Variants of Callous-Unemotional Conduct Problems in a Community Sample of Adolescents

Transcription

Variants of Callous-Unemotional Conduct
Problems in a Community Sample of
Adolescents
Kostas A. Fanti, Chara A. Demetriou &
Eva R. Kimonis
Journal of Youth and Adolescence
A Multidisciplinary Research Publication
ISSN 0047-2891
Volume 42
Number 7
J Youth Adolescence (2013) 42:964-979
DOI 10.1007/s10964-013-9958-9
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Author's personal copy
J Youth Adolescence (2013) 42:964–979
DOI 10.1007/s10964-013-9958-9
EMPIRICAL RESEARCH
Variants of Callous-Unemotional Conduct Problems
in a Community Sample of Adolescents
Kostas A. Fanti • Chara A. Demetriou
Eva R. Kimonis
•
Received: 25 February 2013 / Accepted: 26 April 2013 / Published online: 5 May 2013
Ó Springer Science+Business Media New York 2013
Abstract Callous-unemotional traits are believed to be a
childhood precursor to psychopathy, and among youth with
conduct problems they designate those showing a particularly severe, stable, and aggressive pattern of antisocial
behavior. Youth with callous-unemotional traits are a heterogeneous population and, analogous to adults with psychopathy, research suggests that lower anxious primary and
high-anxious secondary variants exist. Using a community
sample of 2,306 Greek-Cypriot adolescents (M age =
16 years; 49.7 % female), the first aim of the study was to
examine whether variants of callous-unemotional traits
could be identified using latent profile analysis of scores on
measures of callous-unemotional traits, conduct problems,
and anxiety. Additional aims of the study were to compare
the identified clusters on external measures theorized to
distinguish them (i.e., self-esteem, narcissism, impulsivity,
sensation seeking and proactive/reactive aggression) and
social factors relevant to adolescent development. Results
indicated that, in addition to low risk (i.e., low scores on
callous-unemotional traits, conduct problems, and anxiety)
and anxious (i.e., high scores on anxiety, low scores on
K. A. Fanti (&)
Department of Psychology, University of Cyprus,
P.O. Box 20537, CY 1678 Nicosia, Cyprus
e-mail: kfanti@ucy.ac.cy
C. A. Demetriou
University College London, London, UK
e-mail: demetriou.chara@ucy.ac.cy
E. R. Kimonis
School of Psychology, The University of New South Wales,
Kensington, NSW 2052, Australia
e-mail: e.kimonis@unsw.edu.au
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callous-unemotional traits and conduct problems) subgroups, two groups of youth scoring high on callousunemotional traits and conduct problems were identified.
High-anxious secondary callous-unemotional variants were
distinguished by lower self-esteem in combination with
greater narcissism, aggression, and markedly higher conduct problems, whereas lower anxious primary variants
showed higher self-esteem. Secondary callous-unemotional
variants also reported greater susceptibility to peer pressure
and popularity striving than primary variants. Both variants
exhibited poorer outcomes relative to low risk and anxious
youth, although anxious youth reported lower self-esteem
and higher impulsivity and reactive aggression scores in
comparison with low risk youth. Findings integrate two
lines of inquiry focused on subtyping children and adults
with psychopathic traits and antisocial behaviors. They also
support the utility of subtyping callous-unemotional traits
based on conduct problems and anxiety levels and provide
information on common and distinct risk factors associated
with primary and secondary callous-unemotional variants
in a community sample of adolescent boys and girls.
Keywords Callous-unemotional traits Conduct
problems Anxiety Primary and secondary psychopathy Variants Subtypes
Introduction
The presence of callous-unemotional traits (i.e., lack of
remorse/empathy, callous use of others, shallow/deficient
affect) designates an important subgroup of children and
adolescents with conduct problems who show a more
severe and aggressive pattern of antisocial behavior than
youths without callous-unemotional traits (Frick and
Dickens 2006; Frick and White 2008). Callous-unemotional traits are believed to be a developmental precursor to
adult psychopathy (Frick 1995, 2006; Lynam 1996), capturing the affective dimension that Cleckley (1976) viewed
as the hallmark of psychopathy that often is termed the
‘‘affective discomfort’’ component (Hare and Neumann
2010). However, prior research on this potential childhood
antecedent points to the combination of co-occurring callous-unemotional traits and conduct problems as a likely
precursor to psychopathy as opposed to callous-unemotional traits alone. For example, youth with co-occurring
callous-unemotional traits and conduct problems show a
distinct temperamental style characterized by fearlessness,
reward dominance, and emotional insensitivity to cues of
distress and fear in others, similar to deficits observed
among adults with psychopathy (Frick et al. 2003b; Blair
et al. 2001). Some have challenged the notion that antisocial behaviors be included in conceptualizations of adult
psychopathy, suggesting that these behaviors develop
downstream of the core personality features (Skeem and
Cooke 2010; cf. Hare and Neumann 2010). Even when
focused strictly on personality characteristics of psychopathy, traditional theoretical perspectives view these individuals as a largely homogeneous group, as evidenced by
many of the diagnostic measures used to classify them
(Andershed et al. 2002; Hare 2003; Forth et al. 2003;
Lynam 1997). However, conceptualizing psychopathy as a
unitary construct has been challenged by evidence of
measurable heterogeneity among individuals classified as
‘‘psychopaths’’ (see Skeem et al. 2003). What is not clear is
to what extent this heterogeneity maps on to the important
distinction between conduct problems with and without
callous-unemotional traits that is well established in the
juvenile literature.
There is growing empirical support for heterogeneity
among incarcerated adolescent boys and adult offenders
scoring high on measures of psychopathy or callousunemotional traits; the extent of this heterogeneity within
community youth, and across gender, has not yet been
investigated. These paradigms are rooted in early theory
(Karpman 1941, 1948a, b), which introduced the concept
of secondary psychopathy acquired through environmental
insult, particularly competitive disadvantage (Mealey
1995), parental abuse, rejection, or overindulgence (Karpman 1948a, 1955), and other traumatic experiences (Porter
1996). Karpman (1948a, b) theorized that exposure to early
abusive experiences resulted in an excess of negative
emotions and unresolved emotional conflict—chiefly hostility—in the child that disturbed the functioning of an
otherwise intact conscience, giving the appearance of a
‘‘psychopathic façade’’ (Karpman 1948b, p. 523). Primary
psychopathy, in contrast, theoretically results from a
‘‘constitutional’’ deficit that is manifested in part by a lack
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of conscience (Karpman 1948a). Hicks et al. (2004)
extended this perspective to suggest that personality and
temperamental deficits common to primary variants affect
their levels of empathic concern, making them less capable
of feeling guilt and characterizing them by a generalized
lack of concern for others. Contemporary research on
psychopathy variants predominately distinguishes them on
the basis of anxiety, given its centrality to distinguishing
variants in Karpman’s (1941) taxonomy (e.g., Falkenbach
et al. 2008; Kosson and Newman 1995; Skeem et al. 2007).
This contradicts Cleckley’s (1941) view of psychopathy as
a personality disorder characterized by a lack of anxiety,
leading some to label his conceptualization as that of primary psychopathy. With empirical evidence for this anxiety-based distinction, Hicks et al. (2004) labeled primary
variants in their study as ‘‘emotionally stable’’ given their
fearlessness, absent reaction to stress and high social
dominance, and secondary variants as ‘‘aggressive psychopaths’’ characterized by high negative emotionality.
