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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.

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., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Low emotional responsiveness is considered a core feature of callous-unemotional (CU) traits in childhood and, in the context of antisocial behavior, a precursor of psychopathic traits in adulthood. However, recent findings suggest that CU traits are not always characterized by low emotional responsiveness and the evidence base requires review. This review asks a fundamental question- 'Is callous always cold?'-with a specific focus on emotional responsiveness and CU traits in children with conduct problems (CPs). PRISMA review protocols were followed to identify literature reporting on emotional responsiveness for children 3-18 years with CPs and varying (high and low) CU traits. Results from eligible studies were contrasted by age (children 3-11 years, adolescents 12-18 years), emotional responsive measurement type (physiological, behavioral, self-report), emotion-eliciting stimuli type (interactive activities, static imagery, film) and socio-emotional context of the stimuli (other-orientated, self-orientated, neutral). This review highlights considerable variation in results across studies: reduced emotional responsiveness was not synonymous with participants demonstrating high CU traits. A more consistent picture of reduced emotional responsiveness in participants with high CU traits was found when studies used physiological measures, when stimuli were other-orientated in socio-emotional context, and in older, adolescent samples. In conclusion, this paper advocates for a more nuanced understanding of the relationship between high CU traits and the specific factors involved in emotional responsiveness, ultimately suggesting that callous is not always cold. Given that emotional responsiveness is central to theories of moral development, these findings may suggest innovative approaches to early intervention.

Support for the clinical importance of callous and unemotional (CU) traits has grown considerably in recent years, yet tools for the assessment of CU traits in clinical settings have largely been limited to questionnaires. This study examined the validity of the Clinical Assessment of Prosocial Emotions (CAPE 1.1), a newly developed clinician-rating measure of CU traits in children and adolescents. Participants were children aged 3 to 15 years ( N = 82; 75% male) who were referred for treatment of conduct problems. Diagnoses of conduct disorder and oppositional defiant disorder were formulated based on semistructured diagnostic interviews prior to treatment. The CAPE 1.1 was scored based on structured interviews administered jointly to mothers and fathers and was validated with questionnaire measures of CU traits and other correlates of CU traits from multiple informants. Evidence of criterion validity was found in significant associations between CAPE 1.1 scores and questionnaire measures of CU traits completed by mothers, fathers, and teachers. Evidence of construct validity was found in significant associations between CAPE 1.1 scores and established correlates of CU traits, including severity of oppositional defiant disorder/conduct disorder symptoms indexed via diagnostic interview with parents, teacher ratings of proactive aggression, and reports of affective empathy by mothers and fathers. These findings provide support for the clinical utility of the CAPE 1.1 and its inclusion as part of a comprehensive assessment of children and adolescents with conduct problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Parents' attributions about their child's personality and behaviour are known to predict the quality of parent-child interactions and outcomes for the child, including those from parenting interventions. Nothing is known, however, about the quantity and quality of attributions parents use during free speech about their children referred for treatment of behavioural and emotional problems. We tested hypotheses about the types of attributions and associations among parental attributions, parental psychopathology and child conduct problems, using 504 five-minute speech samples (FMSS) coded using the Parent Attribution Speech Sample (PASS) coding system. Both mothers and fathers talked about their thoughts and feelings regarding their children with disruptive behaviour problems (N = 295; 74% male; 3-8 years old). The assessment of spontaneous parental attributions via the PASS coding system was shown to be valid and reliable. Mothers made more negative, dispositional attributions than fathers, however, parents of either gender made, on average, more positive than negative attributions about their children. Parents' natural attributions about these children with emotional and behavioural problems were rather independent from parents' own mental health, but were consistently related to child factors. Specifically, across parent gender and across all attribution dimensions, levels of callous-unemotional traits were associated with spontaneous parental attributions above and beyond other child and parent factors. Overall, the results show that parents' spontaneous speech about referred children contains important information about their causal attributions, and that these are associated with child temperament rather than specific referral symptoms.

