The Association Between Callous-Unemotional Traits and Aggression in Adolescents: A Systematic Review
Rachel Thompson (10575332)
University of Amsterdam
Bachelor Thesis
Assessor: Alithe van den Akker
Amount of words: 5036
Table of Contents Abstract p. 3 Introduction p. 4 Method p. 8 Results p. 10 Discussion p. 14 References p. 20 Tables p. 30
Abstract
This article reviews research on the relation between Callous unemotional traits and aggression in adolescents. Research has shown the association between callous-unemotional (CU) traits (i.e. a lack of empathy and guilt) and reactive (impulsive, defensive) and proactive (planned, goal-oriented) forms of aggression in adolescents. Using two electronic databases, 23 relevant studies published between 2007 and 2016, were identified. The studies were diverse in terms of their sample population, measurements for assessing CU traits and measurements for assessing the different forms of aggression. Despite the methodological diversity across studies, there is fairly enough evidence that high levels of
callous-unemotional traits are positively associated with proactive aggression; findings regarding the relationship between the level of CU traits and reactive aggression have been more mixed, with the majority of the identified studies finding associations between low levels of CU traits with reactive aggression. While findings on high levels of CU in association with combined proactive/reactive aggression showed consistencies with previous literature. Finally, the findings strengths and limitations, recommendations and implications for future studies, interventions and treatments are discussed.
Keywords: Callous-unemotional traits, reactive aggression, proactive aggression, detained, youth, adolescents
The Association Between Callous-Unemotional Traits and Aggression in Adolescents: A Systematic Review
The presence of Callous unemotional (CU) traits in children and adolescents is crucial for designating a group of youth with serious levels of aggression and antisocial problems (Frick & Dickens, 2006). CU traits are believed to be a manifestation of adult traits of psychopathy in youth and can be referred to as a temperamental style divided by an affective (lack of empathy) and interpersonal (lack of empathy) style (Frick & Dickens 2006; Howard, Kimonis, Muñoz, & Frick, 2012; Kruh et al., 2005). Youth with such temperamental style are, in general, characterized by features labeled as low harm avoidance, insensitive to punishment and low behavioral inhibition (Frick & Dickens, 2006).
Research findings on children and adolescents with certain levels of CU traits show inconsistencies in findings about the stability of these traits. On the one hand the study of Boonmann et al. (2015) reported that since there is possibility of a temporary presence of CU traits in youth, the stability of the presence of CU traits in adolescents can not be determined. The study noted that because adolescents are not yet fully developed, there is a small chance of psychopathic traits enduring into adulthood. On the other hand several studies found a moderate stability of the presence of CU traits from childhood and adolescence to early adulthood (Frick et al., 2003b; Lynam et al., 2009; Muñoz & Frick 2007). However, these studies also stated that the results do not indicate impossibility of change. The findings of the study of Frick et al. (2003) showed that regardless of the high level of stability in CU traits across a study period of 4-years, a significant number of adolescents showed a decrease in their level of CU traits.
Research findings on children and adolescents with CU traits did show consistencies in findings about emotional deficiency (Frick & Dickens, 2006). Which indicate that CU traits are associated with less punishment sensitivity, because of deficiencies in recognizing
the negative consequences of their aggressive behaviors. The study of Pardini, Lochman, and Frick (2003) found evidence for a positive association between CU traits and a reward dominant response style (i.e. dominating others and obtaining rewards by using aggression). The finding showed that higher levels of CU traits in adolescents were associated with more focus on the positive outcome expectations of aggression, and less focus on the negative consequences of aggression.
Aggression can be described as any behavior that is carried out with the intent to hurt or cause harm to another individual (Anderson & Huessmann, 2003; Marsee & Frick, 2007). Actual harm is not necessary, it is also considered aggression if the perpetrator assumes that his or her behavior will cause harm to an individual, the target, and this individual is triggered to avoid the behavior directed towards him or her (Anderson & Huessmann, 2003).