Several theorists posited that secondary psychopaths
may be more aggressive and violent than primary psychopaths (Blackburn 1987; Karpman 1948a, 1955; Lykken
1995; Mealey 1995). Similarly, Hicks et al. (2004) found
that high-anxious secondary male variants had more
extensive histories of violence and criminality and displayed greater aggression, reactive hostility, and impulsivity than primary variants. Research conducted with
juvenile offenders not only confirms that psychopathy
variants can be identified among male samples and are
distinguishable by varying anxiety levels, but that they also
show different rates of violence. For example, within a
subsample (n = 116) of male juvenile offenders in the
United States scoring high on the Youth Version of the
Psychopathy Checklist (PCL:YV), high-anxious secondary
variants showed more institutional violence compared with
lower anxious primary variants (Kimonis et al. 2011).
Specifically, 92 % of secondary variants compared with
69.4 % of primary variants engaged in institutional violence across a two-year incarceration period. With regard
to the quality of their violence, secondary variants engaged
in more reactively aggressive incidents (82 %) than primary variants (54 %), although they did not differ significantly in their rates of proactive (i.e., instrumental)
violence. Similarly, among a sample of incarcerated
American youth with high scores on a self-report measure
of psychopathy (N = 132), Vaughn et al. (2009) found that
secondary variants manifested more total self-reported
delinquency than primary variants. It would be reasonable
to conclude from these studies that conduct problems, of
which delinquent acts and aggression towards people or
animals are types, might distinguish primary and secondary
variants. However, Karpman (1941) described psychopathy
variants as being phenotypically indistinguishable, which
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would suggest that levels of conduct problems would not
differ significantly between them. Prior studies with juvenile samples are not well-positioned to address this question since they focused on offender samples who tend to
have high rates of conduct problems (e.g., Vaughn et al.
2009; Kimonis et al. 2012b).
Impulsivity and narcissism are two other dimensions of
juvenile psychopathy that might distinguish variants. For
example, Kimonis et al. (2011) found that impulsivity and
narcissism differed between juvenile psychopathy variants,
whereas callous-unemotional traits did not. Regarding
impulsivity, Kimonis et al. (2012a) reported that highanxious secondary psychopathy variants scored significantly higher on impulsivity compared with lower anxious
primary variants. With regard to narcissism, Skeem et al.
(2003) hypothesized that secondary psychopathy may be
associated specifically with covert narcissism—relating to
feelings of inferiority and worthlessness, anxiety, and
vulnerability—whereas primary psychopathy may be
associated with overt narcissism (i.e., grandiosity, exhibitionism, invulnerability, and entitlement; Wink 1996). On
this basis, low self-esteem in combination with high narcissism might differentiate secondary from primary psychopathy variants. Although not examined directly,
Vaughn et al. (2009) found that secondary juvenile psychopathy variants scored higher on a related construct—the
interpersonal sensitivity scale of the Brief Symptom
Inventory—compared with primary variants. This scale
measures feelings of inferiority, self-consciousness, and
dislike by others, which are all indicators of low selfesteem. Based on evidence that the combination of a low or
a fragile self-concept with a grandiose self-view contributes to the severity of aggressive behavior (Barry et al.
2003; Baumeister et al. 1996), and the greater levels of
aggressive and violent behavior among secondary psychopathy variants (Hicks et al. 2004), it is hypothesized
that the high narcissism/low self-esteem combination will
be more evident among youth in the secondary than the
primary variant subgroup.
Sensation seeking is another personality difference
investigated between psychopathy variants to distinguish
them. Lykken (1995) proposed that secondary psychopathy
is characterized by high sensation seeking compared with
primary psychopathy. However, this distinction has
received relatively weak and inconsistent support in prior
studies of adults (Falkenbach et al. 2008; Newman et al.
2005; Poythress et al. 2010), and it is unclear to what extent
any differences will be identified within youth samples.
Comparing primary and secondary callous-unemotional
variants on various personality traits, such as impulsivity,
narcissism/self-esteem, and sensation seeking, is expected
to provide important evidence for differentiating these
groups.
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To date, the majority of research on juvenile psychopathy/callous-unemotional variants has been limited to
male offender populations, constituting a critical gap in
research and fertile grounds for extending research to
community youth and to girls. Normative factors relevant
to the adolescent developmental period may be more
important to shaping the development of antisocial and
aggressive behaviors among youth in typical school settings than they are in atypical residential correctional settings. Peer processes might be particularly important to the
aims of the current study since variables associated with
primary and secondary psychopathy, including conduct
problems, callous-unemotional traits, and anxiety, have
been shown to be related to impaired peer relationships
(see for example, Loeber et al. 2000; Verduin and Kendall
2008; Waschbusch and Willoughby 2008). Specifically,
popularity, and the need to achieve it within one’s peer
group, has been widely examined as a contributor to
youths’ antisocial behavior. Empirical evidence also suggests heterogeneity among popular children and adolescents with the existence of popular prosocial and popular
antisocial subtypes (Luthar and McMahon 1996; Parkhurst
and Hopmeyer 1998; Rodkin et al. 2000). Notably, based
on teacher, peer, and self-perceptions, youth in the popular
antisocial subtype have been characterized as extremely
aggressive and disruptive with co-occurring internalizing
problems (Rodkin et al. 2000), indicating a possible association between secondary psychopathy and popularity
status. Further, Adler and Adler (1998) noted that both
unpopular and popular youths who value and pursue popularity are more prone to engage in delinquent and
aggressive behaviors in an attempt to impress others and
improve their social status or to maintain their already
popular and dominant status, respectively. Moreover, these
adolescents tend to experience higher anxiety levels and
are especially reactive to social exclusion (Adler and Adler
1998), which makes them particularly susceptible to peer
influence and pressure (Cohen and Prinstein 2006; see also
Allen et al. 2005). Oftentimes, these attitudes go hand in
hand with adolescent rebellion against authority (i.e., nonconformity) in an effort to seek peer approval (Burnett
et al. 2011). Although not directly relevant, prior research
on juvenile psychopathy variants reporting greater psychosocial immaturity among high-anxious secondary variants compared with primary variants (Kimonis et al. 2011)
suggests that secondary psychopathy variants also may be
more susceptible to negative peer influences. To the contrary, Kerr et al. (2011) found that adolescents high on
callous-unemotional traits were less likely to be influenced
by their peers’ delinquent behavior, suggesting that youth
with callous-unemotional traits might be less susceptible to
peer pressure; however, no prior work has investigated
whether callous-unemotional variants differ in their
susceptibility to peer pressure. Taking into account these
adolescent peer processes is of great importance since the
association of popularity striving, susceptibility to peer
pressure, and conformity with psychopathic traits has yet to
be explored.
Present Study
Parallel approaches to making sense of heterogeneity in
childhood conduct problems and in adult psychopathy have
not previously converged despite strong evidence supporting the relevance of co-occurring callous-unemotional
traits and conduct problems to psychopathic personality
disorder. Putting aside controversies over whether antisocial behaviors captured by measures of childhood conduct
problems should be considered core to psychopathy, this
study aimed to examine to what extent the combination of
callous-unemotional traits and conduct problems, which
has been linked to emotional deficits similar to adult psychopathy, maps on to conceptualizations of primary and
secondary psychopathy that distinguish more homogeneous
subgroups on the basis of anxiety levels. Prior research
suggests that adolescent offenders—many of whom show
high rates of conduct disorder diagnosis—with callousunemotional/psychopathic traits are a heterogeneous population that can be disaggregated on the basis of anxiety
scores. By studying a large sample of community youth
who show greater variability in their levels of conduct
problems, we are able to address yet unanswered questions
such as: Are primary and secondary distinctions of psychopathy relevant to youth with callous-unemotional traits
with and without co-occurring conduct problems? Are
youth with co-occurring conduct problems and callousunemotional traits heterogeneous with respect to their
variant status?