Objective: We examined the relative efficacy of an online versus face-to-face (FTF) parenting intervention for reducing the severity of child conduct problems and related parent and child outcomes in 2 randomized controlled trials., Method: In Study 1, rural families ( n = 133) with a child 3-9 years of age with a full or subclinical primary diagnosis of oppositional defiant or conduct disorder traveled to Sydney, Australia for a comprehensive assessment and randomization to receive either AccessEI, a 6-10 week online therapist-assisted parenting program, or FTF treatment, whereby they received the same program presented FTF during a 1-week treatment. To control for unavoidable treatment dosage differences in the first study, Study 2 was conducted in which urban families ( n = 73) with a child aged 3 to 14 years meeting similar criteria as Study 1 were randomized to receive AccessEI versus FTF treatment., Results: In both studies, improvements in severity of child diagnoses and maternal measures of child behavior showed very large effect sizes for both treatments at posttreatment and 3-month follow-up and did not differ across treatment conditions. There were moderate effect sizes for improvements in parent mental health and no differences across treatment conditions., Conclusions: It is concluded that the effects of the therapist-assisted online parenting interventions for the treatment of child conduct problems were similar to a FTF intervention, providing evidence for the effectiveness of an accessible treatment for rural and remote families. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: High levels of callous-unemotional (CU) traits are associated with reduced effectiveness of parenting programmes for children with conduct problems. This may be due to low levels of emotional engagement (EE) by these children with their parents. We evaluate a theoretically driven strategy for improving emotional engagement in high CU traits children undergoing a parenting intervention (parent management training; PMT) for child conduct problems., Methods: N = 40, 3- to 8-year-old children referred for conduct problems and showing stable, high levels of CU traits, were randomised to receive PMT+Emotional Engagement (EE), or the control condition PMT+Child Centred Play (CCP). A benchmarking sample of N = 70 children who received PMT only was also included. Observational coding of the parent-child interactions targeted by EE and CCP respectively was repeated throughout treatment and follow-up., Results: Emotional engagement produced unique improvements in parent-child emotional engagement (shared eye gaze); however, these reverted to baseline levels after treatment. CCP produced unique improvements in parents' child centeredness and child positive play, but by post-treatment, all children had improved on these factors. Both interventions produced similar improvements in general parental warmth. Reductions in severity of conduct problems at post-treatment and follow-up were large in size and did not differ between conditions or from the benchmarking group. Levels of CU traits reduced significantly but again did not differ between groups., Conclusions: The putative mechanism of emotional engagement through reciprocated eye gaze proved to be impervious to sustained change, and thus failed to have a specific impact of conduct problems or levels of CU traits. The development of novel treatment approaches to children with high levels of CU is a challenging endeavour, and these results indicate that focussing on children with stable levels at pretreatment should be a priority., (© 2019 Association for Child and Adolescent Mental Health.)

We present and evaluate a new self-report measure of parental attributions developed for assessing child causal and dispositional attributions in parenting interventions. The Parent Attribution Measure (PAM) ascribes attributions along first-order dimensions of intentionality, permanence, likeability, and disposition, and a higher-order Total Scale. The psychometric analyses involved participants drawn from populations of clinical (n = 318) and community-based families (n = 214) who completed questionnaires assessing parental attributions, parenting behaviours, parental depression, parental feelings about the child, and child behavioural problems. Confirmatory factor analysis indicated that a 3-factor hierarchical structure provided a close fitting model. The model with intentionality, permanence, and disposition (consolidating likeability and disposition) dimensions as first-order factors grouped under a higher-order general factor was validated in independent samples and demonstrated sound psychometric properties. The PAM presents as a brief measure of parental attributions assessing parents' intentionality, permanence, and dispositional attributions of their child with conduct problems.

Children with co-occurring conduct problems and callous-unemotional (CU) traits show a distinct pattern of early starting, chronic, and aggressive antisocial behaviors that are resistant to traditional parent-training interventions. The aim of this study was to examine in an open trial the acceptability and initial outcomes of a novel adaptation of Parent-Child Interaction Therapy, called PCIT-CU, designed to target 3 distinct deficits of children with CU traits. Twenty-three Australian families with a 3- to 6-year-old (M age = 4.5 years, SD = .92) child with clinically significant conduct problems and CU traits participated in the 21-week intervention and 5 assessments measuring child conduct problems, CU traits, and empathy at a university-based research clinic. Treatment retention was high (74%), and parents reported a high level of satisfaction with the program. Results of linear mixed models indicated that the intervention produced decreases in child conduct problems and CU traits, and increases in empathy, with "medium" to "huge" effect sizes (ds = 0.7-2.0) that maintained at a 3-month follow-up. By 3 months posttreatment, 75% of treatment completers no longer showed clinically significant conduct problems relative to 25% of dropouts. Findings provide preliminary support for using the targeted PCIT-CU adaptation to treat young children with conduct problems and co-occurring CU traits.

Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P-Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a 'no intervention' scenario, using a health sector perspective. The model targeted a cohort of 5-9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471-1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146-39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

This study investigated the stability of callous and unemotional (CU) traits across generations by assessing self-report assessments of psychopathy factors in parents and their relationship to children's CU traits in a clinical sample: 223 boys (M age = 7.65) and 83 girls (M = 7.35) referred for treatment of disruptive behavior disorders. First, we expanded previous findings showing a positive relationship between maternal psychopathy scores and CU traits in boys. Second, we tested whether parental psychopathy scores predicted CU traits in children over and above general indicators of mental health risk: parental psychopathology, parental warmth, and harsh parenting. Fathers' psychopathy factor 1 was uniquely related to CU traits. In contrast, the relationship between mothers' psychopathy factor 2 and children's CU traits disappeared when maternal warmth was included. Gender differences suggested these results are most applicable to boys. These findings support the intergenerational stability of psychopathy factor 1 between children and their fathers.

The role of environmental adversity in the development of high callous-unemotional (CU) traits in children is controversial. Evidence speaks to the traits being largely independent of adversity; however, recent data shows that those with high CU traits and high adversity and/or high anxiety might differ in important ways from those with no such history. We tested this using emotion recognition (ER) skills. We tested whether maltreatment history and anxiety levels moderated the relationship between level of CU traits and ER skills in N = 364 children with behavioral problems who were 3 to 16 years old. As hypothesised, in the full sample, the relationship between CU traits and ER differed according to maltreatment history, such that CU traits were associated with poorer recognition for those with zero or negligible history of maltreatment. This moderation of the CU-ER relationship by maltreatment was inconsistent across subgroups, however, and for the cohort utilizing youth self-report of maltreatment, high CU traits were associated with poor ER in those with lower anxiety levels. Maltreatment history and/or anxiety levels can identify different emotional impairments associated with high CU traits, and the impairments might be characteristic of "primary" high CU traits defined as occurring independently of maltreatment and/or high anxiety.

Callous-unemotional traits (CU) are defined by low responsiveness to, and unfeeling disregard for the emotions of others. There is controversial evidence, however, that children with high CU traits can demonstrate affective responsiveness under certain conditions, namely those associated with attachment threat. We tested this using 'fear + amusing' and 'attachment rich' stimuli from the Lion King film. Of N = 76, 4-14 years old children, 56 were clinic-referred children divided into high and low CU traits groups, and 20 children were drawn from the community. Participants watched film sequences of fearful, attachment-related and neutral stimuli and their affective responses and emotion-regulation strategies were coded by independent observers. Children in the high CU traits group were able to disengage from the fear stimuli by showing more 'happiness' to a brief slapstick interlude. In the attachment scenario, high CU children expressed similar or trends toward higher emotional responses and emotion regulation strategies, compared to low-CU children and control children. The results support the idea that high CU children may have the potential for emotional responsiveness to complex emotional stimuli in attachment contexts. Implications of these results for the development of interventions are discussed.

Callous-unemotional (CU) traits and autism spectrum disorders (ASD) symptoms are characterized by problems in empathy; however, these behavioral features are rarely examined together in children with conduct problems. This study investigated additive and interactive effects of CU traits and ASD symptoms in relation to cognitive and affective empathy in a non-ASD clinic-referred sample. Participants were 134 children aged 3 to 9 years (M=5.60; 79% boys) with oppositional defiant/conduct disorder, and their parents. Clinicians, teachers, and parents reported on dimensions of child behavior, and parental reports of family dysfunction and direct observations of parental warmth/responsiveness assessed quality of family relationships. Results from multiple regression analysis showed that, over and above the effects of child conduct problem severity and quality of family relationships, both ASD symptoms and CU traits were uniquely associated with deficits in cognitive empathy. Moreover, CU traits demonstrated an independent association with affective empathy, and this relationship was moderated by ASD symptoms. That is, there was a stronger negative association between CU traits and affective empathy at higher versus lower levels of ASD symptoms. These findings suggest including both CU traits and ASD-related social impairments in models delineating the atypical development of empathy in children with conduct problems., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The treatment of conduct problems among children and adolescents with callous-unemotional (CU) traits has been subject to much speculation; however, treatment outcome research has been surprisingly limited and findings have been mixed. This review examines the research to date in this field as it pertains to two key questions. First, are CU traits associated with clinical outcomes and processes in the family based treatment of child and adolescent conduct problems? Second, can family based intervention produce change in CU traits? Using a systematic search strategy, we identified 16 treatment outcomes studies that can be brought to bear on these questions. These studies provide strong evidence of unique associations between CU traits and risk for poor treatment outcomes, while at the same time indicating that social-learning-based parent training is capable of producing lasting improvement in CU traits, particularly when delivered early in childhood. We discuss the potential for this emerging evidence base to inform the planning and delivery of treatments for clinic-referred children with CU traits, and detail an ongoing program of translational research into the development of novel interventions for this high-risk subgroup.

