Todorov Jessica J, Kohls Gregor, Pauli Ruth, Rogers Jack, Bernhard Anka, Ackermann Katharina, Raschle Nora M, Dugre Jules R, Fernandez-Rivas Aranzazu, Gonzalez-Torres Miguel Angel, Hervas Amaia, Smaragdi Areti, Gonzalez Karen, Vetró Ágnes, Dikeos Dimitris, Popma Arne, Stadler Christina, Konrad Kerstin, Freitag Christine M, Fairchild Graeme, Devine Rory T, De Brito Stephane A
Centre for Human Brain Health School of Psychology University of Birmingham Birmingham UK.
Department of Child and Adolescent Psychiatry and Psychotherapy Faculty of Medicine Technische Universität Dresden Dresden Germany.
JCPP Adv. 2024 Jul 30;5(2):e12266. doi: 10.1002/jcv2.12266. eCollection 2025 Jun.
Youth with conduct disorder (CD) and high callous-unemotional (CU) traits are not a homogenous group and can be disaggregated into primary and secondary subgroups. However, there are inconsistencies in defining primary and secondary subgroups, with some studies using anxiety, others using maltreatment and still others using both features to identify subgroups. There is a paucity of work comparing primary and secondary subgroups with typically developing (TD) youth on experiences of maltreatment and parenting as well as a lack of studies investigating sex differences.
In a large sample of TD youth ( = 946, 66% female) and youth with CD ( = 885, 60% female), we used latent profile analysis in youth with CD aged between 9 and 18 years to address four aims: (i) to demonstrate how primary and secondary subgroup membership differs when anxiety, maltreatment, or both are used as continuous indicators, (ii) to compare primary and secondary subgroups with TD youth on abuse and neglect measures, and (iii) to compare primary and secondary subgroups with TD youth on parenting experiences, and (iv) to examine whether the results were consistent across sexes.
Anxiety without maltreatment yielded the best fitting and most theoretically interpretable classification of primary and secondary subgroups across both sexes (Bayesian information criterion = 17832.33, Entropy = 0.75, Lo-Mendell-Rubin: < 0.01). Compared with TD youth, youth with primary and secondary CU traits experienced greater levels of abuse and neglect ( < 0.001, = 0.04-0.16) and maladaptive parenting practices ( < 0.001, = 0.04-0.13). Youth with primary and secondary CU traits were equally high on levels of abuse, neglect, and maladaptive parenting (all values >0.05).
We provide evidence that anxiety and maltreatment cannot be used interchangeably to identify youth with primary versus secondary CU traits. Anxiey yielded the best fitting and most theoretically interpretable classifications across both sexes. Our results signify the need for researchers and clinicians to adopt a unified approach to defining primary and secondary subgroups of CU traits using anxiety in both sexes.
患有品行障碍（CD）且冷酷无情（CU）特质高的青少年并非同质群体，可分为原发性和继发性亚组。然而，在定义原发性和继发性亚组方面存在不一致之处，一些研究使用焦虑，另一些研究使用虐待经历，还有一些研究使用这两个特征来识别亚组。在比较原发性和继发性亚组与正常发育（TD）青少年在虐待经历和养育方式方面的差异方面，研究工作较少，并且缺乏对性别差异的研究。
在一个由大量TD青少年（n = 946，66%为女性）和患有CD的青少年（n = 885，60%为女性）组成的样本中，我们对年龄在9至18岁的患有CD的青少年进行了潜在剖面分析，以实现四个目标：（i）展示当将焦虑、虐待经历或两者都用作连续指标时，原发性和继发性亚组成员身份如何不同；（ii）在虐待和忽视测量方面，将原发性和继发性亚组与TD青少年进行比较；（iii）在养育经历方面，将原发性和继发性亚组与TD青少年进行比较；（iv）检验结果在不同性别之间是否一致。
无虐待经历的焦虑产生了对两性原发性和继发性亚组的最佳拟合且最具理论可解释性的分类（贝叶斯信息准则 = 17832.33，熵 = 0.75，洛 - 门德尔 - 鲁宾检验：p < 0.01）。与TD青少年相比，具有原发性和继发性CU特质的青少年经历了更高水平的虐待和忽视（p < 0.001，d = 0.04 - 0.16）以及适应不良的养育方式（p < 0.001，d = 0.04 - 0.13）。具有原发性和继发性CU特质的青少年在虐待、忽视和适应不良养育方式的水平上同样高（所有p值 > 0.05）。
我们提供的证据表明，焦虑和虐待经历不能互换使用来识别具有原发性与继发性CU特质的青少年。焦虑产生了对两性的最佳拟合且最具理论可解释性的分类。我们的结果表明，研究人员和临床医生需要采用统一的方法，利用焦虑来定义两性中CU特质的原发性和继发性亚组。