Thus, the primary aim of the current study was to
examine whether variants of callous-unemotional traits
could be identified among a community sample of adolescent boys and girls on the basis of callous-unemotional
traits, conduct problems, and anxiety scores. We hypothesized that we would identify two groups of youth with cooccurring callous-unemotional traits and conduct problems,
one with lower anxiety scores consistent with primary
psychopathy and one with high anxiety scores consistent
with secondary psychopathy, as well as a low risk group.
Latent profile analysis was employed to identify the
hypothesized groups of children. Latent profile analysis is
similar to cluster analysis in that the identified class solutions depend entirely on measured variables; however, it is
a more advanced maximum likelihood based statistical
model and possesses a number of advantages compared to
cluster analysis, such as the reliance on person based
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probabilities to form classes, the non-reliance on the
assumptions of normality and linearity, and the use of more
rigorous criteria to decide on final model selection (Pastor
et al. 2007).
Our second aim was to compare the resulting clusters on
several personality and behavioral measures that are theorized to distinguish them, but have received little attention
in prior studies of youth and inconsistent findings among
adults (i.e., self-esteem/narcissism, impulsivity, proactive/
reactive aggression, and sensation seeking). On the basis of
prior research and theory, we hypothesized that secondary
callous-unemotional variants would score lower on selfesteem and higher on narcissism, impulsivity, sensation
seeking and reactive aggression than primary variants, and
that both groups would show poorer outcomes than low
callous-unemotional youth.
Our third aim was to compare these adolescent community-based callous-unemotional variants on peer factors
relevant to adolescent development not previously investigated in the literature, namely susceptibility to peer
pressure, popularity striving, and general conformity/obedience. Focusing on these peer processes as they relate to
primary and secondary psychopathy in adolescence may be
particularly important given that adolescents are more
prone to peer influences due to their increased need for
individuation from their parents (Steinberg and Monahan
2007). The need for autonomy from parents leads adolescents to be highly dependent on their peers and highly
susceptible to their pressures, resulting in antisocial
behavior (Erickson et al. 2000). We hypothesized that
secondary callous-unemotional variants would report
greater susceptibility to peer influences and popularity
striving than primary variants, but would not differ on
conformity/obedience such that both variants would report
lower levels than low risk youth given their higher levels of
conduct problems.
Finally, taking gender differences into account might
also be important because boys tend to score higher on
psychopathic traits, are more likely to engage in antisocial
behaviors, and tend to score lower on internalizing problems compared to girls (e.g., Fanti and Henrich 2010;
Lewinsohn et al. 1998; Marsee et al. 2005). This suggests
possible differences in the percentage of boys and girls that
might be identified in the primary and secondary variant
subgroups. Although research on psychopathy in females is
scant relative to males, both primary and secondary psychopathy variants have been identified in male and female
adult offender samples (Skeem et al. 2007; Hicks et al.
2004, 2010). For the most part, phenotypic manifestations
are similar across gender in that both men and women with
secondary psychopathy were distinguished from primary
psychopaths by greater anxiety, antisocial and violent
behavior; however, adult female offenders reported lower
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mean levels of aggression and greater psychopathology
(Hicks et al. 2010). To replicate and extend these findings
to a community sample of adolescent boys and girls,
prevalence differences and phenotypic manifestations of
primary and secondary callous-unemotional variants across
gender were explored.
Method
Participants
The sample consisted of 2,306 high school students living
in Cyprus, and was divided evenly between boys
(n = 1,160) and girls (n = 1,146). Adolescents ranged in
age between 15 and 18 years at the initial assessment
(M age = 16, SD = .89) and data were collected from high
school students in grades 10 (39 % of the sample), 11
(31.5 %), and 12 (29.5 %). The sample was diverse in
terms of parental education levels; 17.61 % did not complete high school, 47.89 % had a high school education,
and 34.5 % had a higher education degree, which is representative of the population in Cyprus.
Procedure
Following approval of the study by the Cyprus Ministry of
Education and Culture, 12 high schools in three different
Greek-Cypriot provinces (Nicosia, Larnaca, Limassol)
were selected randomly for participation. Parents/guardians
were informed of the longitudinal nature of the study and
96 % of those contacted consented to their child’s participation in the study. Ninety five percent of students
assented to participate (n = 2,414). In the first year of the
study, students completed a battery of questionnaires,
which took approximately one hour and included measures
used in the latent profile analysis (i.e., callous-unemotional
traits, conduct problems, anxiety), and self-esteem, narcissism, and impulsivity. Six months later, youth completed a second assessment of the same duration, which
included questionnaires about aggression, sensation seeking, social influences and conformity. A high percentage of
students in the original sample (95.51 %, n = 2,306) participated in the follow-up assessment. Attrition was due to
an inability to contact students who had moved away from
the area or had transferred to a different school.
Measures
Clustering Measures
Callous-Unemotional Traits The Inventory of CallousUnemotional Traits (ICU; Frick 2004) is a 24-item scale
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designed to assess self-reported callous-unemotional traits
in youth. The ICU comprises 12 positively worded (e.g., ‘‘I
express my feelings openly’’) and 12 negatively worded
items (e.g., ‘‘What I think is ‘‘right’’ and ‘‘wrong’’ is different from what other people think’’) that are rated on a
4-point Likert-scale ranging from 0 (not at all true) to 3
(definitely true). Item scores are summed to form a total
score that demonstrated adequate internal consistency in
the present study, a = .80. Previous research has provided
evidence for the validity of ICU scores in community and
high risk samples of American, German, and Greek Cypriot
youth (Essau et al. 2006; Fanti et al. 2009; Kimonis et al.
2008).
Conduct Problems and Anxiety The Checkmate plus
Youth’s Inventory-4 (YI-4; Gadow and Sprafkin 1999) is a
self-report checklist of DSM-IV symptomatology for the
most common disorders of childhood and adolescence.
Youth rate YI-4 symptoms on a 4-point Likert scale
ranging from 0 (never) to 3 (very often), with middle ratings of 1 (sometimes) and 2 (often). For the purposes of the
present study, only items corresponding to the 15-item
Conduct Disorder (e.g., ‘‘I stay out at night when I am not
supposed to’’; a = .90) and 6-item Anxiety symptoms
(e.g., ‘‘I have trouble getting myself to stop worrying’’;
a = .85) scales were used. The items were summed to
create overall conduct problems and anxiety subscales.
Previous research has provided evidence for the validity of
the YI-4 in a community sample of Greek Cypriot children
(Fanti 2011). In addition, prior work suggests high convergent and discriminant validity in community and clinical samples in the United States (Gadow and Sprafkin
1999; Gadow et al. 2002).
