at a higher risk of self-reported offending and rearrests as measured by official records, after controlling for preexisting risk factors. However, baseline CU traits moderated this association such that those with high CU traits reported offending at high rates across the subsequent three years regardless of how the juvenile justice system processed their case. CONCLUSIONS: CU traits are important to psychiatric classification for designating a subgroup of antisocial youth who may respond differently to contextual influences, including being less susceptible to the negative effects of juvenile justice system involvement. The public health significance of this moderation is significant by suggesting that previous estimates of the harmful impact of formal processing by the juvenile justice system may underestimate its impact, given that the majority of arrested adolescents have normative levels of CU traits.

Assessing Callous-Unemotional Traits Using the Total Score from the Inventory of Callous-Unemotional Traits: A Meta-Analysis.

The Inventory of Callous-Unemotional Traits (ICU) is a widely used rating scale measure of callous-unemotional (CU) traits. Most studies have used a unit-weighted total score that sums all of the items into a composite, despite the consistent finding that items from this measure can be described using a bifactor model (1 general factor and 3 bifactors). We conducted a meta-analysis using the results of past published bifactor tests of the ICU, using indices to estimate the sources of variance in the total and subscale scores. We included studies in our review that tested and found adequate fit for the bifactor model of the ICU resulting in 12 published studies (M age = 9-26 from both community and justice-involved samples) using either the self-report (n = 9) or parent-report (n = 4) versions of the ICU scale (one published study conducted separate factor analyses for each version). We reported model-based reliability estimates that break down unit-weighted ICU scores into the variance due to individual differences in the general factor and the variance due to individual differences in the bifactors. The reliable variance in the unit-weighted total scale score of the ICU is largely determined by the general factor. Findings support the ICU total score as a measure of the general construct of CU traits, despite support for a bifactor model in multiple samples. Concerns about using the unit-weighted subscale scores from the ICU are raised since their reliable variance was strongly influenced by the general factor.

Risky Sex, Drugs, Sensation Seeking, and Callous Unemotional Traits in Justice-Involved Male Adolescents.

The current study examined whether callous-unemotional (CU) traits predicted risky sexual behavior (i.e., unprotected sex, casual sex) and whether substance use and sensation seeking mediated this relationship over 24 months in justice-involved young men. Participants (N = 1,216) were an ethnically and racially diverse sample (46.3% White Latino, 38% Black, 15.7% White non-Latino) of first-time offending male adolescents (ages 13-17 years) from 3 U.S. cities. Participants completed 5 self-reported interviews at 6-month intervals over 2 years. Bootstrapped mediation analyses were conducted to test direct effects of CU traits on risky sexual behaviors, as well as indirect effects through substance use and sensation seeking. CU traits at baseline were positively associated with risky sexual behavior 18-24 months later. CU traits were also associated with the hypothesized mediators, sensation seeking and substance use, measured 6-12 months after baseline. CU traits exerted direct effects on later unprotected sex and casual sex, as well as indirect effects through substance use but not sensation seeking. These effects were largely unchanged when accounting for the youth's level of self-reported delinquency. These findings demonstrate that CU traits predict later risky sexual outcomes, and this is at least partly explained by substance use. Further, the findings highlight the importance of CU traits for several outcomes that are of significant public health concern among justice-involved adolescents, namely, risky sexual behavior and substance use.

The Portuguese Version of the Inventory of Callous-Unemotional Traits Self-Report and its Short Form Among a Normative Sample of Community Youths.

The primary aim of the present study was to examine the psychometric properties and measurement invariance of the Inventory of Callous-Unemotional Traits (ICU) self-report and its short version (ICU-12) among a mixed-sex normative sample of 782 Portuguese youth (M = 15.87 years; SD = 1.72). Confirmatory factor analysis revealed that the three-factor structure of the ICU obtained the best fit after the removal of two items, and the two-factor structure of the ICU-12 obtained the best fit after the removal of one item. Cross-sex measurement invariance was demonstrated for both versions of the inventory. The 22-item version of the ICU and its 11-item short form (ICU-SF) demonstrated generally adequate psychometric properties of internal consistency, convergent validity, discriminant validity, and criterion-related validity (e.g., with conduct disorder symptoms). In terms of known-groups validity, males scored significantly higher than females. Results suggest that the use of the ICU and ICU-SF among Portuguese-speaking youth is psychometrically justified.

The Self-Report Delinquency Scale From the National Longitudinal Study of Adolescent to Adult Health Among At-Risk for Delinquency Youths.

Juvenile delinquency is a universal problem, with serious personal, economic, and social consequences that span national boundaries. Thus, cross-culturally valid and reliable measures of delinquency are critical to providing a better understanding of the causes, correlates, and outcomes of delinquency. The main aim of the present study was to examine the psychometric properties of a Portuguese version of the self-report delinquency measure items created for the National Longitudinal Study of Adolescent Health (Add Health). A sample (N = 412) of male (n = 200) and female (n = 212) at-risk for delinquency youths agreed to participate in the present study. The measure demonstrated satisfactory psychometric properties, namely in terms of its two-factor structure (violent and nonviolent delinquency), internal consistency, convergent validity, discriminant validity, criterion-related validity, and known-groups validity. Findings suggest the Add Health Self-Report Delinquency (AHSRD) is an interculturally valid and reliable measure of violent and nonviolent delinquency among at-risk male and female youths.

