Distinguishing primary and secondary variants of callous-unemotional traits among adolescents in a clinic-referred sample.

Abstract

The current study used model-based cluster analyses to determine if there are two distinct variants of adolescents (ages 11 - 18) high on callous-unemotional (CU) traits that differ on their level of anxiety and history of trauma. The sample (n = 272) consisted of clinic-referred youths who were primarily African-American (90%) and from low income families. Consistent with hypotheses, three clusters emerged, including a group low on CU traits, as well as two groups high on CU traits that differed in their level of anxiety and past trauma. Consistent with past research on incarcerated adults and adolescents, the group high on anxiety (i.e., secondary variant) was more likely to have histories of abuse and had higher levels of impulsivity, externalizing behaviors, aggression, and behavioral activation. In contrast, the group low on anxiety (i.e., primary variant) scored lower on a measure of behavioral inhibition. On measures of impulsivity and externalizing behavior, the higher scores for the secondary cluster only were found for self-report measures, not on parent-report measures. Youths in the primary cluster also were perceived as less credible reporters than youth in the secondary or cluster low on CU traits. These reporter and credibility differences suggest that adolescents within the primary variant may underreport their level of behavioral disturbance, which has important assessment implications.

Anxiety and Callous-Unemotional Traits: Physiological and Behavioral Responses to Others' Distress

“…It is possible that the increased attention to distress cues noted among CU youth experiencing anxiety represents a sensitivity to negative emotional cues in general, similar to the attentional biases towards negative-and threat-related cues (Mogg & Bradley, 2005;Reid et al, 2006), and bias towards interpreting ambiguous information negatively (Taghavi et al, 2000) documented among anxious children. While CU traits have not previously been associated with a hostile attribution bias (HAB; Dodge, Price, Bachorowski, & Newman, 1990;Frick et al, 2003a;Helseth, Waschbusch, King, & Willoughby, 2015), perhaps the combination of cognitive biases associated with anxiety and the callousness of CU traits yields the impulsive, aggressive reactivity documented in these youth (e.g., Fanti et al, 2013;Kahn et al, 2013).…”

“…Anxiety may interact with CU in important ways, but the nature of such interactions and their impact on youth aggressive behavior remain unclear, impeding the identification of tailored treatment targets, and hindering efforts to address the unique needs of children at various points on these continua. Moreover, and importantly, research examining interactions between CU and anxiety and their effects on AB has relied almost exclusively on questionnaire reports of child aggressive behavior (e.g., Fanti et al, 2013;Kahn et al, 2013, Rosan et al, 2015, and the studies that used criminal records did not assess aggression in an experimental context (e.g., Kimonis et al, 2011;Lee et al, 2010), which limits interpretations and cannot rule out issues related to reporter biases, shared method variance, and external circumstances.…”

“…Empirical work suggests that anxiety-related heterogeneity in youth showing CU traits may be related to meaningful differences in associated aggressive behavior, with the presence of both CU traits and anxiety associated with a specific pattern of emotional processing deficits and higher levels of aggression than children with just CU traits (Docherty, Boxer, Huesmann, O'Brien, & Bushman, 2015;Euler et al, 2015;Fanti, Demetrious, & Kimonis, 2013;Humayun, Kahn, Frick, & Viding, 2014;Kahn et al, 2013;Kimonis, Skeem, Cauffman, & Dmitrieva, 2011;Lee, Salekin, & Iselin, 2010;Rosan, Frick, Gottlieb, & Fasicaru, 2015). However, much of this research has relied exclusively on questionnaire reports of aggressive behavior rather than observed aggressive behavior (e.g., Kimonis et al, 2011;Lee et al, 2010), and has not examined how anxiety and CU traits predict child aggression in the context of experimentally manipulated distress cue salience from potential victims.…”

“…Of note, several studies have observed greater trauma exposure among CU youth experiencing anxiety symptoms relative to their counterparts without anxiety (Euler et al, 2015;Kahn et al, 2013;Kimonis et al, 2012;Tatar et al, 2012). Trauma is central to theory underlying origins of primary and secondary variants in psychopathy (e.g., Porter, 1996), and may be a particularly relevant factor in the affective and behavioral characteristics of children with CU and anxiety, considering research suggesting that traumatic stress-related emotional numbing symptoms link violence exposure and delinquency (Allwood, Bell, & Horan, 2011), and often co-occur with hypervigilance/hyperarousal symptoms (Weems, Saltzman, Reiss, & Carrion, 2003).…”

“…Hypotheses: It was expected that the predictive value of the interaction between CU and traumatic stress symptoms would differ in the presence versus absence of others' distress cues, given the trauma histories reported among youth with CU and anxiety (e.g., Kahn et al, 2013), and the emotional deficits observed among youth with posttraumatic stress (e.g., Dalgleish et al, 2001;Masten et al, 2008). …”