Aggression can be divided in the categories proactive and reactive aggression. Proactive aggression (i.e. also known as instrumental aggression) can be described as planned and goal-oriented behavior characterized by an absence of emotion, which does not require any
provocation (Anderson & Huesmann, 2003; Brendgen, Vitaro, Tremblay & Lavoie, 2003). Results of previous studies revealed strong associations between CU traits and proactive aggression and positive outcome expectations of aggressive behavior (Marsee & Frick, 2007). Adolescents with high levels of proactive aggression are driven by gain and see aggression as a method for accomplishing their goals and expect positive results for their aggressive behavior (Flight & Forth, 2007; Marsee & Frick, 2007). Furthermore, proactive aggression was associated with adult psychopathy and early manifestation of persistent forms of antisocial behaviors (Vitaro & Brendgen, 2005).
Reactive aggression can be described as an impulsive, defensive behavior in response to provocation or threat, such as an angry outburst (Anderson & Huesmann, 2003; Brendgen, Vitaro, Flight, & Forth, 2007;Tremblay & Lavoie, 2003). Results of previous studies revealed
strong associations between reactive aggression and deficits in emotion regulation and anger to provocation (Marsee & Frick, 2007). Adolescents with high levels of reactive aggression tend to pay attention to negative social cues, are unsuccessful at considering reactions that are non-aggressive, and are also unsuccessful at considering the negative consequences of their actions (Marsee & Frick, 2007). Furthermore, reactive aggression was associated with anxiety in adulthood.
The study of Fite et al. (2009) focused on the future consequences of CU traits in youth. The findings showed that individuals that are known to exhibit proactively aggressive behaviors are at a higher risk of engaging in substance use. They clarified this statement by showing that these individuals exaggerate the positive effects of the use of substances, while they do not take into account the consequences of substance use. Moreover, they experience little to no anxiety when it comes to the negative consequences. Additional findings of the study of Pardini et al. (2003) showed that these individuals were characterized by low levels of fearfulness, which was positively associated with the initiation substance use. Besides the positive association with the development of alcohol abuse at late adolescence. Especially, proactive aggression was associated with diminished focus on the negative affect as well as increased sensation seeking tendencies (Raine et al., 2006).
The results of the study of Anderson and Huesmann (2003) and Brendgen et al. (2003) reported interesting findings about the differences and similarities of these two forms of aggression. The findings on proactive and reactive aggression showed that although both forms of aggressive behavior often seemed to co-occur, not all aggressive individuals displayed both forms of aggression. Interestingly the study of Vitaro et al. (2006) about the occurrence of these two forms of aggression during childhood, found that whereas proactive aggression does not seem to be a predictor of reactive aggression, reactive aggression in one year appeared to be a predictor of proactive aggression in the next year. The results of the
study of Brendgen et al. (2003) pointed out that around 53% of the children that exhibited some form of aggressive behaviors, where not necessarily found to exhibit both proactive and reactive forms of aggressive. Whereas around 32% of these children displayed only reactive aggression behaviors, only 15% seemed to engage in only proactive forms of aggression.
The association between CU traits and antisocial behavior, such as conduct problems, violence, delinquency and aggression has already been reviewed before. Firstly, the article of Frick and White (2008) about “The importance of callous‐unemotional traits for
developmental models of aggressive and antisocial behavior” reviewed 24 studies. This review found consistent evidence for an positive association between CU traits and severe forms of antisocial behavior. Antisocial youth with higher levels of CU traits showed
distinctive risk factors when it comes to cognitive, emotional, and personality characteristics. These youth where characterized by deficits in punishment insensitivity and decreased
responsiveness to the distress in others, when compared to youth with low levels of CU traits. Secondly, the article of Muñoz and Frick (2012) reviewed studies on the development of aggression and callous-unemotional traits. This review found positive associations between callous-unemotional (CU) traits and proactive aggression. Furthermore, this review revealed distinctive mechanisms in the development of aggressive and antisocial behavior for youths with and without CU traits.
