THE JOURNAL OF

CHILD PSYCHOLOGY AND PSYCHIATRY

Journal of Child Psychology and Psychiatry 49:4 (2008), pp 359–375 doi:10.1111/j.1469-7610.2007.01862.x

Research Review: The importance of callous-

unemotional traits for developmental models of
aggressive and antisocial behavior
Paul J. Frick and Stuart F. White
University of New Orleans, USA

The current paper reviews research suggesting that the presence of a callous and unemotional inter-
personal style designates an important subgroup of antisocial and aggressive youth. Specifically,
callous-unemotional (CU) traits (e.g., lack of guilt, absence of empathy, callous use of others) seem to
be relatively stable across childhood and adolescence and they designate a group of youth with a
particularly severe, aggressive, and stable pattern of antisocial behavior. Further, antisocial youth with
CU traits show a number of distinct emotional, cognitive, and personality characteristics compared to
other antisocial youth. These characteristics of youth with CU traits have important implications for
causal models of antisocial and aggressive behavior, for methods used to study antisocial youth,
and for assessing and treating antisocial and aggressive behavior in children and adolescents.
Keywords: Callous-unemotional traits, aggression, antisocial behavior, conduct problems, children
and adolescents, psychopathy.

There recently have been a number of reviews docu- traits has great potential for explaining the causes of
menting a large number of risk factors that have the most severe and aggressive patterns of antisocial
been associated with aggressive and antisocial behavior displayed by youth and that use of these
behavior (Dodge & Pettit, 2003; Frick & Marsee, traits to subtype antisocial youth could help to
2006; Loeber & Farrington, 2000; Raine, 2002). integrate many of the past attempts for defining
These risk factors include characteristics of the child distinct groups of antisocial youth.
(e.g., neuropsychological deficits, autonomic irregu-
larities, temperamental traits) and characteristics of
the many social contexts (e.g., peer rejection, family CU traits and developmental models of
dysfunction, neighborhood disorganization) that can psychopathy
influence the child’s development. Such reviews have
CU traits are prominent in most conceptualizations
made it clear that theoretical models attempting to
of psychopathy in adults (Cleckley, 1976; Hare,
explain the development of antisocial and aggressive
1993). The construct of psychopathy in adults has
behavior and related psychiatric diagnoses (e.g.,
proven to designate a particular severe and violent
conduct disorder) need to be able to incorporate this
group of antisocial adults (Hemphill, 2007; Porter &
broad array of risk factors into their proposed causal
Woodworth, 2006) and a group of adults who seem
mechanisms.
to have distinct causal processes leading to their
It has also become increasingly clear that, within
antisocial behavior (Blair, Peschardt, Budhani,
youth who develop severe patterns of aggressive and
Mitchell, & Pine, 2006; Patrick, 2007). There is still
antisocial behavior, there are likely to be subgroups
substantial debate about how many dimensions
who may show distinct casual processes leading to
best capture the construct of psychopathy in adult
their problem behavior. As a result, there have been
samples (see for a discussion Cooke, Michie, &
a number of attempts to define important subgroups
Hart, 2006). However, at least three dimensions
of antisocial and aggressive individuals that differ in
consistently emerge, one of which includes CU
their types of behavior, risk for future problem
traits and has been variously labeled as ‘deficient
behavior, and associated risk factors that could
affective experience’ (Cooke at al., 2006) or the
suggest distinct etiologies (see Frick & Marsee, 2006
‘affective factor’ (Hare, 1993). The other two
for a review). In the current review, we focus on one
dimensions include a) an arrogant and deceitful
specific method for defining important subgroups
interpersonal style involving a narcissistic view of
of antisocial youth. This method focuses on the
one’s self and conning and manipulative behavior
presence or absence of callous-unemotional (CU)
and b) an impulsive and irresponsible behavioral
traits (e.g., lack of guilt, lack empathy, callous use of
style involving poorly planned behavior and prone-
others for one’s own gain). We argue that use of these
ness to boredom.
When the various traits associated with psycho-
Conflict of interest statement: Paul J. Frick is the author of the
Antisocial Process Screening Device, in which he has a signif- pathy are studied in samples of youth, three similar
icant financial interest. dimensions often emerge whether using teacher and
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
360 Paul J. Frick and Stuart F. White

