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Maltreatment Profiles Among Incarcerated Boys With Callous-Unemotional Traits Eva R. Kimonis, Kostas A. Fanti, Zachary Isoma and Kathleen Donoghue Child Maltreat published online 3 April 2013 DOI: 10.1177/1077559513483002 The online version of this article can be found at: http://cmx.sagepub.com/content/early/2013/04/01/1077559513483002

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Article

Maltreatment Profiles Among Incarcerated Boys With Callous-Unemotional Traits

Child Maltreatment 00(0) 1-14 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077559513483002 cmx.sagepub.com

Eva R. Kimonis1,2, Kostas A. Fanti3, Zachary Isoma4, and Kathleen Donoghue1,5

Abstract Callous-unemotional (CU) traits in youth are believed to be a developmental precursor to adult psychopathy, tapping its affective dimension. There is growing support for the existence of variants of psychopathy that can be distinguished based on the presence of anxiety, maltreatment histories, and comorbid psychopathology. The purpose of the present study was to examine whether primary and secondary variants of CU traits could be differentiated according to their experiences of distinct types of childhood maltreatment among a sample of 227 incarcerated adolescent boys. Results indicated that variants of youth scoring high on CU traits could be identified which were consistent with theory and prior research. Greater sexual abuse histories, violent and property delinquency, and a sexually motivated index offense distinguished secondary variants, whereas greater neglect distinguished primary variants of youth with CU traits. Psychopathy variants were behaviorally indistinguishable with respect to their levels of aggression and drug delinquency, although they differed in several important ways from youth scoring low on CU traits. Variants also showed distinct patterns of scores on the measure of CU traits. These findings are important to informing developmental theories of psychopathy and have practical and policy implications for intervening with maltreated and antisocial youth. Keywords callous-unemotional traits, psychopathy, maltreatment, neglect, sexual abuse, psychopathy subtypes, sexual offending

Psychopathic personality disorder is defined by a constellation of characteristics that include a callous and deficient affective experience, an arrogant and deceitful interpersonal style, and an impulsive and irresponsible lifestyle. Efforts to identify childhood precursors to psychopathy have pinpointed the affective characteristics (i.e., low empathy/guilt, uncaring attitudes), which are described as callous-unemotional (CU) traits, as best distinguishing those with a particularly severe, stable, and aggressive pattern of antisocial behavior (Obradovic´, Pardini, Long, & Loeber, 2007; Pardini & Fite, 2010; White & Frick, 2010). There is mounting support for disaggregating the construct of psychopathy into more homogenous primary and secondary subtypes, or variants. Theoretically, primary variants most closely resemble Cleckley’s (1941/1976) original conceptualization of psychopathy that focused on a core emotional deficiency not attributed to any ‘‘obvious mistreatment’’ by parents (p. 24); however, prior research supports a specific relationship between neglect and primary psychopathy. In contrast, Karpman (1941) and others described secondary psychopathy as originating from parental physical or sexual abuse, despite a phenotypically similar presentation to primary variants (Porter, 1996). In the present study, we examine whether variants of youth scoring high on CU traits can be identified and distinguished by their maltreatment experiences.

Childhood Maltreatment and Psychopathy The literature on biological and temperamental differences vastly overshadows that of psychosocial risk factors for the development of psychopathy; however, there are at least 10 studies generated over more than a decade documenting a link between childhood abuse and psychopathy (e.g., Bernstein, Stein, & Handelsman, 1998; Koivisto & Haapasalo, 1996; Lang, Klinteberg, & Alm, 2002). In their landmark longitudinal study, Weiler and Widom (1996) examined psychopathy scores among 652 individuals with a legally documented history of childhood abuse (i.e., physical, sexual abuse) and/or neglect (combined), compared with a matched control group of 489 individuals without a documented history of maltreatment. They found that victims of childhood maltreatment scored

1

University of South Florida, Tampa, FL, USA The University of New South Wales, Sydney, Australia 3 University of Cyprus, Nicosia, Cyprus 4 Pacific University, Forest Grove, OR, USA 5 Wayne State University, Detroit, MI, USA 2

Corresponding Author: Eva R. Kimonis, School of Psychology, The University of New South Wales, Sydney NSW 2052, Australia. Email: [email protected]


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Child Maltreatment 00(0)

significantly higher on the Psychopathy Checklist–Revised (PCL-R; Hare, 2003) as adults (see also Koivisto & Haapasalo, 1996; Lang et al., 2002). Few published studies have examined associations between psychopathy and specific types of maltreatment. Those that have find a relationship between psychopathy and physical, sexual, and verbal/emotional abuse (i.e., insulted, degraded or yelled at by parents, feeling disliked; Marshall & Cooke, 1999; Poythress, Skeem, & Lilienfeld, 2006). Neglect, however, has been relatively understudied in relation to psychopathy and its variants. This may be a major oversight given that neglect appears to be associated with similar affective deficiencies to those identified in primary psychopathy. For example, similar to individuals with psychopathy, neglected children are more likely to show a blunted affective response (Gaensbauer & Harmon, 1982). Neglected children experience barren emotional learning environments that may account for their abnormal affective functioning. Compared with other maltreatment groups, neglectful parents are less engaged and interact less frequently, are less emotionally expressive and sympathetic, and exchange less affective information with their children (Bousha & Twentyman, 1984; Crittenden, 1981). Such rearing environments are inadequate for fostering empathic or altruistic responses to others’ distress (Zahn-Waxler, Radke-Yarrow, & King, 1979). McCord and McCord (1956) articulated several decades ago that emotional deprivation, neglect, and lack of affection lead to the development of a psychopathic personality, generally, and the core CU deficits specifically. They suggested that ‘‘psychopathy flourishes in an atmosphere of rejection . . . emotional deprivation precipitate[s] a psychopathic personality’’ (p. 61). There is an important distinction between physical and emotional neglect. Emotional neglect may be defined as a caretaker’s failure to provide a child’s basic psychological and emotional needs, while physical neglect refers to the failure to provide a child’s basic physical needs (i.e., food, clothing, shelter) or protect the child from harm or danger (Erickson & Egeland, 2002). Whereas most prior studies investigating their relationship with psychopathy lumped neglect types together, Farrington and colleagues specifically found that childhood physical neglect and poor supervision increased the risk of high psychopathy scores at age 48 (Farrington, 2006, 2007; Farrington, Ullrich, & Salekin, 2010; see also Bernstein et al., 1998). However, Marshall and Cooke (1999) found that emotional psychopathic criminals reported experiencing more childhood neglect (e.g., parental indifference) over their welfare than nonpsychopathic criminals. While these studies did not consider emotional and physical forms of neglect simultaneously, Krischer and Sevecke (2008) did and found that psychopathy scores were associated with emotional, but not physical, neglect among an incarcerated youth sample using the same measure of maltreatment history used in the present study (see also Graham, Kimonis, Wasserman, & Kline, 2012; Lang et al., 2002). However, with regard to the specific emotional deficits attributed to the primary variant of psychopathy, both physical and emotional forms of neglect may provide impoverished emotional environments that prevent the normative development of emotional skills (Pollak,