This article aims to contribute to earlier research on CU traits and aggression by focusing on a specific age group of adolescents. As well as, focusing on the level of CU traits associated with reactive and proactive aggression. This systematic review examines several questions: First, what is the association between callous-unemotional traits and proactive aggression? Second, what is the association between callous-unemotional traits and reactive aggression? Third, what is the association between callous-unemotional traits and combined
aggression? These questions will contribute to answering the main question: What is the association between callous-unemotional traits and aggression?
Methods
This review was based on a systematic search of two databases: MEDLINE and Web of Science. The search strategy combined terms to identify studies investigating CU traits and aggression among adolescents: (Callous* OR CU traits OR unemotional OR
callous-unemotional traits) AND (Reactive aggression OR non-instrumental aggression OR proactive aggression OR instrumental aggression OR aggress* OR) AND (incarcerated OR detained OR offenders OR delinquents) AND (juvenile OR adolescen* OR youth OR young OR boy OR girl OR female OR male). The search mainly captured articles published between 2000 and 2016 and was limited to English-language literature. To be included, studies must have (a) been published after 2006; and (b) been empirically based. Two inclusion criteria were established for the screening of abstracts of identified articles. The abstracts of these articles were screened for the following criteria: (a) presentation of data, testing the associations between the level of CU traits and proactive of reactive aggression; and (b) assessment of adolescents.
The search identified 148 records. First, titles and abstracts of relevant identified records were screened. Studies that corresponded to the aims of the review were kept for further inspection. From then the method and discussion section of approximately 67
potentially relevant studies were examined to assess whether they met the inclusion criteria of the review. After inspecting these 67 papers, 44 were removed. Studies were excluded if: (a) they did not specify callous-unemotional traits but only reported data on psychopathic traits; and (b) they did not reported specific data about the form of aggression. The remaining 23 studies included research published between 2007 and 2016. Of 23 studies, one was
out in the US, the other studies were carried out in Canada, Portugal, Switzerland and Romania. Studies were systematically and critically evaluated for methodological
characteristics according to: (a) sample size; (b) type of sample; (c) measurement of callous-unemotional traits; and (d) measurement aggression. A summary of the study characteristics is presented in Table 1 and the main findings for each study is presented in Table 2.
Methodological characteristics of included studies (see Table 1)
Within cross-sectional studies, several sample sizes were small (five studies with N < 200) or very small (four studies with N < 100). The nine remaining cross-sectional studies had medium (four studies with N > 200) to large (N > 500) sample sizes. The longitudinal study had a medium sample size (N < 500). The case study and the two cohort studies both had small to very small sample sizes. Within the 22 studies, nine examined detained samples with only males, five studies examined mixed detained samples and two remaining studies examined detained samples with only females (See table 1). The majority of these detained adolescents tended to be Caucasian or African- American. Five studies examined students, only one study with only males, other four studies combined.
Among the 22 studies, 14 used the Inventory of Callous-Unemotional Traits (ICU; Frick 2004), to assess callous-unemotional traits. The ICU is a 24-item measure, in which terms are rated on a 4-point Likert-type scale (0 = Not at all true to 3 = Definitely true) was developed to provide a more comprehensive assessment of Callous-unemotional traits. Several studies support the construct validity of the ICU in community and incarcerated youth (e.g., Kimonis et al., 2008; Roose et al., 2010). The total scores proved to be internally consistent in these samples (coefficient alpha .77 to .89). The remaining studies assessed CU traits with subscales of psychopathy measures (see Table 1).