The co-occurrence of child conduct problems (CPs) and callous-unemotional (CU) traits confers risk for psychopathy. The oxytocin (OXT) system is a likely candidate for involvement in the development of psychopathy. We tested variations in the OXT receptor gene (OXTR) in CP children and adolescents with varying levels of CU traits. Two samples of Caucasian children, aged 4-16 years, who met DSM criteria for disruptive behavior problems and had no features of autism spectrum disorder, were stratified into low versus high CU traits. Measures were the frequencies of nine candidate OXTR polymorphisms (single nucleotide polymorphisms). In Sample 1, high CU traits were associated with single nucleotide polymorphism rs1042778 in the 3' untranslated region of OXTR and the CGCT haplotype of rs2268490, rs2254298, rs237889, and rs13316193. The association of rs1042778 was replicated in the second rural sample and held across gender and child versus adolescent age groups. We conclude that polymorphic variation of the OXTR characterizes children with high levels of CU traits and CPs. The results are consistent with a hypothesized role of OXT in the developmental antecedents of psychopathy, particularly the differential amygdala activation model of psychopathic traits, and add genetic evidence that high CU traits specify a distinct subgroup within CP children.

Child conduct problems (CPs) are a robust predictor of adult mental health; the concurrence of callous-unemotional (CU) traits confers specific risk for psychopathy. Psychopathy may be related to disturbances in the oxytocin (OXT) system. Evidence suggests that epigenetic changes in the OXT receptor gene (OXTR) are associated with lower circulating OXT and social-cognitive difficulties. We tested methylation levels of OXTR in 4- to 16-year-old males who met DSM criteria for a diagnosis of oppositional-defiant or conduct disorder and were stratified by CU traits and age. Measures were DNA methylation levels of six CpG sites in the promoter region of the OXTR gene (where a CpG site is a cytosine nucleotide occurs next to a guanine nucleotide in the linear sequence of bases along its lenth, linked together by phosphate binding), and OXT blood levels. High CU traits were associated with greater methylation of the OXTR gene for two cytosine nucleotide and guanine nucleotide phosphate linked sites and lower circulating OXT in older males. Higher methylation correlated with lower OXT levels. We conclude that greater methylation of OXTR characterizes adolescent males with high levels of CU and CPs, and this methylation is associated with lower circulating OXT and functional impairment in interpersonal empathy. The results add genetic evidence that high CU traits specify a distinct subgroup within CP children, and they suggest models of psychopathy may be informed by further identification of these epigenetic processes and their functional significance.

Clinical theory predicts that individuals high in psychopathic traits possess average or above average intelligence; however findings in adult and child samples have been mixed. The present study aimed to investigate (1) the relationship between verbal and nonverbal intelligence and the three dimensions of psychopathy (callous-unemotional (CU) traits, narcissism, impulsivity); and (2) whether these dimensions moderate the association between verbal and nonverbal intelligence and the severity of antisocial behavior. Participants were 361 adolescents aged 9-18 years (68% boys) and their parents, drawn from four samples with different levels of risk for antisocial behavior. Families were disadvantaged and 25% were from an ethnic minority. Verbal intelligence was unrelated to parent-reported CU traits, narcissism or impulsivity after controlling for gender, sociodemographic disadvantage, sample, antisocial behavior and hyperactivity. Narcissism, but not CU traits or impulsivity, was significantly related to lower nonverbal IQ. None of the three psychopathic trait dimensions moderated the relationship between verbal or nonverbal IQ and antisocial behavior. CU traits, narcissism, hyperactivity and inclusion in the very high or high risk samples were significantly related to more severe antisocial behavior. Results contradict the widely held view that psychopathic traits are associated with better than average verbal or nonverbal intelligence., (Crown Copyright © 2013 Published by Elsevier Ireland Ltd. All rights reserved.)