parenting ratings of these traits in preadolescent (i.e., impulsivity and narcissism) were higher in
children (Frick, Bodin, & Barry, 2000a; Kotler & children with disruptive behavior disorders but did
McMahon, 2005) or using self-report or clinical rat- not differentiate within this broad diagnostic cate-
ings of these traits in incarcerated adolescents gory (Christian, Frick, Hill, Tyler, & Frazer 1997).
(Neumann, Kosson, Forth, & Hare, 2006; Vitacco, Thus, a critical issue for this review is to focus on
Rogers, & Neumann, 2003b; however, see Poythress, whether CU traits predict important external criteria
Dembo, Wareham, & Greenbaum, 2006 for a failure independent of general measures of conduct prob-
to separate these dimensions in justice-involved lems and antisocial behavior. Stated in person-cen-
adolescents). Given this multidimensional structure tered terms, the focus is on whether CU traits
of psychopathy, only one of which involves CU traits, designate an important subgroup within antisocial
the question becomes why focus on CU traits as the youth.
critical dimension for designating a unique group of
antisocial youth?
Before addressing this question, it is important to
Stability of CU traits
note that a significant portion of research attempting
to extend the construct of psychopathy to youth has Before focusing on the associations with external
used measures that have combined across these criteria, an important issue that has been raised is
three dimensions (see Frick & Dickens, 2006 for a whether the behaviors that define CU traits are
review) based on the assumption that these dimen- stable enough in children or adolescents to warrant
sions all represent a higher-order construct that, the designation of ‘traits’ that implies some level of
when combined, best represents the construct stability across development (Edens, Skeem, Cruise,
of psychopathy (Neumann et al., 2006). Also, there & Cauffman, 2001; Seagrave & Grisso, 2002). There
have been conceptualizations proposed for youth are now a number of studies showing that these
that focus on other dimensions as being most traits are relatively stable from late childhood
important for subtyping youth with conduct prob- to early adolescence either when assessed by self-
lems, such as the one proposed by Lynam (1996) report (Munoz & Frick, 2007) or by parent report
that focuses on the impulsive and irresponsible (Frick, Kimonis, Dandreaux, & Farrell, 2003c). This
dimension as being most critical. In some support of stability was particularly strong for parent report,
this latter conceptualization, the impulsive and where the Intraclass Correlation Coefficient for
irresponsible dimension from many measures of parent ratings of CU traits over a 4-year period was
psychopathy often shows the strongest and most .71 (Frick et al., 2003). Such stability is much higher
consistent correlations with measures of conduct than is typically reported for other parent ratings of
problems, delinquency, and other antisocial indices children’s adjustment (Verhulst, Koot, & Berden,
(Frick et al., 2000; Kotler & McMahon, 2005; Lynam, 1990). Over an even longer follow-up period,
1998). Obradović, Pardini, Long, and Loeber (2007) also
However, for a construct to be important for sub- reported relatively high rates of stability for parent
typing within antisocial individuals, it also needs to and teacher ratings of CU traits in a sample of 506
show important areas of independence from general inner-city boys assessed annually from ages 8 to 16,
measures of antisocial behavior. That is, if a dimen- although this again was higher for parent-reports
sion accounts for the same variance in predicting (r ¼ .50 and .27 across 9 years for parent and
important external criteria (e.g., risk for future teacher report, respectively). Importantly, these
aggression and violence) as general antisocial authors also reported relatively strong measurement
behavior, the incremental utility of this dimension is invariance in the items used to assess these traits
limited and it is unlikely to designate a distinct group across their study period, suggesting that the items
within antisocial individuals. In adult samples, it is were measuring the construct of CU traits in similar
the callous and unemotional dimension that seems ways across this rather extended developmental
to be most specific to individuals’ high on psycho- period.
pathic traits compared to other antisocial individu- Based on these findings, there does appear to be
als (Cooke & Michie, 1997). There is some evidence relatively high stability in ratings of CU traits from
that the same may be true for youth. For example, in childhood to adolescence, although this seems to be
a sample of detained adolescents, CU traits were especially true for parenting ratings. However, this
higher in violent sex offenders compared to other level of stability does not imply that these traits are
violent offenders and non-violent offenders, whereas unchangeable. That is, Frick et al. (2003) reported
the other dimensions of psychopathy did not differ- that, despite the high level of stability in these traits
entiate across offender groups (Caputo, Frick, across their 4-year study period, there were a sig-
& Brodsky, 1999). Similarly, within a clinic-referred nificant number of youth who decreased in their level
sample of preadolescent youth (ages 6–13), only the of CU traits over the course of the study (see also
CU dimension designated a distinct group within Lynam, Caspi, Moffitt, Loeber, & Stouthamer-Loe-
children who showed early-onset disruptive behavior ber, 2007 for a similar pattern of change over a
disorder diagnoses, whereas the other dimensions longer period of development). Further, this decrease
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
 The importance of CU traits 361

in the level of CU traits was related to the level of and antisocial behavior and 12 were longitudinal
conduct problems displayed by the child, the socio- studies demonstrating predictive relations between
economic status of the child’s parents, and the these two constructs. Further, they reviewed five
quality of parenting the child received. Thus, CU published studies showing an association between
traits do appear to be at least somewhat malleable psychopathic traits and poor treatment outcome.
and seem to be influenced by factors in the child’s While these studies were weighted towards adoles-
psychosocial environment. cent samples and tended to have limited follow-up
It is also important to note that studies on the periods (e.g., 1 to 2 years), the review did include
stability of CU traits have largely focused on the studies with samples as young as age 3 (Kimonis
developmental period from later childhood to early et al., 2006a) and with follow-up periods as long as
adolescence. Such studies do not address the 10 years (Gretton, Catchpole, & Hare, 2004). Not
stability of these traits earlier in development or, included in this review were eight additional con-
most critically, the stability of these traits from current studies showing the association between
childhood or adolescence into adulthood (Edens psychopathic traits and severity of conduct problems
et al., 2001). With respect to younger children, (Dadds, Whiting, & Hawes, 2006b), violence and
Dadds, Fraser, Frost, and Hawes (2005) found aggression (Dolan & Rennie, 2006a); Enebrink,
moderate 1-year stability estimates for parent- Anderson, & Langstrom, 2005; Skeem & Cauffman,
reported CU traits (r ¼ .55) in a community sample of 2003; Vitacco, Neumann, Caldwell, Leistico, & Van
Australian children who were 4 to 9 years of age. Rybroek, 2006) and delinquency (Dolan & Rennie,
With respect to the prediction of adult psychopathy 2006c; Loeber et al., 2005; Poythress et al., 2006)
measures, Blonigen, Hicks, Kruger, Patrick, and and three longitudinal studies showing the predict-
Iacono (2006) reported that the CU dimension was ive relationships between psychopathic traits and
relatively stable (r ¼ .60) from late adolescence (age later antisocial personality (Loeber, Burke, & Lahey,
17) into early adulthood (age 24). In a longer follow- 2002), violence and aggression (Ridenour, Marchant,
up assessments, Burke, Loeber, and Lahey (2007) & Dean, 2001) and delinquency (Pardini, Obradović,
reported that CU traits assessed in clinic-referred & Loeber, 2003).
boys ages 7 to 12 predicted adult measures of psy- Taken together, this body of research provides
chopathy at ages 18 to 19, even after controlling for quite compelling evidence that psychopathic traits in
the child’s level of conduct problems and other risk general are associated with more severe conduct
factors (e.g., dysfunctional parenting, economic dis- problems, violence and aggression, and delinquency
advantage, intelligence). Using a measure that in samples of youth. However, a significant propor-
included CU traits, Lynam et al. (2007) reported tion of these studies did not investigate the role of CU
similar findings with early measures of these traits traits specifically, either alone or in comparison to
(age 13) predicting adult measures of psychopathy the other dimensions of psychopathy. However, in
(age 24), even after controlling for childhood antiso- the studies that did address this issue, CU traits
cial behavior and other psychosocial risk factors. generally were less associated with measures of
Besides showing the stability of these traits from conduct problems than the impulsive and narcis-
childhood to adulthood, both of these latter two sism dimensions of psychopathy (Corrado, Vincent,
longitudinal studies are notable for showing the Hart, & Cohen, 2004; Frick et al., 2000a). However,
predictive utility of these traits after controlling for CU traits were important for designating a more
childhood antisocial behavior. As noted previously, severe (Christian et al., 1997) and stable (Frick,
such findings are important for supporting the un- Stickle, Dandreaux, Farrell, & Kimonis, 2005; Loe-
ique predictive utility of CU traits after controlling for ber, Burke, & Lahey, 2002) pattern of antisocial
the severity of antisocial behaviors. behavior within children who showed serious con-
duct problems.
In terms of aggression, in the studies that did
compare the dimensions of psychopathy, CU traits
CU traits and the severity of conduct problems,
generally showed similar associations to general
aggression, and delinquency
measures of aggression and violence compared to
One of the most important and useful aspects of the the other dimensions of psychopathy (Brandt, Ken-
construct of psychopathy in adult samples has been nedy, Patrick, & Curtin, 1997; Dadds et al., 2005;
its ability to designate a particularly violent and Dolan & Rennie, 2006b; Kruh, Frick, & Clements,
chronic subgroup of antisocial individuals. Frick and 2005; Marsee, Silverthorn, & Frick, 2005), although
Dickens (2006) reviewed 24 published studies using a few studies did show somewhat higher associ-
child or adolescent samples in which either psycho- ations between aggression and CU traits compared
pathic traits in general, or CU traits specifically, were to the narcissism and impulsive dimensions
associated with more severe conduct problems, (Skeem & Cauffman, 2003; Lexcen, Vincent, &
delinquency, or aggression. Ten of these studies were Grisso, 2004). However, as was the case for conduct
cross-sectional studies demonstrating contempor- problems, CU traits seemed to be important for
aneous associations between psychopathic traits designating a subgroup of antisocial youth who
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
362 Paul J. Frick and Stuart F. White