Among the 22 studies, 9 used the self-report Peer Conflict Scale (PCS; Marsee et al., 2011) to assess, proactive and reactive aggression. The PCS was developed to improve
existing measures for assessing aggression by measuring four dimensions: reactive overt, proactive overt, reactive relational and proactive relational. The PCS includes a sufficient number of items (n= 10) for each dimension, terms were rated on a 4-point Likert scale from 0 (“Not at all true”) to 3 (“Definitely true”). Of the 40-items, most studies only used the 20 total over aggression items (see Table 1). The internal consistency ranged from .82 to .89. Seven studies used the RPQ to asses proactive and reactive aggression. The RPQ includes 23 items based on previous teacher-rating measures of these two forms of aggression. Of the 23 items, eleven items measure reactive aggression and twelve items measure proactive
aggression. The response items included 3 answer options, never, sometimes or often. The remaining studies assessed aggression with different measures or subscales of delinquency measures (see Table 1). Fourteen of the reviewed studies provided data on the internal consistency of their CU traits measure and seventeen of the reviewed studies
provided data on the internal consistency of their aggression measures. Of the fifteen studies that did provide Cronbach's alphas, five were reported as being < .70, and, of the seventeen studies that did provide Cronbach’s alphas, three were reported as being < .70, one was reported as low as 0.45 (Kunimatsu et al., 2012). An alpha as low, is a threat to the validity of measures, however low alphas do not directly imply that the items do not measure the same construct. A low alpha can also be due to short questionnaires, since a lot of studies used a few amount of items (Tavako & Dennick, 2011).
Results CU traits and Proactive aggression
Seventeen studies explored the association between CU traits and proactive aggression among mostly detained samples of adolescents. The results of fifteen studies found moderate to strong positive associations between CU traits and proactive aggression, adolescents with higher levels of CU traits showed higher levels of proactive aggression.
Seven studies that investigated this association among a detained sample of adolescents, found that detained adolescents with high levels of CU traits have a specific goal-oriented mindset (Kimonis, Frick, Muñoz & Aucoin, 2008a; Kunimatsu, Marsee, Lau, Fassnacht, 2012; Muñoz, Frick, Kimonis, & Aucoin, 2008; Pardini, 2011; Kimonis et al., 2014; Pihet, Etter, Schmid, & Kimonis, 2015; Rosan, Frick, Gotttlieb, & Fasicau, 2015). For example, the study of Muñoz et al. (2008) on a detained sample of boys (n= 85) showed that these
adolescents high on CU trait expect positive outcomes of their aggressive behaviors and negative expectations when it comes to punishment.
In accordance with these results, three studies on a community sample of students, also found positive associations between a high level of callous-unemotional traits and proactive aggression (Fanti et al., 2009; Fite et al., 2009; Raine et al., 2006). Students with higher levels of CU traits were more likely to show deficits in emotion regulation, affective deficits and emotional detachments. Besides, appearing less distressed by the negative consequences of their aggressive behavior on others.
Two studies investigated the association between CU traits and proactive aggression by using an affective-interpersonal dimension of a psychopathic measure, whose items proved to be a good representation of CU traits. High levels of CU traits were indicated by low levels on the affective-dimension, such as low scores on items concerning remorse, empathy, shallow emotions and taking responsibility for actions. (Forth & Flight, 2007; Meloy, 2006). Both studies also found that adolescents with high levels of CU traits, thus low levels on the affective-dimension (e.g. interpersonal and affective features of psychopathy) were positively associated with proactive aggression (Cook, 2010; Forth & Flight, 2007).
The study of Kimonis et al. (2008b) was one of the few studies that explored this association among a mixed sample of detained adolescents (N = 248). This study revealed gender differences in the association between CU traits and proactive aggression, with girls
showing stronger positive associations between their level of CU traits and proactive aggression. Contrary to these previous results, the study of Perenc & Radochonski (2014) among a community sample of students (N = 9415) found positive associations between CU traits and proactive aggression for boys, with boys also showing higher levels of callous-unemotional traits than girls.
CU traits and Reactive aggression
Five studies assessed the association between CU traits and reactive aggression among mostly detained samples of adolescents, with the exception of one study among a community sample of students. The results of Colin (2016) found positive associations between high levels of CU traits and reactive aggression when compared to detained boys with lower levels of CU traits (N = 807). The study of Kimonis et al. (2013) also found high levels on CU traits to be more positively associated with reactive aggression, among detained youth exposed to low levels of maternal care. The findings of this study pointed out that CU traits in combination with low maternal care contributed to an increased risk for aggressive behavior that is rather defensive and impulsive. These studies are inconsistent with earlier literature about reactive aggression being rather explained by deficits in anger reactivity and impulsivity, than by high levels of CU traits (forth and flight, 2007).
