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==References==
==References==
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{{reflist | colwidth=35em}}

== Further reading ==
* {{cite journal |author=Herpers PC, Rommelse NN, Bons DM, Buitelaar JK, Scheepers FE |title=Callous-unemotional traits as a cross-disorders construct |journal=Soc Psychiatry Psychiatr Epidemiol |volume=47 |issue=12 |pages=2045–64 |year=2012 |month=December |pmid=22570257 |pmc=3496473 |doi=10.1007/s00127-012-0513-x}}
* {{cite journal |author=Viding E, McCrory EJ |title=Genetic and neurocognitive contributions to the development of psychopathy |journal=Dev. Psychopathol. |volume=24 |issue=3 |pages=969–83 |year=2012 |month=August |pmid=22781866 |doi=10.1017/S095457941200048X}}
* {{cite journal |author=Waller R, Gardner F, Hyde LW |title=What are the associations between parenting, callous-unemotional traits, and antisocial behavior in youth? A systematic review of evidence |journal=Clin Psychol Rev |volume=33 |issue=4 |pages=593–608 |year=2013 |month=June |pmid=23583974 |doi=10.1016/j.cpr.2013.03.001 }}



[[Category:Abnormal psychology]]
[[Category:Abnormal psychology]]

Revision as of 15:25, 2 December 2013

Callous and unemotional (CU) traits are distinguished by a persistent pattern of behavior that reflects a disregard for others, and also a lack of empathy and generally deficient affect. The interplay between genetic and environmental risk factors may play a role in the expression of these traits as a conduct disorder (CD).

A CU specifier has been included as a feature of conduct disorder in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).[1]

Classification

A CU specifier for conduct disorder was added to DSM-5.[1] The addition "with significant callous-unemotional traits" to the conduct disorder diagnosis in DSM-5 is to classify a specific subgroup of antisocial youth with distinquishing antisocial behaviors and psychopathic traits.[2] The provision of the CU specifier for CD youth is claimed to improve the diagnostic power, treatment options, and increase the understanding life-course outcomes.[2] A 2008 review concluded that CU did not have the required evidence base to be included as a new diagnosis in DSM-5.[3]

Symptoms

Children with CU traits have distinct problems in emotional and behavioral regulation that distinguish them from other antisocial youth and show more similarity to characteristics found in adult psychopathy.[4] Antisocial youth with CU traits tend to have a range of distinctive cognitive characteristics. They are often less sensitive to punishment cues, particularly when they are already keen for a reward[5] and tend to expect more positive outcomes in aggressive situations with peers.[6] CU traits are positively related to intellectual skills in the verbal realm.[7]

Causes

Neural mechanisms

Abnormally low cortisol levels may be a biological marker for individuals with CU traits.[8] Research has found that CU males had lower resting cortisol levels, and therefore lower hypothalamic-pituitary-adrenal HPA axis activity, compared to healthy individuals.[8] The fearlessness theory of CU traits suggests that low amounts of cortisol lead to underarousal, causing impairments in fear processing, a trait seen in CU individuals.[9] Hypoactivity in the HPA axis in combination with environmental stressors is thought to cause the development of antisocial behavior.[10] However, recent studies have found that hypoactivity in the HPA in combination with CU traits seem to cause antisocial behavior even without external hardships.[9]

FMRI research has demonstrated that decreased amygdala activation in response to fearful faces as well as distress based social cues is seen in children with CU traits.[11] Further research has demonstrated decreased functional connectivity between the amygdala and regulatory regions. This includes decreased connectivity with the orbitofrontal cortex when making moral judgments,[12] and decreased functional connectivity between the amygdala and ventromedial prefrontal cortex, with symptom severity negatively correlated with connection strength.[11]

