Characterising youth with callous–unemotional traits and concurrent anxiety: evidence for a high-risk clinical group

Abstract

Growing evidence supports the existence of two variants of youth with high callous–unemotional (CU) traits who present with markedly different risk profiles and outcomes, with potential implications for risk assessment and treatment formulation. So far, studies have identified variants of CU youth mainly using data-driven cluster approaches based on levels of CU traits and co-occurring anxiety. Yet, the extent to which this knowledge may be translated into clinical practice is unclear. To this end, the present study employed a severity-based, cut-off approach to systematically characterise CU groups across a range of clinically informative domains, including trauma history, psychiatric symptomatology, affective functioning, attachment style and behavioural risk. Analyses were based on multi-rated data from a community sample of high-risk youths (n = 155, M = 18 years). Consistent with previous studies, we found that, whereas variants show comparable levels of antisocial behaviour, those who present with both high CU and high anxiety report more severe childhood maltreatment, psychological distress, ADHD symptomatology and behavioural risk—including substance use, suicidal ideation and unsafe sex. In addition, these youth show greater attachment insecurity and affective dysregulation, as indexed by levels of irritability and alexithymia. Together, findings indicate that (1) trauma history is a key factor that differentiates variants of CU youth high vs. low on anxiety, and (2) differences in individual functioning across variants point to the need for tailored clinical assessment tools and intervention strategies. Importantly, the present findings indicate that variants of CU youth can be meaningfully differentiated using cut-off based approaches that parallel methods used in clinical assessments.

Identifying Patterns of Emotional and Behavioural Problems in Preschool children : Facilitating Early Detection

“…Within the field of developmental psychology, emotional regulation as well as empathic problems are especially associated with behavioural difficulties. In time, emotional regulation problems can result in major negative effects on relationships with both children and adults alike (Cecil, McCrory, Barker, Guiney & Viding, 2018;Robins, 1966;Valiente et al, 2004). A child's character or temperament affects how they are treated by the people in their surroundings.…”

“…Worse outcomes are more common in children with comorbid disruptive/aggressive disorders, a group which also experiences a greater level of overall impairment (Hinshaw & Melnick, 1995). A number of these comorbid disorders change from childhood to adulthood; for example, mood and anxiety disorders, with nicotine and substance use developing later (Cecil et al, 2018;Wilens & Spencer, 2010).…”

“…Depression in preadolescence often exists in comorbidity with ADHD and conduct problems, and in adolescence with oppositional-defiant problems and substance abuse. Even anxiety is found to be comorbid with disruptive behavioural problems and substance abuse in adolescence (Cecil et al, 2018;Lewis & Rudolph, 2014). This comorbidity of internalised and externalised problems is worth investigating even among preschool children.…”

“…It is also likely that the problematic behaviour seen in preschool children stems from the child's "normal reactions to abnormal situations" in the environment (Egger & Angold, 2006). There are several factors constituting the aforementioned mechanisms, ranging from innate vulnerability and early relational disturbances, through traumatic experiences and psychosocial stressors, to organic injuries, as well as a combination of causal factors, such as the above in combination with inheritance, context and environment (Cecil et al, 2018;McCrory et al, 2010). This does not reduce the need for detection and intervention; quite the opposite, if there is something wrong in the child's environment, it should be acted upon.…”

Primary and Secondary Variants of Psychopathy in a Volunteer Sample Are Associated With Different Neurocognitive Mechanisms

“…In both childhood and adulthood, those with a secondary presentation do not appear to present with a simple combination of callous/unempathetic and anxious vulnerabilities, but rather show distinct behavioral and psychiatric features not explained by either set of vulnerabilities alone (20, 22–24). Such a secondary presentation has been linked to experiences of significant childhood adversity (23), and is proposed to have a distinct aetiology from the primary, putatively heritable, presentation (25).…”