Cicchetti, Hornung, & Reed, 2000). Together, these findings suggest that emotional and physical forms of neglect may be linked with psychopathy, and more specifically, both may be relevant to primary psychopathy. With regard to secondary psychopathy, decades ago, Benjamin Karpman (1941, 1948a, 1948b) theorized that exposure to parental abuse can lead to unresolved hostility that disrupts the functioning of an otherwise intact or developing conscience. He described this condition as a ‘‘psychopathic façade’’ and referred to it as secondary psychopathy (Karpman, 1948b, p. 523). Prior to this time, psychopathy was conceptualized as a unitary construct matching accounts by Cleckley (1941) in The Mask of Sanity, which has come to be called primary psychopathy. Porter (1996) further elaborated on this idea to suggest that secondary psychopathy develops as a coping mechanism in response to severe and repeated ‘‘physical or sexual abuse,’’ specifically (pp. 183, 185). He theorized that this traumatic experience interfered with the child’s ability to form or sustain attachments with others and resulted in emotional detachment. In contrast, the lack of conscience and underlying affective deficiency characterizing primary psychopathy was attributed to a ‘‘constitutional’’ deficit (Karpman, 1948a, pp. 478, 485).

Empirical Support for Psychopathy Variants Another key distinction between primary and secondary variants of psychopathy is trait anxiety. Several theorists described secondary psychopaths as highly anxious and socially withdrawn compared with primary psychopaths that are low anxious and socially dominant (Blackburn, 1975, 1979; Karpman, 1941, 1948b; Lykken, 1995). These theoretical perspectives enjoy empirical support from several studies employing various clustering strategies with adult and juvenile offenders; they find that individuals scoring high on psychopathy measures can be disaggregated into high-anxious secondary and lower anxious primary variants (Hicks, Markon, Patrick, Krueger, & Newman, 2004; Kimonis, Skeem, Cauffman, & Dmitrieva, 2011; Skeem, Johansson, Andershed, Kerr, & Louden, 2007). Across studies, secondary variants report greater depression, anger and hostility, impaired interpersonal functioning, substance abuse, and most notably, share common histories of childhood abuse and exposure to stressful life events compared with primary variants and nonpsychopaths (e.g., Kimonis, Frick, Cauffman, Goldweber, & Skeem, 2012; Kimonis, Tatar, & Cauffman, 2012; Poythress et al., 2010; Tatar, Cauffman, Kimonis, & Skeem, 2012). Unfortunately, prior studies investigating psychopathy variants have largely lumped maltreatment types into a single construct, thus failing to examine whether they differ in their childhood experiences of specific types of maltreatment. Together, the literature suggests that emotional and physical neglect may relate specifically to the development of primary psychopathy, which is distinguished from secondary psychopathy by deficient affective processing (Kimonis, Frick et al., 2012). In contrast, theory suggests that secondary psychopathy relates specifically to physical and sexual abuse (Porter, 1996).


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Maltreatment and Dimensions of CU Traits

Study Aims

Theory suggesting that primary psychopathy variants manifest greater CU traits (i.e., affective dimension) than secondary variants is largely unsupported in studies of antisocial youth (Cleckley, 1976; Karpman, 1941, 1948a). For example, Kimonis, Skeem, Cauffman, and Dmitrieva (2011) found that both primary and secondary variants of juvenile psychopathy had elevated scores on the affective dimension of the Psychopathy Checklist–Youth Version (PCL-YV; Forth, Kosson, & Hare, 2003). This finding is in keeping with also Karpman’s (1941, 1948a, 1948b) observation that it is difficult to distinguish between variants on the basis of their phenotypic presentations (i.e., psychopathic traits and antisocial behavior), and also the results of some, but not all, studies of adults reporting that variants differ in levels of anxiety, impulsivity, and social dominance, but are indistinguishable in their core affective features (i.e., CU traits; Hicks et al., 2004; Poythress et al., 2010; Skeem et al., 2007). However, prior studies have failed to take into consideration recent developments in factor analytic research on a popular measure of CU traits, the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004). These studies, conducted across several countries and with non-referred and incarcerated samples, consistently identify a three-factor structure, comprising uncaring (i.e., lack of caring about others’ feelings and one’s performance in structured activities), callousness (i.e., remorselessness, disregard for formal responsibilities), and unemotional dimensions (i.e., absence of emotional expression), which may further distinguish between primary and secondary psychopathy variants (e.g., Roose, Bijttebier, Decoene, Claes, & Frick, 2010). The unemotional factor of the ICU is most consistently associated with core affective deficiencies (i.e., low empathy, anxiety, emotional expression) that are characteristic of classic conceptualizations of primary psychopathy, after controlling for other ICU dimensions (Essau, Sasagawa, & Frick, 2006; Kimonis et al., 2008). For example, in an earlier iteration of their publication, Kimonis, Frick, Cauffman, Goldweber, and Skeem (2012) compared juvenile psychopathy variants on subscale scores of the Youth Psychopathic Traits Inventory (YPI; Andershed, Kerr, Stattin, & Levander, 2002) and found that primary variants scored significantly higher on the scale assessing empathic responding (sadness during sad movies, sadness when other people are sad) that most closely resembles the unemotional scale of the ICU. In contrast, secondary variants who had a marked history of childhood maltreatment scored significantly higher on the remorselessness scale, which most closely resembles the callousness subscale of the ICU. (Both scales comprise the affective/CU dimension of the YPI.) However, other research suggests that psychopathy variants may score similarly on callousness since this and the uncaring subscale are both associated with measures of antisocial and aggressive behavior that are similar between variants (e.g., Fanti, Frick, & Georgiou, 2009; Kimonis et al., 2008). Together, this body of research suggests that CU traits in youth can be disaggregated into meaningful dimensions, which may distinctly characterize specific variants (Lynam et al., 2005; Roose et al., 2010).

