Alone, Aggressive and Unwanted: Callous Unemotional Traits in Primary School Aged
Children
By
Jedda Narida Crow
This thesis is presented for the degree of Doctor of Philosophy undertaken at
The University of Western Australia
2015
Abstract
The present research sought to examine the assertion that children with Callous
Unemotional (C/U) traits in mainstream primary school settings are alone, aggressive,
and unwanted. This is important because the presence of C/U traits designate a
subgroup of children with more severe and chronic antisocial behaviour who are at
increased risk of suspension and exclusion from school and on a developmental
trajectory leading to educational failure and criminal behaviour. Furthermore, the
presence of C/U traits presents a treatment challenge because children with C/U traits
often do not respond positively to typical treatments.
Three sequentially linked studies were conducted. Study One sought to develop and
establish the psychometrics of a new instrument suitable for assessing C/U traits in
children because there are currently few existing instruments specifically developed to
solely measure these traits in children. Following a review of the relevant literature and
existing instruments, an item pool of 48 items was generated for inclusion in a draft
instrument. Following consultation with experts in the field 40 of these items were
retained for testing. To initially validate the draft instrument it was presented to 20
postgraduate Master of Educational Psychology professional training programme
students and three teachers/psychologists in Primary Behaviour Centres (for children
with challenging behaviours). Feedback on the face and content appropriateness of the
newly developed scale was satisfactory. A pilot sample of 30 primary school students
from Grades Three, Four, Five, Six and Seven (ages 7 to 12 years) then completed the
draft instrument. Examination of the item statistics revealed that affectivity ranged from
.37 to .84 and discrimination from -.011 to .74. Consequently, four items were removed
from the draft scale. The internal reliability across the scale was found to be satisfactory
(α = .94). The scale was tentatively named the Children’s Affective Traits Inventory and
i
its readability level was assessed. This was considered appropriate, comprehensible and
easy for Australian school students enrolled in Grade Three.
Study Two further validated the ChATI by confirming its factor structure (using
Confirmatory Factor Analysis) with a larger sample size (n = 268; 138 males, 115
females, [15 unknown], ages seven to 12 years). The model fit indices showed mixed
support for the hypothesised three-factor model: χ2 (df = 592) = 1233.183, p < .001 and
CFI (.72) indicated a poor fit, but the CMIN/DF ratio (2.083) and RMSEA (.064)
indicated acceptable fit. Competing factor models were then tested and the incremental
removal of items eventually revealed a 16-item two factor model comprising of
Uncaring (i.e., a lack of caring about one’s performance in tasks and for others’
feelings) and Callous (i.e., a lack of empathy, guilt and remorse, and an absence of
emotional expression) dimensions. This model best achieved satisfactory levels of fit: χ2
(df = 95) = 221.63, p < .001, CFI = .90, CMIN/DF = 2.33, RMSEA = .07, (90% CI: .06,
.08). This two factor model was invariant across gender, supporting factor structure
equivalence across the two groups, but there was a small significant effect with regards
to age, with older children having significantly higher scores on Uncaring than younger
children.
Study Three was conducted in two phases. Phase I examined the differential patterns of
children’s Callous and Uncaring, Aggression and Loneliness; and Phase II developed
specific case profiles of children scoring highly on both the Callous and Uncaring
variables. In Phase I the data from 180 primary school students (76 males, 104 females,
ages 7.25 years to 13.0 years) were subjected to a multivariate analysis of variance. The
internal reliability coefficients for the instruments were satisfactory: ChATI C/U α =
.88; ChATI Uncaring α = .79; Child and Adolescent Scale of Aggression CASA
ii
(Physical Proactive Aggression α = .85, Verbal Proactive Aggression α = .81, Verbal
Reactive Aggression α = .77, and Physical Reactive Aggression α = .84); Perth A-
Loneness Scale PALs (Friendship Related Loneliness α = .86; Isolation α = 80;
Negative Attitude to Solitude α = .79; and Positive Attitude to Solitude: α = .76). Using
Bonferroni adjusted alpha levels of .025, .0125, and .0125 for the ChATI, CASA and
PALs variables respectively, there were no main interaction effects for Gender × Age F
(10, 165) = 1.729, p = .078, partial η2 = .09. However, there were multivariate main
effects of Gender, F (10, 165) = 2.432, p = .010, partial η2 = .13 and Age, F (10, 165) =
2.286, p = .010, partial η2 = .12. None of the Univariate values for any of the variables
reached statistical significance, however.
In Phase II the empirical profiles of three individual participants whose mean scores
were 1.5 standard deviations above the mean on both the Callous and Uncaring
subscales were generated. These data were juxtaposed with information gathered from
official school behaviour records and from semi structured interviews conducted with
the principal teacher of these individuals. While the empirical profiles for the three
cases did not really identify any marked differences or similarities between the three,
the semi structured interviews and school records did identify some common elements.
Specifically, all three had deficiencies in the affective domain of their functioning and
were said to be “a Jekyll and Hyde”, “sulky and moody”, and “flying under the radar”.
Furthermore, although all three cases initially had friends, they eventually divided their
peer group/friends or isolated themselves from the group. Documented acts of
aggression were evident, but the teachers did not think these participants were
physically aggressive, which was contrary to the empirical profiles generated.
iii
The findings from the three research studies are discussed in the light of the literature
reviewed and implications are then drawn for researchers and educators. The limitations
of the research are acknowledged and finally recommendations for future research are
suggested.
iv
ACKNOWLEDGEMENTS
The completion of this thesis has provided me a wonderful opportunity for learning and
I would like to thank all those who have contributed.
I would first like to thank Professor Stephen Houghton for his supervision. Under his
guidance, I have learned invaluable research skills. I am particularly grateful for his
availability and support. I would also like to thank Dr Ken Glasgow for his co-
supervisory support.
The schools, educators and participants who have provided their time, have been vital to
this research, and I would like to thank them.
I am grateful to the staff from the Graduate School of Education for the service they
have provided during the course of this research.
Finally, I would like to thank my family and friends for their encouragement. I am
indebted to my husband, Andrew, for his assistance and support; my children, Heather,
Jeremy, and Holly, for their understanding; and my mother for her unerring belief in
me.
v
DECLARATION
In accordance with the regulations for presenting thesis and other work for higher
degrees, I hereby declare that this is entirely my own work and that it has been not been
submitted for a degree at this or any other university.
Jedda N. Crow
The University of Western Australia
July 2015
Note: This thesis has been formatted in accordance with American Psychological
Association (2010) publication guidelines.
vi
TABLE OF CONTENTS
Page
ABSTRACT i
ACKNOWLEDGEMENTS v
DECLARATION vi
TABLE OF CONTENTS vii
LIST OF TABLES xi
LIST OF FIGURES xii
LIST OF APPENDICES xiii
CHAPTER ONE: INTRODUCTION 1
Callous Unemotional Traits 2
C/U Traits and Aggression 6
Peer Relationships, C/U Traits, and Loneliness 8
Significance of the Research 11
Structure of the Thesis 11
CHAPTER TWO: LITERATURE REVIEW 14
Callous Unemotional Traits in Children: Alone, Aggressive and Unwanted? 14
Callous and Unemotional Traits 14
Genetic and Environmental Factors in C/U Traits 19
Peer Relationships and C/U Traits 23
Measuring C/U Traits 26
Peer Relationships and Children with C/U Traits: Alone and Lonely? 33
Loneliness 39
Aetiology of Loneliness 40
Measuring Loneliness 42
Loneliness and C/U Traits 46
Aggression 47
Forms of Aggression (Physical Versus Verbal) and Functions of Aggression
(Proactive Versus Reactive) 48
Gender Differences in Aggression 51
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Page
Peer Rejection and Aggression 53
Aggression and C/U Traits 57
Research Questions 63
CHAPTER THREE: STUDY ONE: THE DEVELOPMENT OF THE
CHILDREN’S AFFECTIVE TRAITS INVENTORY 65
Phase I: Reviewing the Literature and Instruments 65
Phase II: Creating the Item Pool 72
Phase III: Initial Pilot Study and Validation of the Instrument 76
Method 76
Participants and Settings 76
Instrumentation 77
Procedure 77
Results 78
Data Analyses 78
Item Affectivity 79
Item Discrimination 82
Reliability of the Scale 87
Readability of the Scale 88
CHAPTER FOUR. STUDY TWO: ASSESSING CALLOUS
UNEMOTIONAL TRAITS IN CHILDREN - FURTHER VALIDATION
OF THE ChATI 89
Method 89
Participants and Settings 89
Instrumentation 90
Procedure 90
Data Analyses 91
Results 92
Invariance of the First Order Measurement Model Across Gender and Age 101
viii
Page
Gender 102
Age 102
Effects of Gender and Age on Factor Score 103
Discussion 104
CHAPTER FIVE. STUDY THREE: DIFFERENTIAL PATTERNS OF
CALLOUSNESS AND UNCARING, LONELINESS, AND AGGRESSION
IN MAINSTREAM PRIMARY SCHOOL CHILDREN
Phase I: Differential Patterns of Children’s Callous and Uncaring, Aggression,
and Loneliness 108
Method 108
Participants and Settings 108
Instrumentation 109
Procedure 112
Results 113
Callous and Uncaring, Aggression, and Loneliness, Gender, and Age 114
Phase II: Differential Case Study Profiles of Children with High Scores on
Callous and Uncaring Subscales 117
Case Studies. 117
Method 118
Participants and Settings 118
Materials 119
Procedure 119
Data Analyses
Results 121
Case Study One 122
Empirical Findings 122
Case Interview 124
Callous and Uncaring 124
Friendships/Loneliness 125
Aggression 126
Concluding Comments 126
Case Study Two 127
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Page
Empirical Findings 127
Case Interview 129
Callous and Uncaring 129
Friendships 130
Aggression 130
Concluding Comments 131
Case Study Three 131
Empirical Findings 131
Case Interview 133
Callous and Uncaring 133
Friendships 134
Aggression 135
Concluding Comments 135
Overall Summary 136
CHAPTER SIX. GENERAL DISCUSSION 141
Limitations of the Research 158
Directions for Future Research 160
REFERENCES 163
APPENDICES 206
x
LIST OF TABLES
Page
3.1 Summary of Instruments Reviewed that Measure Callous Unemotional Traits.
71
3.2 Source of the 48 initial items for the draft CU Scale. 72
3.3 Source of the 40 items for the draft CU Scale following Panel Refinement.
74
3.4 Item Affectivity of the Draft Children’s Affective Trait Inventory. 80
3.5 Discrimination of Children’s Affective Trait Inventory Items. 83
3.6 Item Discrimination and Item Affectivity Values for the Children’s Affective Traits Inventory (R indicates reverse scored).
86
3.7 Cronbach’s Alphas if Item Deleted. 87
4.1 Regression weights for the three-factor model. 94
4.2 Standardised regression weights for the three-factor model. 95
4.3 Regression weights for the 16 item two-factor model. 100
4.4 Factor Loadings and Factor Score Weights for the Children’s Affective Traits Inventory.
101
4.5 Fit Indices for Models Assessing Invariance Across Gender and Age. 103
4.6 Means (and Standard Deviations) by Gender and School Stage. 104
5.1 Univariate F Statistics, Observed Means, and Standard Deviations for Dependent Variables with Gender as the Independent Variable.