Understanding the link between exposure to violence and aggression in justice-involved adolescents.

The current study advanced research on the link between community violence exposure and aggression by comparing the effects of violence exposure on different functions of aggression and by testing four potential (i.e., callous-unemotional traits, consideration of others, impulse control, and anxiety) mediators of this relationship. Analyses were conducted in an ethnically/racially diverse sample of 1,216 male first-time juvenile offenders (M = 15.30 years, SD = 1.29). Our results indicated that violence exposure had direct effects on both proactive and reactive aggression 18 months later. The predictive link of violence exposure to proactive aggression was no longer significant after controlling for proactive aggression at baseline and the overlap with reactive aggression. In contrast, violence exposure predicted later reactive aggression even after controlling for baseline reactive aggression and the overlap with proactive aggression. Mediation analyses of the association between violence exposure and reactive aggression indicated indirect effects through all potential mediators, but the strongest indirect effect was through impulse control. The findings help to advance knowledge on the consequences of community violence exposure on justice-involved youth.

Protecting High-Risk Youth in High-Risk Contexts: Neighborhoods, Parenting, and Victimization.

Victimization theories suggest parents can serve as guardians to protect adolescents from victimization, yet findings from studies examining the main effects of parenting variables on adolescent victimization are mixed. Prior research suggests that it is the combination of parental warmth and monitoring that produces the best results across a range of other outcomes. The current study used data collected from a sample of serious adolescent offenders as part of the Pathways to Desistance study (N = 888; 16.1% female; mean age = 15.92). Using the first two waves (baseline and 6-month time points) of data, we estimated a series of negative binomial regression models to observe the main and interactive effects of parental warmth and monitoring on adolescent victimization and the potential moderating influence of neighborhood disorder. The results indicate that the combination of warmth and monitoring reduces adolescent victimization, and that parental warmth may be particularly important for protecting adolescents in neighborhoods with moderate-high levels of disorder.

Evaluating Callous-Unemotional Traits as a Personality Construct.

We evaluate the importance of callous-unemotional (CU) traits as a personality construct in isolation from other facets of psychopathy. Specifically, we review research suggesting that these traits are useful for designating a subgroup of youth with serious conduct problems who differ from other antisocial youth on important biological, emotional, cognitive, and social characteristics. In addition, the temperamental features related to CU traits are risk factors for impairments in conscience development in young children. Thus, these traits could advance theoretical models explaining the development of severe antisocial behavior and psychopathy. CU traits also have important clinical utility because they designate a particularly severe and impaired subgroup of antisocial youth, leading to their inclusion in the DSM-5. As a result of this inclusion in diagnostic classification, there has been an increased focus on how to best assess CU traits, and we discuss several key issues in their assessment, highlighting several limitations in existing measures. Finally, the increased use of CU traits, separately from other facets of psychopathy, makes it important to determine how these traits relate to other personality constructs. Thus, we examine how measures of CU traits relate to the broader construct of psychopathy and to other basic personality dimensions.

Callous-unemotional traits and adolescents' role in group crime.

The current study examined the association of callous-unemotional (CU) traits with group offending (i.e., committing a crime with others; gang involvement) and with the role that the offender may play in a group offense (e.g., being the leader). This analysis was conducted in an ethnically and racially diverse sample (N = 1,216) of justice-involved adolescents (ages 13 to 17) from 3 different sites. CU traits were associated with a greater likelihood of the adolescent offending in groups and being in a gang. Importantly, both associations remained significant after controlling for the adolescent's age, level of intelligence, race and ethnicity, and level of impulse control. The association of CU traits with gang membership also remained significant after controlling for the adolescent's history of delinquent behavior. Further, CU traits were associated with several measures of taking a leadership role in group crimes. CU traits were also associated with greater levels of planning in the group offense for which the adolescent was arrested, although this was moderated by the adolescent's race and was not found in Black youth. These results highlight the importance of CU traits for understanding the group process involved in delinquent acts committed by adolescents. They also underscore the importance of enhancing the effectiveness of treatments for these traits in order to reduce juvenile delinquency.

Annual research review: A developmental psychopathology approach to understanding callous-unemotional traits in children and adolescents with serious conduct problems.