Genetic

Twin studies have found CU traits to be highly heritable, and not significantly related to environmental factors such as socioeconomic status, school quality, or parent quality.[2] Two twin studies suggested a significant genetic influence for CU, with an estimated average amount of variation (42.5%) in CU traits accounted for by genetic effects.[2] A substantial proportion of this genetic variation occurred independent of other dimensions of psychopathy.[2] Children with conduct problems who also exhibit high levels of CU traits reflect a particularly high heritability rate of 0.81, as reflected in longitudinal research.[5]

Maltreatment and parenting may play a role in the development of antisocial behavior, but better research is needed to understand the interaction between genetic and epigenetic factors.[13]

Diagnosis

Research has attempted to subtype youth with callous and unemotional traits by distinguishing between those with childhood-onset versus adolescent-onset conduct disorder, conduct disorder co-morbid with attention deficit hyperactivity disorder (ADHD), or by the severity and type of aggression displayed.[4] Children with CU traits have more severe conduct disorder, and respond to different management.[1] The Inventory of Callous-Unemotional Traits (ICU) assesses three independent factors in CU traits: uncaring, callous, and unemotional.[14] The ICU has been studied in both male and female populations.[15] The severity of CD has been studied in children rated high on CU traits.[5]

Management

Though CU traits are relatively stable, they can decrease over time through effective treatment.[2] Early intervention is thought to be more effective because CU traits are thought to be more malleable early in life.[16]

Parenting techniques

Parenting interventions are the best treatment for early onset antisocial behaviors in children.[17]

Quality parenting can decrease the manifestation of CU traits.[2] Children with high CU traits are less responsive to time-out and other punishing techniques than are healthy children as time-out does not seem to bother them, so their behavior does not improve.[18] Reward-based disciplining techniques, such as praise and reinforcement, tend to have a greater effect than punishing techniques on children with high CU traits.[5]

Prognosis

Childhood-onset CU shows a more aggressive and stable pattern of antisocial behavior with higher rates of CU traits, as well as more severe temperamental and neuropsychological risk factors relative to their adolescent-onset counterparts.[19] Children with combined CD and ADHD are more likely to show features associated with psychopathy, but only in those who have high rates of CU traits.[20] In support of the idea of lifetime persistence of CU traits, childhood-onset delinquency has been more strongly associated with psychopathic traits than adolescent-onset delinquency.[21] A longitudinal twin study of children with CD showed that high or increasing levels of CU traits comorbid with CD presented with the most negative outcomes after twelve years in relationships with peers and family, as well as emotional and behavioral problems, as compared to those with low CU traits or CD alone.[22] In addition, adolescents with CU traits have shown higher likelihood to commit a violent crime within a two-year period of their release from a correctional facility than those without CU traits.[23] Antisocial youth with CU traits tend to show less response to treatment.[5]

History

Due to the potential severity of antisocial and violent traits seen in adult psychopathy, research has focused on identifying the associated traits in childhood. In adult psychopathy, individuals with primarily affective and interpersonal deficits show a distinct etiology.[24] Similarly, different subtypes of aggressive and antisocial behaviors in youth may predict distinct problem-behaviors and risk factors. There have been a number of attempts to officially designate psychopathic-like traits in antisocial youths based on the affective and interpersonal traits of psychopathy. The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) divided conduct disorder into four subtypes: unsocialized-aggressive, undersocialized-nonaggressive, socialized-aggressive, and socialized-nonaggressive in an attempt to recognize the existence of psychopathic traits in children.[20] The distinction between "socialized" and "unsocialized" children was the most pertinent in distinguishing between psychopathic-like youths. According to these definitions, "undersocialized" children exhibited characteristic behaviors of psychopathy, including: lack of empathy, lack of affection, and inappropriate social relationships (DSM III). This differed from "socialized" individuals, who were able to form healthy social attachments to others, and whose aggressive and antisocial acts typically derived from engagement in a deviant social group (e.g. youth gangs).