115
5.2 Univariate F Statistics, Observed Means, and Standard Deviations for the Dependent Variables with Age (Upper versus Lower Primary school) as the Independent Variable.
116
xi
LIST OF FIGURES
Page
3.1 Examples of Item Affectivity (q-values) for some items of the Children’s Affective Traits Inventory.
81
4.1 The 36 Item Three Factor Model Fit Indices. 93
4.2 The 20 Item Three factor Model Fit Indices. 96
4.3 Two Factor Model with the Four Unemotional Items Loaded on CU.
97
4.4 Two Factor Model with Fit Indices. 99
5.1 Empirical Profile of Case Study One (Participant #66). 122
5.2 Empirical Profile of Case Study Two (Participant #46). 128
5.3 Empirical Profile of Case Study Three (Participant #15). 132
5.4 Empirical Profiles for the Three Case Studies. 137
xii
LIST OF APPENDICES
Page
Appendix A Draft Children’s Affective Traits Inventory. 207
Appendix B Information Sheet for Principals. 213
Appendix C Information Sheet for Parents. 215
Appendix D Consent Form. 217
Appendix E Assessment Instrument. 219
Appendix F Semi-Structured Interview questions for Case Studies.
224
xiii
CHAPTER ONE
INTRODUCTION
In mainstream primary schools there exists a distinct subgroup of children whose
antisocial behaviour places them at increased risk of suspension and exclusion from
school and on a developmental trajectory leading to outcomes that include educational
failure, delinquent behaviour, substance abuse, chronic physical and mental illness, and
unemployment in adulthood (Frick, Ray, Thornton, & Kahn, 2013; Jezior, McKenzie, &
Lee, 2015; Parsonage, Khan, & Saunders, 2014). Many of these children go on to
represent a major education and public health problem, both monetarily (e.g., costs of
incarceration, limited success with current interventions and suspension programs,
recidivism) and socially (e.g., escalation of antisocial behaviour, family problems) (see
Australian Institute of Criminology, 2010). According to Jezior et al. (2015) across a
seven year period the average public health costs for these children exceeds $70,000 per
child. Blair (2013a) calculated that antisocial/aggressive individuals cost society up to
ten times more than their healthy counterparts in aggregate health care and social
service expenditures. Therefore, by virtue of their current and projected behavioural
outcomes developing as full an understanding as possible about these children is
essential if they are to be reconnected with the school system and adverse outcomes are
to be prevented (Moffitt & Caspi, 2001).
Although the research evidence is unequivocal that aggression is the most frequently
displayed characteristic of children with antisocial behaviour, differentiating between
the forms (e.g., direct, overt, and physical aggression vs. indirect, covert, verbal, and
relational aggression) and functions (e.g., proactive and instrumental aggression vs.
1
reactive and defensive aggression; Fite, Stauffacher, Ostrov, & Colder, 2008; Little,
Jones, Henrich, & Hawley, 2003; Vitaro, Brendgen, & Barker, 2006) of their aggression
is especially important (Blair, 2005; Fite, Raine, Stouthamer-Loeber, Loeber, & Pardini,
2010; Fite, Wynn, Wimsatt, Gaertner, & Rathert, 2010: Raine et al., 2006). According
to Fite, Rubens, Preddy, Raine and Pardini (2014) and Raine et al. (2006) the distinction
between proactive and reactive aggression holds great potential because they appear to
be distinct dimensions of aggression, with different theoretical underpinnings.
Furthermore each type of aggression can pose different, yet significant problems for the
child him/herself, and for peers, teachers, and the school system in general. When
callous unemotional traits (C/U) are also present with these forms of aggression - and
there are significant associations between them (see Benesch, Gortz-Dorten, Bruer, &
Dopfner, 2014) - the problems are exacerbated (Houghton, Hunter, & Crow, 2013).
Callous Unemotional Traits
The presence of C/U traits in children is important to identify because not only are they
particularly associated with the childhood onset trajectory of severe conduct problems
but they identify and present important information about a specific subgroup of
children at very high risk (for a review see Frick, Ray, Thornton, & Kahn, 2014; Has,
Waschbusch, King, & Walsh, 2015; Kimonis et al., 2008; Muñoz, Qualter, & Padgett,
2011). Children with severe conduct problems, especially those with elevated levels of
C/U, typically: Fail to show empathy or concern for the feelings of others; callously use
others for their own gain; have a shallow and constrictive display of emotions; a
pronounced lack of remorse or guilt for wrong-doing; are self-centred with a grandiose
sense of superiority over others; and have a lack of personal responsibility or concern
for their actions (Barry et al., 2007; Frick et al., 2013; Frick & White, 2008; Jezior et
al., 2015; Kimonis et al., 2008; Willoughby, Mills-Koonce, Gottfredson, & Wagner,
2
2014; Wolf & Centifanti, 2014). Children and adolescents with elevated levels of C/U
traits also score the highest on global measures of psychopathic traits (Schrum &
Salekin, 2006).
Identifying and understanding children with C/U traits may facilitate efforts to prevent
severe and persistent antisocial behaviour in adolescence and adulthood. Thus, the
present research has a specific focus on children with C/U in mainstream primary
schools and also seeks to examine their associated profiles of aggression. Although only
limited C/U related research has been conducted with young children, C/U traits have
been reliably identified in individuals as young as three and four years of age (Hawes &
Dadds, 2005; Willoughby et al., 2014). Furthermore, Hyde, Shaw, Gardner, Cheong,
Dishion and Wilson (2013) established that deceitful and callous behaviours (measured
using items collated from the CBCL [Achenbach & Rescorla, 2000], Eyberg Child
Behavior Inventory ECCBI: Robinson, Eyberg, & Ross, 1980] and Student-Teacher
Relationship Scale [STRS: Pianta, 2001]) - a construct consistent with C/U traits but
termed “behaviours” due to their measurement at this early age - can be reliably
measured at three years of age. Three studies conducted over a six month to two year
period with children aged two to eight years have reported stability estimates of .59
(range .41 - .84) thereby demonstrating that C/U traits are fairly stable in childhood
(Frick et al., 2013). Furthermore, studies have shown that C/U traits assessed by
teachers at age seven years predict criminal behaviour at 25 years of age (Byrd, Loeber
& Pardini, 2012), thereby underscoring the importance of developing an understanding
of the construct during their period of development and stability.
The importance of C/U in “antisocial behaviour” research has grown considerably over
the past two decades. The primary focus of this research has been on the association
between C/U and Psychopathy (i.e., a disorder involving a pronounced lack of guilt,
3
remorse, and empathy (Glenn & Raine, 2009; Hare, 2003) and the findings have shown
that C/U traits are important markers of more severe forms of antisocial behaviour
(Barry et al., 2007) and are distinct causal pathways to serious conduct problems (Frick
et al., 2013; Frick & Marsee, 2006). The evidence is unequivocal that the presence of
elevated C/U traits designates a subgroup of young people with more severe and chronic
antisocial behaviour in forensic (Vitacco, Rogers, & Neumann, 2003), clinic-referred
(Frick, O’Brien, Wooten, & McBurnett, 1994), and community (Frick, Bodin, & Barry,
2000) samples. Consequently, research has re-directed to also focus on C/U traits in
their own right.
The subsequent advancements in C/U research following this re-direction have
demonstrated that a number of psychophysiological and biological correlates are
specific to C/U traits rather than to severe conduct problems in general (for a review see
Frick et al., 2014). For example, the amount of variation in C/U traits accounted for by
genetic effects ranges from 42% to 68% (Bezdjian, Raine, Baker, & Lynam, 2011) and
much of the stability in C/U traits is due to these genetic effects (Fontaine, Rijsdijk,
McCrory, & Viding, 2010). Furthermore, studies appear to support a neural basis of
C/U traits and a number of areas of the brain have been implicated through functional
imaging studies - specifically, deficits in the amygdala and its connections to the
prefrontal cortex (Finger, Marsh, & Blair, 2012; Marsh, Finger, & Mitchell, 2008;
Sebastian, McCrory, Cecil, Lockwood, De Brito, Fontaine, & Viding, 2012) and
increased grey matter concentration in the medial orbitofrontal and anterior cingulate
cortex and temporal lobes bilaterally (De Brito et al., 2009). C/U traits have also been
consistently associated with an insensitivity to punishment (Frick et al., 2003); the
endorsement of deviant values, viewing aggression as acceptable for obtaining goals
4
and lower levels of fear (Pardini, 2011); and deficits in cognitive empathy (i.e., the
ability to take others’ perspective) (Dadds et al., 2009).
In the recent Diagnostic and Statistical Manual (DSM-5, American Psychiatric
Association, 2013) iteration the importance of C/U traits was acknowledged through its
inclusion as a specifier within the criteria for conduct disorder (CD). This specifier
(designated with ‘Limited Prosocial Emotions’ to avoid potential harmful labelling
effects) was included because individuals meeting the DSM-5 criteria for CD who, in
addition to this, persistently show elevated levels of two to four C/U characteristics in
two or more settings (e.g., school, home) over 12 months (i.e., lack of remorse or guilt,
callous lack of empathy, lack of concern about performance at school or in other
important activities, shallow or deficient affect) have been found to display a more
severe form of the disorder. Importantly, the addition of this C/U specifier is expected
to provide greater information about etiology, current and future impairment, and to aid
in treatment planning for youth diagnosed with CD (Frick, Ray, Thornton, & Kahn,
2014).
Although the assessment of C/U has been a major focus of research for the past decade
(see Benesch et al., 2014), issues continue to be raised (see Ansel, Barry, Gillen, &
Herrington, 2015). Specifically, because in many studies C/U traits have been measured
as part of the psychopathy construct, only a few items have been included that
specifically measure C/U (Frick et al., 2014). In addition, some of the measurement
formats used are not amenable to large-scale assessments in community samples
because of their time intensive nature (e.g., require extensive training and time
consuming interviews) and because they require the use of institutional records (Ciucci,
Baroncelli, Franchi, Golmaryami, & Frick, 2014). However, the development of the
5
Inventory of Callous Unemotional Traits (ICU: Frick, 2004), with its more
comprehensive item pool, has addressed this issue. Although researchers posit that more
work is still needed to test the theoretical and practical importance of the C/U
dimensions in the ICU, it does present a relatively consistent structure consisting of an
overarching C/U dimension and three sub-dimensions (i.e., callous, uncaring, and
unemotional). This is very promising because, to date, there has been only modest
agreement across measures of C/U traits when assessed using different informants and
methods (Mean r = .24, range -.09 to .54) (see Fink, Tant, Tremba, & Kiehl, 2012).
Researchers are also strong in their arguments that research is needed with persons with
C/U traits but without significant conduct problems, because C/U traits in childhood in
the absence of significant conduct problems are a stronger predictor of antisocial
personality disorder in adulthood (Burke, Waldman, & Lahey, 2010).