In sum, there is accumulating support for disaggregating psychopathy into primary and secondary variants; however, little is known about the types of childhood maltreatment experiences that might distinguish them. Furthermore, prior research has not specifically examined whether psychopathy variants that are differentiated by their experiences of childhood maltreatment can be distinguished on the basis of their patterns of CU dimensions, which are uniquely associated with criterion measures. Our first aim was to identify CU variants among a sample of incarcerated youth and to test whether they showed hypothesized differences in their experiences of specific types of childhood maltreatment using a person-centered approach. We hypothesized that analyses would reveal two groups of youth scoring high on a measure of CU traits, one resembling secondary psychopathy with higher anxiety scores and physical and sexual abuse histories, and a second resembling primary emotional and physical psychopathy with lower anxiety scores and greater childhood neglect, consistent with their underlying deficits in affective reactivity and empathic responding. By identifying groups within the full sample of incarcerated boys, we also expected to find a group of youth with low CU scores and levels of maltreatment that could be used as a low psychopathy comparison group. A second exploratory aim was to determine whether CU variants who were distinguished by their maltreatment experiences also differed with respect to their presentation of CU trait dimensions. We hypothesized that primary variants would be distinguished by higher unemotional scores that are most consistently associated with core deficits in affective and empathic responding common to neglected youth. Our third aim was to test whether psychopathy variants were indistinguishable in their manifestations of antisocial (i.e., delinquency) and aggressive behavior as theory and some prior research would suggest (Hicks et al., 2004; Karpman, 1948a). Thus, we did not expect differences in levels of aggression and delinquency between CU variants.

Method Participants Participants included 227 male adolescents adjudicated delinquent and housed in secure confinement facilities in a large city in the southeastern United States. To achieve a representative sample of incarcerated youth, facilities were selected for both moderate and high risk level, as well as housing of youth adjudicated of both sexual and nonsexual offenses. Participants’ most serious index offenses were extracted from their institutional files and included 36% contact sexual (n ¼ 81; e.g., sexual assault, lewd and lascivious conduct), 21% nonsexual violent (n ¼ 47, e.g., robbery, assault), 22% property (n ¼ 50, e.g., arson, burglary), 13% procedural/ public order (n ¼ 29, e.g., violation of probation, trespassing), 4% drug (n ¼ 8, e.g., possession of marijuana), and 2% noncontact sexual (n ¼ 4, e.g., lewd and lascivious exhibition) offenses; index offenses were not available


4


for eight youth. Youth ranged in age between 12 and 19 years (M ¼ 15.73, SD ¼ 1.27). Only youth not diagnosed with an intellectual disability or a psychotic disorder were eligible to enroll. The sample was ethnically heterogeneous with 88 youth selfidentifying as Caucasian (38.8%), 100 as African American (44.1%), 24 as Hispanic (10.6%), 3 as Pacific Islander/ Asian (1.3%), 4 as Native American (1.8%), and 8 as mixed race/ethnicity (3.5%).

Procedure A University Institutional Review Board and the Department of Juvenile Justice approved all study procedures. Participants provided in-person assent and their parents provided informed consent to researchers by telephone. Youth completed several study questionnaires (1–2 hr) and researchers completed a comprehensive review of each youth’s institutional files. Participants self-reported their age and ethnicity.

Measures Childhood Maltreatment History. The Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998) is a 28-item selfreport measure that captures five types of maltreatment that each comprise 5 items: physical (i.e., ‘‘I was punished with a belt, a board, a cord, or some other hard object’’), sexual (i.e., ‘‘Someone tried to make me do sexual things or watch sexual things’’) and emotional abuse (i.e., ‘‘People in my family said hurtful or insulting things to me’’), and physical (i.e., ‘‘I didn’t have enough to eat’’) and emotional neglect (i.e., ‘‘People in my family looked out for each other’’-reverse scored). Items, rated between 1 (never true) and 5 (very often true), were summed to compute a CTQ total score and subscale scores described above, to be used in analyses. There is support for the reliability and validity of CTQ total and subscale scores (Bernstein et al., 1994). Additionally, CTQ total scores demonstrated a test–retest correlation of .88 and convergence with the Childhood Trauma Interview, suggesting stability in reports of maltreatment on the CTQ across time and across methods. In the present study, the CTQ total score was internally consistent (a ¼ .83), as were emotional (.85), physical (.82), and sexual abuse (.94) and emotional neglect (.90) subscales; the physical neglect subscale demonstrated lower internal consistency (.68). In the present sample, 7.4% and 10.4% of youth experienced emotional abuse in the ‘‘moderate to severe’’ and ‘‘severe to extreme’’ ranges, respectively, according to the CTQ manual (Bernstein & Fink, 1998); 13.9% and 18.7% experienced physical abuse in the moderate/severe and severe/extreme ranges, respectively; 10.4% and 14.8% experienced sexual abuse in the moderate/severe and severe/ extreme ranges, respectively; 6.5% and 8.7% experienced emotional neglect in the moderate/severe and severe/extreme ranges, respectively; and 10% and 10.4% experienced physical neglect in the moderate/severe and severe/extreme ranges, respectively. There was substantial overlap between