Inconsistent with these findings, but consistent with previous studies, two studies on detained samples of adolescents found positive associations between low levels on CU traits and reactive aggression. While the study of Kimonis et al. 2014 found positive associations between moderate levels on CU traits with reactive aggression, the study of Rosan & Iu (2013) found the same positive association but for low levels of CU traits. These results show adolescents with low levels of CU traits rather show reactive forms of aggression. The study of Rosan & Iu (2013) also investigated the effect of impulsivity on this association and found that impulsivity is a much better predictor of reactive aggression when it comes to low levels
on CU traits. The results of the study of Fite et al. (2009) carried out among a community sample of students (N = 336), did not display a significant association between callous affect dimension of psychopathy and reactive aggression. No conclusions can be made about this association, since there is a probability that the found correlation occurred by chance and does not indicate the presence of a relationship.
CU traits and combined proactive/reactive aggression
Four studies investigated the association between CU traits and combined aggression (Colins, 2016; Fanti et al, 2008; Lawing. 2010; Marsee et al, 2014; Stickle, 2011), while two studies did this on a community samples of students, two other studies did this on a detained sample of adolescents. Findings on this association indicate that high levels of CU traits show more strong positive associations with combined proactive and reactive aggression, with the group of adolescents with high levels of CU traits exhibiting more combined
proactive/reactive aggression than only one form of aggression (Fanti et al., 2009; Marsee et al., 2014). With the group of adolescents with high levels of CU traits exhibiting a
combination of proactive and reactive forms of aggression.
The study of Stickle et al. (2012) explored this association among a mixed sample of detained adolescents (N=150). The results showed that for both boys and girls, the combined proactive/reactive aggression was positively associated with high levels on
callous-unemotional traits. For both boys and girls, the combination of proactive/reactive aggression was also associated with higher levels of impulsivity. Furthermore, the study showed that girls appeared to show higher levels of CU traits and appeared to have stronger positive associations with proactive/reactive aggression than boys.. The elevated level of CU traits in girls was clarified by general higher levels of disturbance in girls, such as higher levels of emotional distress. The study of Lawing et al. (2010) on detained sexual offenders (N=150) showed positive associations between high levels on CU traits and combined
proactive/reactive aggression, The findings indicated that these offenders among other things were more likely to engage in more sexual offense planning than those low on these traits.
Discussion and conclusion
The aim of this systematic review was to create a clear overview of literature on the associations between callous-unemotional traits and aggression in adolescents. When it comes to this association, various conclusions can be drawn about the identified relations and (in)consistencies in the literature. Firstly, the results of the seventeen identified studies on the association between callous-unemotional traits and proactive aggression showed no
inconsistencies. All studies found evidence for adolescents with high levels of CU traits to exhibit more planned and goal oriented aggressive behavior (Fanti et al., 2009; Fite et al., 2009; Pardini, 2011; Kimonis et al., 2014; Muñoz, Frick, Kimonis, & Aucoin, 2008; Rosan, Frick, Gotttlieb, & Fasicau, 2015; Kimonis, Frick, Muñoz & Aucoin, 2008a; Kunimatsu, Marsee, Lau, Fassnacht, 2012; Pihet, Etter, Schmid, & Kimonis, 2015; Raine et al., 2006; kimonis et al.,2008b; Perenc & Radochonski, 2014). The findings on proactive aggression are in line with previous literature about youth with higher levels of CU traits being more inclined to use forms of aggression driven by gain and see aggression as a method for achieving their goal (Pardini, 2003).