C/U Traits and Aggression
Aggression shows developmental trends across childhood and adolescence, being
normative in some forms at some times (Loeber & Hay, 1997). Physical aggression
characteristically declines after the third year of life, with highly physically aggressive
children possibly continuing to be verbally and relationally aggressive (Vitaro, Barker,
Boivin, Brendgen, & Tremblay, 2006). The sex of the child has also been suggested as a
factor in defining normative aggression, with, by middle childhood, a pattern of indirect
aggression described as more typical for girls (Bjorkqvist, 1994; Cote, Vaillancourt,
Barker, Nagin, & Tremblay, 2007). However, Card, Stucky, Sawalani and Little (2008)
concluded an extensive review with the statement that indirect aggression is equitably
enacted by both boys and girls, whereas direct aggression is more often enacted by
boys.
6
A substantial body of evidence exists linking C/U traits with aggression (Barry et al.,
2007; Enebrink, Andershed, & Langstrom, 2005; Fanti, Frick, & Georgiou, 2009; Fite,
Stoppelbein, & Greening, 2009; Flight & Forth, 2007; Kruh, Frick, & Clements, 2005;
Marsee & Frick, 2007; Mayberry & Espelage, 2007; Munoz, Kerr, & Besic, 2008;
Raine et al., 2006). While reactive and proactive aggression have both been found to be
associated with C/U, proactive aggression is considered to be uniquely related to C/U
(Marsee & Frick, 2007). A recent review (Frick et al., 2014) found that of 118 studies
examined, 105 (89%) provided evidence that C/U traits are significantly associated with
aggressive behaviour in children and adolescents (average correlation .33, range -.15 to
.84). However, the majority of these studies were North American based and were either
heavily weighted to boys-only or girls-only samples. Nevertheless, a clear directive that
emerged from this review was that because of the underlying function or motivation of
aggressive behaviour, particularly when C/U is present, the distinction between
proactive and reactive aggression must be made.
Proactive aggression is purposeful and coercive, serving the purpose of obtaining a
desired external goal or object: it is premeditated and not preceded by a strong
emotional response (Glenn & Raine, 2009). It has been associated with psychopathic
traits (in young people and adults), a construct of which C/U traits are a key component
(Raine et al., 2006). In a follow up to Raine et al.’s (2006) study, which looked at the
differential relationship of reactive and proactive aggression to psychosocial factors
from adolescence to early adulthood, Fite et al. (2010) found that at a mean age of 26
years, proactive aggression was related to psychopathic features and antisocial
behaviour.
7
When examined as a construct in its own right, the association between C/U traits and
proactive aggression is evident in the research findings emanating from studies
involving youth from community samples (Barry et al., 2007; Fanti et al., 2009;
Mayberry & Espelage, 2007; Munoz et al., 2008); detained youth (Flight & Forth, 2007;
Kruh et al., 2005; Marsee & Frick, 2007); children from community samples (Raine et
al., 2006); and referred children (Enebrink et al., 2005; Fite et al., 2009). According to
Pardini, Lochman and Frick (2003) youth with C/U traits perceive proactive aggression
as an effective means of producing rewards. However, although research with younger
children is limited, there is evidence that fourth and fifth grade children exhibiting C/U
traits view aggression as an effective means of social interaction (Pardini & Byrd,
2012). Supportive of this, Hubbard, Dodge, Cillessen, Coie and Schwartz (2001)
reported that with groups of 8- to 10-year-old boys the characteristics of the group
influence the use of reactive aggression, but the use of proactive aggression is related to
the characteristics of the aggressor (tendency to use proactive aggression) and the
characteristics of the target that may influence expectations of a positive outcome to the
aggressor from the aggressive act. Not surprisingly, it has been argued that the presence
of C/U traits and aggression impact negatively on the peer relationships of those with
elevated levels (of C/U), the outcome being perceived social isolation (i.e., loneliness)
for the individual characterised with C/U. To date, however, there appears to have been
very limited research (if any) examining loneliness in children with C/U traits.
Peer Relationships, C/U Traits and Loneliness
Throughout child development peer relationships are of undoubted importance
(Bukowski & Adams, 2005; Burt & Klump, 2013; Deater-Deckard, 2001; Dodge, Coie,
& Brakke, 1982; Hay, Payne, & Chadwick, 2004) and this importance (i.e., specifically
peers compared to family members) increases through the primary school years (Burt &
8
Klump, 2013). Research has identified peer rejection as having serious consequences in
childhood (Bagwell, Newcomb, & Bukowski, 1998; Coie, Lochman, Terry, & Hyman,
1992; Dodge et al., 2003; Parker & Asher, 1987; Rabiner, Coie, Miller-Johnson,
Boykin, & Lochman, 2005; Rubin, Hymel, Lemare, & Rowden, 1989; Veronneau,
Vitaro, Brendgen, Dishion, & Tremblay, 2010) and given the propensity of those with
C/U traits towards aggressive behaviour the expectation would be of being rejected by
peers, and consequently having limited friendships and experiencing high levels of
loneliness. Of the minimal research into C/U and friendships, Munoz et al. (2008) found
that 12- to 15-year-olds with elevated levels of C/U traits had as many friends as others,
but these friendships were not stable and were highly conflictual. Consequently, Munoz
et al. (2008) argued that one might expect adolescents who are high on psychopathic-
like traits to experience difficulty in keeping friends - the outcome being loneliness.
However, in contrast to other aspects of C/U research the evidence regarding C/U traits
and loneliness is scant.
Described as typically failing to show empathy or concern for the feelings of others,
callously using others for their own gain, having a shallow and constrictive display of
emotions, a pronounced lack of remorse or guilt for wrong-doing, being self-centred
with a grandiose sense of superiority over others, and having a lack of personal
responsibility or concern for one’s actions (Frick et al., 2014; Frick & White, 2008;
Kimonis et al., 2008), it is not too difficult to see why individuals with elevated C/U
traits might experience difficulties in their peer relationships and therefore be lonely
individuals. With the added aggression the likelihood of being lonely seemingly
increases. While there is no evidence regarding loneliness in children with C/U traits,
aggressive-rejected children in the primary school years in general have not been found
9
to experience higher levels of loneliness compared to average children (Galanaki,
Polychronopoulou, & Babalis, 2008).
Loneliness is known to be a debilitating psychological condition, characterized by a
deep sense of social isolation, emptiness, worthlessness, lack of control and personal
threat (Lasgaard, Goossens, Bramsen, Trillingsgaard, & Elklit, 2011; VanderWeele,
Hawkley, & Cacioppo, 2012). Children and adolescents in general who have limited or
no friendships and who are lonely are more likely to experience poor school adjustment,
mental health problems, and involvement with the juvenile justice system - compared to
those who have friends (Rose & Asher, 2000). Furthermore, during early adolescence
young people without friends report greater levels of loneliness (Parker & Asher, 1993),
and because loneliness is a barrier to social development, it can have an impact on
mental and physical health later in life (Krause-Parello, 2008). However, research has
drawn attention to the multidimensional nature of loneliness (e.g., Chipuer, 2001;
Goossens et al., 2009; Houghton et al., 2014a) and that feelings of loneliness can result
for some young people when they are part of a social group but do not feel connected,
while for others it occurs when they are by themselves and wanting to be with others.
Whether children with elevated C/U traits experience loneliness, or prefer to spend time
alone is unknown. Given the established links between loneliness and short and long
term adverse physical and mental health outcomes (see Houghton et al., 2014a)
investigating the links between with children C/U traits and loneliness is important.
In conclusion, children with behaviour problems and elevated levels of C/U are a
“treatment challenge” (Frick et al., 2014, p.45) because they often do not respond
positively to typical treatments. However, they are not untreatable and studying C/U in
young children may identify potential opportunities to “interrupt a developmental
10
cascade of early emerging aggressive behaviours in early childhood that persist
throughout middle childhood” (Willoughby et al., 2014, p. 39). Although some
researchers have questioned the ethics of using the term C/U traits, the benefits that can
accrue from such research “outweighs concerns related to negative stigmatization
associated with the inappropriate use of terminology involving callous unemotional
behaviours” (Willoughby et al., 2014, p. 39)
Significance of the Research
The present research is significant in six ways. First, it will develop and validate a self-
report instrument to identify primary school aged children with C/U traits. Second, it
will investigate physical and verbal proactive and reactive dimensions of aggression in
children and relate this to C/U traits. Third, it will be the first investigation of loneliness
in children with C/U traits. Loneliness will be investigated across the dimensions of
Friendship Related Loneliness, Isolation, Positive Attitudes to Solitude, and Negative
Attitudes to Solitude. Fourth, it will be the first research to investigate differential
patterns of C/U, aggression, and loneliness in primary school aged children. Fifth, it will
generate case studies to develop profiles of mainstream, primary school children with
C/U traits. Sixth, it will provide information by which the assertion that children with
C/U traits in mainstream primary school settings, are alone, aggressive, and unwanted
can be challenged or confirmed and in doing so will provide information that may
contribute to effective interventions.
Structure of the Thesis
The second chapter of the thesis presents a critical review of the literature. It begins
with a detailed overview of callous unemotional traits (C/U). It positions this set of
affective and interpersonal characteristics, which is central to the thesis, in terms of its
11
importance to the understanding of a subset of serious antisocial behaviour and
proceeds to present the findings from relevant research. The review focuses on the
genetic and environmental factors associated with C/U, the relationship of C/U traits to
peer interaction, and the issues pertaining to the measurement of C/U traits. Although
there is little available research, the review elucidates the position of C/U traits in terms
of peer relationships. This is examined further by reviewing the extant research
literature on loneliness, aggression, and peer rejection. Within this, the aetiology and
measurement of loneliness is examined. The relationship between loneliness and C/U
traits is then examined. The review of research into aggression investigates its forms
and functions, gender differences, the relationship of aggression to peer rejection, and
the relationship of C/U traits and aggression. A series of research questions is then
presented.
Chapter Three provides details of Study One, which comprises three phases. Phase I
describes a critical review of the literature and current instruments relating to C/U, and a
review of the Inventory of Callous Unemotional Traits (ICU)
(Frick: ICU, 2004), which is the most recent and promising of instruments developed.
Phase II describes the item identification and preliminary validation for a new
instrument for assessing of C/U. Phase III provides details of the pilot study whereby
item affectivity, item discrimination and scale reliability were ascertained for the new
self-report instrument.
Chapter Four reports the methodology and results from Study Two, which extends the
validation of the psychometric properties of the new instrument developed by
confirming its factor structure and invariance with a sample of 268 children.
12
Study Three, which explores the differential patterns of children’s C/U traits, aggression
and feelings of loneliness, is described in Chapter Five. Phase I of this study involves
the administration of the newly developed instrument, as well as measures of aggression
and loneliness, to 180 primary school children. The data from a series of multivariate
analyses and univariate F tests are then presented. To more fully comprehend the
profiles of children with high scores on C/U traits a number of case studies were
subsequently generated and presented in Phase II. These cases were constructed from
the empirical profiles generated from the instruments administered in Study Three and
follow-up semi-structured interviews conducted with the classroom teachers of each of
the cases.