External Measures
Self-Esteem The Rosenberg Self-Esteem Scale (RSES;
Rosenberg 1965) is a 10-item measure of global selfesteem. Individuals report on their current feelings on a
five-point Likert scale ranging from 0 (strongly disagree) to
3 (strongly agree). Five items are worded positively (e.g.,
‘‘On the whole, I am satisfied with myself’’) and five are
worded negatively (e.g., ‘‘At times, I think I am no good at
all’’). RSES items are summed to form a total score with
higher scores indicating higher self-esteem (a = .73).
RSES scores have been found to be associated with ratings
of aggression and delinquency (Barry et al. 2009; Bushman
and Baumeister 1998).
Impulsivity and Narcissism The Antisocial Process
Screening Device—Youth Version (APSD; Frick and Hare
2001) is a self-report rating scale designed to assess
dimensions of psychopathy among youth. APSD items are
rated on a three-point Likert scale ranging from 0 (not at
all true) to 2 (definitely true). For the present study, only
the 5 items corresponding to the Impulsivity (e.g., ‘‘I do
not plan ahead or leave things until the last moment’’;
a = .69) and the 7 items corresponding to the Narcissism
(e.g., ‘‘I act charming or nice to get things I want’’;
a = .73) subscales were used in analyses. There is substantial support for the validity of the self-report version of
the APSD and for its ability to designate a group of antisocial youth with deficits in emotional functioning (e.g.,
Kimonis et al. 2006). Furthermore, self-reported APSD
scores were associated with parent ratings of psychopathic
traits, aggression, conduct problems and delinquency
(Munõz and Frick 2007).
Sensation Seeking The Sensation Seeking Scale FormV (SSS-V; Zuckerman, Eysenck, and Eysenck 1978) is a
40-item forced choice questionnaire that was developed to
measure individual differences in stimulation and arousal
needs. The SSS-V yields four 10-item subscales and a total
score. The Thrill and Adventure Seeking subscale assesses
the desire to engage in sports or activities involving some
physical risk (e.g., ‘‘I often wish I could be a mountain
climber’’; a = .79); the Experience Seeking scale assesses
the desire to seek out novel experiences through the mind
and the senses (e.g., ‘‘I like some of the earthly body
smells’’; a = .73); the Disinhibition scale assesses the need
to disinhibit behavior in the social sphere (e.g., ‘‘I like wild
uninhibited parties’’; a = .78); and the Boredom Susceptibility scale assesses an aversion for repetitive experiences
and restless reactions (e.g., ‘‘I can’t stand watching a movie
that I’ve seen before’’; a = .75). Scores are summed to
form a total score (a = .80) and four subscale scores. The
reliability, construct and cross-cultural validity for this
instrument is well established (for a review, see Zuckerman
1994).
Proactive and Reactive Aggression The self-rating scale
of the Proactive and Reactive Aggression Questionnaire
(Raine et al. 2006) is a 23-item questionnaire that measures
proactive (12 items; e.g., ‘‘Had fights with others to show
who was on top’’; a = .90) and reactive aggression (11
items; e.g., ‘‘Gotten angry when others threatened you’’;
a = .89). Items are rated on a 3-point Likert scale ranging
from 0 (never) to 2 (often) for frequency of occurrence.
The items refer either to physical or verbal aggression for
both proactive and reactive aggression subscales. Prior
research found that proactive aggression scores were
associated with delinquency, psychosocial adversity, psychopathic personality, blunted affect, and serious violent
offending in a sample of adolescents, while reactive
aggression scores were associated with adolescents’
impulsivity, hostility, social anxiety, lack of close friends,
969
unusual perceptual experiences, and ideas of reference
(Raine et al. 2006).
Social Influences and Conformity The Peer Pressure
Questionnaire (PPQ; Santor et al. 2000) is a 30-item selfreport questionnaire that yields three subscales: The 7-item
General Conformity subscale assesses the extent to which
individuals are obedient and conform to authority in general (e.g., ‘‘I usually do what I am told’’; a = .67); the
11-item Peer Pressure subscale assesses the subjective
experience of feeling pressured, urged, or dared by peers to
do certain things (e.g., ‘‘My friends could push me into
doing just about anything’’; a = .77); and the 12-item
Popularity Striving subscale measures an individual’s
intention to do certain things in order to be viewed as
popular among their peers (e.g., ‘‘I have done things to
make me more popular, even when it meant doing something I would not usually do’’; a = .85). PPQ items, which
are rated on a 5-point Likert scale ranging from 0 (strongly
disagree) to 4 (strongly agree), were averaged to create the
three subscales. PPQ subscales were found to predict
adolescent well-being (e.g., self-esteem and dysphoria),
risk behaviors (e.g., substance use, delinquency, and sexual
behavior), and school performance (Santor et al. 2000).
Plan of Analysis
To address the first aim of identifying primary and secondary callous-unemotional variants, latent profile analysis
was conducted with the three continuous indicators of
callous-unemotional traits, conduct problems, and anxiety
measured at Time 1. Analyses were run using Mplus 6.1
statistical software (Mutheń and Mutheń 2010). Latent
profile analysis is an extension of latent class analysis that
accommodates continuous indicators and identifies heterogeneous latent classes by decomposing the covariance
matrix to highlight relationships among individuals, and
clusters individuals into latent classes (Bauer and Curran
2004). Separate latent profile analysis models are specified
that differ in the number of classes, which allows for the
identification of the optimal number of groups to retain.
Several statistical criteria are used to compare the relative fit of the various models, including the Bayesian
information criterion (BIC), the Akaike information criterion (AIC), the Lo-Mendel-Rubin (LMR) statistic, and the
entropy value (Nylund et al. 2007). Models with lower BIC
and AIC values are preferred. The LMR statistic tests k – 1
classes against k classes, and a significant Chi square value
(p \ .05) indicates that the k – 1 class model is rejected in
favor of the k class model (Lo, Mendell and Rubin 2001).
A non-significant Chi square value (p [ .05) suggests that
a model with one fewer class is preferred. Entropy values
greater than .70 are preferable as they indicate clear
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classification and greater power to predict class membership (Mutheń 2000). Latent profile analysis estimation in
Mplus outputs two sets of results: (1) scores for each
cluster on the measured variables, and (2) the posterior
probability of class membership for each case. The average
posterior probabilities are taken into consideration in concert with entropy values to determine the precision of
classification and the degree to which classes are distinguishable. Average posterior probabilities equal to or
greater than .70 imply satisfactory fit (Nagin 2005).
To address our second aim of validating identified
clusters, we used multivariate analyses of variance (MANOVA) to test for main effects of gender, identified groups,
and gender by group interactions (2 9 4 design) on external
measures of self-esteem, narcissism, impulsivity, sensation
seeking and proactive/reactive aggression. Separate MANOVAs were conducted for conceptually similar and more
highly correlated measures. MANOVA also was used to
address our third aim of comparing callous-unemotional
variants on peer factors, including general conformity,
susceptibility to peer pressure, and popularity striving.
Because the focus of the study is on primary and secondary
callous-unemotional variants, only main effects and interactions involving group were examined in detail, although
main effects of gender are reported when significant.
Results
Descriptive Statistics
Means and standard deviations (SD) for the main study
variables are reported in Table 1. The average scores for
callous-unemotional traits reported in the current study
were lower compared to scores of incarcerated youth in the
United States (Kimonis et al. 2013), but similar to average
scores reported by German community youth (Essau et al.