The co-occurrence of conduct problems (CPs) and high callous-unemotional (CU) traits specifies risk for adult psychopathy and is under a high genetic influence. A previous genome-wide pooled DNA study of 7-year olds identified a set of candidate single-nucleotide polymorphisms (SNPs) that might differentiate high CP+CU children from healthy children. We attempted to replicate an identified subset of these SNP-psychopathy associations. In a case-control design, 210 clinically referred children were partitioned into Comparison, High CP+Low CU, and High CP+CU groups and genotyped. One SNP, rs13064369, differentiated the groups but was associated with high CP, regardless of the level of CU traits, that is, the rare and heterozygote variants CC and CT were significantly more frequent in both CP groups compared with Comparisons but did not differ from each other. We replicated the finding that a polymorphism associated with the ROBO2 gene, which is involved in neurodevelopment, confers risk for the common emotionally reactive, impulsive aspects of conduct disorder, independent of concurrent risk for psychopathy.

Objective: This study examined whether the diminished treatment response previously reported for children with conduct problems and high levels of callous-unemotional (CU) traits is evident when these traits are indexed using multi-informant data collected from mothers, fathers, and teachers. It also tested whether treatment outcomes associated with CU traits are independent of overlap between CU traits and autism spectrum disorder (ASD) symptoms., Method: Diagnostic data on oppositional defiant disorder (ODD) severity were collected pre-treatment (time 1) and at 6-month follow-up (time 2) in a sample of children (N = 95; 67 boys, 28 girls) aged 3-9 years with clinic-referred conduct problems and comorbid symptoms in a range of diagnostic domains. Time 1 measures of CU traits and ASD symptoms were tested as predictors of time 2 ODD severity using structural equation modeling, with multi-informant ratings of CU traits modeled as a single latent variable., Results: Compared to children with low levels of CU traits, those with high levels exhibited more severe ODD symptoms at follow-up (β = 0.33, SE = 0.08, p < 0.05), after controlling for pre-treatment severity, socio-economic status, other demographics (age, gender), and parameters of treatment (number of treatment sessions, medication status). Although CU traits and ASD symptoms were positively correlated, ASD symptoms showed no association with change in ODD severity from pre-treatment to follow-up. Likewise, the association between CU traits and ODD outcomes held when controlling for covariation between CU traits and ASD symptoms., Conclusions: Our findings replicate previous evidence that CU traits are uniquely associated with poor clinical outcomes among children treated for conduct problems, and show for the first time that this association is not accounted for by symptoms of ASD.

In accordance with a recently proposed account of amygdala function in psychopathy, it is hypothesized that people with high levels of psychopathic personality traits have a bias in learning style to encode the general valence, and neglect the specific-features, of an outcome. We present a novel learning task designed to operationalize these biases in learning style. The results from pilot samples of healthy adults and children and from a clinical sample of children with conduct problems provide support for the validity of the learning task as a measure of learning style and demonstrate a significant relationship between general-valence style learning and psychopathic personality traits. It is suggested that this relationship may be important for the aetiology of the social-cognitive deficits exhibited by psychopaths. These preliminary results suggest that this measure of learning style has the potential to be utilized as a research tool and may assist with the early identification, and treatment, of children with conduct problems and high levels of callous-unemotional traits.