To conclude the thesis, Chapter Six, provides a general discussion, which further
extends the discussions presented at the conclusion of each of the thesis study chapters.
The findings from the three research studies are discussed in the light of the literature
reviewed and implications are then drawn for researchers, educators and allied
professionals. The limitations of the research are acknowledged and finally
recommendations for future research are suggested.
13
CHAPTER TWO
LITERATURE REVIEW
Callous Unemotional Traits in Children: Alone, Aggressive and Unwanted?
This chapter critically reviews the relevant literature and is divided into three sections
which correspond with the main heading of the chapter. The first section presents an
overview of callous unemotional traits (C/U) and examines how this key element of
psychopathy applies to young people. The second section then examines the current
research evidence from the field of loneliness and explores, albeit briefly, the
methodological and conceptual issues pertaining to the assessment of loneliness. The
section concludes with an overview of the very limited research relating to loneliness
and C/U traits in children. The third section investigates the forms and functions of
aggression in children, particularly in relation to C/U. Following this, gender
differences in aggression are discussed. The chapter then posits why children with C/U
might be unwanted by their peers. Relevant research questions to be answered are then
posed.
Callous Unemotional Traits
Callous unemotional traits (C/U) refer to specific deficiencies in affective experience
(absence of guilt, constrictive display of emotion) and interpersonal style (failure to
show empathy, callous use of others for one’s own gain) (Cooke, Michie, & Hart, 2006;
Fanti et al., 2009; Frick & White, 2008; Frick et al., 2013; Jezior et al., 2015; Kimonis
et al., 2008; Munoz et al., 2011). C/U traits are one of at least three dimensions that
consistently emerge in the construct of adult (Cleckley, 1976; Hare, 1999) and juvenile
psychopathy (Andershed, Kerr, Stattin, & Levander, 2002; Forth, Kosson, & Hare,
14
2003; Lynam, 1997; Neumann, Kosson, Forth, & Hare, 2006), whether using teacher,
parent, self-report, or clinical ratings (Frick & White, 2008). (A psychopathic
personality involves an arrogant and deceitful interpersonal style [including
manipulation, dishonesty, grandiosity, and glibness], a defective emotional experience
[e.g., shallow emotions, a pronounced lack of remorse and empathy, and lack of
personal responsibility for one’s own actions], and impulsive, irresponsible, and
sensation-seeking behaviour [see Hare, 2006; Hare & Neumann, 2008].)
C/U traits have been measured in children as young as two and three years of age
(Waller, Gardner, Hyde, Shaw, Dishion, & Wilson, 2012) and prevalence rates for
elevated levels of C/U traits have ranged from 10% to 32% in community samples and
21% to 50% in clinic-referred samples of children (for a review see Herpers, Rommelse,
Bons, Buitelaar, & Scheepers, 2012; Kahn, Frick, Youngstrom, Findling, &
Youngstrom, 2012). C/U traits designate a particularly aggressive subgroup of children
(Frick et al., 2013), and those with elevated levels of C/U display more instrumental
aggression (i.e., for personal gain) and premeditated predatory forms of aggression,
compared to other children with conduct problems (Marsee & Frick, 2007). Fanti et al.
(2009) reported that adolescents with C/U traits are more likely to exhibit combined
proactive and reactive aggression, while Andershed, Gustafson, Kerr and Stattin (2002)
identified C/U traits as a marker for distinguishing more violent, frequently antisocial
youths from other problem, non-referred youths. Furthermore, Chabrol, Van Leeuwen,
Rogers and Gibbs (2011) and Pardini and Byrd (2012) reported that children with
elevated C/U traits endorse more deviant values and goals in social situations such as
viewing aggression as an acceptable means for obtaining goals, blaming others for their
inappropriate behaviour and emphasising the importance of dominance and revenge in
social conflicts.
15
The research findings also demonstrate that C/U traits are associated with higher levels
of aggression in pre-school children as young as three years of age (Ezspeteta, de la
Osa, Granero, Penelo, & Domenech, 2013). Furthermore, there is evidence from a
number of studies, including longitudinal studies, that C/U traits are relatively stable
from three to four years of age, and late childhood through to early adolescence, when
measured using self- or parent-report (e.g., Munoz & Frick, 2007; Obradovic, Pardini,
Long, & Loeber, 2007). In their extensive review of developmental pathways to C/U
Frick et al. (2014) cited three studies conducted with children aged two to eight years
for between six months and two years to measure the stability of C/U traits. A mean
stability estimate of .59 (range .41 - .84) was calculated which identified C/U traits to be
“fairly stable in childhood, but ……with substantial variability in the level of stability”
(Frick et al., 2014, p. 7).
Elevated levels of C/U traits in childhood have been found to account for the unique
variance in the prediction of later antisocial outcomes, over and above the influence of
disruptive behaviours such as Conduct Disorder (CD) and Attention-Deficit/
Hyperactivity Disorder (ADHD) (McMahon, Witkiewitz, & Kotler, 2010). Accordingly,
C/U traits have significance in the conceptualization of aetiological and diagnostic
models of conduct problems (Frick, 2012). Overall, the research is unequivocal that C/U
traits are important for designating a distinct subgroup of antisocial and delinquent
adolescents and pre-adolescents (Essau, Sasagawa, & Frick, 2006; for reviews see
Frick, 2006; and Frick & Marsee, 2006), where the causal processes leading to their
antisocial behaviour operate differently from those processes implicated in the antisocial
behaviours of youth without C/U traits (Kimonis et al., 2008). These individuals (with
C/U traits) show a more severe, stable, and aggressive pattern of behaviour (Kahn et al.,
16
2012), which is more premeditated and instrumental in nature (Pardini et al., 2003).
They are also at increased risk for early onset delinquency and later antisocial behaviour
(Frick & White, 2008). Furthermore, these young people show a much poorer response
to treatment (Frick & Dickens, 2006).
Given that C/U traits are one component of the features indicative of adult psychopathy
(Cooke & Michie, 2001), and are more associated with the childhood onset trajectory of
severe conduct problems, the potential importance of identifying those with C/U before
the conduct problems and aggression become too severe is critical. This assumes greater
importance given there is evidence of malleability of levels of C/U traits during
adolescence (Fontaine et al., 2010). Distinguishing between those characterised by
childhood onset severe conduct problems and those characterised by adolescent onset,
could lead to an understanding of the developmental processes involved (Roose,
Bijttebier, Decoene, Claes, & Frick, 2010) and may suggest avenues for preventive
intervention (Frick & White, 2008). However, research into C/U traits in children has
been relatively limited, even though Shirtcliff et al. (2009, p.138) described C/U traits
as a “core feature of psychopathy”, and Hare (1980) argued that C/U type traits reflect
what most clinicians consider to be at the core of psychopathy namely, a lack of
empathy, genuine affection and concern for others. Moreover, this lack of research is
despite the findings that this core component (i.e., C/U) predicts involvement in future
severe antisocial behaviour and can be measured in children as young as two to three
years of age (Waller et al., 2012).
A consistent theme emerging in the research literature is that C/U traits are one of at
least three dimensions in the construct of adult (Cleckley, 1976; Hare, 1999) and
juvenile psychopathy (Andershed et al., 2002; Forth et al., 2003; Lynam, 1997) whether
17
using teacher, parent, self-report, or clinical ratings (Frick & White, 2008). (A
psychopathic personality involves an arrogant and deceitful interpersonal style
[including manipulation, dishonesty, grandiosity, and glibness], a defective emotional
experience [e.g., shallow emotions, a pronounced lack of remorse and empathy, and
lack of personal responsibility for one’s own actions], and impulsive, irresponsible, and
sensation-seeking behaviour: see Hare, 2006).
The classification of psychopathy in childhood and adulthood identifies a relatively
homogeneous pathology when compared with Conduct Disorder (CD) (Blair, Peschardt,
Budhani, Mitchell, & Pine, 2006). That is, children with CD are a heterogeneous
population (i.e., one child might be characterised by a marked reduction in empathy,
anxiety and guilt associated with psychopathy, while another may present with the
opposite pathology). Unlike CD, psychopathy involves a pervasive pattern of emotional
(reduced empathy and guilt) and behavioural (criminal activity and frequently violence)
symptoms (Frick et al., 1994). While both psychopathy and CD focus on behavioural
problems such as criminality and rule breaking, it is the emotional component that is the
crucial feature of psychopathy (compared to the behavioural feature of antisocial
behaviour, which is the focus of CD) (Blair et al., 2006). C/U traits describe the
characteristic interpersonal and affective characteristics, which are considered the
hallmark of psychopathy (see Houghton, Hunter, Khan, & Tan, 2013). Thus, as
asserted by Viding, Fontaine and McCrory (2012) C/U traits have value as a useful
clinical indicator for psychiatric vulnerability and psychosocial maladjustment.
It is worth noting that the importance of C/U traits was recently recognized when, partly
as a result of neurobiological studies, a form of callous–unemotional specifier (termed
‘limited prosocial emotions’) was introduced to the Conduct Disorder diagnosis in the
18
fifth edition of the Diagnostic and Statistical Manual (DSM-5) (see Blair, 2013b). To
qualify for this specifier, an individual must have displayed at least two of four
characteristics, in multiple settings, in the previous 12 months: lack of remorse or guilt;
callousness (i.e. lack of empathy); lack of concern about performance (e.g., at school);
and shallow or deficient affect (a lack of expression of feelings to others) (see Blair
2013b).
Genetic and Environmental Factors in C/U Traits
Results from over 100 behavioural genetics studies with different designs, including
twin studies, studies of twins reared apart and adoption studies, have converged on the
conclusion that antisocial and aggressive behaviour have a substantial genetic basis
(Raine, 2014,). Similarly, studies have also found that C/U traits have a strong genetic
influence (Dadds & Salmon, 2003). Using data from the Twins Early Development
Study (TEDS) Viding and colleagues (see Viding, 2004; Viding, Blair, Moffitt, &
Plomin, 2005; Viding, Frick, & Plomin, 2007) examined 3,687 twin pairs, assessed at
age seven years (Mage = 7.1 years, SD = .23) This study provided strong evidence of a
genetic contribution to the development of conduct problems in children with C/U traits,
compared to those without C/U traits. To conduct this study data on C/U traits were
obtained using a seven-item teacher rating scale made up of three Antisocial Personality
Screening Device items (see Frick & Hare, 2001) and four Strengths and Difficulties
Questionnaire items (Goodman, 1997). Viding et al. (2005) reported that C/U traits
showed a strong heritability (h2g = .67) with minimal group shared environmental
influence (c2g = .06), for children with high levels of antisocial behaviour, suggesting
that C/U traits are strongly heritable and the extreme antisocial behaviour exhibited by
this group is also strongly inherited. This contrasted with the group with extreme
antisocial behaviour but without C/U traits whose extreme behaviour was found to be
19
only moderately heritable (h2g = .30), with moderate shared environmental influence
(C2g). A further study by Viding, Jones, Frick, Moffit and Plomin (2008) with nine-
year-old participants found antisocial behaviour with C/U traits was under genetic
influence and that a combination of CD and C/U traits had a heritability coefficient of
0.81.