showed more severe aggression and violence, espec- independent of antisocial behavior (Taylor et al.,
ially youth who were more likely to show both instru- 2003). While these studies show that CU traits do
mental (e.g., for gain) and reactive (e.g., in response have a heritable component, they do not directly ad-
to perceived provocation) aggression (Enebrink dress the issue of whether children with conduct
et al., 2005; Frick et al., 2003a; Kruh et al., 2005). problems with and without CU traits have different
Following a similar pattern, CU traits were con- patterns of genetic influence. Viding, Blair, Moffitt,
sistently related to measures of delinquency but it is and Plomin (2005) addressed this question directly in
not clear that they were more predictive than other a sample of 3,687 twin pairs who were 7 years old.
dimensions of psychopathy (Brandt et al., 1997; They selected twins high on conduct problems and
Corrado et al., 2004; Lexcen et al., 2004; Poythress further divided them into those who were high and low
et al., 2006; Spain, Douglas, Poythress, & Epstein, on CU traits. Overall, the heritability for the high
2004). However, CU traits did predict later delin- conduct problem group was substantial (.68) but the
quency even after controlling for the level of conduct estimate was very different for those high on CU traits
problems (Pardini et al., 2006) or antisocial behavior (.81) and those low on CU traits (.30). This finding was
(Salekin, Ziegler, Larrea, Anthony, & Bennett, 2003). replicated in the same sample two years later at age 9
Also, they designated a group of antisocial and con- (Viding, Jones, Frick, Moffitt, & Plomin, in press).
duct problem youth who were at greater risk for both Interestingly, Viding et al. (2005) reported that, in
concurrent (Enebrink et al., 2005) and later delin- addition to the difference in genetic influences in the
quency (Frick et al., 2005) and who showed an groups high and low on CU traits, the influence of
earlier age of onset to their delinquency (Christian shared environment was substantial for the group low
et al., 1997; Frick et al., 2005; Silverthorn, Frick, & on CU traits but negligible for the group high on these
Reynolds, 2001). traits. This would be consistent with four studies
Taken together, these studies suggest that CU summarized in Table 1 showing that conduct prob-
traits are associated with conduct problems, lems tend to be more associated with ineffective par-
aggression, and delinquency. However, they do not enting practices in children low on CU traits.
appear to be any more highly correlated than the Table 1 also provides a summary of 27 additional
other dimensions of psychopathy (i.e., narcissism, published studies showing different emotional, cog-
impulsivity) in various samples of youth. In fact, they nitive, and personality characteristics of antisocial
appear to be less highly correlated with measures of youth with and without CU traits. Importantly, as
conduct problems. In contrast, CU traits seem to be noted in this table, the studies generally focused on
quite important for designating within antisocial school-aged samples of children or adolescents with
youth, a group who shows a more stable and no study including children below the age of 6.
aggressive pattern of behavior, who is at increased Eleven studies included only boys and the studies
risk for early-onset delinquency, and who is at risk involved a mix of community (n ¼ 11), clinic-referred
for later antisocial and delinquent behavior. Thus, (n ¼ 11) and adjudicated (n ¼ 5) samples.
these data provide some support for our theoretical In terms of emotional correlates, 10 studies doc-
model suggesting that these traits may be particu- umented abnormalities in how antisocial youth with
larly important for designating a unique develop- CU traits process emotional stimuli, including emo-
mental pathway to severe antisocial behavior and tional pictures (Kimonis, Frick, Fazekas, & Loney,
aggression. However, the more important test of the 2006b), emotional words (Loney, Frick, Clements,
utility of these traits for causal theories is whether Ellis, & Kerlin, 2003), emotional facial expressions
antisocial youth with and without CU traits show (Dadds et al., 2005; Blair, Colledge, Murray, &
different risk factors that could suggest different Mitchell, 2001b), and emotional vocal tones (Blair,
processes contributing to the development of Budhani, College, & Scott, 2005). When studies have
behavioral problems across the two groups. compared types of emotional stimuli, there is con-
sistent evidence that youth with CU traits do not
show abnormalities in how they process stimuli with
positive emotional content. Instead, the deficits are
CU traits and distinct correlates to antisocial
found in the processing of negative emotional stimuli
behavior
(Kimonis et al., 2006b; Loney et al., 2003) and, even
To date, two large twin studies have reported sub- more specifically, to signs of fear (Blair & Coles,
stantial genetic influences on measures of CU traits 2000) and distress (Kimonis et al., 2006b) in others.
(Larson, Andershed & Lichtenstein, 2006; Taylor, Another 10 studies summarized in Table 1 have
Loney, Bobadilla, Iacono, & McGue, 2003), with both documented a number of distinct cognitive charac-
providing very similar estimates of the amount of teristics of antisocial youth with CU traits, such as
variation in CU traits accounted for by genetic effects being less sensitive to punishment cues, especially
(i.e., 43% and 42%, respectively). Importantly, a when a reward oriented response set is primed
substantial proportion of this genetic variance for (Fisher & Blair, 1998; O’Brien & Frick, 1996;
explaining CU traits was independent of other Pardini, Lochman, & Frick, 2003) and a tendency to
dimensions of psychopathy (Larson et al., 2006) and show more positive outcome expectancies in
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
 Table 1 Studies investigating unique correlates to CU traits