maltreatment types such that 13.9% of youth experienced two maltreatment types, 9.6% experienced three maltreatment types, 5.2% experienced four maltreatment types, and 2.6% experienced all five maltreatment types when collapsing across moderate/severe and severe/extreme ranges. Of youth who reported exposure to one or more moderate to extreme types of abuse (emotional, physical, sexual), 40.6% also reported experiencing emotional or physical neglect in the moderate to extreme range (21.9% when limited to only severe/extreme levels of maltreatment). Callous-Unemotional Traits. CU traits were assessed using the 24-item self-report ICU (Frick, 2004). ICU items, such as ‘‘I do not show my emotions to others,’’ are rated on a 4point Likert-type scale from 0 (not at all true) to 3 (definitely true), with higher scores indicating greater CU traits. The construct validity of the ICU is supported in community and incarcerated samples of youth (e.g., Fanti et al., 2009; Kimonis et al., 2008). For example, the ICU total scale showed predicted associations with aggression, delinquency, personality traits, psychophysiology, and psychosocial impairment (Essau et al., 2006; Kimonis et al., 2006). Consistent with past studies, items 2 and 10 were deleted from the total score due to low corrected item-total correlations (.17 and .05, respectively). The remaining 22 items were summed for a total score, which demonstrated good internal consistency (a ¼ .87) in the present study. Items were summed to compute uncaring (8 items; a ¼ .83; ‘‘I work hard on everything I do’’-reverse scored), callous (9 items; a ¼ .80; ‘‘I do not feel remorseful when I do something wrong’’), and unemotional (5 items; a ¼ .62; ‘‘I express my feelings openly’’-reverse scored) subscale scores. Anxiety. The Revised Children’s Manifest Anxiety scale (RCMAS) is a standardized measure designed to assess selfreported anxiety in youth between the ages of 6 and 19 (Reynolds & Richmond, 1985, 2000). The RCMAS includes 37 items that load onto four subscales: Physiological Anxiety (10 items; e.g., ‘‘Often I feel sick in my stomach’’), Worry/ Oversensitivity (11 items; e.g., ‘‘I worry about what is going to happen’’), Social Concerns/Concentration (7 items; ‘‘A lot of people are against me’’), and a Lie scale (9 items; e.g., ‘‘I never get angry,’’ not included in analyses). Youth respond to each question with a ‘‘Yes’’ or ‘‘No’’ answer. The RCMAS is internally consistent (a ¼ .85) and possesses moderate test–retest reliability over a 9-month period (r ¼ .63; Reynolds & Paget, 1981; Reynolds & Richmond, 1985). It is significantly more strongly associated with other measures of anxiety (e.g., the State–Trait Anxiety Inventory for Children, r ¼ .88) than it is with measures of depression (e.g., Child Depression Inventory), providing some support for its construct validity (e.g., Muris, Merckelbach, Ollendick, King, & Bogie, 2002). In the present study, the RCMAS total score (a ¼ .88) and subscale scores (a ¼ .70 to .84) demonstrated adequate internal consistency.


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Aggression. Participants’ self-report of aggression was measured using the Peer Conflict scale (PCS; Marsee et al., 2011). The PCS was developed to improve upon existing tools by providing a more comprehensive assessment of four dimensions of aggression (i.e., reactive, proactive, overt, and relational aggression) and including a sufficient number of items for each, while also limiting items to acts harming another person. The PCS includes 10 items in each of four aggressive subtype categories: proactive overt (e.g., ‘‘I am deliberately cruel to others, even if they haven’t done anything to me’’), proactive relational (e.g., ‘‘I gossip about others to become popular’’), reactive overt (e.g., ‘‘I have gotten into fights, even over small insults from others’’), and reactive relational (e.g., ‘‘If others make me mad, I tell their secrets’’). Items are rated on a 4point scale from 0 (not at all true) to 3 (definitely true). Internal consistencies for the total score and subscale scores were good (a’s ranging from .87 to .94). Delinquency. The Self-Reported Delinquency scale (SRD) assesses the number of crimes committed by youth by listing 36 questions about illegal juvenile acts selected from a list of all offenses reported in the Uniform Crime Report with a juvenile base rate of greater than 1% (Elliott & Ageton, 1980; Elliott & Huizinga, 1984). For each question, the youth responds with a ‘‘yes’’ or ‘‘no’’ regarding whether or not he has ever engaged in the behavior. Consistent with past uses of the scale, the total number of delinquent acts committed was summed to form a total delinquency composite (with a possible range of 0–36; a ¼ .90; Krueger et al., 1994). Also, the 10-item property offenses (a ¼ .78; e.g., ‘‘purposely damaged or destroyed property belonging to school?’’), 8-item violent offenses (a ¼ .76; e.g., ‘‘been involved in gang fights?’’), and 9-item drug offenses (a ¼ .84; e.g., ‘‘sold hard drugs such as heroin, cocaine, and LSD?’’) subscales were used in the present study.

Plan of Analyses To address our first two aims, latent profile analysis (LPA) using Mplus 6.1 statistical software was conducted to identify distinct subgroups of youth scoring high on CU traits and sharing common maltreatment histories (Mutheń & Mutheń, 2010). LPA is an extension of latent class analysis that accommodates continuous indicators. Eleven continuous indicators, selected for their theoretical and empirical relevance to the literature on psychopathy variants, were included in the analysis: maltreatment (physical, sexual and emotional abuse, and emotional and physical neglect), anxiety (physiological anxiety, worryoversensitivity, social concerns), and CU traits (uncaring, callousness, unemotional). LPA identifies different latent classes by decomposing the covariance matrix to highlight relationships among individuals and clustering individuals who are similar on the constellation of indicators into latent classes (Bauer & Curran, 2004). LPA models that specify different numbers of classes are tested and the Bayesian information criterion (BIC), Akaike information criterion (AIC), Lo-Mendel-Rubin (LMR) statistics and

entropy value are used as statistical criteria to compare models to identify the optimal number of groups to retain (Nylund, Asparouhov, & Mutheń, 2007). The model with the lowest BIC and AIC values is preferred. The LMR statistic, which is considered a likelihood ratio test between models with a different number of latent classes specified, tests k – 1 classes against k classes, and reveals a significant chi-square value (p < .05) indicating whether the k – 1 class model is rejected in favor of the k class model (Lo, Mendell, & Rubin, 2001). A nonsignificant chi-square value (p > .05) suggests that a model with one fewer class is preferred. Average posterior probabilities of class membership and the entropy value are also taken into consideration to determine the precision of classification and the degree to which the classes are distinguishable, respectively. Average probabilities equal to or greater than .70 imply satisfactory fit, and an entropy value greater than .70 is preferred because it indicates clear classification and greater power to predict class membership (Mutheń, 2000; Nagin, 2005). LPA estimation in Mplus also generates mean scores for each group on the indicator variables. To test our third aim of comparing subgroups on types of aggression and delinquency, multivariate analyses of variance (MANOVAs) were used.