Impairments in emotion recognition skills are a trans-diagnostic indicator of early mental health problems and may be responsive to intervention. We report on a randomized controlled trial of "Emotion-recognition-training" (ERT) versus treatment-as-usual (TAU) with N=195 mixed diagnostic children (mean age 10.52 years) referred for behavioral/emotional problems measured at pre- and 6 months post-treatment. We tested overall outcomes plus moderation and mediation models, whereby diagnostic profile was tested as a moderator of change. ERT had no impact on the group as a whole. Diagnostic status of the child did not moderate outcomes; however, levels of callous-unemotional (CU) traits moderated outcomes such that children with high CU traits responded less well to TAU, while ERT produced significant improvements in affective empathy and conduct problems in these children. Emotion recognition training has potential as an adjunctive intervention specifically for clinically referred children with high CU traits, regardless of their diagnostic status., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: In children with conduct problems, high levels of callous-unemotional traits are associated with amygdala hypoactivity to consciously perceived fear, while low levels of callous-unemotional traits may be associated with amygdala hyperactivity. Behavioral data suggest that fear processing deficits in children with high callous-unemotional traits may extend to stimuli presented below conscious awareness (preattentively). The authors investigated the neural basis of this effect. Amygdala involvement was predicted on the basis of its role in preattentive affective processing in healthy adults and its dysfunction in previous studies of conduct problems., Method: Functional MRI was used to measure neural responses to fearful and calm faces presented preattentively (for 17 ms followed by backward masking) in boys with conduct problems and high callous-unemotional traits (N=15), conduct problems and low callous-unemotional traits (N=15), and typically developing comparison boys (N=16). Amygdala response to fearful and calm faces was predicted to differentiate groups, with the greatest response in boys with conduct problems and low callous-unemotional traits and the lowest in boys with conduct problems and high callous-unemotional traits., Results: In the right amygdala, a greater amygdala response was seen in boys with conduct problems and low callous-unemotional traits than in those with high callous-unemotional traits. The findings were not explained by symptom levels of conduct disorder, attention-deficit hyperactivity disorder, anxiety, or depression., Conclusions: These data demonstrate differential amygdala activity to preattentively presented fear in children with conduct problems grouped by callous-unemotional traits, with high levels associated with lower amygdala reactivity. The study's findings complement increasing evidence suggesting that callous-unemotional traits are an important specifier in the classification of children with conduct problems.

Background: Antisocial children with callous-unemotional (CU) traits appear to be disconnected from other people's emotions; although little is known about their experience of the parent-child emotional bond. This study examined parent-child attachment relationships and levels of CU traits in conduct-problem children., Method: Attachment classifications in boys (M = 6.31 years) with disruptive behaviour disorders were assessed using the Manchester Child Attachment Story Task. Multiple informants rated children's CU traits., Results: Independent of severity of conduct problems, high levels of CU traits were associated with more insecure attachment; specifically, disorganised attachment representations; however, CU traits were not associated with avoidant representations., Conclusions: Among conduct-problem children, those higher on CU traits appear to be at increased risk of experiencing disruptions in parent-child attachment relationships; attachment may be an important area for treatment and prevention efforts for CU traits in young children., (© 2012 The Authors. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.)

Background: A propensity to attend to other people's emotions is a necessary condition for human empathy., Aims: To test our hypothesis that psychopathic disorder begins as a failure to attend to the eyes of attachment figures, using a `love' scenario in young children., Method: Children with oppositional defiant disorder, assessed for callous-unemotional traits, and a control group were observed in a love interaction with mothers. Eye contact and affection were measured for each dyad., Results: There was no group difference in affection and eye contact expressed by the mothers. Compared with controls, children with oppositional defiant disorder expressed lower levels of affection back towards their mothers; those with high levels of callous-unemotional traits showed significantly lower levels of affection than the children lacking these traits. As predicted, the former group showed low levels of eye contact toward their mothers. Low eye contact was not correlated with maternal coercive parenting or feelings toward the child, but was correlated with psychopathic fearlessness in their fathers., Conclusions: Impairments in eye contact are characteristic of children with callous-unemotional traits, and these impairments are independent of maternal behaviour.

This study examined relationships between parent-child emotional communication and callous-unemotional (CU) traits and conduct problems. References to negative and positive emotions made by clinic-referred boys (3-9 years) and their parents were coded from direct observations of family interactions involving the discussion of shared emotional experiences. Although frequencies of parents' emotion expression did not generally relate to levels of CU traits, boys higher on CU traits were observed to be more expressive of negative emotions in conversation with their caregivers-specifically for sadness and fear. Independent coders did not judge these children to be less genuine in their emotion expression compared to their low-CU counterparts. We also examined whether CU traits moderated the relationship between parents' focus on emotions and conduct problem severity. Higher levels of maternal focus on negative emotions were found to be associated with lower conduct problems in high-CU boys but related to higher conduct problems in low-CU boys. Frequencies of fathers' emotional communication were unrelated to either child CU traits or conduct problems. We discuss the implications of these findings for the conceptualization of CU traits in preadolescent children, and interventions for conduct problems in children elevated on these traits.