Study n Age range Percent male Sample type Measure Results

Emotion
Blair, 1999 42 8–17 100% Clinical APSD Boys with behavior problems and
high levels of psychopathic traitsA
were less responsive to distress cues.

Ó 2008 The Authors

Blair, Budhani, College, & Scott, 2005 43 11–15 100% Clinical APSD Boys with behavior problems and high
levels of psychopathic traits showed impaired
recognition of fearful
vocal tones.
Blair & Coles, 2000 55 11–14 56% Community APSD Psychopathic traits were inversely related to ability
to recognize sad and fearful
facial expressions.
Blair, College, Murray, & Mitchell, 2001b 51 9–17 100% Clinical APSD Boys with behavior problems and psychopathic traits
made more errors recognizing fearful facial
expressions and were less
responsive to sad expressions.
Dadds et al., 2006a 98 8–15 100% Community APSD Antisocial youth with CU traits showed poor
recognition of facial expressions of
fear unless instructed to attend
to the eyes.
Kimonis et al., 2006b 50 6–13 54% Community APSD Children high on both CU traits and
conduct problems showed reduced attentional
orienting responses to distressing
pictorial stimuli.
Loney, Butler, Lima, Counts, & Eckel, 2006 108 12–18 49% Community APSD Boys high on CU traits and conduct
problems showed lower resting
levels of cortisol.
Loney, Frick, Clements, Ellis, & Kerlin, 2003 60 12–18 100% Adjudicated APSD CU traits were associated with
diminished reactivity to

Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
negative emotional words.
Sharp, Van Goozen, & Goodyer, 2006 659 7–11 48% Community APSD Psychopathic traits were associated
with low arousal to
unpleasant stimuli.
Stevens, Charman, & Blair, 2001 37 9–15 100% Clinical APSD Boys with behavior problems and high
levels of psychopathic traits were less
able to recognize sad and fearful
faces and sad vocal tones.
Cognition
Blair, 1997 42 Mn ¼ 13.2 100% Clinical APSD Boys with behavior problems and high levels of
psychopathic traits made fewer distinctions
between moral and conventional social
rules and were less likely to attribute
moral motivations/emotions in story protagonists.
Blair, College, & Mitchell, 2001a 51 9–17 100% Clinical APSD Boys with behavior problems and high
The importance of CU traits

levels of psychopathic traits were less

able to change stimulus responses
and responded poorly to
gradual punishment.
363
 364
Table 1 (Continued)

Study n Age range Percent male Sample type Measure Results

Blair, Monson, & 102 8–16 100% Clinical APSD Boys with behavior problems and high levels of
Frederickson, 2001c psychopathic traits performed more
poorly when asked to make distinctions
between moral and conventional
social rules and made fewer
references to the welfare of others
when making determinations between
moral and conventional rules.
Fisher & Blair, 1998 39 9–16 100% Clinical APSD Boys with behavior problems and high levels of
psychopathic traits showed deficient responses
to punishment when reward oriented
Paul J. Frick and Stuart F. White

response was primed; also, showed poorer

ability to make moral versus conventional
distinctions about social rules.
Frick, Cornell, 98 Mn ¼ 12.36 53% Community APSD Youth high on CU traits and conduct
Bodin, et al., 2003 problems showed poorer response to punishment
when reward oriented response
was primed and, for boys only, were less
likely to show a hostile
attributional bias.
Loney, Frick, 117 6–13 78% Clinical APSD Antisocial youth with high levels of CU
Ellis, et al., 1998 traits showed higher levels of
verbal intelligence.
O’Brien & Frick, 1996 132 6–13 78% Clinical APSD Children high on psychopathic traits and low
anxiety were showed less responsiveness
to punishment when a reward-oriented
response set was primed.
Pardini, Lochman, 169 11–18 57% Adjudicated APSD CU traits were associated with lower
et al., 2003 scores on a measures of
empathy and perspective taking; were
also associated with valuing reward
and dominance and devaluing punishment in
aggressive peer interactions.
Salekin, Neumann, 122 11–18 66% Adjudicated PCL:YV CU traits were positively correlated
Leistico, & Zalot, 2004 with verbal IQ scores.
Vitale et al., 2005 329 16 53% Community APSD Youth with high levels of psychopathic traits
showed reduced interference on
a Stroop task and made more
passive avoidance errors.
Personality
Andershed et al., 2002 1077 Mn ¼ 14.42 NR Community SRP-II Boys with high levels of psychopathic traits
and conduct problems were more impulsive,
more prone to boredom, and showed
less trait anxiety.

Ó 2008 The Authors

Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
 Table 1 (Continued)

Study n Age range Percent male Sample type Measure Results

Essau, Sagagawa, 1443 13–18 54% Community ICU CU traits were positively associated
& Frick, 2006 with sensation seeking and negatively
correlated with extraversion, agreeableness,
conscientiousness, and openness.