2006). Correlations among the measured variables also are
reported in Table 1. With the exception of self-esteem and
conformity, the majority of variables were associated
positively with callous-unemotional traits and conduct
problems. Anxiety was associated positively with impulsivity, narcissism, reactive aggression, susceptibility to
peer pressure, and popularity striving, and associated
negatively with self-esteem. Conduct problems were
associated positively with both callous-unemotional traits
and anxiety, although callous-unemotional traits were not
associated significantly with anxiety.
Latent Profile Analysis
To identify the optimal number of groups to retain, five
separate latent profile analysis models were estimated to
123
compare the relative fit of models specifying one to five
groups. As shown in Table 2, the BIC statistic increased
from four classes to five classes and the LMR statistic fell
out of significance for the five-class model, suggesting that
the four-class model better fit the data. Moreover, the fiveclass model identified a small group of twelve adolescents
that split a larger class into two. As a result, the more
parsimonious four-class model was selected for further
analyses. Furthermore, the mean posterior probabilities for
the four identified classes ranged from .88 to .98 and the
entropy value was .91, suggesting that the classes were
separated well.
The standardized scores and 95 % confidence intervals
for each variable included in the latent profile analysis are
depicted in Figure 1 for the four group solution. The
majority of adolescents fell into group 1 (n = 1,856;
80.5 %), labeled the low risk group because they scored
below average on anxiety (M = 4.23, SD = 2.89), conduct
problems (M = 2.05, SD = 2.02), and callous-unemotional traits (M = 22.70, SD = 8.17). Adolescents in group
2 (n = 206; 8.9 %), labeled the anxious group, scored
higher on anxiety (M = 13.25, SD = 2.09) compared to
the low risk group, but similarly on callous-unemotional
traits (M = 20.86, SD = 8.13) and conduct problems
(M = 2.78, SD = 2.17) to the low risk group. Adolescents
in group 3 (n = 180; 7.8 %), labeled the primary callousunemotional group, scored higher on callous-unemotional
traits (M = 32.30, SD = 7.16) and conduct problems
(M = 11.98, SD = 3.19) compared to the low and anxious
groups, but lower on anxiety (M = 6.40, SD = 3.99)
compared to the anxious group. Finally, adolescents in
group 4 (n = 64; 2.8 %), labeled the secondary callousunemotional group, showed comparable levels of callousunemotional traits (M = 36.01, SD = 6.33) to the primary
callous-unemotional group, although they scored higher on
conduct problems (M = 18.57, SD = 6.91) compared to
the rest of the identified groups. Further, youth in the
secondary callous-unemotional group scored higher on
anxiety (M = 9.09, SD = 4.28) compared to the primary
and low risk groups, although their anxiety levels were
lower than the anxious group.
Post-hoc Chi square analyses revealed that boys were
more likely to comprise the primary (160 boys, 20 girls; 8:1
ratio) and secondary (58 boys, 6 girls; 10:1 ratio) callousunemotional subgroups than were girls; however, girls were
more likely to comprise the anxious (53 boys, 153 girls; 1:3
ratio) subgroup compared with boys. The gender ratio was
more comparable for the low risk subgroup (889 boys, 967
girls), v2(2, N = 2306) = 202.88, p \ .001. The identified groups
did not differ in their grade level, v2(6, N = 2306) = 11.42,
p = .08, or parental education level, v2(6, N = 2306) = 3.77,
p = .71, and therefore these variables were not included in
further analyses.
.29**
.02
.05*
.23**
.26**
.33**
.21**
.14**
.24**
-.39**
23.65
6. Impulsivity
7.TAS
8. ES
9. DIS
10.BS
11. Proactive Ag
12. Reactive Ag
13. Popularity striving
14. Peer pressure
15. Conformity
Descriptives
Mean
5.35
3.58
-.32**
.43**
.32**
.36**
.48**
.28**
.30**
.09**
.05*
.42**
.49**
-.13**
.23**
1
2
3.99
5.34
-.04*
.24**
.21**
.26**
.06*
.01
-.03
.05*
-.04
.30**
.20**
-.35**
1
3
4.44
19.42
.09**
-.28**
-.13**
-.12**
-.07*
.01
.01
-.01
.06*
-.14**
-.02
1
4
.39**
.43**
.27**
.33**
.24**
.23**
.06*
.02
.59**
3.40
4.13
-.20**
1
5
.15**
.43**
.33**
.32**
.27**
.21**
.27**
.19**
2.85
4.87
-.28**
1
6
.08*
.03
.11**
.02
.01
.16**
.29**
2.63
6.05
-.10**
1
7
1.65
4.56
-.13**
.11**
.02
.12**
.13**
.17**
.25**
1
8
2.34
4.10
-.28**
.29**
.20**
.31**
.33**
.47**
1
9
1.83
3.09
-.27**
.15**
.13**
.27**
.36**
1
10
3.84
2.79
-.21**
.29**
.25**
.60**
1
11
4.11
8.08
-.23**
.29**
.22**
1
12
.98
1.02
-.03
.62**
1
13
.56
.98
-.12**
1
14
.62
2.20
1
15
* p \ .05; ** p \ .01
CU callous-unemotional, CP conduct problems, TAS thrill and adventure seeking, ES experience seeking, DIS disinhibition, BS boredom susceptibility, Ag aggression; Peer pressure
susceptibility to peer pressure
8.72
.32**
5. Narcissism
SD
-.23**
4. Self-esteem
.40**
-.01
2. CP
3. Anxiety
1
1. CU Traits
1
Table 1 Descriptive statistics and correlations among the main study variables
971
123
972
Table 2 Model fit statistics for the latent profile analysis
Classes
BIC
AIC
Entropy
LMR
1
43,788.21
43,753.75
N/A
N/A
2
42,035.31
41,977.87
.98
p \ .001
3
41,490.45
41,410.04
.96
p \ .05
4
41,354.80
41,251.42
.91
p < .05
5
41,837.03
41,963.38
.89
p = .35
Values in bold indicate the optimal number of groups to retain for
analysis
3.50
Anxiety
3.00
Z- scores
2.50
CP
CU
2.00
1.50
1.00
.50
.00
-.50
-1.00
Low risk
(80.5%)
Anxious
(8.9%)
Primary CU
(7.8%)
Secondary CU
(2.8%)
the overall sensation seeking measure using ANOVA. Findings shown in Table 3 suggested that the primary and secondary callous-unemotional subgroups scored higher on
sensation seeking compared to the low risk and anxious subgroups, but did not differ significantly from each other. Gender differences suggested that boys reported higher sensation
seeking than girls, F(1, 2306) = 8.11, p \ .01.
MANOVA results comparing subgroups on aggression
types was significant [Wilks’ Lambda = .86, F(6,
4594) = 60.47, p \ .001]. The secondary callous-unemotional subgroup scored higher on reactive aggression
compared with the primary callous-unemotional subgroup
and the other two subgroups. The primary callousunemotional subgroup scored higher on reactive aggression
than the anxious group, which scored higher than the low
risk group (S [ P [ A [ L). Both callous-unemotional
subgroups scored higher on proactive aggression than the
low callous-unemotional groups, and the secondary callous-unemotional group scored higher on proactive
aggression compared to the primary callous-unemotional
group. Gender differences [Wilks’ Lambda = .99, F(2,
2297) = 13.21, p = .01] further suggested that boys
scored higher on proactive aggression than girls.