Results Descriptive Statistics Descriptive statistics and correlations among variables used in LPA are reported in Table 1. The uncaring subscale of the ICU was positively associated with emotional and physical neglect. Uncaring and unemotional subscales were negatively associated with sexual abuse, as well as the worry/oversensitivity subscale of the RCMAS. The callousness subscale was positively associated with the physiological anxiety and social concerns subscales of the RCMAS. Ten of the 15 correlations between maltreatment and anxiety subscales were significantly positively correlated. Other than the association between physical neglect and physiological anxiety, neglect subscales were generally uncorrelated with anxiety subscales. Uncaring and callousness were positively associated with delinquency and proactive aggression; callousness was also associated with reactive aggression. Abuse and anxiety subscales were positively correlated with proactive and reactive aggression, although the neglect subscales were only associated with proactive aggression. Physical abuse, physiological anxiety, and social concerns were also associated with delinquency. Delinquency and proactive/reactive aggression subscales were positively inter-correlated.

Identifying Subgroups of Incarcerated Youth With Shared Histories of Maltreatment and Patterns of CU Traits (Aims 1 and 2) To identify the optimal number of groups to retain, three separate LPA models were estimated, ranging from two to four groups. As shown in Table 2, the change in the BIC and AIC


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Table 1. Descriptive Statistics and Correlations Among the Main Study Variables. 1

2

1. Emotional abuse 2. Physical abuse .72** 3. Sexual abuse .56** .48** 4. Emotional .46** .36** neglect 5. Physical .53** .50** neglect 6. Physiological .30** .22** anxiety 7. Worry/ .29** .20** oversensitivity 8. Social .29** .19** concerns 9. Uncaring .07 .09 10. Unemotional .12þ .09þ 11. Callousness .03 .02 12. Delinquency .12þ .18** 13. Proactive .22** .22** aggression 14. Reactive .30** .25** aggression Descriptives M 1.87 1.81 SD .94 .89

3

4

5

6

7

8

9

10

11

12

.42** .50** .16* .18**

.30** .11 .06

.31** .46**

.27**

.05

.02

.40**

.34**

1.39 .66

1.65 .57

13

14

.18** .26**

.73**

.15**

.09

.14*

.23** .01

.08

.52**

.12**

.09

.58**

.04

.26** .23** .13* .25** .02 .05 .08 .08 .08 .08 .02 .03 .20** .16** .15* .22**

.04

1.57 1.10

1.81 1.05

.13þ

1.49 .68

.62**

.03 .26** .04 .12þ .22** .06 .24** .02 .24** .32** .11 .14* .45** .23** .29** .51**

3.51 2.40

.34**

3.85 3.06

.35**

2.67 2.02

.70 .50

13.92 7.55

.79**

6.88 8.11

13.59 10.10

Note. þp ¼ .06. *p < .05. **p < .01.

Table 2. Model Fit Statistics for the Latent Profile Analysis. Classes 2 3 4

BIC

AIC

Entropy

LMR

5387.81 5198.06 5091.88

5271.36 5040.51 4908.06

.83 .94 .93

557.82, p < .05 263.92, p < .05 197.56, p ¼ .39

Note: BIC ¼ Bayesian information criterion; AIC ¼ Akaike information criterion; LMR ¼ Lo-Mendel-Rubin statistic. 2 classes - p = .018 3 classes - p = .031 4 classes - p = .394

statistics from three to four classes was smaller than the change from two to three classes, suggesting that the greatest improvement in fit occurred from the two-class to the three-class model. In addition, the LMR statistic was not significant for the four-class model, suggesting that the three-class model better fit the data. Moreover, the four-class model identified a small group of nine adolescents that split a larger class into two groups. As a result, the more parsimonious three-class model was selected. The mean posterior probability scores for the three identified classes ranged from .91 to .99 and the entropy value was high, suggesting that the classes were well separated. The characteristics of the three groups identified by LPA are illustrated in Figure 1, which shows standardized scores by group on each of the indicator variables included in the analysis. The MANOVA comparing adolescents’ scores on each measured variable included in the LPA was significant,

Wilks’s l ¼ 0.67, F(22, 227) ¼ 3.72, p < .001, Z2 ¼ .18. Adolescents in the ‘‘primary psychopathy’’ group (n ¼ 30) were differentiated from the ‘‘low psychopathy’’ (n ¼ 175) and ‘‘secondary psychopathy’’ groups (n ¼ 22) by higher scores on emotional and physical neglect and the unemotional subscale of the ICU, and lower scores on anxiety compared to the secondary psychopathy group. Adolescents comprising the ‘‘secondary psychopathy’’ group were differentiated from the low psychopathy and primary psychopathy groups by higher scores on sexual abuse and two anxiety subscales (physiological anxiety and social concerns), and they also scored higher than the low psychopathy group on the callousness dimension of the ICU. Primary and secondary CU groups scored similarly on the uncaring and callousness subscales of the ICU. They also scored higher on emotional/ physical abuse and physical neglect compared with the low psychopathy group. Adolescents comprising the low psychopathy group scored below average on all indicator measures. According to w2 analyses, the identified groups were not differentiated with respect to ethnicity (White vs. other: w2(2, N ¼ 227) ¼ 3.70, p ¼ .16) or age: w2(14, N ¼ 227) ¼ 12.17, p ¼ .58.

Delinquency and Aggression Across Identified Subgroups (Aim 3) After extracting the three latent classes, individuals were assigned to their most likely class using posterior probabilities generated by LPA. MANOVAs were employed to compare low


Kimonis et al.

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1.15

Low-psychopathic (77.1%)

b c

.95

Primary psychopathy (13.2%) Secondary psychopathy (9.7%)

.75

b

b b

Z scores

.55

b

b

b

b

b

.35

b

b

a a a

.15 -.05 -.25

a a

a

ab

a

a

a a a

a

a

a

a

a

a

a

a

a

Figure 1. Profiles of maltreatment, anxiety, and Callous-unemotional (CU) traits for identified groups. Different subscripts (a,b,c) denote significant differences between groups in post hoc pairwise comparisons using the Tukey’s Honestly Significantly Different (HSD) procedure. Subscript a is always used to designate the lower risk group. All F statistics (range 2.99–25.25) were significant, except for comparisons involving the worry/oversensitivity and the uncaring subscales. Table 3. Comparisons Between Identified Groups on Delinquency and Aggression.