Ó 2008 The Authors

Frick, Lilienfeld, 143 6–13 77% Clinical APSD When controlling for level of conduct problems, CU
et al., 1999 traits were negatively related to trait anxiety
and positively related to fearlessness.
Lynam, Caspi, 746 13–16 100% Community CPS CU traits were negatively related to neuroticism and
et al., 2005 agreeableness when controlling for level of
conduct problems.
Pardini, 2006 169 11–18 58% Adjudicated APSD CU traits were associated with fearlessness
and this was mediated by
level of punishment concern.
Pardini et al., 2007 120 9–12 59 High risk community APSD CU traits were negatively related
to trait anxiety, controlling for
level of conduct problems
Salekin, Lestico, Trobst, 114 11–18 70% Adjudicated APSD, CPS, PCL:YV CU traits were negatively related to agreeableness,
Schrum, & Lochman, 2005 conscientiousness, and openness.
Parenting
Hipwell et al., 2007 990 5–8 0% Community APSD Ineffective parenting was less strongly related to
conduct problems in children high on CU traits.
Oxford et al., 2003 243 Mn ¼ 8.24 65 Community APSD Ineffective parenting was less strongly related to
externalizing problems in children high on CU traits.
Vitacco, Neumann, Ramos, 136 10–15 0% Community APSD CU traits were not related to poor parenting
& Roberts, 2003a but impulsivity and narcissism were.
Wooton et al., 1997 166 6–13 78 Clinical APSD Ineffective parenting was not related to conduct
problems in youth high on CU traits.

Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
Note: APSD ¼ Antisocial Process Screening Device (Frick & Hare, 2001); CPS ¼ Childhood Psychopathy Scale (Lynam, 1997); PCL-YV ¼ Psychopathy Checklist: Youth Version (Forth,
Kosson, & Hare, 2003); SRP-II ¼ Self-Report of Psychopathy-II (Harpur & Hare, unpublished instrument); APsychopathic traits include CU traits with other dimensions such as
impulsivity and narcissism.
The importance of CU traits
365
366 Paul J. Frick and Stuart F. White

aggressive situations with peers (Pardini et al., et al. (2005) and Viding (2004) have suggested that
2004). Further, a few studies have suggested that these specific emotional and cognitive deficits could
antisocial youth with CU traits are less likely to show implicate deficits in amygdala functioning and
verbal deficits than other antisocial youth (Loney related neural circuitry. Fear and sad expressions in
et al., 1998; Salekin, Neumann, Leistico, & Zalot, others activate the amygdala in normal subjects
2004). (Blair, Morris, Frith, Perret, & Dolan, 1999) and the
As also indicated in Table 1, seven studies have amygdala is involved in several types of instrumental
indicated that CU traits were associated with distinct learning tasks involving the use of punishment
personality correlates compared to general measures information (Blair et al., 2005). Further, there is
of antisocial behavior or conduct problems. Two of evidence that adults with psychopathic traits show
the most consistent findings is that CU traits tend to reduced amygdala activation during a task involving
be positively correlated with measures of fearless or affective memory (Kiehl, Smith, & Hare, 2001).
thrill-seeking behaviors (Essau et al., 2006; Frick Second, these findings can be used to link devel-
et al., 1999; Pardini, 2006) and negatively correlated opmental theories of temperament and conscience
with measures of trait anxiety or neuroticism development with etiological theories of antisocial
(Andershed, Gustafson, Kerr, & Stattin, 2002; Frick and aggressive behaviors (Dadds & Salmon, 2003;
et al., 1999; Lynam et al., 2005; Pardini et al., Frick & Morris, 2004). Specifically, there have been a
2007), whereas conduct problems tend to be unre- number of studies of normally developing children
lated to thrill-seeking behaviors and positively cor- documenting both concurrent (e.g., Fowles &
related with measures of trait anxiety. Importantly, Kochanska, 2000; Kochanska, Gross, Lin, & Nic-
the negative correlation between measures of CU hols, 2002) and predictive (Rothbart, Ahadi, & Her-
traits and trait anxiety/neuroticism are generally shey, 1994) associations between a fearless
only found controlling for the level of conduct prob- temperament and lower scores on measures of con-
lems (Frick et al., 1999; Lynam et al., 2005). That is, science development. Further, this research has led
children with CU traits tend to show less trait anxiety to a number of theories to explain this link, such as
given the same level of conduct problems. This pat- fearless children being less likely to experience
tern of results suggest that children with CU traits transgression-related arousal in response to behav-
are less distressed by the consequences of their ior that has been punished by others (Newman,
behavior problems on themselves and others com- 1987; Kochanska, 1993) or being less likely to
pared to youth with comparable levels of conduct experience empathic arousal linked to distress in
problems (Frick et al., 1999; Pardini et al., 2003). others (Blair, 1999). In short, the temperamental
deficits in emotional reactivity could make it more
difficult for a child to development appropriate levels
of guilt, empathy, and other dimensions of con-
Theoretical implications of the distinct
science that, at its extreme, could result in CU traits.
correlates
Consistent with this theoretical model, Pardini
This body of research suggests that antisocial youth (2006) reported that the association between fear-
with CU traits show a number of distinct cognitive, lessness and violent delinquency was mediated by
emotional, and personality characteristics support- the presence of CU traits in a sample of adjudicated
ing the contention that the causal processes leading adolescents.
to their antisocial behavior are different from those Third, by investigating and understanding the
operating for other antisocial youth. Specifically, developmental mechanisms that may lead to prob-
youth with CU traits seem to show a temperament lems in conscience development, and potentially CU
that is characterized by deficits in their emotional traits, this line of research could provide clues as to
arousal to fear and distress in others and abnor- possible protective factors that may enhance con-
malities in their responses to cues of punishment science development in children who may have
and danger. These temperament characteristics temperaments that make optimal development more
could lead to personality traits characterized by a difficult. For example, Cornell and Frick (2007)
reduced level of distress over the consequences of reported that preschool children who were behav-
their behavior and a tendency to display thrill- and iorally uninhibited showed enhanced conscience
novelty-seeking behaviors. This conceptualization development if they experienced consistent discip-
has a number of important implications for devel- line and a parenting style that emphasized a
opmental models of severe antisocial and aggressive strongand obedience-oriented (i.e., authoritarian)
behavior. approach to parenting. These authors suggested that
First, these temperamental characteristics could the under-arousal exhibited by fearless children may
provide clues to distinct neural mechanisms that require parents to incorporate stronger methods of
may be involved in the development of the antisocial socialization that bring arousal levels to an optimal
behavior in this group of youth and these neural range in order for the child to internalize parental
pathways could help to explain the genetic diathesis norms for prosocial behavior (Kochanska, DeVet,
to their antisocial behavior. Specifically, both Blair Goldman, Murray, & Putnam, 1994). However, it is
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
 The importance of CU traits 367