Secondly, the results of the reviewed studies on the association between callous-unemotional traits and reactive aggression showed inconsistencies. Two studies, inconsistent with previous literature on this association, showed that adolescents with high levels of CU traits tend to exhibit more impulsive, defensive aggressive behavior (Colin, 2016; Kimonis et al., 2013). Although the results of the study of Colin (2016) were not consistent with previous literature on this association, the study does support the claims about reactive aggression being characterized by anger and a loss of impulse control. Impulsiveness was an important aspect, showing unpremeditated response to provocation such as, frustration or anger (e.g.,,
initiating fights, using an object, weapon, that can possibly lead to severe physical harm). The study of Kimonis et al. (2013) that also focused on the effect of parental warmth on the association between CU traits and aggression, showed the importance of the parent–child attachment in the development of CU traits and other psychopathic traits in relationship with antisocial behaviors in adolescents. The inconsistency was thought to be declared due to the variable maternal care. However, the findings also pointed out a significant positive
association between callousness traits and aggression even when the mediating effects of low maternal care were not included in the association, which indicates that adolescents high on CU traits in combination with and also without low maternal care are at a greater risk for aggressive behavior that are defensive.
Three other studies, in line with previous literature, pointed out the importance of emotion regulation deficits and impulsivity when it comes to reactive aggression and showed that low levels of CU traits, rather than high levels of CU traits are positively associated with reactive aggression (Kimonis et al., 2008a; Kimonis et al.,2014; Rosan & Iu, 2013). The study of fite et al. (2009) found a non-significant association between CU traits and reactive aggression. The findings did show a positive relationship between reactive aggression and internalizing behavior, because of the similar temperamental style with character features, such as reactivity and anger. Furthermore, this study only found positive associations between high levels of CU traits and aggression. These findings do support the study of Brendgen (2003) on the stronger associations between reactive aggression in children and internalizing problems, than children that are more proactively aggressive.
The three studies on the association between adolescents with low levels of CU traits and reactive forms of aggression showed consistencies with previous literature of Frick and Dickens (2006). This study found evidence for children with low levels of CU traits
children with low levels of CU traits seemed to show deficits in their emotion regulation. Furthermore, other study pointed out that these youth with low levels of CU traits, were characterized by having biases in processing social information and are known to attribute hostile intents to the behavior of others (Anderson & Huesman, 2003).
Lastly, the results on the association between callous-unemotional traits and
combined proactive/reactive aggression were consistent and pointed out that adolescents with high levels CU traits tend to use a combination of these two forms of aggression. Previous research showed that the relation between CU traits is different for proactive and reactive forms of aggression, but when it comes to adolescents with high levels of CU traits exhibitions of more severe aggressive behaviors and aggression that is both reactive and proactive in nature, are found (Enebrink et al. 2005; Frick et al., 2003; Kruh et al., 2005).
The study of Lawing et al. (2010) supports this claim and found that detained adolescents with high levels of CU traits are more likely to exhibit both proactive and reactive aggression given the reason that it leads to greater harm to their victims. Furthermore, reactive aggression was in particular associated with features of negative emotionality (Frick & Dickens, 2006; Vitaro et al., 2002). These adolescents appeared to have high levels of self-reported anxiety, besides being more reactive to the distress of others in social situations and to various types of negative emotional stimuli (Frick & Dickens, 2006). These findings are in line with the findings of (Pardini et al., 2003) that showed
adolescents that show only reactive form of aggression appeared to be distressed by their own behavior, whereas this was not the case when it comes to adolescents with high levels of CU traits. Who were clearly less distressed by the negative consequences of their aggressive behavior on others.
The strengths and limitations of studies have to be taken into account. This study reviewed 22 published studies and selectively reported results important to the aims of the review. Limitations that need to be considered alongside results are firstly, the risk of reduced generalizability of the findings due to small sample sizes, since several studies had less than 100 participants. Secondly, also the fact that so many studies used different measures for aggression reduces the comparability of results. Future research could prevent this problem by only reviewing studies with a medium-to-large sample size. Also a more careful selection of studies with comparable measurement instruments could increase generalizability in the future. Thirdly, there was a limited number of studies that focused on this association among girls. More research on girls are highly required, literature has mainly focused on the
association between CU traits and the levels of aggression among males, but few studies have done the same on samples of , detained, female adolescents. The findings of Stickle et al. (2012) emphasized the need to understand gender differences among detained sample of youth and the underlying factors that are responsible for the differences between boys. Lastly, studies in this review were mostly based on self-report questionnaires. Whereas previous research shows that interviews are more reliable when it comes to more precise
measurements of psychopathic traits, such as callous-unemotional traits (Murrie, Cornell, Kaplan, McConville, & Levy‐Elkon, 2004).