Groups
Fig. 1 Z-scores and confidence intervals across subgroups identified
using latent profile analysis. CU callous-unemotional; CP conduct
problems
Validating the Identified Groups
As depicted in Table 3, MANOVA findings comparing the
identified groups on self-esteem, narcissism and impulsivity
suggested main effects for groups [Wilks’ Lambda = .86,
F(9, 5588.01) = 39.33, p \ .001]. Anxious and secondary
callous-unemotional groups scored lower on self-esteem
compared with the primary callous-unemotional and low
risk groups. The two callous-unemotional subgroups
reported significantly higher rates of impulsivity and narcissism compared with the low risk and anxious subgroups,
although the secondary callous-unemotional subgroup
scored higher on narcissism compared to the primary callous-unemotional subgroup. The anxious group scored
higher on impulsivity compared with the low risk group.
MANOVA results comparing subgroups on different subscales of sensation seeking suggested main effects for gender
[Wilks’ Lambda = .99, F(4, 2286) = 5.01, p \ .001] and
group [Wilks’ Lambda = .96, F(12, 6048.48) = 6.62,
p \ .001]. Boys scored higher on the Thrill and Adventure
Seeking and Disinhibition subscales than girls. There were no
significant differences between callous-unemotional subgroups; however, they both scored higher on disinhibition and
boredom susceptibility compared with low callous-unemotional subgroups. We further compared identified groups on
123
Comparing Groups on Social Influences
MANOVA results comparing subgroups on measures of
general conformity, susceptibility to peer pressure, and
popularity striving suggested main effects for gender
[Wilks’ Lambda = .98, F(3, 2296) = 14.37, p \ .001],
groups [Wilks’ Lambda = .92, F(9, 5588.01) = 22.04,
p \ .001], and a significant gender by group interaction
[Wilks’ Lambda = .98, F(9, 5588.01) = 3.59, p \ .001].
Boys reported higher levels of susceptibility to peer pressure and popularity striving than girls. The secondary
callous-unemotional subgroup scored significantly higher
on susceptibility to peer pressure and popularity striving
compared with the primary callous-unemotional subgroup.
Both high callous-unemotional subgroups scored significantly higher on susceptibility to peer pressure and popularity striving, but lower on general conformity/obedience,
compared with low callous-unemotional groups. According
to the identified gender by group interaction shown in
Fig. 2, boys, but not girls, in the secondary callousunemotional subgroup reported greater susceptibility to
peer pressure compared with the rest of the sample.
Discussion
The present study aimed to determine whether community
boys and girls with callous-unemotional traits are a heterogeneous population similar to offending youth and
973
Table 3 Comparisons between the identified groups
F-value
df
p
g2
Low risk (n = 1,856)
Anxious (n = 206)
Primary CU (n = 180)
Secondary CU (n = 64)
19.90(.10)a
16.65(.30)b
18.70(.32)a
16.69(.54)b
46.02
3
.00
.06
a
a
b
10.83(.38)c
173.11
3
.00
.18
Variables
Self-esteem
Narcissism
3.60(.07)
Impulsivity
4.42(.06)a
5.80(.19)b
7.28(.20)c
8.00(.33)c
103.22
3
.00
.12
a
a
a
5.89(.33)a
1.39
3
.24
.00
4.28(.21)
7.04(.23)
TAS
6.07(.06)
ES
4.51(.04)a
4.73(.12)a
4.83(.12)a
4.70(.20)a
3.15
3
.02
.01
DIS
3.92(.05)a
3.69(.16)a
5.86(.17)b
5.59(.86)b
50.55
3
.00
.06
BS
2.95(.04)a
2.89(.12)a
4.24(.13)b
4.64(.22)b
45.47
3
.00
.06
16.44(.12)a
16.86(.42)a
20.70(.62)b
20.31(1.11)b
8.37
3
.00
.02
a
a
b
c
Sensation seeking
5.77(.18)
6.30(.19)
Proactive Ag
2.20(.07)
301.64
3
.00
.28
Reactive Ag
Popularity striving
8.35(.09)a
.95(.01)a
10.75(.26)b
1.14(.04)a
12.52(.27)c
1.32(.05)b
13.84(.46)d
1.80(.08)c
126.11
58.15
3
3
.00
.00
.14
.07
.90(.01)a
1.13(.04)b
1.37(.04)c
1.89(.07)d
117.63
3
.00
.13
b
b
a
1.78(.08)a
61.77
3
.00
.07
Peer pressure
Conformity
2.26(.01)
2.61(.19)
2.18(.04)
7.09(.20)
1.69(.05)
9.76(.35)
Susceptibility to peer pressure
Estimated marginal means (SE); Different superscripts (a,b,c) denote significant differences between groups in post hoc pairwise comparisons.
CU callous-unemotional, CP conduct problems, TAS thrill and adventure seeking, ES experience seeking, DIS disinhibition, BS boredom
susceptibility, Peer Pressure = Susceptibility to Peer Pressure
Groups
Fig. 2 Gender by group interaction effects including 95 % confidence intervals. CU callous-unemotional; CP conduct problems
psychopathic adults (e.g., Hicks et al. 2004; Kimonis et al.
2012a, b). It aimed to combine two separate but parallel
lines of research highlighting the importance of the cooccurrence of callous-unemotional traits and conduct
problems, on the one hand, and the heterogeneity of callous-unemotional/psychopathic traits among antisocial
populations, on the other, to determine whether community-based adolescents who show variability in their levels
of conduct problems can be distinguished into primary and
secondary variants when levels of callous-unemotional
traits are high. It also aimed to examine whether variants
would differ in their reports of distinct personality traits
(i.e., self-esteem, narcissism, impulsivity, and sensation
seeking) or could be distinguished on the basis of showing
proactive or reactive forms of aggression. Furthermore, this
study extends prior work by examining whether developmental factors that are relevant to antisocial and aggressive
behavior in typically developing youth distinctly relate to
the personality profiles of primary and secondary callousunemotional variants. In this respect, this research contributes four key findings. First, using a rigorous clustering
approach, we successfully identified community-based
primary and secondary callous-unemotional variants
showing characteristics consistent with theory and prior
empirical work conducted with adult and juvenile offenders (e.g., Vassileva et al. 2005; Vaughn et al. 2009), further
supporting the idea that the construct of psychopathy is not
unitary in adolescence. Second, callous-unemotional variants showed important differences on several social influence factors relevant to adolescent development, namely
susceptibility to peer pressure and popularity striving.
Third, secondary variants were distinguished by lower selfesteem in combination with greater narcissism, whereas
primary variants displayed higher self-esteem. Fourth, we
identified gender differences in prevalence rates for youth
in the primary and secondary callous-unemotional variant
subgroups, although boys and girls were relatively indistinguishable phenotypically. Our findings are placed in the
context of the broader literature below.
The most marked difference between adolescent callous-unemotional variants was in their levels of conduct
problems. Both groups of youth scoring high on callousunemotional traits showed high levels of conduct problems,
consistent with Karpman’s (1941) perspective that psychopathy variants are phenotypically indistinguishable.
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However, with respect to the number of conduct problems
symptoms that they reported, the proportionally smaller
group of community-based secondary callous-unemotional
variants reported levels approximately 1.5 standard deviations higher than primary variants, and almost three standard deviations greater on average compared with low risk
youth. Similarly, secondary variants also reported the
greatest levels of aggression, consistent with prior research
with adult and male juvenile offender samples (e.g., Hicks
et al. 2004; Kimonis et al. 2011). Anxiety was a second
chief distinction between primary and secondary variants
in this study, consistent with theoretical conceptualizations
(Blackburn 1975; Karpman 1941, 1948a, b). The robustness of this finding—across several studies using various
methods and samples—suggests that anxiety is important
for distinguishing this taxonomy among adults and youth
alike (e.g., Blackburn 1975; Hicks et al. 2004; Skeem et al.