also possible that certain parenting practices can traits show high levels of impulsivity (Christian
lead to too much arousal from even fearless children et al., 1997; Frick et al., 2003b), are more likely to
and negatively affect the development of conscience show deficits in verbal intelligence (Loney et al.,
(Kochanska, 1993). As a result, it has also been 1998), are more likely to show a hostile attribution
proposed that a parent–child mutually responsive bias in social situations (Frick et al., 2003b) and are
orientation that encompasses shared positive affect, more likely to come from families with high rates of
parent–child cooperation, and parental warmth and dysfunctional parenting practices (Hipwell, Pardini,
responsiveness may be critical for socializing fear- Loeber, Sembower, Keenan, & Stouthamer-Loeber,
less children (Kochanska, 1997; Kochanska & in press; Oxford, Cavell, & Hughes, 2003; Wootton,
Murray, 2000). This type of parenting does not rely Frick, Shelton, & Silverthorn, 1997). Further, this
on punishment-related arousal for internalization group is less likely to be aggressive than the group
but instead focuses on the positive qualities of the with CU traits but, when they are aggressive, it is
parent–child relationship (Kochanska & Murray, often confined to reactive forms of aggression (Frick
2000). et al., 2003a; Kruh et al., 2005). Also, this group
Fourth, the use of CU traits to designate a distinct seems to be highly reactive to emotional stimuli
group of antisocial and aggressive youth could help (Kimonis et al., 2006; Loney et al., 2003) and to
to expand and integrate some past attempts to define the distress of others (Pardini et al., 2003), leading
important subgroups of antisocial youth (see Frick & some theories to focus on their problems regulating
Marsee, 2006 for a review). For example, an import- emotion as being critical for understanding the
ant distinction has been made between children causes of their behavioral problems (Frick, 2006;
who show largely reactive forms of aggression (e.g., Frick & Morris, 2004).
in response to perceived provocation) and those who
show both reactive and instrumental (e.g., premedit-
ated aggression for some gain) forms of aggression
Methodological implications
(Poulin & Boivin, 2000; Salmivalli & Nieminen,
2002). There is evidence that children and adoles- In addition to these important theoretical implica-
cents who show both forms of aggression show tions of research on CU traits, there are a number of
higher levels of CU traits (Frick et al., 2003a; Kruh methodological implications for research investi-
et al., 2005). Further, some research suggests that it gating antisocial and aggressive behavior in youth.
may be the CU traits, and not the distinct patterns of Most generally, it suggests that research cannot
aggression, that are most directly related to some of treat antisocial, aggressive, delinquent, or conduct
the social-cognitive (Pardini et al., 2003) and emo- problem behavior as a unitary outcome. That is,
tional (Munoz, Frick, Kimonis, & Aucoin, in press) research has traditionally focused on documenting
deficits displayed by this group of aggressive youth. what risk factors are associated with antisocial
As another example of the potential for research on behavior or which risk factors account for the most
CU traits to advance past subtyping approaches, one or the most unique variance in measures of anti-
of the most widely accepted methods for dividing social or aggressive behaviors. However, these
children with conduct problems or adolescents with overall associations often obscure the fact that a
delinquent and antisocial behavior into important risk factor may only be related to the behavior of a
subgroups is by distinguishing between those who subgroup of antisocial and aggressive youth (see
begin showing severe behavior problems in early Richters, 1997 for a more extended discussion of
childhood (i.e., childhood-onset) and those who this issue).
begin showing severe conduct problems only after For example, in a sample of pre-adolescent
the onset of adolescence (i.e., adolescent-onset) children, a measure of dysfunctional parenting
(Frick, 2006; Moffitt, 2003). The presence of CU showed a moderate, but significant, relation to
traits seems to be more highly associated with the a measure of conduct problems after controlling for
childhood-onset trajectory (Silverthorn et al., 2001). such demographic variables as age, gender, ethni-
However, these traits seem to designate a more se- city, socioeconomic status, and intellectual level of
vere (Christian et al., 1997), chronic (Frick et al., the child (Wootton et al., 1997). However, this overall
2005), and aggressive (Frick et al., 2003a) subgroup association obscured the fact that there was a rather
within this trajectory, and a subgroup with distinct strong association between ineffective parenting and
temperamental characteristics (Frick, 2006; Frick & conduct problems for children low on CU traits (Std.
Morris, 2004). Beta ¼ .47, p < .01) but there was a non-significant
Fifth, by providing a method for defining a distinct negative association between ineffective parenting
subgroup of antisocial youth, this research can also and conduct problems for children high on CU traits
help in developing models to explain other groups of (Beta ¼ ).14, p ¼ n.s.). Thus, the overall association
antisocial youth by reducing some of the heterogen- underestimated the association between ineffective
eity within antisocial samples (Frick, 2006; Frick & parenting and conduct problems for children low on
Morris, 2004). For example, youth with severe con- CU traits but overestimated the association for youth
duct problems who do not show high levels of CU high on these traits.
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
368 Paul J. Frick and Stuart F. White

