Keywords
personality disorder, Gurwitch, ’ distress, anxiety, psychopathy, primary CU traits, antisocial behavior, early-onset, hypersensitivity, trauma
SECONDARY, HYPERSENSITIVITY, INTERACTION
Open Access funding enabled and organized by CAUL and its Member InstitutionsChildren with conduct problems are a heterogeneous group. Researchers have attempted to parse this population into more homogenous subgroups via subtyping, whereby certain characteristics identify children with distinct etiological profiles who may differ in prognostic risk. Subtyping according to the presence of callous-unemotional (CU) traits has proven useful for designating a subgroup of children with early-onset, stable, and severe conduct problems who are at considerable risk for poor outcomes in later life (Frick et al., CU traits are the putative developmental precursor to the affective dimension of psychopathy, which is a multidimensional personality disorder characterized by a narcissistic and manipulative interpersonal style; shallow and deficient affect; and impulsive and antisocial behavior (De Brito et al., A burgeoning empirical literature supports the validity of childhood CU variants. A recent systematic review reported that most studies found evidence for clinically meaningful and theoretically consistent CU or psychopathy variants across community, clinical, and justice-involved samples of children and adolescents from ethnically diverse backgrounds (Craig et al., Taken together, these longitudinal studies provide preliminary support for the predictive—and thus clinical—utility of parsing CU variants, showing that co-occurring CU traits and anxiety assessed as early as three years are associated with moderate stability and considerable risk for numerous, varied, and severe outcomes into adulthood. However, there is also robust evidence that CU traits are not immutable, but influenced by both genetic and environmental factors, including parenting practices (Hyde et al., The broader literature indicates that children with CU traits benefit from intervention, but begin and end treatment with more severe conduct problems that may continue to meet or exceed diagnostic thresholds, compared to children with conduct problems alone (Fleming, However, these treatment adaptations were specifically designed to target risk factors associated with primary CU traits. Critically, it is unclear whether they also address the risk factors involved in the development and maintenance of secondary CU traits, giving rise to the possibility that the adaptations may not be equally effective for all members of the CU subgroup. Indeed, many modern theories of secondary psychopathy/CU traits position temperamentally-based emotional Regarding trauma or maltreatment exposure, none of the adapted programs explicitly address trauma responses or associated anxiety symptoms. However, some adaptations are to interventions classified as trauma-informed, with accumulating evidence for their efficacy in reducing conduct problems, trauma symptoms, and future maltreatment incidents among children exposed to abuse and neglect (e.g., Parent-Child Interaction Therapy [PCIT]; Gurwitch and Warner-Metzger, Regarding emotional hypersensitivity and dysregulation, it is possible that the central focus of treatment adaptations on improving empathy by enhancing sensitivity to others’ distress cues (Dadds et al., Taken as a whole, this literature offers a murky picture regarding possible variant differences in treatment responsiveness. It sheds little light on whether we can expect treatment adaptations specifically developed to address the risk factors involved in the development of primary CU traits to be more, less, or equally effective for young children with secondary CU traits. In lieu of empirical guidance, predictions based on theory warrant consideration. Both Karpman and Porter argued that secondary psychopathy is conditioned or acquired and that these individuals are thus “decidedly approachable by psychotherapy” (Karpman, 