Delinquency types Property Violent Drug Aggression types Proactive overt Reactive overt Proactive relational Reactive relational

Low psychopathy (n ¼ 175)

Primary psychopathy (n ¼ 30)

Secondary psychopathy (n ¼ 22)

F value

df

p

Z2

Cohen’s d

5.29(.21)a 2.41(.16)a 3.14(.19)a

4.87(.51)a 3.00(.37)a 3.30(.46)a,b

7.54(.60)b 4.36(.44)b 4.55(.54)b

7.61 9.45 3.00

2 2 2

.00 .00 .05

.07 .08 .03

.26 .58 .27

3.34(.36)a 9.26(.54)a 2.58(.28)a 3.47(.34)

5.17(.87)a,b 9.80(1.31)a,b 3.60(.67)a,b 4.01(.82)

7.14(1.04)b 15.29(1.56)b 4.95(.80)b 5.33(.98)

7.11 6.65 4.47 1.68

2 2 2 2

.00 .00 .01 .19

.06 .05 .04 .02

.55 .39 .43

Note: Estimated marginal means (SE); Different superscripts (a,b) denote significant differences between groups in post hoc pairwise comparisons using the Tukey’s Honestly Significantly Different (HSD) procedure. Superscript a is always used to designate the lower risk group.

psychopathy youth with below average levels of maltreatment and average anxiety scores, CU variants with high levels of abuse/neglect and low to average levels of anxiety (i.e., primary psychopathy), and CU variants with high levels of abuse and anxiety (i.e., secondary psychopathy), on (1) property, violent, and drug delinquency; Wilks’s l ¼ 0.89, F(6, 440) ¼ 4.28, p < .001, Z2 ¼ .06 and (2) proactive/reactive overt aggression, and proactive/reactive relational aggression Wilks’s l ¼ 0.91, F(8, 227) ¼ 2.59, p < .05, Z2 ¼ .05. Findings indicated that the three latent groups differed significantly on delinquency and aggression subscales. As depicted in Table 3, follow-up post hoc pairwise comparisons revealed that secondary variants

reported engaging in significantly more property delinquency compared with primary variants (Cohen’s d ¼ .97) and youth scoring low on psychopathy (d ¼ .81), and more violent delinquency compared with primary variants (d ¼ .68) and low psychopathy youth (d ¼ .93). There were no significant differences between variants in their levels of drug delinquency, although secondary variants scored higher than the low psychopathy group (d ¼ .56). There were no significant differences between variants in their levels of aggression, although secondary variants scored higher on proactive overt (d ¼ .80) and relational (d ¼ .64) aggression, and reactive overt aggression (d ¼ .85) relative to the low psychopathy group. Finally, secondary


8


variants were more likely to be adjudicated of a sexual index offense compared with primary variants and low psychopathy youth, w2(2, N ¼ 227) ¼ 16.78, p < .001.

Discussion Youth scoring high on CU traits are heterogeneous and showed marked differences in their reported childhood maltreatment experiences. On average, secondary psychopathy variants (showing high levels of anxiety) reported rates of sexual abuse almost one half standard deviation higher than primary variants and low psychopathy groups, whereas primary variants (showing average to below average levels of anxiety) reported rates of neglectful childhood experiences roughly one standard deviation higher than secondary variants and low psychopathy youth. Psychopathy variants showed comparable histories of childhood emotional and physical abuse that were elevated relative to low psychopathy comparison youth. With regard to their manifestation of CU traits, the results of exploratory analyses revealed that primary variants displayed more unemotional features compared with secondary variants, although callousness and uncaring scores did not differ significantly between them. Consistent with theory, variants were also relatively indistinguishable behaviorally; they did not differ significantly in their levels of aggression or drug delinquency, although secondary variants did report engaging in significantly more property and violent delinquency. Consistent with their greater childhood histories of sexual abuse, secondary variants were also more likely to be adjudicated of a sexual offense compared with primary variants. This is the first study to document differences between juvenile psychopathy variants in their experiences of childhood maltreatment, making an important contribution to the literature. The most pronounced difference between variants was in their experience of neglect, which suggests that gaining a better understanding of its role in the development of CU traits is a promising, albeit challenging, avenue for future research. Although early theory attributes the development of secondary psychopathy to abusive (physically or sexually) and otherwise traumatic childhood experiences, neglect, specifically, has not played a prominent role in this literature (Karpman 1941, 1948; Porter, 1996). However, our findings are consistent with the writings of McCord and McCord (1956) who identified emotional deprivation, rejection, and neglect as being central to the development of the psychopathic personality. Similarly, prior research finds that youth with CU traits are less likely to rate their parents as warm and loving (Kimonis, Cross, Howard, & Donoghue, 2013; Pardini, Lochman, & Powell, 2007; Pasalich, Dadds, Hawes, & Brennan, 2011). Daversa (2010) suggested that parental neglect that is chronic and sustained over development may contribute to alterations in brain regions (e.g., amygdala) that are theoretically and empirically linked to the affective features of psychopathy (see Blair, 2003). Neglect may be, at least in part, relevant to the development of deficits in defensive reactivity that are central to traits of emotional detachment (Patrick, Fowles, & Krueger, 2009). For