The importance of the distinction between cognitive and emotional empathy was
expressed by Blair (2008). Blair (2013b) further explored this distinction in his
influential review paper on the neurobiology of psychopathic traits in youth, arguing
that it was the latter (i.e., emotional empathy) that was critical in those with C/U traits.
According to Blair (2013b) reductions in emotional empathy (particularly responding to
the fear, sadness, pain and happiness of others) is most marked in youths with
psychopathic traits and that this is associated with reduced amygdala and ventromedial
prefrontal cortex responsiveness to distress cues. Similarly, Marsh et al. (2008) reported
that young persons with high levels of C/U traits did not evidence any distinctive
amygdala activation to fearful, angry or neutral faces, whereas comparison groups of
healthy youth and youth with ADHD showed increased amygdala activation in response
to fearful faces. This is highly similar to individuals high on psychopathic traits who are
characterised by an inability to recognize and experience the emotional significance of
social events (i.e., suggesting possible emotional impairments; Patrick, 2001). These
deficits have consistently been confirmed in fMRI studies (Carre, Hyde, Neumann,
Viding, & Hariri, 2013).
In addition to the fMRI studies, 10 studies have also documented abnormalities in how
antisocial youth with C/U traits process emotional stimuli, including: emotional pictures
(Kimonis, Frick, Fazekas, & Loney, 2006); emotional words (Loney, Frick, Clements,
20
Ellis, & Kerlin, 2003); emotional facial expressions (Blair, Colledge, Murray, &
Mitchell, 2001; Dadds et al., 2006) and emotional vocal tones (Blair, Budhani,
Colledge, & Scott, 2005). The evidence has consistently demonstrated that although
young persons with C/U traits do not show abnormalities in how they process stimuli
with positive emotional content, there are deficits in the processing of negative
emotional stimuli (Blair, 1999; Kimonis, Frick, Fazekas et al., 2006; Loney et al., 2003)
and, even more specifically, the processing of signs of fear (Blair & Coles, 2000) and
distress (Kimonis et al., 2006) in others.
Deficits in empathy are therefore a key element of C/U traits and its related aggression
(Frick & Dickens, 2006). Attempts to identify the biological basis of this related
aggression have led to the assertion that structural deficits in brain regions, implicated
in empathy, are also associated with aggression (Sterzer, Stadler, Poustka, &
Kleinschmidt, 2007). Associations between empathy deficits identified in toddlerhood
and early childhood, and antisocial behaviour in middle childhood, have been
demonstrated in longitudinal studies (Rhee et al., 2013).
Emotional empathy is important because it has a communication function that translates
the emotional cues of others to the individual. Children with high C/U traits display
impaired processing of distress cues (i.e., fear, sadness and pain), but not happy
expressions, from verbal tones and the body language of others (see Blair & Coles,
2000). Such children are also found to be less concerned that aggressive behaviour will
result in suffering in others (Blair & Coles, 2000). Research has clearly demonstrated
that the amygdala is one of the most important components in the neural circuit
underlying emotion processing (i.e., social-emotional judgments, moral emotion, and
judging trustworthiness; Glenn & Raine, 2008; Phelps, 2006; Raine & Yang, 2006;
21
Shirtcliff et al., 2009). According to Blair (2006) amygdala dysfunction negatively
influences socialisation, and the appropriate processing of distress cues is absolutely
critical for socialization (Blair 2013b). A functional magnetic resonance imaging study
with 17 boys, aged 10 to 12 years (Mage = 11.6 years) with conduct problems and
elevated levels of C/U traits, highlighted the importance of amygdala dysfunction in
explaining the lack of empathy in those with psychopathy (Jones, Laurens, Herba,
Barker, & Viding, 2009).
Although there is ample evidence showing the genetic contribution to C/U traits, the
specific gene variants associated with reduced amygdala responsivity (i.e., the
neurobiological characteristic that might underpin psychopathic traits including C/U and
increased risk of aggression) have yet to be identified (Blair, 2013b). With regard to
environmental factors that may reduce amygdala expression, data suggest these factors
play a small role with regard to the high levels of aggression shown by young persons
with C/U traits. What the data suggest is that although no specific environmental factors
that reduce amygdala responsiveness have yet been identified, environmental factors
play a small role in the high levels of aggression in young persons with C/U traits
(Fontaine et al., 2010). For example, there is some suggestion that exposure to high
levels of threat (in the family context where there is violence, abuse, or neglect) may
lead to heightened levels of amygdala responsiveness to threat, and increased reactive
aggression (see Dodge, Pettit, Bates, & Valente, 1995). In addition, prenatal factors
such as maternal substance abuse during pregnancy have been linked to increased C/U
traits in children (Barker, Oliver, Viding, Salekin, & Maughan, 2011). Fontaine et al.
(2011) documented poor verbal and non-verbal cognitive ability; conduct problems;
hyperactivity; peer problems; lack of prosocial activity; poor parenting; and chaotic
home life at age four years as environmental factors associated with high stable
22
trajectories of C/U traits. Of particular interest to the present research is the very limited
findings to date regarding peer problems in young persons with C/U traits (see Kimonis,
Frick, & Barry, 2004; Munoz et al., 2008). What seems to be the case is that although
environmental factors only play a very small part in the pathophysiology of C/U traits,
they clearly affect their expression. Consequently, Frick et al. (2013) strongly argued
that research should expand its focus beyond parenting factors to peer factors.
Peer Relationships and C/U Traits
To date very little research has investigated the peer relationships of children with C/U
traits. Described as having a defective emotional experience (e.g., shallow emotions, a
pronounced lack of remorse and empathy, and lack of personal responsibility for one’s
own actions), (Andershed et al., 2002; Cooke & Michie, 2001; Frick & Hare, 2001), it is
not difficult to see why a young person with C/U traits might experience difficulties
with developing peer relationships. According to Centifanti and Modecki (2013) the
327 males in their sample of n = 675 youths (total sample ages 16 to 20 years, Mage
=16.9) who were high on C/U traits were quicker to take risks in a gambling task than
males low on C/U traits. Centifanti and Modecki (2013) speculated that this quick risk
taking may be motivated by a desire to exert their power or authority, as opposed to
facilitating their social popularity. Although these young males appear to be cognitively
able to take the perspectives of others into account, research shows that they seemingly
do not care about the implications of their actions on others (Jones, Happe, Gilbert,
Burnett, & Viding, 2010).
Related research has been conducted with individuals characterised by psychopathic
traits, of which C/U traits are a key component (Cooke & Michie, 2001). Munoz et al.
(2008) for example argued that it might be expected that adolescents high on
23
psychopathic traits have relatively unstable and conflict-ridden peer relationships, and
consequently experience great difficulty in making and keeping friends. Barry, Barry,
Deming and Lochman (2008) examined the stability of psychopathic like traits in
childhood and the influence of peer relationships in the development of psychopathy,
over three time periods (Grade Four, Grade Five, Grade Six). Levels of psychopathic
like traits were established using the Antisocial Personality Screening Device (APSD;
Frick & Hare, 2001). Peer sociometrics were used to assess social status. Eighty
participants, aged 9 to 12 years at initial assessment (Mage = 10.7 years, SD = .57) (i.e.,
fourth grade) were followed over the three years. Findings revealed that greater
impairment in social relationships was associated with more stable and persistent
psychopathic like characteristics, while better social functioning was associated with
reduced levels of these characteristics across time.
There is evidence, however that youth with psychopathic traits do have friends and that
these are fairly stable. Kimonis et al. (2004) investigated the peer delinquent affiliations
of 98 third, fourth, sixth, and seventh grade students (Mage = 12.4 years, SD = 1.73)
with high levels of psychopathic like traits. Parents and teachers completed the 6-item
callous-unemotional subscale of the Antisocial Personality Screening Device (ASPD;
Frick & Hare, 2001) while the students completed the Peer Delinquency Scale (PDS;
Keenan, Loeber, Zhang, Stouthamer-Loeber, & van Kammen, 1995), which recorded
the number of friends who engaged in an array of delinquent activities (e.g., shopping
lifting and selling drugs). Kimonis et al. (2004) found that although youths high on C/U
traits did have friends, they were more likely to be antisocial friends.
Munoz et al. (2008) extended the work of Kimonis et al. (2004) by examining the peer
relationships and delinquent peer associations of adolescents over a four-year period.
24
The Youth Psychopathic Traits Inventory (YPI; Andershed et al., 2002) was
administered to a sample of 667 community-based Swedish adolescents (ages 10 to 18
years) to identify those high or low on psychopathic traits. Peer relationships and their
quality were also determined via peer nomination and the Friendship Quality
Questionnaire (FQQ; Parker & Asher, 1993). Similar to Kimonis et al. (2004), Munoz et
al. (2008) reported that adolescents high on psychopathic traits had friends and that their
friendships were fairly stable. These friendships were not unilateral however, and
adolescents high on psychopathic traits had peer-reciprocated relationships, as did those
with low psychopathic traits (mostly true in the case of boys). Furthermore, peers of
individuals with high psychopathic traits did not perceive friendships as unsupportive or
conflict ridden. However, the youths who were high on psychopathic traits did perceive
conflict in these relationships, suggesting that C/U traits may be related to social
misperception. According to Munoz et al. (2008) it may be that adolescents with high
levels of psychopathic traits have friends because with the increasing prevalence of
delinquency in this age group (see Moffitt, 1993), finding willing antisocial peers
becomes less difficult. In a study some five years later comprising a similar age group
to that of Munoz et al. (2008), Ciucci, Baroncelli, Franchi, Golmaryami and Frick
(2013) examined classmates’ perceptions of peers’ social and behavioural
characteristics and found that C/U traits, particularly the Unemotional dimension, was
associated with deficits in pro-social emotions.
It should be noted that of the relatively limited C/U traits research conducted with
children and youth to date, the measurement of the construct has been inconsistent. C/U
traits have been assessed using several different formats, including parent- and teacher-
rating scales (Frick et al., 2000; Lynam, 1997), self-report scales (Andershed et al.,
2002; Houghton et al., 2014a; Muñoz & Frick, 2007), parent and youth structured
25
interviews (Lahey et al., 2008), and clinician ratings (Forth et al., 2003). Many of these
measurement formats have proven to be time intensive and time consuming, especially
in the case of interviews. Some have required the use of institutional records and are
therefore not amenable to large-scale assessments in community samples. Furthermore,
the primary method of measuring C/U traits has in the majority of studies been to
administer a subscale from an instrument specifically developed to measure
psychopathic traits. The issue with this is that separation of the C/U scale is difficult,
especially as most measures that assess these traits typically include only a limited
number of items specifically assessing this dimension. Consequently, with a limited
item pool, measures of C/U traits in some response formats (Poythress, Dembo,
Wareham, & Greenbaum, 2006), have frequently had significant psychometric
limitations (e.g., poor internal consistency). This is highly important to the present
research which seeks to assess C/U traits in children and therefore instruments used in
measuring C/U traits will now be examined.