A strength of this review that must be noted is that many studies used the same measurements of CU traits, which enables greater comparability of results. The ICU was the most used measurement for assessing CU traits and has been proved to be a good and important measure of construct of callous-unemotional traits by the study of Kimonis et al. (2008a) . Furthermore the use of the affective-interpersonal dimension of psychopathy for measuring CU traits were considered as possible limitations. However, previous studies have argued that this dimension may be one of the most important ones for identifying the
development of psychopathic traits and important for the understanding of disturbances in personality at an older age (Barry et al., 2000; Skeem & Cooke, 2006). Therefore, not only may these traits be important for understanding a group of adolescents that exhibit mild to very severe forms of aggressive behaviors, but also state the importance of understanding the developmental of traits that precede serious forms of personality disturbances (Barry et al., 2000; Kimonis et al., 2008b; Skeem & Cooke, 2006). Additional study of Raine et al. (2006) showed the importance of proactive aggression as an early indicator of psychopathic
personality. The findings altogether support prior literature on the positive associations between CU traits and proactive aggression rather than reactive aggression. Furthermore, the review helped to cultivate more understanding on the associations between these CU traits and aggression. Understanding CU traits, which proved to be an important component in the development of aggression is an important contribution to the improvement of interventions designed to prevent the exhibition of these forms of aggressive behavior. Especially, for this important group of antisocial adolescents. Furthermore, this review can help to improve preventive interventions that meet the needs of these difficult groups of adolescents.
It must be noted that the presence of certain levels of callous-unemotional traits, are not a required trait in adolescents that exhibit proactive aggressive behavior. Based on the positive associations found in adolescents known to exhibit reactive and/or proactive forms of aggression, interventions must distinguish their treatment strategies. Interventions focused on reactive aggression should put more attention on social-information processing to tackle hostile attributions to the intentions of others and treating anger problem. This because of the positive associations found between impulsivity among youths with low levels of CU traits and reactive aggression (Colins, 2016). Adolescents that exhibit more forms of proactive aggression find more benefits from being exposed peers that are not aggressive and also
problem solving strategies focused on behaviors that are not aggressive behaviors. These children might also benefit from strategies focused on awareness of the negative
consequences of their aggressive behaviors. Adolescents showing a combination of reactive and proactive aggression could benefit from a combination of both treatment
strategies.
Future studies should focus on reviewing the prevention and intervention for this group of adolescents and juvenile offenders, which is important for the treatment of incarcerated and non-incarcerated aggressive adolescents.
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Table 1
Characteristics of included studies.
Study Study design N Mean
age Percent female Measure of CU Measure of Aggression
Colins (2016) Cross-sectional 807 16.71 0 YPI RPQ
SDQ Cook et al. (2010) Case-study 100 16.08 50 PCL: YV FEDS Fanti et al. (2008) Cross-sectional
study
347 14.63 49 ICU RPQ
Fite et al. (2009) Longitudinal 336 16 0 CPSr RPQ
Forth & Flight (2007)
Cross-sectional 51 17.10 0 PCL:YV Motivations for violence Kimonis et al. (2008a) Cross-sectional 88 15.57 0 ICU PCS Kimonis et al. (2008b) Cross-sectional 248 15.47 24 ICU PCS SRD Kimonis et al. (2013) Cross-sectional 227 15-73 0 ICU PCS Kimonis et al. (2014) Cross-sectional 643 16.50 0 ICU PCS SRD Kunimatsu et al. (2012) Cross-sectional 59 14.98 100 ICU SRD OEQ OEQ Lawing (2010) Cross-sectional 150 15.89 0 ICU J-SOAP II Marsee and Frick