Recent research has suggested that the presence of significant levels of callous-unemotional (CU) traits designates a clinically important and etiologically distinct subgroup of children and adolescents with serious conduct problems. Based on this research, CU traits have been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5; American Psychiatric Association, 2013)--as a specifier for the diagnosis of conduct disorder. In this review, we attempt to understand CU traits within a developmental psychopathological framework. Specifically, we summarize research on the normal development of the prosocial emotions of empathy and guilt (i.e., conscience) and we illustrate how the development of CU traits can be viewed as the normal development of conscience gone awry. Furthermore, we review research on the stability of CU traits across different developmental periods and highlight factors that can influence this stability. Finally, we highlight the implications of this developmental psychopathological framework for future etiological research, for assessment and diagnostic classification, and for treatment of children with serious conduct problems.

Correlates and moderators of child pornography consumption in a community sample.

This study compares pornography users who report child pornography (CP) consumption with those who do not on demographic characteristics (age, ethnicity, and education level), psychological characteristics (e.g., loneliness, attachment style, anxiety, and sensation seeking), frequency of pornography use, and intentions to engage in contact sexual abuse. Participants were recruited on the Internet to complete an online anonymous survey about "problematic pornography use." Approximately, one fifth of the recruited male pornography users (21%, n = 37) reported consuming CP. The two groups were similar on all demographic and psychological characteristics. However, the probability of CP consumption was the greatest among men scoring high on a measure of sensation seeking who reported frequent pornography use (i.e., statistical moderation). CP consumers also reported a greater interest in engaging in sexual contact with a minor than non-CP consumers.

The Inventory of Callous-Unemotional Traits (ICU) self-report version: Factor structure, measurement invariance, and predictive validity in justice-involved male adolescents.

The Inventory of Callous-Unemotional Traits (ICU) is a widely used measure of callous-unemotional (CU) traits that may aid in the assessment of the diagnostic specifier "with limited prosocial emotions," which has been added to diagnostic criteria for conduct disorder. Though there is substantial support for use of the ICU total score, the scale's factor structure has been highly debated. Inconsistencies in past factor analyses may be largely attributed to failure to control for method variance due to item wording (i.e., half of the items being worded in the callous direction and half worded in the prosocial direction). Thus, the present study used a multitrait-multimethod confirmatory factor analytic approach that models both trait and method variance to test the factor structure of the ICU self-report in a clinically relevant, high-risk sample of justice-involved male adolescents (N = 1,216). When comparing the fit of empirical and theoretical models, goodness of fit indices (χ² = 1105.877, df = 190, root-mean-square error of approximation = .063, comparative fit index = .916, Tucker-Lewis index = .878, standardized root-mean-square residual = .051) provided support for a hierarchical four-factor model (i.e., one overarching callous-unemotional factor, four latent trait factors) when accounting for method variance (i.e., covarying positively worded items). This factor structure is consistent with the way the ICU was constructed and with criteria for the limited prosocial emotions specifier. In addition, measurement invariance of this factor structure across age, race, and ethnicity was supported, and the predictive validity of the ICU was supported across these demographic groups in predicting self-reported antisocial behavior and rearrests over a 5-year period following an adolescent's first arrest. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differential Item Functioning of the Youth Psychopathic Traits Inventory Across Race/Ethnicity and Gender Among a Sample of Justice-Involved Youth: An Item Response Theory Analysis.

Research is yet to examine whether the items of the Youth Psychopathic Traits Inventory (YPI) function equally well across race/ethnicity and gender. The current study applies an item response theory analysis to detect differential item functioning (DIF) of the YPI subscale across White, Black, and Hispanic youth and males and females among a sample of justice-involved youth. Significant DIF was detected for several items between Black youth and White youth and Black youth and Hispanic youth. Few incidences of DIF emerged between White and Hispanic youth and between males and females. The findings suggest that subscales of the YPI provide more information for White and Hispanic youth compared with Black youth. They also suggest that while there was significant DIF in the difficulty of items, the direction of DIF did not substantially favor one group or another. Thus, the findings suggest that the YPI produces comparable estimates of psychopathic traits for females and males and for White and Hispanic youth. However, the results raise concerns about comparing YPI subscale scores between White and Black youth and Hispanic and Black youth. The findings have important implications for the use of the YPI subscales among diverse samples.

Examining Differences in the Effect of Vicarious and Personal Procedural Justice on Legal Orientations and Offending Across Race/Ethnicity Among a Sample of Serious Juvenile Offenders.

In the current study it is examined if the impact of vicarious and personal perceptions of procedural justice on legal cynicism, legitimacy, and offending across time is invariant across race/ethnicity. Using longitudinal data from a sample of serious juvenile offenders from the Pathways to Desistance, the within- and between-individual associations of procedural justice, legal orientations, and offending were tested. Race/ethnic-specific models were estimated to examine differences across race/ethnicity. Positive personal and vicarious experiences with police had positive effects on legal orientations (i.e., legitimacy and cynicism), while vicarious experiences were more influential on offending compared to personal experiences. These effects were consistent across race/ethnicity. Both changes in legitimacy (positive) and cynicism (negative) were important for understanding changes in offending; however, the effect of cynicism was more consistent across race/ethnicity. The findings suggest that procedurally just treatment of juveniles by police can enhance legal compliance.