Örebro University, Sweden; Ghent University, Belgium.
Universidade de Santiago de Compostela, Spain.
J Am Acad Child Adolesc Psychiatry. 2024 Apr;63(4):443-453. doi: 10.1016/j.jaac.2023.05.022. Epub 2023 Jun 24.
To better describe and treat children with conduct problems (CP), grandiose-manipulative and daring-impulsive traits are proposed for subtyping CP, instead of using only a callous-unemotional specifier. However, the acclaimed benefits of having multiple specifiers for CP remain largely untested and therefore highly speculative. To fill this gap, this study tested longitudinal relations between these 3 specifiers and developmental outcomes in childhood and adolescence, independent of early childhood CP.
Longitudinal data from 2 community studies were used. Teacher ratings were used to measure CP and the specifiers in 3- to 5-year-olds from Sweden (n = 2,064) and Spain (n = 2,055). Developmental outcomes were assessed by multiple informants (ie, teachers, parents, and children) 1 to 8 years later.
Early childhood CP were predictive of all outcomes. Callous-unemotional traits predicted low levels of social competence and prosocial behavior, independent of CP (and age, sex, and socioeconomic status). Grandiose-manipulative and daring-impulsive traits were predictive of aggression and violent delinquency, respectively, independent of CP, but also of higher levels of prosocial behavior or social competence.
The 3 specifiers are predictive of different outcomes, independent of CP, which is thought to form the basis for developing specifiers for CP. Findings tentatively challenge the centrality of callous-unemotional traits for subtyping CP, but it is premature to conclude that grandiose-manipulative and daring-impulsive specifiers are needed in future revisions of DSM and ICD. Efforts to systematically evaluate the utility of these specifiers should be welcomed to inform ongoing debates on this matter.
为了更好地描述和治疗品行问题（CP）儿童，提出了将夸大-操纵和大胆-冲动特质作为 CP 的亚型分类，而不是仅使用无情-无情感的特征。然而，CP 具有多个特征的好处在很大程度上仍未得到验证，因此具有高度推测性。为了填补这一空白，本研究测试了这 3 个特征与儿童和青少年时期发展结果之间的纵向关系，而不考虑早期 CP。
使用了来自 2 项社区研究的纵向数据。教师评定用于测量瑞典（n=2064）和西班牙（n=2055）3 至 5 岁儿童的 CP 和特征。发展结果由多个信息源（即教师、家长和儿童）在 1 至 8 年后进行评估。
早期 CP 是所有结果的预测因素。无情-无情感特征预测了社会能力和亲社会行为水平低，独立于 CP（以及年龄、性别和社会经济地位）。夸大-操纵特质和大胆-冲动特质分别预测了攻击行为和暴力犯罪，独立于 CP，但也预测了更高水平的亲社会行为或社会能力。
这 3 个特征是不同结果的预测因素，独立于 CP，这被认为是为 CP 制定特征的基础。研究结果初步挑战了无情-无情感特征在 CP 亚型分类中的核心地位，但目前还为时过早，不能得出需要在 DSM 和 ICD 的未来修订中增加夸大-操纵和大胆-冲动特征的结论。应该欢迎系统地评估这些特征的实用性的努力，以便为这一问题的持续争论提供信息。