This differential association between parenting metrical, with there being significant numbers of
and conduct problems was detected through testing antisocial youth with and without CU traits but very
an interaction between a measure of parenting few individuals high on CU traits but low on antiso-
practices and a measure of CU traits in predicting cial behavior (Frick et al., 2000a), which also violates
conduct problems using multiple regression analy- the assumptions of bivariate normality. Finally,
sis. However, it is also important to test for potential there is some evidence to suggest that youth high on
suppressor effects in correlational analyses in which CU traits may best be considered as being qualitat-
differential associations with important risk factors ively distinct from those who score lower on these
for CU traits and antisocial behavior may be traits (Vasey, Kotov, Frick, & Loney, 2005), although
obscured by the high correlation between these two conclusive statements on the taxonicity of the con-
constructs (see also Hicks & Patrick, 2006). For struct awaits further testing due to contradictory
example, in a sample of clinic-referred children, findings in adult samples (Marcus, John, & Edens,
conduct problems were significantly associated with 2004).
anxiety (r ¼ .30, p < .001) but this association
increased (partial r ¼ .41, p < .001) when the level
of CU traits were controlled (Frick et al., 1999).
Assessment and treatment implications
Further, there was a non-significant negative corre-
lation between CU traits and anxiety (r ¼ ).12, p ¼ In terms of assessment implications, the research on
n.s.) that became significant after controlling for CU traits clearly argues for assessments that separ-
conduct problems (partial r ¼ )31, p < .001). This ate these traits from other antisocial dimensions. As
suppressor effect was replicated in a community noted previously in our review of past research,
sample of children (Frick et al., 2003b) and an many studies have not separated these affective and
adjudicated sample of adolescents (Frick, Lilienfeld, interpersonal traits from other dimensions related to
Edens, Poythress, & McBurnett, 2000b). The reason antisocial behavior, such as impulsivity, narcissism,
for this suppressor effect was that children with or conduct problems (e.g., Blair, 1999; Lynam,
conduct problems tend to have higher rates of anxi- 1997). One issue that makes this separation difficult
ety. Further, children with CU traits tend to have is that most measures that assess these traits typ-
higher levels of conduct problems. However, given ically include only a limited number of items specifi-
the same level of conduct problems (i.e., controlling cally assessing this dimension, often with as few as 4
for level of conduct problems), children with CU (Forth, Kosson, & Hare, 2003) or 6 (Frick & Hare,
traits tend to show less anxiety or, as stated previ- 2001) items. Further, and possibly due to this lim-
ously, seem to be less distressed by the effects of ited item pool, measures of CU traits often have had
their behavior on themselves and others. some significant psychometric limitations, such as
These interactive and suppressor effects are just displaying poor internal consistency in many de-
two examples of some of the complex multivariate tained samples of adolescents (Poythress et al.,
associations that are often ignored in research that 2006).
just focuses on univariate or main effects of risk One attempt to overcome these limitations is the
factors. Because of the difficulty in detecting and development of the Inventory of Callous-Unemo-
interpreting these complex multivariate associ- tional Traits (ICU; Frick, 2004) that provides a more
ations, some researchers have recommended greater extended assessment (e.g., 24 items) of the construct
use of person-centered analyses (Bergman & Mag- of CU traits. The factor structure of this measure has
nusson, 1997). Specifically, this would involve using been tested in a large (n ¼ 1,443) community sample
methods that explicitly divide children into theoret- of German adolescents ages 12 to 18 (Essau,
ically meaningful subgroups with or without high Sasagawa, & Frick, 2006) and a moderate sized (n ¼
levels of CU traits (see for examples Christian et al., 248) sample of juvenile offenders ages 12 to 20 in the
1997; Frick et al., 2003b). Such an analytic United States (Kimonis et al., in press). In both
approach is somewhat antithetical to traditional samples, a similar factor structure emerged with
recommendations that creating categorical distinc- three factors (e.g., Uncaring, Callousness, Unemo-
tions from continuous measures results in a loss of tional) loading on a higher-order CU dimension
power to detect associations (Cohen, 1983). providing the best fit in both samples. The items on
Unfortunately, interactions and suppressor effects the ICU and the three factors are provided in Table 2.
are often difficult to interpret in general and, in Importantly, the total scores proved to be internally
particular, very difficult to apply their results to consistent in both samples (coefficient alpha .77 to
subgroups of individuals. Further, the loss of power .81) and were related to antisocial behavior, aggres-
that occurs with dichotomization assumes bivariate sion, delinquency, various personality dimensions,
normality (Cohen, 1983). However, often measures and psychophysiological measures of emotional
of CU traits are not normally distributed, even in reactivity in ways consistent with past research on
detained samples (e.g., Loney et al., 2003). More CU traits.
importantly, the overlap between CU traits and Thus, the ICU could be a promising method for
measures of antisocial behavior is typically asym- providing a more extended assessment of CU traits
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
 The importance of CU traits 369

Table 2 Dimensions of callous-unemotional traits pictures enhanced the prediction of self-reported

