Behavioral Improvements but Limited Change in Callous-Unemotional Traits in Adolescents Treated for Conduct Problems

Abstract

Callous-unemotional (CU) traits have been linked to more severe and sustained behavior problems among adolescents. The aims of this study were to examine the treatment impact and malleability of CU traits among adolescents and explore potential moderation effects of treatment condition and CU sub-typology. A sample of 159 adolescents (45.9% girls; M age = 14.7 years, SD = 1.47) and their parents participated in a randomized controlled trial of Functional Family Therapy with three assessments (baseline, 6-months and 18-months) of behavior problems, CU traits, prosocial skills and the parent-youth relationship. Latent growth curve model (LGCM) analyses revealed that children with higher CU traits had greater reductions in aggressive and rule-breaking behavior and greater improvements in social skills (|standardized coefficients| = 0.27–0.32). Similarly, higher CU traits were linked to larger increases in parent-ratings of family cohesion and youth-ratings of maternal support (standardized coefficients = 0.26–0.27). Reliable Change Index summaries showed that CU traits remained unchanged for the majority of participants (73.6% and 72.6% had no reliable short- and long-term change, respectively). Baseline anxiety linked to CU sub-typology moderated some of the study results. Findings show that adolescents with co-occurring behavior problems and elevated CU traits can obtain improvement in behavioral and relational outcomes in out-patient treatment. Strikingly, such improvements can occur notwithstanding a limited reduction in CU traits. Future work should investigate whether the treatment gains would be more substantial and stable if treatment adjuncts modifying the CU traits themselves were concurrently deployed.

Age and sex differences of the PID-5-100 maladaptive personality traits throughout adulthood.

“…Importantly, in a substantial amount of PID-5 facets (i.e., 19 out of 50 β's) spread across the PID-5 domains, flat age trajectories were observed, suggesting no natural maturation effects. Remarkably, the current findings suggest that this is especially true for those traits that have been described as stable even after intentional treatment (Thøgersen et al, 2022), such as Callousness and Grandiosity in the Antagonism domain (cf. callous-unemotional traits), suggesting that a strong biological base or genetic underpinning may help to understand the steadiness in these traits throughout adulthood (Mann et al, 2015).…”

Commentary: Optimism and guidance for improving treatment effects among children with callous‐unemotional traits – reflections on Perlstein et al. (2023)

“…To date, however, these studies have been few. Some studies have investigated improvement in CU traits after splitting their sample into low and high CU groups, with many of these studies reporting statistically significant improvement in CU traits in the high CU group (e.g., Thøgersen, Elmose, Viding, McCrory, & Bjørnebekk, 2022). Similarly, the few studies that use samples of children with elevated CU traits also report statistically significant improvement (e.g., Dadds, English, Wimalaweera, Schollar‐Root, & Hawes, 2019; Fleming et al., 2022; Kimonis et al., 2019; Lui, Barry, & Marcus, 2019).…”

“…To some degree, these efforts have been hamstrung by a lack of normed measures of CU traits across developmental stages and informants, although this is changing. However, other indicators of normalization or clinically meaningful improvement have offered little evidence that clinical CU traits normalize with treatment, whether traditional (e.g., Thøgersen et al., 2022) or adapted specifically for CP + CU. For example, Dadds et al.…”

“…To some degree, these efforts have been hamstrung by a lack of normed measures of CU traits across developmental stages and informants, although this is changing. However, other indicators of normalization or clinically meaningful improvement have offered little evidence that clinical CU traits normalize with treatment, whether traditional (e.g., Thøgersen et al, 2022) or adapted specifically for CP + CU. For example, Dadds et al (2019) reported that CU group means remained in the borderline high range following adapted treatment for 3-to 8-year-olds, while Lui et al (2019) reported that CU traits improved less than or just above 1 standard deviation from baseline sample means following adapted treatment for adolescents (M = 16.54 years).…”

Using twin-pairs to assess potential bias in polygenic prediction of externalising behaviours across development

“…Common externalising phenotypes, including conduct problems and attention-deficit/hyperactivity disorder (ADHD), are associated with adverse outcomes such as low academic achievement, social isolation and substance use disorders 1,2 . More recently, callous-unemotional traits (CU) have been assessed concurrently and appear to index children with particularly severe behavioural problems 3,4 . Previous research has shown that conduct problems, ADHD and CU traits are moderately to highly heritable 5,6 , share common aetiological influences 7 and can be predicted by polygenic scores extracted from genome-wide association studies (GWAS) 8,9 .…”