example, infants raised in severely impoverished social and emotional environments show a blunted pattern of emotional (i.e., cortisol) reactivity, which may persist into adulthood (Carlson & Earls, 1997; Gilles et al., 2000; van der Vegt, van der Ende, Kirschbaum, Verhulst, & Tiemeier, 2009). The cross-sectional design of this preliminary study prevents any inferences regarding the causal relationship between CU traits and maltreatment, although prior research and theory may shed some light on possible mechanisms linking them. Temperamentally fearless young children who are at risk of insensitivity to emotional stimuli and a lack of emotional reciprocity may evoke unresponsive and, over time, neglectful parenting from their caregivers (see Frick & Morris, 2004). Similarly, research finds that youth with CU traits evoke more dysfunctional parenting (Hawes, Dadds, Frost, & Hasking, 2011; Munõz, Pakalniskiene, & Frick, 2011). Through their lack of reciprocity to emotional interactions, these children may communicate to their parents that they do not need them to be emotionally available. Combined with displays of sometimes overt aversion to parental affection (M.R. Dadds, personal communication, February 23, 2012), this may over time lead parents and other caregivers to disengage from or to neglect their CU child. It is also possible that neglectful parenting maintains and/or worsens already deficient emotional functioning over time, thus perpetuating a vicious cycle of decreasing emotional reciprocity and increasing lack of caring in the parent–child dyad. For example, Pardini, Lochman, and Powell (2007) found that low parental warmth and affection led to increases in child CU traits one year later (see also Pasalich et al., 2011). Baron-Cohen (2011) explains that parental neglect and related psychosocial factors are what distinguish the cruel behavior of individuals with psychopathy from other populations with similar deficits in empathy and emotional reciprocity, namely those with disorders on the autism spectrum. An alternative possibility is that psychopathic children are more likely to have psychopathic parents who, in turn, are more likely to maltreat them (see DiLalla & Gottesman, 1991, for a discussion). The authors are aware of no prior studies testing this intergenerational transmission, constituting a fertile avenue for future research. However, psychopathic parents are likely to provide impoverished emotional environments to their children, in which they are emotionally unavailable and also fail to appropriately model emotional experience and reciprocity. Emotional experience is critical to the development of emotional recognition, expression, and understanding (e.g., Fogel et al., 1992). Neglectful parents differ from nonmaltreating parents in both the frequency and the content of their emotional interactions with their children, showing less emotional expression toward, and less engagement with their children and tending to isolate them from others, thus exposing them to fewer emotional learning opportunities (see Pollak et al., 2000). There is ample research linking neglectful home environments with the deficits that characterize youth with CU traits, including callousness, lack of empathy, and poor emotional recognition (e.g., Sullivan, Carmody, & Lewis, 2010). For example, Pollak, Cicchetti, Hornung, and Reed (2000) found that physically neglected children experienced greater


Kimonis et al.

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difficulty discriminating between emotional expressions compared with physically abused and control children, even simple distinctions between happy and sad expressions that develop in early childhood (Sroufe, 1979). In a recent study, Kimonis, Frick et al. (2012) also found that primary variants of CU traits among incarcerated youth showed deficient attentional orienting to others’ sadness cues on a picture variant of the dot-probe paradigm, whereas secondary variants did not. Future research is needed to determine whether deficits in fearful and empathic responding observed in individuals with psychopathic traits, particularly the primary variant, are a consequence of their greater experiences of neglect or whether they result from internal predispositions that precede and/or evoke this early (lack of) experience. In light of scientific evidence suggesting greater heritability for psychopathic traits as well as compelling work on gene–environment interactions in the development of antisocial behavior, it is likely that children with a genetic liability—for example, to display emotional capacities on the lower end of the spectrum—develop CU traits following exposure to affectionless, rejecting, and neglectful parenting (Blonigen, Hicks, Krueger, Patrick, & Iacono, 2005; KimCohen et al., 2006). While this study is unable to tease apart the temporal ordering of these factors, for which rigorous longitudinal research is needed, it does fill an important gap in the literature with respect to understanding the contribution of neglect to variants of psychopathy among youth. Secondary variants reported greater histories of sexual abuse compared with primary variants. These youth were also more likely to be incarcerated due to a sexually motivated index offense. Similarly, in a recent meta-analysis, Seto and Lalumiere (2010) found that adolescents adjudicated of a sexual offense tended to show higher anxiety levels, were more likely to have sexual abuse histories, and were more likely to be socially isolated, compared with adolescent nonsexual offenders. These findings suggest that adolescent sexual offenders may be more likely than nonsexual offenders to display characteristics of secondary psychopathy. Contrary to expectations, variants reported comparable experiences of physical and emotional abuse, which were greater than the low psychopathy comparison group. In their study of incarcerated adolescent boys, Krischer and Sevecke (2008) also found that CU traits were associated with a history of physical abuse, suggesting that this type of maltreatment may be generally related to psychopathic traits in youth (see also Campbell, Porter, & Santor, 2004). Importantly, there is a robust relationship between physical and emotional abuse and antisocial and aggressive behaviors that are common to individuals with psychopathy (Lansford et al., 2002; Luntz & Widom, 1994). In the present incarcerated sample, the high rates of physical and emotional abuse among youth scoring high on CU traits may explain their greater antisocial behavior compared with low psychopathy adolescents. Although contrary to hypotheses, the greater violent delinquency reported by secondary variants is consistent with prior research finding that adult secondary psychopathy variants are characterized by greater violence than primaries (Hicks et al., 2004; Skeem

et al., 2007). Similarly, Lang, Klinteberg, and Alm (2002) found that Swedish men recruited from high-risk neighborhoods who had high rates of childhood victimization (i.e., secondaries) engaged in significantly more violence than those without such a history. Finally, nonsignificant differences in drug delinquency between variants is inconsistent with prior research, but may be explained by the fact that youth in this region who were adjudicated of a drug-related index offense were housed in a special facility providing substance-related treatment, thus explaining the low proportion (4%) of such youth in the present sample (Kimonis, Tatar, et al., 2012). Also, our measure of drug delinquency was not limited to substance use, but also assessed the selling of drugs. The significant difference in property delinquency was unexpected, and future research is needed to determine the robustness of this and other novel findings. Our findings suggest that beyond their experiences of maltreatment, primary and secondary CU variants differed in their expression of meaningful CU trait dimensions in this sample of incarcerated boys. That is, CU variants evinced different patterns of scores across subscales of the ICU, with primary variants scoring higher on the unemotional subscale compared with secondary variants; other dimensions of CU traits did not significantly distinguish variants. The greater unemotional scores identified among primary variants is consistent with research suggesting that this subscale is the most consistently associated with deficits in empathic responding among ICU subscales (Kimonis et al., 2008; Roose et al., 2010). Although preliminary, these findings suggest that measures such as the ICU may be in a position to clarify inconsistent findings between unidimensional measures of the affective facet of psychopathy and membership within psychopathy variant groups. The results of the present study must be considered within the context of several study limitations. First, self-report was used to assess the main study variables, which may have inflated associations due to shared method variance. Selfreport measures are also subject to reporter bias and it is possible that youth with psychopathic traits reported greater maltreatment than they experienced in reality, which we were unable to verify in the present sample using official records. The CTQ measure also relies on retrospective reports of maltreatment occurring in the past, which is subject to recall and encoding biases. Second, given our focus on a sample of incarcerated adolescent boys, which was due in part to limited access to a large population of girls in the study region, future research is needed to test whether findings generalize across gender as well as to community youth. Third, it is possible that the small group sizes did not result in sufficient statistical power to detect significant differences. Future research using more rigorous multimethod designs that include official reports of maltreatment are needed to replicate the current preliminary results in larger samples of youth that include communitybased and female participants. Such research is important, given that Krischer and Sevecke (2008) did not find a relationship between maltreatment and psychopathy scores among detained German adolescent girls as they found for boys. They