aggression and histories of violent arrests compared
Uncaring
I work hard on everything I do. (I) to either variable alone.
I always try my best. (I) Finally, there are also a number of implications of
I care about how well I do at school or work. (I) this research on CU traits for prevention and treat-
I do things to make others feel good. (I) ment (Frick, 2006). First, by focusing on develop-
I apologize (‘say I am sorry’) to persons I hurt. (I)
mental pathways and by focusing on the
I feel bad or guilty when I do something wrong. (I)
I easily admit to being wrong. (I) developmental mechanisms that may have gone
I try not to hurt others’ feelings. (I) awry in different subgroups of antisocial youth, this
Callousness research can help to designate important targets of
I do not care about doing things well. preventive interventions that can focus on enhan-
I do not like to put the time into doing things well.
cing development, such as promoting the develop-
I do not feel remorseful when I do something wrong.
I do not care about being on time. ment of empathy (Chi-Ming, Greenberg, & Walls,
I do not care if I get into trouble. 2003) or the development of emotional regulation
I seem very cold and uncaring to others. (Larson & Lochman, 2003), even before the conduct
The feelings of others are unimportant to me. problems and aggression are severe enough to war-
I do not care who I hurt to get what I want.
rant a psychiatric diagnosis. Second, the most suc-
I am concerned about the feelings of others. (I)
I do not like to put the time into doing things well.a cessful interventions for children and adolescents
What I think is right and wrong is different from what with severe antisocial and aggressive behavior
other people think.a problems have two important characteristics: they
Unemotional tend to be comprehensive by focusing on a number
I do not show my emotions to others.
of different risk factors that could lead to a child’s
I express my feelings openly. (I)
I hide my feelings from others. behavioral problems and they tend to be individual-
It is easy for others to tell how I am feeling. (I) ized in that the focus of the comprehensive inter-
I am very expressive and emotional. (I) vention is tailored to the child’s unique needs
(Conduct Problems Prevention Research Group,
Note: These are items from the self-report version of the
Inventory of Callous-Unemotional Traits (ICU; Frick, 2004).
2004; Henggeler, Schoenwald, Borduin, Rowland, &
The three dimensions emerged from factor analyses in non- Cunningham, 1998). Knowledge of the different
referred German adolescents (Essau at al., 2006) and detained characteristics of youth with CU traits compared to
adolescents in the United States (Kimonis et al., in press). (I) other antisocial and aggressive youth could aid in
designates items that are inversely coded. adenotes items guiding these individualized treatments by helping
eliminated from the factor analysis of Kimonis et al. due to
poor item-total correlations.
to define the most important targets of intervention
for an individual child (McMahon & Frick, 2005).

(see also Andershed et al., 2002 for another more

Summary and conclusions
extended measure of CU traits). However, much
further testing of this scale would be needed for it to In summary, there now appears to be a rather sub-
be useful in many applied settings, especially in stantial and growing body of research supporting the
determining appropriate cut-scores for designating use of CU traits to designate a distinct subgroup of
non-normative and problematic levels of these antisocial youth. These traits seem to be relatively
traits. Further, its format of relying on self-report or stable across childhood and adolescence and they
the report of others (i.e., parents and teachers) seem to designate a group of antisocial youth who
could limit its usefulness for a number of applied show a more severe, aggressive, and stable pattern of
purposes (Johnstone & Cooke, 2004). In general, antisocial behavior. Further, this subgroup of youth
there is a need to go beyond single methods for show a number of distinct cognitive, emotional, and
assessing CU traits in both research and practice, personality characteristics such as showing abnor-
given evidence that measures of CU traits, like malities in their responsiveness to punishment cues,
many other constructs in psychology, do not show showing a diminished responsiveness to distress
strong correlations across methods (Lee, Vincent, cues in others, and showing less trait anxiety when
Hart, & Corrado, 2003). One example of the controlling for their level of antisocial behavior.
potential utility of combining across methods is a These results are quite promising and we have
study of 88 detained adolescent boys ages 13 to 18 attempted to outline some of the potential implica-
in which scores on the ICU and a laboratory mea- tions of this research for causal models of antisocial
sure of emotional processing of distress cues were and aggressive behavior, for research methods in
used to statistically predict measures of aggression, this area of inquiry, and for assessment and treat-
self-report delinquency, and arrest records (Kimo- ment of antisocial youth. However, it is important to
nis, Frick, Munoz, & Aucoin, 2007). The results note some of the most critical limitations in this
indicated that the combination of high scores on the research as a guide for future work in this area.
ICU and deficits in the processing of emotional First, one area of great promise for this area of
Ó 2008 The Authors
Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.
370 Paul J. Frick and Stuart F. White

research that was discussed previously is its poten- youth with CU traits, Waschbusch, Carrey, Wil-
tial to link research on the normal development of loughby, King, and Andrade (in press) reported that
conscience with research on the development of children (ages 7 to 12) with conduct problems and
antisocial and aggressive behavior. However, this CU traits responded less well to behavior therapy
link has largely been theoretical to date and based alone than children with conduct problems without
largley on data from cross-sectional studies. Much CU traits. However, these differences largely dis-
more longitudinal research is needed to track the appeared when stimulant medication was added to
trajectories of youth at risk for impairments in con- the behavior therapy, although the children with
science development to determine factors that can CU traits were still less likely to score in the nor-
make problems both more and less likely to occur. mative range than those without these traits.
Further, this research needs to directly link vari- Clearly much more research is needed on the
ations in normal conscience development to CU response to treatment of children with CU traits.
traits to support the theoretical connection between However, these two studies provide strong motiva-
these two constructs. tion for such research. Both studies suggest that
Second, although there is emerging research docu- children with CU traits may be more difficult to treat
menting distinct characteristics of youth with CU but they are not unresponsive to treatment. They do
traits on the behavioral, personality, emotional, respond to certain types of interventions. Research
cognitive, and neurological levels, much more work on the unique developmental mechanisms underly-
is needed to refine at each of these multiple levels of ing their antisocial behavior could provide important
analyses what characteristics are unique to children clues as to what types of interventions may be most
with these traits compared to other antisocial youth. effective for this group of youth (Frick, 2006). Thus,
Third, there continues to be a need to develop and there is some cause for at least cautious optimism
validate measures of CU traits that are useful for that this research on CU traits could guide more
both research and practice. As noted previously, effective interventions for a subgroup of youth who
many of the measures currently being used in operate at a high cost to society because of their
research have significant limitations (e.g., limited chronic and serious delinquent and aggressive acts.
content related specifically to CU traits; no well-val-
idated cut scores for making clinical decisions). We
feel that one particularly promising area of work is Correspondence to
the combination of multiple methods (e.g., rating
Paul J. Frick, Department of Psychology, University
scales, interviews, computer tasks) to enhance the
of New Orleans, 2001 Geology & Psychology Bldg.,
assessment of youth with these traits.
New Orleans, LA 70148, USA; Tel: (504) 280 6012
Fourth, and perhaps most importantly, the treat-
Fax: (504) 280 6049; Email: pfrick@uno.edu
ment implications of this research have only recently
begun to be explored. We have proposed that
research on CU traits may be used to guide com-
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Journal compilation Ó 2008 Association for Child and Adolescent Mental Health.