Measuring C/U Traits
It is important to measure C/U traits reliably if a greater understanding is to be brought
about regarding their contribution to the development of severe antisocial behaviour in
children and adolescents (Essau et al., 2006; Kimonis et al., 2008; Roose, Bijttebier,
Claes, & Lilienfeld, 2011). In the research conducted to date, the two most widely used
measures of C/U traits have primarily been used in the assessment of psychopathy,
namely, the Antisocial Process Screening Device (APSD: Frick & Hare, 2001) and The
Psychopathy Checklist: Youth Version (PCL-YV: Forth, et al., 2003). Briefly, the
Antisocial Process Screening Device (APSD; Frick & Hare, 2001) has been used with
children as young as six years of age. This measure consists of 20 items, scored on a
three-point scale. Initially a two-factor structure was reported (Frick et al., 1994),
26
represented by an impulsivity/conduct problem factor (I/CP) and a Callous/Unemotional
(C/U) factor. Subsequent work (Frick et al., 2000) with a large community sample of 6-
to 13-year-olds discerned a three-factor solution consisting of Narcissism, Impulsivity
and Callous/Unemotionality. Further validation of this factor structure was undertaken
by Kotler and McMahon (2002, 2003; as reported by Kotler & McMahon, 2005). The
PCL:YV (Forth et al., 2003), which was adapted from the PCL-R, is primarily for 12- to
18-year-olds. Using an interview format its 18 items are scored on a three-point scale.
Items cover the interpersonal, affective and behavioural dimensions of psychopathy and
represent two factors: interpersonal/affective and socially deviant lifestyle (Forth, Hart
& Hare, 1990).
A relatively new measure that has been used in the assessment of C/U traits – but again
it is a measure specifically developed for the assessment of psychopathy in those over
12 years of age - is The Youth Psychopathic Traits Inventory (YPI: Andershed et al.,
2002). The YPI consists of 50 items, grouped into 10 scales and measures the
affective/interpersonal traits, rather than the behavioural characteristics associated with
psychopathy. The wording of items is such that people with psychopathic traits may see
the characteristics described as admirable and therefore, endorse them (Kotler &
McMahon, 2005). Factor analyses have demonstrated three factors represented by
Grandiose/Manipulative, Callous/Unemotional, and Impulsive/Irresponsible
dimensions. Van Baardewijk, Stegge, Andershed, Thomaes, Scholte and Vermeiren
(2008) subsequently developed a self-report youth version for 9- to 12-year-olds.
Other measures frequently utilised in the assessment of C/U traits have included The
Child and Adolescent Psychopathy Screening Instrument (CAPSI; Cordin, 2007), a
teacher-report measure assessing psychopathic-like traits in suspended and non-
27
suspended children and adolescents. This was specifically developed for use with
Australian mainstream school students. Items in the CAPSI were developed based on a
review of the existing psychopathy literature, eight established instruments measuring
youth psychopathy or severe antisocial behaviour, and a series of 41 individual
interviews and focus group discussions conducted with a wide spectrum of individuals
from within mainstream and incarcerated educational settings. Subsequent research with
the CAPSI (Houghton, Cordin, & Hopkins, 2010) revealed four strong factors: Callous-
Unemotional traits, Narcissism, Thrill-Seeking, and Moral Detachment of Self
(Cronbach α = .81, .86, .77, and .72 respectively).
Houghton, Hunter, Khan and Tan (2013) subsequently developed and evaluated the
Constellation of Affective and Interpersonal Behaviours Screening Instrument
(CAIBSI), a self-report measure to screen for psychopathic traits among mainstream
Australian community adolescents. The CAIBSI built on the extensive work of the
CAPSI. Specifically, all 42 CAPSI items were first revised to be in a self-report, age-
appropriate format. For example, the teacher-report CAPSI item, “This child has a
grandiose sense of self-worth” was modified to “I am more important than anyone else”
and “This child is indifferent to adult approval or praise” was altered to “I do not care
about adult approval or praise”. In addition, 18 new self-report items were included in
the CAIBSI following a further review of the instruments measuring juvenile
psychopathy. This resulted in a total of 60 items using a 4-point scale anchored with the
descriptors definitely not true to definitely true. Scoring was on a one-to-four basis with
higher scores being indicative of higher levels of psychopathic traits. The CAIBSI was
considered appropriate and comprehensible and easy (Reading Ease = 82.3) for
Australian school students enrolled in Grade Five (Flesch-Kincaid Grade Level; age 10
years and above).
28
In a series of three studies with high school adolescents, many of who (i.e., adolescents)
had official records of suspension from school for antisocial behaviour (primarily
against teachers and peers), the psychometrics of the CAIBSI was established. Initially,
following item affectivity and discrimination indices being calculated in a pilot study (n
= 40), an exploratory factor analysis (n = 197) yielded a four-factor structure
(Impulsivity α = .73, Self-Centredness α = .70, Callous-Unemotional α = .69, and
Manipulativeness α = .83) made up of 26 items in total. In the third study with 328 high
school adolescents (174 males, 154 females) 130 of who had school records of
suspension for antisocial behaviour competing measurement models were evaluated
using confirmatory factor analysis. The superiority of a first-order model represented by
four correlated factors was supported, χ2 (df = 293) = 517.28, p < .001, CMIN/DF ratio
= 1.76, CFI = .90, RMSEA = .05 (90% CI: .04, .06). This model was invariant across
gender and age. The C/U subscale consisted of six items: I show respect for those in
authority®; I feel that when others have problems, it is often their own fault; therefore,
we should not help them; I am willing to help others when they need help®; I feel bad
when I do something wrong®; I fulfil the promises I made to others®; and I take
responsibility for my behaviour®. (® denotes reverse scored item.)
Although promising, the CAIBSI like the other instruments described, assesses a
number of dimensions of psychopathy and the C/U dimension is therefore only one of a
number of subscales. Furthermore, the CAIBSI and its more well-established
counterparts, the APSD and PCL-YV, possess only a limited number of items (APSD n
= 6 and PCL-YV n = 4) that measure C/U. In the case of the APSD the few items
probably contributes to the moderate internal consistency reported in many studies
(Essau et al., 2006). With reference to the APSD all but one of its items is positively
29
worded, therefore giving rise to the possibility that ratings could be influenced by a
specific response set. The PCL-YV, which has primarily been used with incarcerated
adolescents, utilizes a 60-90 minute interview format and requires a review of the
respondent’s offence records (Kimonis et al., 2008).
Frick and White (2008) argued that the burgeoning research on C/U traits clearly
demonstrates the need to develop assessments that separate these traits from other
antisocial dimensions. In an attempt to overcome the limitations evident in the existing
instruments, the Inventory of Callous and Unemotional Traits (ICU: Frick, 2004) was
developed, which is a 24-item self-report measure that assesses three aspects of C/U
traits: Uncaring, Callousness, and Unemotional using a four-point Likert scale (0 = Not
at all true, 1 = Somewhat true, 2 = Very true, 3 = Definitely true). These three factors
(i.e., Uncaring, Callousness, and Unemotional) loading onto a higher order C/U
dimension have consistently emerged with a range of samples: 13- to 18-year-old
German adolescents (Essau et al., 2006); 12- to 20-year-old American adolescent
offenders (with 22 of the 24 ICU items) (Kimonis et al., 2008); 12- to 18-year-old
Greek adolescents (Fanti et al., 2009); and 14- to 20-year-old Belgian adolescents and
young adults (Roose et al., 2010). A study in Italy, with a sample of pre-adolescents
(Ciucci et al., 2013) is the closest in terms of age range to the sample of children
involved in the present research. The work by Ciucci et al. (2013) confirmed the ICU
factorial structure, however, two items were excluded from the analyses and the
Cronbach alphas were a modest .61 for callousness, .70 for uncaring and .65 for
unemotional suggesting that for younger people there may be some issues with the
ICU’s psychometrics.
30
In what appears to be the most recent study using the 24 item ICU with adolescents,
Pihet, Schmid and Kimonis (2014) recruited 397 Swiss community based adolescents
and 164 institutionalised juvenile justice adolescents (Mage of total sample = 15.8
years, SD = 1.9; 62% females). The ICU was best fitting as a three-factor bifactor
model with a RMSEA below .05. Cronbach alphas were also satisfactory (.72 for
callousness, .73 for uncaring, and .65 for unemotional). When the model fit statistics
and Cronbach alphas were calculated for the two samples of adolescents separately,
similar statistics to those of the total sample were reported. Pihet et al. (2014) also
calculated the model fit statistics for the 22 item version of the ICU and found no
differences in terms of model fit and internal reliabilities. The conclusion reached was
that the results “confirmed the stability of the ICU scores across age, gender and
community/institutionalised groups for the measures, factor structure and associations
with several criterion measures”. Furthermore, it was highlighted that the ICU holds
great promise as a brief screening instrument for identifying antisocial adolescents at
high risk because of their co-occurring C/U traits.
The ICU has also been tested with older adolescents/young adults. Kimonis, Branch,
Hagman, Graham and Miller (2013) administered the ICU to a sample of n = 687
college students and found that a similar three-factor structure to that identified in
samples of adolescents emerged. Furthermore, the ICU was moderately to strongly
correlated with the Psychopathic Personality Inventory-Revised (PPI-R) Total Score
and Cold heartedness and Self-centered Impulsivity factors. Kimonis et al. (2013)
reported that high scores on the ICU identified college students who tended to show
antisocial tendencies consistent with diagnostic criteria for antisocial personality
disorder, while also exhibiting low levels of empathy.
31
With reference to administrations of the ICU with children the research evidence is less
prominent and where it has been used its psychometrics have been less than impressive.
Benesch, Gortz-Dorten and Breuer (2014) for example, recruited a sample of 135
parents in Germany to complete the ICU with regard to their male children who were
receiving clinical intervention for conduct problems. The ages of the children were in
the range of 6-12 years. Competing one, two and three factor models were tested using
confirmatory factor analysis and none were found to have satisfactory model fit.
Benesch et al. (2014) subsequently employed exploratory factor analysis and identified
a three factor structure, which they labelled as Callousness/Lack of Guilt or Remorse
(12 items), Unconcerned about Performance (7 items) and Unemotional (5 items). On
further investigation three items were found to have unsatisfactory alphas <.25: 1 from
the Callousness/Lack of Guilt or Remorse factor and 2 from Unconcerned about
Performance factor. These were removed, resulting in a 21-item scale. However, the
authors reported that while the Cronbach alphas were acceptable (>.70) for the total
score and for two of the factors, it was marginal (.64) for the Callousness factor. When
compared to other studies reporting the factor structure of the ICU the authors suggested
that the problematic fit of the ICU in their study was possibly because of differences in
raters (i.e., parent versus self-report) and developmental differences (i.e., children
versus adolescents).
Although the psychometrics reported for the ICU are generally promising, a number of
questions have been raised. For example Berg et al. (2013) administered the ICU to 70
at-risk adolescents (ages 13 to 17 years) in the foster care system. These young people
had received intervention for a number of issues and were within a nomological
network of anxiety, depression, hopefulness, loneliness, and physiological stress. The
findings suggested that the description given to high ICU scorers as globally
32
“unemotional” may have been misleading, because these adolescents were marked by
high levels of internalizing symptoms. Berg et al. (2013) argued that this provided
strong support for a separation of “C/U traits” into “C and U traits.” Furthermore they
suggested that the findings raised the possibility of false positives on the ICU, as
moderately high scores can sometimes reflect negative emotionality rather than the cal-
lousness seemingly associated with later psychopathy.