10


instead found that other family factors (i.e., number of foster homes) were more important to the development of psychopathic traits among girls than was childhood maltreatment. However, given the high prevalence of maltreatment among incarcerated girls relative to boys, it is possible that placement outside of the home and number of placements are indicators of the severity of maltreatment or the severity of the antisocial behavior that distinguishes those with high levels of psychopathy (Abram et al., 2004). Important strengths of the current study are its use of a rigorous data-driven approach to identify clusters and its use of an ethnically heterogeneous sample of youth representative of the demographic profile of the region of the United States from which they were obtained. This study also addresses a critical gap in the literature with regard to better understanding the importance of an understudied form of maltreatment in contemporary research, neglect, to the development of a severe and stable condition among antisocial youth.

Study Implications There are several theoretical, practical, and policy implications of this research. It is clear that psychopathy has a long-standing relationship with childhood maltreatment, and the field is making progress toward clarifying the nature of this relationship. Our results suggest that neglect, in particular, may hold a place in developmental theory for psychopathy as was originally suggested decades ago (e.g., McCord & McCord, 1956). It has been suggested that there are multiple developmental pathways to CU traits in youth, and one such path may result from the poverty in emotional experience that neglectful environments offer (Frick & Marsee, 2006; see Kumsta, Sonuga-Barke, & Rutter, 2012). Further research may clarify whether the combination of childhood neglect with physical and/or emotional abuse that have robust associations with antisocial and aggressive behaviors plays an additive role in contributing to the multidimensional presentation that characterizes psychopathy (Hare, 2003). Alternatively, when the antisocial-aggressive behaviors associated with physical/emotional abuse combine with the experience of sexual abuse, they may place youth at risk for the comorbid externalizing-internalizing presentation that appears to characterize the secondary variant of psychopathy. Furthermore, the developmental timing and chronicity of abusive experiences appears to be important to the development of pathology (Manly, Kim, Rogosch, & Cicchetti, 2001; Thornberry, Ireland, & Smith, 2001). This is echoed by McCord and McCord (1956) who theorized that ‘‘early emotional starvation, particularly during the first three years, leads to psychopathy’’ (p. 61) and also accounts for the inability to maintain close relations with others. Future research is needed to elucidate whether such factors also explain the development of CU trait precursors to psychopathy in youth. Gaining a better understanding of how maltreatment contributes to the development of psychopathic traits can inform the development of more effective prevention and intervention programs for youth on these developmental trajectories.

It is important that our results are first replicated in future research before solid implications for practice and policy can be discussed. At the least, the greater risk among maltreated youth for developing psychopathic traits must be considered. A particularly important population in need of future research is those youth involved in both the child welfare and the juvenile justice systems (i.e., ‘‘cross-over’’ youth). Assessing child welfare–involved youth with conduct problems for the presence of CU traits has clinical utility for identifying those at risk for a severe and stable trajectory of antisocial behavior and also determining optimal treatment strategies. It is also consistent with changes to the Diagnostic and Statistical Manual in its fifth revision to include a CU specifier to the diagnosis of CD, called ‘‘with Limited Prosocial Emotions’’ (Frick & Moffitt, 2010). Several brief self-report and rater measures are available for this express purpose (e.g., Frick & Hare, 2001; Kimonis et al., 2008). Traditional interventions appear to be effective at reducing future levels of CU traits among these youth; however, the state of research is more mixed with regard to reducing their antisocial behaviors (Kimonis, Pardini, Pasalich, & McMahon, in press). At least preliminary research suggests youth with CU/psychopathic may be amenable to (a) components of traditional interventions for childhood conduct problems (e.g., parent management training) that teach parents to consistently use reward-based behavioral strategies, (b) evidence-based strategies to target the child’s emotional deficits, and (c) the delivery of these interventions within the context of a warm and responsive parent–child relationship that also provides parents with emotional support (for a review, see Kimonis et al., in press). To date, research has not examined differences in treatment outcomes for juvenile psychopathy variants. However, with accumulating research suggesting that a secondary variant of juvenile psychopathy exists that shows marked trauma and internalizing psychopathology, it is critical for the field to test the efficacy of evidence-based trauma-focused and cognitive behavioral interventions for this unique subpopulation. Following research and policy trends toward a greater focus on the early childhood years (Loeber & Farrington, 2000), interventions such as parent–child interaction therapy that fosters greater parental responsiveness may benefit both variants as it provides a more stimulating emotional environment and has also been found to reduce childhood antisocial behaviors and revictimization by abusive parents (e.g., Chaffin et al., 2004; Thomas & ZimmerGembeck, 2012). With evidence that CU traits can be reliably and validly assessed as early as the preschool years using tools such as the ICU or Achenbach System of Empirically Based Assessment (ASEBA), young children referred to child welfare due to suspected or substantiated maltreatment may be averted from developing this chronic and severe condition through screening to identify those in need of services (Ezpeleta, de la Osa, Granero, Penelo, & Domenech, 2013; Willoughby, Waschbusch, Moore, & Propper, 2011). When early prevention is not possible, the outlook is hopeful even for incarcerated adolescents with psychopathic traits when they are treated with individualized and comprehensive


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interventions that address their unique treatment needs (Frick, 2012). For example, adolescent offenders with psychopathic traits that were treated using a multimodal intervention, incorporating reward-oriented contingency management strategies that targeted the adolescent’s self-interests and also taught empathy skills, were less likely to recidivate over a 2-year follow-up period than those who underwent treatment as usual in the same correctional facility (Caldwell, Skeem, Salekin, & Van Rybroek, 2006). In conclusion, this line of research is promising in its ability to identify psychosocial risk factors that are amenable to treatment, which are relevant to a subgroup of antisocial youth that cause significant harm and destruction to others. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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