2007; Vaughn et al. 2009). Similar to Swogger and Kosson’s (2007) and others’ findings, primary variants exhibited lower levels of anxiety compared with secondary
variants that exhibited high levels that were close to one
standard deviation above the sample mean. Interestingly,
although anxiety is not strongly associated with callousunemotional traits (Frick and Ellis 1999), which is in
agreement with the non-significant correlation between
anxiety and callous-unemotional traits found in the current
study (r = -.01), anxiety is an important subtyping variable for identifying different callous-unemotional variants.
These findings expand upon a robust research base
supporting the importance of callous-unemotional traits to
distinguishing a more severe group of antisocial youth who
show greater conduct problems and proactive and reactive
aggression (Frick et al. 2003a, 2005), and suggest that
within this group the additional presence of comorbid
anxiety problems might further distinguish those youth
with markedly more severe and aggressive conduct problems. Our finding that secondary callous-unemotional
variants showed significantly greater levels of both proactive and reactive forms of aggression relative to primary
variants was contrary to our hypotheses. However, reactive
versus proactive forms of aggression have poorly distinguished psychopathy variants in prior research as well (see
Skeem et al. 2003), and in hindsight it is likely that the
presence of proactive aggression is what distinguishes
youth with callous-unemotional/psychopathic traits from
antisocial youth without these traits, as prior research
suggests (Frick et al. 2003a), irrespective of whether the
youth is classified as a primary or secondary variant. What
this study was not able to address is to what extent the
small subpopulation of secondary callous-unemotional
variants are victims of trauma (i.e., victimization, violence
exposure) as theory suggests (Karpman 1948a, b; Porter
1996), which recent research has uncovered as one
123
mechanism through which youth high on callous-unemotional traits come to express their antisocial tendencies in
aggressive ways (Howard et al. 2012). In contrast, these
authors suggest that high callous-unemotional youth not
exposed to violent models will be likely to offend in nonviolent ways, such as engaging in property crimes. It will
be important for future research to uncover whether
exposure to violence (e.g., domestic, community violence,
maltreatment) accounts for the pattern of anxious and
aggressive characteristics that distinguishes secondary
from primary variants.
Primary and secondary variants did not differ significantly in their levels of callous-unemotional traits, which is
consistent with prior research (Hicks et al., 2004; Kimonis
et al. 2012a, b; Vassileva et al. 2005). However, they did
show important differences on several external measures;
primary variants reported high levels of self-esteem,
whereas high-anxious secondary variants reported lower
levels of self-esteem but greater narcissism. Similarly,
Kimonis et al. (2011) found higher narcissism scores
among incarcerated male secondary juvenile psychopathy
variants compared with primary variants, supporting consistency in findings across different methods of measurement (i.e., interview-based vs. self-report instruments).
Low self-esteem has long been theorized as a risk factor for
antisocial and aggressive behavior, and in combination
with high narcissism suggests a possible mechanism for
leading secondary variants to engage in aggressive
behaviors (see Barry et al. 2003; Baumeister et al. 1996).
That is, decades of research on narcissism suggests that
feelings of inferiority and insecurity, defensively masked
by a grandiose self-view, may explain why these youth
come to aggress against others proactively in order to
achieve dominance and popularity among peers (Olweus
1995; Salmivalli 2001), and also reactively to preserve and
avenge potential threats to their fragile egos (i.e., threatened egotism theory, Bushman and Baumeister 1998; see
also Thomaes et al. 2009). Consistently, secondary callousunemotional variants’ patterns of aggression were both
reactive and proactive in nature. Moreover, poor selfesteem and high narcissism are common among maltreated
youth (e.g., Vondra et al. 1989), which is identified by
theoretical models as a central causal factor for distinguishing secondary variants, yielding consistent empirical
support among juvenile offenders (Kimonis et al. 2011;
Tatar et al. 2012; Vaughn et al. 2009). With respect to
primary variants, some studies report that high levels of
self-esteem also may lead youth to aggressive and antisocial acts (e.g., Thomaes et al. 2008), providing a possible
explanation for their engagement in aggressive behavior.
Another possibility is that primary variants are better
adjusted than secondary variants. For example, Hicks et al.
(2010) found that individuals in the primary psychopathy
subgroup were characterized by relatively normal scores on
personality measures, which might reflect Cleckley’s
(1976) notion of the psychopath’s ‘‘mask of sanity’’ (p. 13).
A novel contribution of this study was the finding that
community-based secondary callous-unemotional variants
showed greater susceptibility to peer pressure and popularity striving than primary variants. Consistent with their
greater levels of conduct problems and aggression, Allen
et al. (2006) reported a significant association between high
susceptibility to peer pressure, low self-esteem and high
antisocial behavior (Bamaca and Umana-Taylor 2006).
Although our findings contradict Kerr et al.’s (2011) proposal that the higher adolescents are on psychopathic traits,
the less they seem to be influenced by others, they do
suggest that adolescents high on callous-unemotional traits
and anxiety are particularly susceptible to negative peer
influences and desperately strive to be popular. A significant gender by group interaction indicated that boys in the
secondary callous-unemotional subgroup were more susceptible to peer pressure compared to girls. As a result,
boys with high scores on conduct problems, callousunemotional traits, and anxiety are at heightened risk to be
influenced by their peers during adolescence, which might
relate to their greater engagement in antisocial behaviors.
Because this is the first study that compares callousunemotional variants on peer status measures, these findings need to be replicated in future work.
The present study uncovered a few unexpected findings.
First, callous-unemotional variants did not score significantly differently from one another on measures of
impulsivity and all types of sensation seeking. This finding
is of note given that Karpman (1948a, b) believed that
impulsivity best characterized the behavior of secondary
psychopathic individuals, whereas he described primary
psychopaths as carrying out their actions in a calm and
purposeful way. Consistently, among an incarcerated adolescent male offender sample (N = 373), Kimonis et al.
(2012a, b) found that high-anxious secondary variants of
youth scoring high on the Youth Psychopathic Traits
Inventory (YPI; Andershed et al. 2002) (n = 43) scored
significantly higher on its impulsivity scale compared with
lower anxious primary variants (n = 122), but not significantly different on its grandiose-manipulative scale.
However, whereas some prior studies document higher
impulsivity scores among adult secondary variants (Hicks
et al. 2004), others do not (Skeem et al. 2007). Further,
agreeing with our findings, Ray et al. (2009) found that
both primary and secondary psychopathy variants are
associated with sensation seeking. Whereas the impulsive
behavior of secondary variants may result from high
urgency and attempts to reduce the intensity of one’s
experience of negative affect (Lynam and Miller 2004), the
impulsive behavior characterizing primary variants may
975
result from their lack of inhibition to aversive stimuli,
insensitivity to cues of punishment, and reward oriented
behavior (Frick et al. 2003b).