Background: Research suggests that parenting has little influence on the development of antisocial behavior in children with callous-unemotional (CU) traits. We aimed to extend and improve on prior studies examining the moderating role of CU traits on associations between parenting and conduct problems, by using independent observations of two key dimensions of parenting: coercion and warmth., Methods: The participants included clinic-referred conduct-disordered boys (4-12 years; N = 95) and their families. Coercive parenting was coded from observations of family interaction and parental warmth was coded from Five-Minute Speech Samples. CU traits and conduct problems were rated by multiple informants., Results: In both mothers and fathers, CU traits moderated links between observed parenting and conduct problems. Specifically, coercive parenting was more strongly positively associated with conduct problems in boys with lower levels of CU traits, whereas parental warmth was more strongly negatively associated with conduct problems in boys with higher levels of CU traits., Conclusions: These findings suggest that different dimensions of parenting may need to be targeted in the treatment of early onset conduct problems in children high and low on CU traits., (© 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.)

Background: A pervasive failure to attend and respond to emotionally salient stimuli is a core feature of psychopathy. We hypothesise that this begins early in life and is expressed most importantly as a failure to attend to core emotional features (viz., the eyes) of attachment figures. The current study tested whether impaired eye contact is a characteristic of children with antisocial behaviour and callous-unemotional (CU) traits in real life settings., Methods: Conduct problem males were assessed on levels of CU traits and observed in free play and 'emotion talk' scenarios with their parents. Eye contact was measured for each dyad (child to mother, child to father, mother to child, father to child) as a proportion of intervals in which the child and parent interacted., Results: Levels of eye contact were reciprocated in mother-son and father-son dyads, but males with high CU traits showed consistent impairments in eye contact towards their parents. Mothers of high CU boys did not show impairments; however, fathers of high CU boys showed similar impairment. Levels of eye contact were also associated with independent measures of fear recognition, and general empathy in the boys., Conclusions: The findings provide the first evidence that impairments in eye contact, previously shown during computer tasks, characterise psychopathic traits in young males., (© 2010 The Authors. Journal of Child Psychology and Psychiatry © 2010 Association for Child and Adolescent Mental Health.)

To assess the effectiveness of providing training in elaborative, emotion rich reminiscing (emotional reminiscing, ER) as an adjunct to Parent Management Training (PMT) for parents of children (N = 38, M age = 56.9, SD = 15.8 months) with oppositional behaviors. Control parents received PMT and non-language adjunct intervention, child-directed play. All components of the intervention were manualized. Parents in both conditions received training in an abbreviated course of PMT. Parents in the ER condition additionally received brief training in discussing everyday past events with their child incorporating emotion labels and causes, "wh" questions, and detailed descriptive information. Parents in the control condition received training in allowing their child to lead during play sessions. Across both conditions, children's oppositional behaviors decreased between the beginning and end of training. Providing parents with training parents in an elaborative, emotion-rich reminiscing style resulted in greater parent and child use of elaborations and emotion references during shared conversations. Given findings in the literature of an association between parental emotion talk and children's emotional competence, developmental skills that are frequently compromised in oppositional children, the current pilot study has implications for interventions that broaden the focus of PMT.

This study examined stability and malleability in the callous-unemotional (CU) traits of young boys (M age = 6.29 years, SD = 1.55) referred to clinics with conduct problems who underwent a parent-training intervention. In contrast to the high stability predicted, CU scores dropped posttreatment for a subset of the sample. However, as hypothesized, posttreatment and 6-month follow-up measures of CU traits and general conduct problems were predicted by different variables. Post hoc analyses of cases grouped according to pattern of CU stability indicated that boys with the most stable high CU traits showed the poorest outcomes at follow-up.

Previous research has produced mixed findings on the role of child and family factors in the genesis of childhood cruelty. The authors examined the relationships of cruelty to animals to a range of child and family factors. First, the authors test the idea that cruelty is a callous aggression that will be more strongly associated with psychopathic (callous or unemotional, CU) traits than general externalizing problems. Second, the authors operationalize family problems as open conflict rather than parenting problems as used earlier. Results indicated that for both genders, CU traits were associated strongly with cruelty. For boys, externalizing problems also added prediction in regression analyses. Family conflict was not associated with cruelty for either. These results suggest that cruelty to animals may be an early manifestation of the subgroup of children developing conduct problems associated with traits of low empathy and callous disregard rather than the more common pathway of externalizing problems and parenting problems.

