Callous-unemotional Traits In Children

Question 1

What are callous-unemotional trait?

Answer 1

Downward extension of psychopathy to children
Lack remorse/ guilt, callous-lack of empathy, shallow/ blunted affect, unconcerned about school performance

Question 2

What are some psychiatric traits in children?

Answer 2

Similar presentation to adults
Reliably measured in kids as young as 2
Traits at 2 predicted behaviour problems at 3 & 4
Traits at 2-4 predicted CU traits, aggression & rule breaking at 9
Stable across childhood

Question 3

What is the clinical significance of CU traits?

Answer 3

More severe conduct problems
Persistence into adulthood
Unique neural, psychophysiological, cognitive & behavioural characteristics
Small group showing CU traits without antisocial behaviour

Question 4

What are the differences between low & high CU?

Answer 4

Affective - low = emotional, high = unemotional
Cognitive-affective - low = HAB, high = less reactive to emotion
Behavioural - low = reactive aggression, reward seeking, high = proactive, punishment insensitive
Genetic - low = moderate heritability, high = high
Treatment - low = effective, high = resistance

Question 5

What are specifiers for CD in DSM-5 (limited prosocial emotions)

Answer 5

Callousness
Lack of guilt/ remorse
Lack of concern about performance in school
Shallow affect

Question 6

What was significant about children who met criteria for LPE?

Answer 6

Externalising problems - physical & relational aggression
Bullying
Cruelty
Comorbidity with ODD & ADHD

Question 7

What are some long-term outcomes for children with LPE?

Answer 7

Delinquency
Future psychopathy
Antisocial personality disorder
Poor interpersonal relationship
Substance abuse
Contact with criminal justice system

Question 8

What are some core emotional processing deficits in CU traits?

Answer 8

Emotional reactivity - don’t response to certain stimuli
Emotion recognition
Biological response - lower HR & low skin conductance

Question 9

What are core deficits in reinforcement learning?

Answer 9

Response preservation - persist in behavioural that was previously rewarded despite potential punishment
Passive avoidance - learn through trial and error
Unchanged by removal of reward

Question 10

What are some reinforcement learning theories?

Answer 10

Reinforcement sensitivity theory (Gray, 1987)
Integrated emotion systems model (Blair, 2004) - amygdala impairment
Response modulation hypothesis (Newman et al, 1997) - not able to modulate response

Question 11

What is the role of parenting in developing CU traits?

Answer 11

Parenting = risk factor for antisocial behaviour
Coercive cycles - target of intervention
Cu traits = low response to punishment, disrupts parents attempt to discipline
Negative parenting practices = stronger association with behaviour problems in low CU traits without

Question 12

What is the early steps project (Waller et al, 2014)?

Answer 12

Harsh parenting observations or warm parenting speech samples
Harsh parenting related to increase in CU traits overtime & warm parenting to decrease in traits
Bi-directional

Question 13

What are gene-environment effects?

Answer 13

Passive gene-environment correlation - parents pass CU gene
Evocative gene-environment correlation - parent pass gene & evoke harsh parenting
Hyde et al (2016) - adoption study - gene x positive environment buffers genetic effects

Question 14

How do twin studies show CU traits?

Answer 14

Difference in parenting for MZ twins - non-shared environment
Difference in parental harshness & warmth leads to differences in aggression & CU traits

Question 15

What are early traits passed on by birth parents?

Answer 15

Fearlessness
Low emotional responsibility
Reward & punishment sensitivity

Question 16

How do CU traits evoke harsh parenting?

Answer 16

Early growth & development study - Trentacosta et al 2019
Interaction effects between harsh parenting & CU traits

Question 17

How can we treat CU traits?

Answer 17

Current best practice interventions = parenting programmes
Include child behaviour management strategies & parent-child relationship enhancement

Question 18

What did Waller et al (2013) find?

Answer 18

CU traits associated with poorer treatment outcomes of parenting programmes
High CU traits have less decline than low

Question 19

What are the current approaches?

Answer 19

Standard treatment with either emotion training or de-emphasis of punishment based strategies & emphasis on reward

Question 20

How did Dadds et al (2019) look at emotion training?

Answer 20

Eye gaze to improve social bonding
3 groups - PMT only or with emotional engagement/ child centred play
Improvements in emotional engagement & shared eye gaze
Reduced back to normal quickly
All 3 result in improved parental warmth

Question 21

How does parent child interaction therapy increase emotional responsivity to distress?

Answer 21

Enhance attention to critical facial cues to improve emotion recognition
Improve emotional understanding by linking expression to context
Teach & positively reinforce prosocial, empathetic behaviour
Increase frustration tolerance through modelling, role play etc

Question 22

What was Kimonis et al (2019)s study?

Answer 22

Pilot study with 23 ppts
No control
Found significant decrease in CU traits which were sustained 3 months post treatment

Question 23

What is the importance of emphasising reward?

Answer 23

Punishment indecisively
Emotionally unaffected by time-out - less emotion & more negative behaviour
Positive reinforcement related to decrease in CU traits which
Parental praise & tangible rewards associated with lower conduct problems in high CU traits

Question 24

What did Waschbusch et al (2019) look at?

Answer 24

8 week intensive treatment programme
Modified behvaiour therapy vs standard
Reward emphasised, punishment deemphasised
Gained points for positive, no loss for negative
Being good = ticket, exchanged for toys
Found social (not just form parent) & tangible rewards most effective for high CU
Time out for extreme misbehaviour

Question 25

What are reward preferences?

Answer 25

High CU preferred social - sig effects with affection & spending time together