Another unexpected, yet logical, finding was that the
latent profile analysis identified a fourth subgroup of youth
scoring low on callous-unemotional traits that were distinguished primarily by high anxiety levels, higher impulsivity and reactive aggression scores and lower self-esteem
in comparison with low-risk youth. This group was comprised of a proportionately greater number of girls than
boys, which might explain the failure to identify this subgroup in prior juvenile subtyping studies that focused
predominately on male samples. However, Swogger and
Kosson (2007) similarly found a high anxious group when
clustering their full sample of male inmates, which is
typically not identified when only including high psychopathy scoring individuals in analyses. More in line with
expectations and prior research (Fontaine et al. 2011; Rowe
et al. 2010), both callous-unemotional variants exhibited
more negative outcomes relative to low risk youth who
exhibited the lowest levels of conduct problems, anxiety,
narcissism, impulsivity, popularity striving, and susceptibility to peer pressure.
Gender Differences
By using a large nationally representative sample of community adolescent boys and girls, we were able to identify
gender differences in rates of primary and secondary callous-unemotional traits with co-occurring conduct problems. A higher percentage of boys than girls was identified
in both the primary and secondary callous-unemotional
subgroups, which is in agreement with prior work showing
that adolescent boys are at higher risk than girls to show
co-occurring callous-unemotional traits and conduct problems (Fanti 2013). The lower percentage of girls identified
in the high callous-unemotional groups might be due to
gender differences in socialization experiences, as those of
girls are more likely to promote empathic sensitivity
(Zahn-Waxler 2000). Consistent with evidence that adolescent girls are more likely to experience anxiety than
boys (Lewinsohn et al. 1998), a higher percentage of girls
than boys were identified in the anxious low callousunemotional group. Although a gender by group interaction
was identified in relation to the susceptibility to peer
pressure measure, it is important to consider the absence of
such interactions at the phenotypic level for the majority of
individual and social outcomes across the identified groups.
This suggests that boys and girls in the primary and secondary callous-unemotional subgroups showed similar
phenotypic manifestations of personality traits, aggressive
behaviors, and social influence factors relevant to adolescent development. However, a number of mean level
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976
differences were identified, with boys reporting greater
sensation seeking, susceptibility to peer pressure, popularity striving, and proactive aggression than girls. Indeed,
boys prefer more novel and dangerous activities (Crapanzano et al. 2010), are more susceptible to peer pressure
(Adler and Adler 1998), and are more likely to engage in
proactive aggression (Fanti et al. 2009) compared with
girls.
Strengths and Limitations
The study findings must be considered within the context
of some limitations. First, all constructs were assessed
using adolescents’ self-report, which may have inflated
correlations due to shared method variance, or led to possible underreporting of undesirable characteristics and
behaviors (Pakaslahti and Keltikangas-Jarvinen 2000).
However, recent research comparing self- and parentreports of callous-unemotional traits among adolescents
revealed that there may be bias in caregiver responses, and
that callous-unemotional traits might be more reliably
assessed using self-report or interview measures during
adolescence, which tend to be significantly correlated (Fink
et al. 2012). Moreover, the validity of self-report measures
of psychopathic and other personality traits tends to
increase with age, and the validity of parent- and teacherreports is lowest during adolescence (Frick et al. 2010).
Second, we did not assess childhood abuse and other
traumatic experiences that have been found to be relevant
to distinguishing psychopathy variants in offender populations (e.g., Kerr et al. 2011). As a result, we were unable
to evaluate whether similar theorized causal factors may be
in operation for the less pathological community youth.
Third, in the current study we used the narcissism scale of
the APSD that assesses more maladaptive (entitlement,
exploitativeness, exhibitionism) than adaptive (leadership,
authority, self-sufficiency) traits; however future studies
need to consider these different dimensions of narcissism
(see Barry et al. 2003) in relation to primary and secondary
callous-unemotional variants.
Notwithstanding these limitations, the study also has
important strengths. Notably, it makes use of a large
nationally representative study sample, which allowed for
the use of rigorous latent profile analysis, and the collection
of data from both boys and girls, enabling the investigation
of gender differences and gender by group interactions.
Additionally, the current study was conducted in a cultural
group that has not been the focus of research on callousunemotional traits. This is also the first study to be conducted in a community sample of youth to identify primary
and secondary adolescent psychopathy variants. As such, it
supports the contention that primary and secondary callous-unemotional variants can be identified across cultures
123
and in both community and incarcerated adolescent samples. Furthermore, the variables measured in the current
study extended the association of primary and secondary
callous-unemotional variants to social influence factors
relevant to adolescent development.
Practical Implications
Practically, in community settings the presence of callousunemotional traits may signal greater risk for severe antisocial and aggressive behavior when they co-occur with
anxiety than when they appear alone. If the goal is to
decrease antisocial behavior, the secondary variant is the
most appropriate group to target with intervention efforts.
Karpman (1948b) believed that secondary variants ‘‘are
amenable to psychotherapeutic treatment and therefore
offer a far more hopeful outlook than is currently given to
the [primary] psychopathic cases’’ (p. 533). This hypothesized potential for change in response to environmental
influences highlights the importance of focusing intervention efforts and resources on this small subgroup of antisocial youth (\3 %). Furthermore, evidence for their
greater susceptibility to peer influences suggests that
establishing autonomy with peers may be beneficial for
secondary variants, which might decrease their engagement
in deviant behavior (Allen et al. 2006). Strengthening their
self-esteem and reducing grandiosity can lessen youths’
vulnerability to ego threats, and reduce their potential for
aggressive behavior (Thomaes et al. 2009). Another possibility is to focus efforts on alleviating their pathological
anxiety by implementing evidence-based cognitivebehavioral treatments. If further research is able to establish a link between secondary callous-unemotional traits
and trauma among community youth that is supported
among offender populations, trauma-focused interventions
may be important to future intervention research with this
population. Current findings also provide information on
common risk factors associated with primary and secondary callous-unemotional variants. Importantly, interventions that promote executive functioning and empathic
responding might be successful for reducing problem
behaviors for both primary and secondary callous-unemotional variants. In closing, adolescents with callous-unemotional/psychopathic traits are heterogeneous with
respect to co-occurring conduct problems and internalizing
psychopathology. Appreciating these distinctions is likely
to improve the field’s understanding of the development,
identification, and treatment of these traits that are relevant
to a population of youth at risk for a severe and stable
pattern of impairment across the lifespan.
Acknowledgments This work was supported by the University of
Cyprus (Internal Research Grant awarded to the first author).
Author Contributions KF and CD conceived of the study, participated in its design and coordination and performed the measurement;
KF, CD, and EK participated in the statistical analysis, interpretation
of the data and drafted the manuscript. All authors read and approved
the final manuscript.
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Author Biographies
Kostas A. Fanti is a Lecturer of Developmental Psychology at the
Department of Psychology, University of Cyprus. He received his
doctorate in Developmental Psychology from Georgia State University. His major research interests include the development of
antisocial behavior, and how biological, individual and social risk
and protective factors are associated with the development of
aggressive and violent behavior.
Chara A. Demetriou holds an MA in school psychology from the
Department of Psychology, University of Cyprus, and she is working
toward her MSc degree in child and adolescent Mental Health at the
Institute of Child Health, University College London. Her major
research interests focus on child and adolescent antisocial behavior.
Eva R. Kimonis is a Senior Lecturer in the School of Psychology at
the University of New South Wales. She received her doctorate in
Applied Developmental Psychology from the University of New
Orleans. Her program of research focuses on risk factors for the
development of psychopathy and violent behavior, with special
interest in the role of childhood abuse experiences and emotional
processing.
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Variants of Callous-Unemotional Conduct Problems in a Community Sample of Adolescents

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