Following the publication of DSM-III, these distinctions prompted research, but there were still issues with the terminology in diagnosing the core features of the undersocialized versus socialized subtype. The word undersocialized was used in order to avoid the negative connotations of psychopathy, but was commonly misinterpreted to mean that the child was not well socialized by parents or lacked a peer group. Also, the operational definition failed to include dimensions that could reliably predict the affective and interpersonal deficits in psychopathic-like youths. Due to these issues, the American Psychiatric Association removed the undersocialized and socialized distinctions from the conduct disorder description in the DSM after the third edition. The only subtypes that have been included in the manual since then relate to the time of onset: childhood-onset (before age 10), adolescent-onset (absence of antisocial traits before age 10), and unspecified-onset.[19]

References

  1. ^ a b c "Highlights of Changes from DSM-IV-TR to DSM-5" (PDF). DSM5.org. American Psychiatric Association. 2013. Retrieved October 23, 2013.
  2. ^ a b c d e f g Frick PJ, White SF (2008). "Research review: the importance of callous-unemotional traits for developmental models of aggressive and antisocial behavior". J Child Psychol Psychiatry. 49 (4): 359–75. doi:10.1111/j.1469-7610.2007.01862.x. PMID 18221345. {{cite journal}}: Unknown parameter |month= ignored (help)
  3. ^ Moffitt TE, Arseneault L, Jaffee SR, Kim-Cohen J, Koenen KC, Odgers CL, Slutske WS, Viding E (2008). "Research review: DSM-V conduct disorder: research needs for an evidence base". J Child Psychol Psychiatry. 49 (1): 3–33. doi:10.1111/j.1469-7610.2007.01823.x. PMC 2822647. PMID 18181878. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  4. ^ a b Frick PJ (2009). "Extending the construct of psychopathy to youth: implications for understanding, diagnosing, and treating antisocial children and adolescents". Can J Psychiatry. 54 (12): 803–12. PMID 20047719. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ a b c d e Frick PJ, Dickens C (2006). "Current perspectives on conduct disorder". Curr Psychiatry Rep. 8 (1): 59–72. doi:10.1007/s11920-006-0082-3. PMID 16513044. {{cite journal}}: Unknown parameter |month= ignored (help)
  6. ^ Pardini D, Lochman J, Wells K (2004). "Negative emotions and alcohol use initiation in high-risk boys: the moderating effect of good inhibitory control". J Abnorm Child Psychol. 32 (5): 505–18. doi:10.1023/B:JACP.0000037780.22849.23. PMID 15500030. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ Salekin RT, Neumann CS, Leistico AM, Zalot AA (2004). "Psychopathy in youth and intelligence: an investigation of Cleckley's hypothesis". J Clin Child Adolesc Psychol. 33 (4): 731–42. doi:10.1207/s15374424jccp3304_8. PMID 15498740. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ a b Loney BR, Butler MA, Lima EN, Counts CA, Eckel LA (2006). "The relation between salivary cortisol, callous-unemotional traits, and conduct problems in an adolescent non-referred sample". J Child Psychol Psychiatry. 47 (1): 30–6. doi:10.1111/j.1469-7610.2005.01444.x. PMID 16405638. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  9. ^ a b Hawes DJ, Brennan J, Dadds MR (2009). "Cortisol, callous-unemotional traits, and pathways to antisocial behavior". Curr Opin Psychiatry. 22 (4): 357–62. doi:10.1097/YCO.0b013e32832bfa6d. PMID 19455037. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  10. ^ van Goozen SH, Matthys W, Cohen-Kettenis PT, Buitelaar JK, van Engeland H (2000). "Hypothalamic-pituitary-adrenal axis and autonomic nervous system activity in disruptive children and matched controls". J Am Acad Child Adolesc Psychiatry. 39 (11): 1438–45. doi:10.1097/00004583-200011000-00019. PMID 11068900. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ a b Marsh AA, Finger EC, Mitchell DG, Reid ME, Sims C, Kosson DS, Towbin KE, Leibenluft E, Pine DS, Blair RJ (2008). "Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders". Am J Psychiatry. 165 (6): 712–20. doi:10.1176/appi.ajp.2007.07071145. PMID 18281412. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Marsh AA, Finger EC, Fowler KA, Jurkowitz IT, Schechter JC, Yu HH, Pine DS, Blair RJ (2011). "Reduced amygdala-orbitofrontal connectivity during moral judgments in youths with disruptive behavior disorders and psychopathic traits". Psychiatry Res. 194 (3): 279–86. doi:10.1016/j.pscychresns.2011.07.008. PMC 3225495. PMID 22047730. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. ^ Viding E, Larsson H, Jones AP (2008). "Quantitative genetic studies of antisocial behaviour". Philos. Trans. R. Soc. Lond., B, Biol. Sci. 363 (1503): 2519–27. doi:10.1098/rstb.2008.0037. PMC 2606717. PMID 18434281. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Kimonis ER, Frick PJ, Skeem JL, Marsee MA, Cruise K, Munoz LC, Aucoin KJ, Morris AS (2008). "Assessing callous-unemotional traits in adolescent offenders: validation of the Inventory of Callous-Unemotional Traits". Int J Law Psychiatry. 31 (3): 241–52. doi:10.1016/j.ijlp.2008.04.002. PMID 18514315.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Essau CA, Sasagawa S, Frick PJ (2006). "Callous-unemotional traits in a community sample of adolescents". Assessment. 13 (4): 454–69. doi:10.1177/1073191106287354. PMID 17050915. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  16. ^ Frick PJ, Ellis M (1999). "Callous-unemotional traits and subtypes of conduct disorder". Clin Child Fam Psychol Rev. 2 (3): 149–68. doi:10.1023/A:1021803005547. PMID 11227072. {{cite journal}}: Unknown parameter |month= ignored (help)
  17. ^ Dadds MR, Rhodes T (2008). "Aggression in young children with concurrent callous-unemotional traits: can the neurosciences inform progress and innovation in treatment approaches?". Philos. Trans. R. Soc. Lond., B, Biol. Sci. 363 (1503): 2567–76. doi:10.1098/rstb.2008.0029. PMC 2606711. PMID 18434286. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ^ Loeber R, Burke JD, Pardini DA (2009). "Development and etiology of disruptive and delinquent behavior". Annu Rev Clin Psychol. 5: 291–310. doi:10.1146/annurev.clinpsy.032408.153631. PMID 19154139.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ^ a b Moffitt TE (2006). "Life-course persistent versus adolescence-limited antisocial behavior". In Cicchetti D, Cohen DJ (ed.). Developmental psychopathology (2 ed.). New Jersey: John Wiley & Sons. pp. 570–98. ISBN 978-0-470-05006-4. OCLC 300282429.
  20. ^ a b Barry CT, Frick PJ, DeShazo TM, McCoy MG, Ellis M, Loney BR (2000). "The importance of callous-unemotional traits for extending the concept of psychopathy to children". J Abnorm Psychol. 109 (2): 335–40. doi:10.1037/0021-843X.109.2.335. PMID 10895572. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. ^ Moffitt TE, Caspi A, Harrington H, Milne BJ (2002). "Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years". Dev. Psychopathol. 14 (1): 179–207. doi:10.1017/S0954579402001104. PMID 11893092.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  22. ^ Fontaine NM, McCrory EJ, Boivin M, Moffitt TE, Viding E (2011). "Predictors and outcomes of joint trajectories of callous-unemotional traits and conduct problems in childhood". J Abnorm Psychol. 120 (3): 730–42. doi:10.1037/a0022620. PMID 21341879. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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  24. ^ Hare RD, Neumann CS (2008). "Psychopathy as a clinical and empirical construct". Annu Rev Clin Psychol. 4: 217–46. doi:10.1146/annurev.clinpsy.3.022806.091452. PMID 18370617.

Further reading

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