The aim of this study was to examine the impact of callous-unemotional (CU) traits on treatment outcomes and processes in a 10-week behavioral parent-training intervention with young boys referred for conduct problems (N = 56; mean age 6.29 years). CU traits were associated with greater conduct problems at pretreatment and with poor outcomes at 6-month follow-up. CU traits uniquely predicted clinical outcomes when analyzed in relation to conduct-problem severity, other predictors of antisocial behavior, and parents' implementation of treatment. Boys with high CU traits were less responsive to discipline with time-out than boys without CU traits and reacted to this discipline with less affect. These findings present important implications for the role of child temperament in intervention for conduct problems., (Copyright 2005 APA, all rights reserved.)

The psychometric and predictive validity of callous-unemotional (CU) traits as an early precursor of conduct disorder and antisocial behavior were assessed. A community sample of children (4-9 years of age) were tested 12 months apart with the Antisocial Process Screening Device (APSD; P. J. Frick & R. D. Hare, 2002), a measure of early signs of psychopathy in children. Factor analysis supported the structure of the APSD. Given controversy surrounding construct overlap between psychopathy and conduct problems, a factor analysis was conducted on pooled items from the Strengths and Difficulties Questionnaire and APSD. A 5-factor solution resulted: antisocial, hyperactivity, CU traits, anxiety, and peer problems. CU traits added small but significant improvements in the 12-month prediction of antisocial behavior for boys and older girls, after controlling for Time 1 measures. These results indicate that although the dimensions of the APSD overlap with dimensions of the disruptive behavior disorders, CU traits have unique predictive validity in childhood., ((c) 2005 APA, all rights reserved.)

Improving the parent–child relationship by using strategies based on social learning theory has become the cornerstone for the treatment of conduct problems in children. Over the past 40 years, interventions have expanded greatly from small, experimental procedures to substantial, systematic programmes that provide clear guidelines in detailed manuals on how practitioners should implement the standardised treatments. They are now widely disseminated and there is a great deal of empirical support that they are very effective for the majority of cases. However, evaluations of even the best of these evidence-based programmes show that a quarter to a third of families and their children do not benefit. What does the practitioner then do, when a standard social learning approach, diligently applied, doesn’t work? We argue that under these circumstances, some of the major theories of child development, family functioning and individual psychology can help the skilled practitioner think his or her way through complex clinical situations. This paper describes a set of practical strategies that can then be flexibly applied, based on a systematic theoretical analysis. We hold that social learning theory remains the core of effective parent training interventions, but that ideas from attachment theory, structural family systems theory, cognitive-attribution theory, and shared empowerment/motivational interviewing can each, according to the nature of the difficulty, greatly enrich the practitioner’s ability to help bring about change in families who are stuck. We summarise each of these models and present practical examples of when and how they may help the clinician plan treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Parent attributions about the causes of their children's behaviour problems are a known predictor of problematic parenting and ongoing child problems. However, their importance in parenting interventions remains unknown as research has not addressed whether parental attributions predict outcomes associated with parenting training. The current study examined whether problematic pre-treatment and change resistant parental attributions during treatment uniquely predict child behaviour outcomes. Method Participants were 250 families with children aged from 3 to 16 referred to specialist clinics for the treatment of conduct problems. Measures of family demographic information, parental attributions, and severity of child conduct problems were collected as part of pre-treatment, post-treatment, and 3-month follow-up assessments. Results Linear regression showed that mothers' pre-treatment parental attributions uniquely predicted severity of conduct problems at the post-treatment and 3-month follow-up assessments. Fathers' pre-treatment parental attributions uniquely predicted severity of conduct problems at the 3-month follow-up assessment. Reductions in problematic pre-treatment parental attributions were recorded at post-treatment for both parents. However, smaller reductions or increases in mothers' problematic attributions uniquely predicted worse child behaviour outcomes, a result not replicated for fathers. Conclusions Findings that pre-treatment and change resistant parental attributions predict poorer child behaviour outcomes after controlling for other predictors and treatment effects recommend that parental attributions should be assessed prior to and after treatment and possibly included in treatment to maximise treatment gains for children with conduct problems. Highlights • Parents differ in the attributions they make about their child and his/her behaviours. • Little is known about whether parental attributions predict parenting intervention outcomes. • Negative and change resistant parental attributions uniquely predicted poor treatment outcomes in the current study. • Parental attributions may be possibly inlcuded in treatment to maximise treatment gains for children with conduct problems. [ABSTRACT FROM AUTHOR]