It should be noted that the development of the ICU content is based on the APSD (Frick
& Hare, 2001) C/U subscale. Specifically, the four (of its six) items that have loaded
consistently on the C/U scale, in both clinical and community samples (i.e., “Feels bad
or guilty when he/she does something wrong”, “Does not show feelings or emotions”,
“Is concerned about the feelings of others”, and “Is concerned about how well he/she
does at school or work”) (see Frick et al., 2000). To construct the ICU three positively
worded and three negatively worded items were developed for each of these original
four items, which resulted in the current 24 items (12 are reverse scored). Internal
reliabilities have ranged between .77 and .81 suggesting satisfactory reliability. Thus,
there is a growing body of evidence supporting the ICU to be a promising and more
comprehensive assessment instrument of C/U traits.
Peer Relationships and Children with C/U Traits: Alone and Lonely?
The importance of peer relationships throughout human development is well established
(Bukowski & Adams, 2005; Burt & Klump, 2013; Deater-Deckard, 2001; Dodge et al.,
1982; Hay et al., 2004; Kupersmidt & Coie, 1990; Parker & Asher, 1987). Moreover,
the development of skills required for successful peer relationships begins in infancy
and continues over the lifespan. Conversely, the antecedents to problematic peer
relationships may be tracked to the early years of a person’s life (Keiley, Bates, Dodge,
33
& Pettit, 2000) and research is clear that the presence of C/U traits is associated with
increased levels of impairments in peer relationships and developing and maintaining
friendships (Waschbusch & Willoughby, 2008). This is not to say that spending time
alone during pre-adolescence and adolescence is detrimental because research clearly
shows that particular forms of time spent alone during adolescence (primarily though
lack of peer relationships) can have its advantages (see Houghton et al., 2014a).
However, this may not be the case during childhood (see Coplan & Bowker, 2013) and
many researchers have paid special attention to children who play alone, or are
generally not engaged in social interaction when peers are present (Coplan, Rubin, Fox,
Calkins, & Stewart, 1994). According to research, the absence of social interaction can
be a result of children being excluded (i.e., active isolation) or of children socially
withdrawing themselves (i.e., social withdrawal, cf: Rubin, Bukowski, & Parker, 2006).
Indeed, the motivational reasons for children playing on their own has shown that some
individuals are afraid of their age mates or are socially anxious, while others show a
non-fearful preference for solitary activities (Asendorpf, 1993; Coplan & Rubin, 2010;
Gazell & Rubin, 2010). For children who become alone as a result of peer rejection,
individual differences in the level of competence in peer interactions appear by the
preschool years (Hay et al., 2004) and it becomes apparent that, as a result of their
interaction styles, these children are likely to be rejected by their peers. For these
children there is increased risk of social emotional problems (Coie et al., 1992; Parker
& Asher, 1987; Rabiner et al., 2005; Rubin et al., 1989), mental health problems
(Bagwell et al., 1998), delinquency, substance abuse and adult criminality (Dodge et al.,
2009; Miller-Johnson, Lochman, Coie, Terry, & Hyman, 1998), internalizing problems
(Crick & Grotpeter, 1995; Ladd, 2006), and poor academic achievement (Veronneau et
al., 2010). This highlights the importance of developing as full an understanding as
34
possible about children who are lonely and what dimensions of their
loneliness/aloneness distinguish them from their peers who are not lonely/alone.
The significance of loneliness/being alone and peer relationships was demonstrated
across eight years of schooling by Ladd (2006), who emphasised the uniqueness of
rejection in its social effect. Specifically, peer rejection was identified as a predictor of
externalizing behaviour (consisting of classroom disruptiveness and under-controlled
behaviour), and internalizing problems (consisting of anxiety and depression). Ladd
(2006) argued that the status of rejection indicates to others that a child is a target for
victimization, which then leads to further social adjustment difficulties. Of particular
interest to the present research is that the strongest negative influence of peer rejection
was found in the five- to nine-year-old age group, suggesting that age and
developmental level may have strong influences on the effect of rejection. Earlier
research with 8- to 10-year-old boys found (at a 2-year follow-up) that many children
who had been rejected earlier in their schooling subsequently joined friendship groups
(see Bierman & Wargo, 1995), which offers some support to Ladd’s (2006) assertion
that the effects of rejection differ with developmental stage. However, aggression was
also found to be a significant factor, particularly among boys; rejected children without
concomitant aggression were found to have fewer long-term negative behavioural and
social outcomes, and disruptive behaviours.
What this research demonstrated was that aggression, in the context of peer rejection, is
an important factor to be considered and there exists a reciprocal relationship between
peer rejection and aggression (e.g., Coie et al., 1992; Ladd, 2006). Indeed, the role of
childhood aggression and peer rejection on the development of problems later in
adolescence is well known: Peer rejection and aggression show the strongest predictive
35
effect for psychological maladjustment, excessive school absences, suspension from
school, and low grades (see Ladd, 2006).
The relative predictive values of childhood aggression and peer rejection on adolescent
psychopathology are also known longitudinally (Coie et al., 1992). Both peer rejection
and aggression have a role to play in the development of school adjustment,
externalizing and internalizing disorders, conduct disorder, psychological problems, and
drug and alcohol abuse (Coie et al., 1992). With regard to a causal pathway, it was
argued that rejected children may find their peer options to be restricted to the more
deviant members of the peer group, thus restricting positive social learning
opportunities and exposing them to more aggressive and problematic behaviours. In
another longitudinal study of children aged 5 to 12 years Ladd (2006) developed an
additive model to explore the relationship between rejection and aggression and their
effect on maladaptive outcomes (externalizing and internalizing problems). The co-
occurrence of aggression and rejection was found to be predictive of more severe and
more negative outcomes. That is, both aggression and rejection independently
determined psychological maladjustment and these factors continued to be involved in
the maintenance of psychological dysfunction over the seven years of the study.
The mechanisms thought to account for the relationship between rejection and negative
outcomes were speculated on by Dodge, Lansford, Burks, Bates, Pettit, Fontaine and
Price (2003). One mechanism was hypothesized to involve depriving opportunities for
social skill development through denied access to the peer group. A second mechanism
was said to occur via the negative emotions resulting from rejection, thereby leading to
dysfunctional behaviour. There is the possibility, however, that rejection from the peer
group leads to acceptance by another peer group. Light and Dishion (2007) for example,
36
found that rejected adolescents in their research affiliated with each other and in doing
so encouraged each other’s antisocial and aggressive behaviour.
According to Hay et al. (2004) the inter-relationship between peer rejection and
psychopathology appears to involve the reciprocal influences of the individual child’s
characteristics and his/her peers across the developmental span. The influence of these
factors may vary, however, depending on the developmental period in which they occur.
For example, Ladd (2006) found peer rejection was most predictive of externalising
behaviour during the early school years (ages five to nine years) because at this age peer
acceptance is a heightened need. The relationship between internalising behaviours and
peer rejection appears to be stronger in the later primary school years, however,
possibly due to accessibility to a wider peer group (Bierman & Wargo, 1995). Vitaro,
Gagnon and Tremblay (1990) found that the stability of rejection increases over the
school years and it was the absence of pro-social behaviour, rather than the presence of
aggression, that was predictive of rejection in children in pre-primary and year one of
schooling. (However, as noted by Hay et al. 2004, children who exhibit aggressive
behaviours also tend to be rejected by peers.)
Friendships are known to assist in the positive socialisation of physically aggressive
children in the early school years (Salvas et al., 2011). Friendships are also important
for withdrawn and excluded children who are at risk for depressed affect: These risks
are minimised if they have friends (Bukowski, Laursen, & Hoza, 2010). However, as
cautioned by Criss, Pettit, Bates, Dodge and Lapp (2002), if the behaviour does not
match that expected by gender norms children may be rejected. Conversely, where
friendships do occur during the preschool years they act as a protective factor against
externalising behaviour when assessed at age seven years (Criss et al., 2002).
37
Peer relationships represent an important function for learning appropriate socialisation
(Parker & Asher, 1987), and positive peer relationships have been found to exert a
powerful influence on the outcome of various disadvantaging environments. Gifford-
Smith and Brownell (2003) for example, posited that more than 30% of children’s
social interactions involve peers. Moreover, research is unequivocal that the relative
influence of peers in childhood, compared to family members, steadily increases
through the primary school years with peer influence becoming a significant factor in
behavioural choices by early adolescence (see Teppers et al., 2013). In an investigation
of the moderating effect of positive peer relationships in the context of family adversity
and children’s externalising behaviour during the first years of formal schooling, Criss
et al. (2002) found that peer acceptance and friendship was a protective factor,
attenuating the relationship between family adversities and externalising behaviour.
The research examining the peer relationships of children with C/U traits and whether
they are lonely/alone is scant. Childhood conduct problems are known to be associated
with the generation of fewer pro-social and more antisocial solutions to hypothetical
social problems involving sharing and friendship-making (Waschbusch, Walsh,
Andrade, King, & Carrey, 2007). When C/U traits are also present it would be expected
to find that these outcomes were exacerbated and that children with C/U traits had few
friends, primarily because they display several core emotional deficits that potentially
undermine healthy social interactions (Pasalich, Waschbusch, Dadds, & Hawes, 2014).
Specifically, C/U traits are related to empathy deficits, which are particularly evident in
sharing in another’s feelings (i.e., affective empathy) (Dadds et al., 2009), and in pre-
adolescents C/U traits can be associated with difficulties in understanding other
people’s feelings (i.e., cognitive empathy) (Pasalich et al., 2014). In children with
elevated C/U traits, relative difficulties are also evident in recognizing other people’s
38
displays of fear and sadness, as communicated via facial expressions (De Wied, Van
Boxtel, Matthys, & Meeus, 2012), tone of voice (Dadds, et al., 2006), and body gestures
(Munoz, 2009).
It appears, therefore, that children with C/U traits would have few friends and may in
turn be lonely. Bukowski et al. (2010) and Spangler and Gazelle (2009) highlighted the
importance of loneliness in placing peer relationships (and in particular rejection) into
the social context. However, research specifically examining loneliness in children with
C/U traits appears to be non-existent. This is not totally unexpected because a similar
situation was evident regarding loneliness in children and adolescents in general until as
recently as 2009 (see Houghton et al., 2014a). To develop an understanding of
loneliness in children with C/U traits it is necessary to first examine the construct of
loneliness.
Loneliness
Loneliness is defined as a distressing condition resulting from a perceived discrepancy
between desired and experienced levels of social interaction (Perlman & Peplau, 1981)
and can experienced by people of all ages, including children (for a comprehensive
review see Heinrich & Gullone, 2006). Studies show that 66-79% of young people
report feelings of loneliness at some time. It (loneliness) is characterized by a sense of
social isolation, emptiness, worthlessness, lack of control and personal threat
(VanderWeele et al., 2012) and has been linked with numerous negative physical,
psychological, social and mental health outcomes (Cramer & Barry, 1999; Doman & Le
Roux, 2010; Krause-Parello, 2008; Lasgaard, Goossens, & Elklit, 2011).