(2007) Cross-sectional 58 14-98 100 ICU PCS; OEQ Marsee et al. (2014) Cross-sectional 2883 14.29 14.97 13.55 19 ICU PCS Muñoz et al. (2008)
Cohort study 85 15.53 0 ICU PCS
CRTT
Pardini (2011) Cohort-study 156 15.83 46 APSD OEQ
Perence and Radochonski (2013) Cross-sectional study 9415 14.38 48.9 ASPD RPQ
Note. APSD = Antisocial Process Screening Device; ICU = Inventory of Callous– Unemotional Traits; PCL-YV = Psychopathy Checklist-Youth Version; YPI = Youth Psychopathic Traits Inventory; CRTT = Competitive Reaction Time Task; PCS = Peer Conflict Scale; SRD = Self-Reported Delinquency Scale; YSR = Youth Self-report Form; OEQ = The Outcome Expectations Questionnaire; ASRDS = The Adapted Self-Reported Delinquency Scale; RPQ= Reactive-Proactive Aggression Questionnaire
Pihet et al. (2015) Cross-sectional 164 15.8 30 ICU RPQ Raine et al. (2006) Cross-sectional 334 16.15 0 CPS RPQ Rosan and Barlitou
(2013)
Cross-sectional 125 14-19 0 ICU PCS
Rosan et al. (2015) Cross-sectional 125 14-18 0 ICU PCS
Table 2
Main findings relevant to aims of the review.
Study Proactive Reactive Combined
Colins (2016) Adolescents with higher
levels of CU traits - reactive aggression. Adolescents with higher levels of CU traits - combination of reactive/proactive aggressio Cook (2010) Affective-interpersonal dimension corresponding with CU traits significant predictor for proactive aggression Fanti et al. (2008) callous subscale is more strongly related to proactive aggression Higher levels of CU traits - combined proactive and reactive aggression
Fite et al. (2009) Callous affect psychopathy
non-significant relation between Callous affect
subscales were positively associated with proactive aggression
psychopathy subscales and reactive aggression
Forth & Flight (2007) Youth with higher levels on interpersonal and affective features of psychopathy were classified as nstrumentally violent. Kimonis et al. (2008a)
Aggressive youth low on CU traits are more likely to show impairments in their ability to regulate their emotions, reactive aggression
Kimonis et al. (2008b)
Total ICU score higher
correlations
Positive association between ICU and reactive aggression for boys lower
with proactive aggression. Positive association between ICU and proactive aggression for boys lower than girls than girls Kimonis et al. (2012) Positive stronger associations for the callousness dimension with proactive aggression
high levels of CU traits and exposure to low levels of maternal care appeared to be we at greatest risk for reactive aggression Kimonis et al. (2014) higher levels of CU – higher on proactive aggression moderate levels of CU – lower scores on reactive aggression Kunimatsu et al. (2012) callousness dimension is a good predictor
of more serious forms of
aggression such as proactive aggression
Lawing (2010) high levels of CU –
positive associations with instrumental and reactive aggression
Marsee and Frick (2007) proactive aggression was more strongly associated with CU traits and positive outcome expectations for aggression Marsee et al. (2014)
high levels of CU traits – high combined aggression and reactive aggression.
(2008) associations between CU traits- proactive aggression
Pardini (2011) Juveniles who are high on both CU traits and violent behavior have a particularly deviant goal-set in conflict situations , proactive aggression Perenc and Radochonski (2013) Higher correlations between cu and proactive aggression boys had higher levels of
callous-unemotional
traits
Pihet et al. (2015) ICU total, Callousness and Uncaring scores contributed significantly to the prediction of proactive aggression.
none of the ICU scores predicted reactive aggression Raine et al. (2006) proactive, but not reactive, aggression was associated with higher levels of CU traits Rosan and Barlitiu (2013) The presence of high CU traits impulsivity strongly predicts proactive overt aggression
when CU traits are low, impulsivity significantly predicts reactive aggression
Rosan et al. (2015)
the group high levels of CU traits showed
higher levels of proactive aggression
Stickle (2011) For both boys and girls,
the combined proactive/reactive aggression cluster showed the greatest levels callous-unemotional traits,