Of the people who report experiencing loneliness, 15-30% describe these feelings as
39
persistent and painful (Brennan, 1982; Heinrich & Gullone, 2006). Of particular
importance to the present research is that loneliness increases through childhood and
pre-adolescence until it peaks in adolescence (Heinrich & Gullone, 2006; Houghton,
Roost, Carroll, & Brandtman, 2014b) and failure to resolve loneliness prior to moving
out of adolescence can have significant adverse social and health outcomes (Heinrich &
Gullone, 2006; McWhirter, Besett-Alesch, Horibata, & Gat, 2002; Witvliet, Brendgen,
Van Lier, Koot, & Vitaro, 2010).
Although there is evidence that loneliness can be experienced in childhood (Asher &
Paquette, 2003) it has not been extensively studied (Krause-Parello, 2008). What is
known is that loneliness in childhood is associated with significantly varying patterns of
peer functioning (Jobe-Shields, Cohen, & Parra, 2011; Qualter et al., 2013). While the
research into childhood loneliness is sparse, the research focussing on loneliness in
children with C/U traits appears to be non-existent. However, given that C/U traits are
associated with increased levels of peer relationship difficulties (Waschbusch &
Willoughby, 2008), loneliness in this context must be investigated.
Aetiology of Loneliness
According to Renshaw and Brown (1993) the interaction between behavioural
(withdrawal), sociometric (poor peer acceptance), and attributional style (self-blaming)
will, over an extended period of time, prevent the development of friendships, and this
predicts loneliness. In seven- to 12-year-olds a relationship was evident between
withdrawal behaviour and loneliness. That is, children who were unable to develop
close friendships in the classroom reported greater levels of loneliness.
40
A strong, positive correlation has also been found between loneliness and peer rejection
(Boivin, Poulin, & Vitaro, 1994; Cassidy & Asher, 1992; Ladd, Kochenderfer, &
Coleman, 1996; Qualter et al., 2013), with rejected children experiencing more
loneliness than other children at all age groups - from early childhood through to early
adolescence (Asher & Wheeler, 1985; Asher & Paquette, 2003). It is in middle
childhood however, that peer relationships appear to have the greatest influence on
experiences of loneliness (Chipuer, 2004). Children at this age with best friends report
less loneliness than those without best friends and children who are unable to establish
close friendships report higher levels of loneliness (Renshaw & Brown, 1993). In
addition to these special friendships, these researchers found that general acceptance by
the peer group helped, and provided even friendless children with some protection from
loneliness.
It has also been posited that during middle to late childhood, social withdrawal becomes
more socially inappropriate (Younger & Boyko, 1987), and this may lead to
victimization and rejection by peers (Bovin, Hymel & Bukowski, 1995) and
consequently to loneliness. Children who exhibit aggressive and withdrawn behaviour
experience high levels of loneliness, social dissatisfaction, and the greatest number of
problematic outcomes (Galanaki et al., 2008; Ladd & Burgess, 1999).
As was the case with the relationship between rejection and aggression, the relationship
between rejection and loneliness has been studied and the mechanisms underlying this
association have been debated. Although a strong relationship exists between rejection
and loneliness, not all rejected children are lonely. In one of the few studies undertaken
aggressive-rejected children in the primary school years were not found to experience
higher levels of loneliness than average children (Galanaki et al., 2008). However, as
41
highlighted earlier, one of the major issues in loneliness research to date has been the
measurement of loneliness, especially with children and adolescents. With reference to
children in particular, a major limitation has been the relative scarcity of appropriate
instruments.
Measuring loneliness
The majority of the loneliness research has been conducted with adults or “young
adults”, with very limited work conducted with children, pre-adolescents and
adolescents. Within the aforementioned issue of measurement, there have been three
major limitations identified among existing loneliness instruments. First, more recent
theoretical models of loneliness presume multidimensionality loneliness, yet most
scales were developed as unidimensional (e.g., the UCLA Loneliness scale: Russell,
Peplau, & Cutrona, 1980; Russell, Peplau, & Ferguson, 1978). Second, many scales
include correlates or consequences of loneliness or aloneness, for example, hopelessness
and blaming others (Loneliness Scale, De Jong-Gierveld & Raadschelders, 1982); do
not view depression as a separate factor from loneliness (Cacioppo, Hughes, Waite,
Hawkley, & Thisted, 2006); or they include other dimensions (anxiety, anger, optimism,
self-esteem, social skills, low social support, avoidant thinking, agreeableness, shyness,
sociability). While loneliness may well be instrumental in activating these states, it (i.e.,
loneliness) remains a central individual difference characteristic. Third, most
instruments do not account for the considerable overlap in the existing scales (see
Cramer & Barry, 1999). However, the recent development and validation of the Perth
A-Loneness scale (PALs: Houghton et al., 2014a) addresses these limitations and
provides an appropriate measure for use in this present research. (The PALs is described
in more detail later in this chapter.)
42
Some researchers have viewed loneliness (and therefore measured it) as a
unidimensional construct (i.e., loneliness is the same for everyone across circumstances
and causes, and can be measured by means of a single scale: Asher & Wheeler, 1985;
Russell et al., 1980; Russell, 1996) while others more recently have conceptualised it as
a multidimensional construct (i.e., varying in intensity and across causes and
circumstances, and where different social relationships give rise to different forms of
loneliness: Dahlberg, 2007; Goossens et al., 2009; Hawkley, Browne, & Cacioppo,
2005; Hawkley, Gu, Luo, & Cacioppo, 2012; Heinrich & Gullone, 2006; Houghton et
al., 2014a).
Although much of the earlier research worked on a unidimensional construct, a
multidimensional model of loneliness was established. The most influential model was
that of Weiss (1973), which proposed that loneliness comprised of social loneliness (a
deficit in one’s social relationships, social networks, and social supports) and emotional
loneliness (an absence or lack of close or intimate companionship/attachment).
Research that built on this work highlighted friendship loneliness (social loneliness),
family loneliness and romantic loneliness (DiTommaso & Spinner, 1993); and
loneliness and aloneness (i.e., peer related loneliness and family loneliness, and positive
attitude to solitude and negative attitude to solitude: see Marcoen & Goossens, 1993).
However, even with this multidimensional perspective, most researchers continued to
measure lomneliness with a unidimensional instrument.
Recent research has developed the multidimensional approach along with appropriate
instrumentation. For example, Goossens et al. (2009) conducted one of the most
compelling studies to date. Competing factor models were tested on data from 534
Dutch adolescents (aged 15 to 18 years) using nine different instruments (representing
43
14 subscales). Employing confirmatory factor analysis a four-factor model of loneliness
and solitude (i.e., peer or friendship related loneliness, family loneliness, positive
attitude to solitude and negative attitude to solitude) was clearly superior. The findings
also indicated that the distinction between loneliness and aloneness was an important
one to make.
Houghton et al. (2014a) extended the work of Goossens et al. (2009) by developing a
new instrument (the PALs) to measure multidimensional loneliness in children and
adolescents, but unlike Goossens et al. (2009) the PALs omitted family related
loneliness items. The reason for this was that including family aspects of loneliness
might unnecessarily confuse the construct with the situations that can relate to
loneliness. Houghton et al. (2014a) reasoned that for some adolescents there are
situational effects relating to loneliness in families but not at school, or that for some
adolescents there is a more underlying trait of loneliness that pervades across situations.
They continued that some young people can be lonely at school but not at home, can
cope with aloneness at home but not at school, or can be lonely at school and home but
not among their group of after school friends. Other adolescents may, however,
experience a sense of loneliness pervasively across all situations.
The PALs has a Grade 4.5 readability level (Flesch-Kincaid Grade Level; age 9 years
and above) and utilizes a six point scale represented by the descriptors “never”, “rarely”,
“sometimes”, “often”, “very often”, and “always”, with higher scores suggestive of
higher levels of loneliness and attitudes to solitude. It was administered to separate large
samples of children and adolescents in separate sequential studies. In the first study
involving 1,074 10- to 18-year-olds an exploratory factor analysis from a random split
(n = 694), Houghton et al. (2014a) reported a four-factor structure (Friendship Related
44
Loneliness, Isolation, Negative Attitude to Solitude, and Positive Attitude to Solitude)
represented by 24 items explaining 42% of the total variance. The Cronbach’s alpha
coefficient was acceptable for each subscale: Friendship Related Loneliness (i.e., having
reliable, trustworthy supportive friends α = .86), Isolation (i.e., having few friends or
believing that there was no one around offering support α = .80), Positive Attitude to
Solitude (i.e., positive aspects and benefits of being alone such as relaxing, happiness α
= .78) and Negative Attitude to Solitude (i.e., negative aspects of being alone such as
time dragging, unhappiness, isolation α = .77). Competing measurement models using
confirmatory factor analysis with data from the remaining 380 participants supported
the conceptual model. When various moderators were included in the analyses it was
found that females scored higher than males on the Friendship Related Loneliness
factor, (i.e., having reliable, trustworthy, supportive friends), and as students got older
Negative Attitudes to Solitude (i.e., negative aspects of being alone such as boredom,
time dragging, unhappiness and wishing there was a friend) declined, while Positive
Attitudes to Solitude (i.e., benefits of spending time on own) increased. In a second
study with a new sample of 235 10- to 16-year-olds the superiority of the first-order
model, represented by four correlated factors, was supported (CFI = .92, RMSEA =
.05). Once again the Cronbach’s alpha coefficients were acceptable for each subscale
Friendship Related Loneliness α = .91; Isolation α = .80; Positive Attitude to Solitude α
= .86; and Negative Attitude to Solitude α = .80. Test-retest reliability (9 months apart)
with 250 of the participants to examine the stability of the loneliness dimensions over
time revealed correlation coefficients of: Friendship Related Loneliness .61, Isolation
.59, Negative Attitude to Solitude .67 and Positive Attitude to Solitude .64 (all p < .01).
The PALs, with its impressive psychometrics and readability level, makes it ideal for
the present research. Furthermore, its ability to differentiate between different
45
dimensions of loneliness and solitude in children and adolescents is important because
children (as young as five years of age) cite aloneness in their descriptions of loneliness
(Cassidy & Asher, 1992). Aloneness, loneliness, and solitude are three related concepts,
which have been found to become meaningfully distinguished at different
developmental stages across childhood and adolescence, with the distinction between
loneliness, negative aloneness, and positive aloneness or solitude representing a crucial
developmental achievement for the mature understanding of loneliness (Galanaki,
2004).
The ability to appreciate positive aspects of being alone has been found to gradually
increase between the ages of 7 and 10 years (Galanaki, 2004). In a study of second,
fourth, and sixth grade children Galanaki (2004) reported that of those in second grade
41.7% stated that people existed who wished to be alone. Of the other two grades,
63.3% of fourth grade and 83.3% of sixth grade children also held this belief.
According to Chipuer (2001) 80% of children in the 9- to 11-year-old age group
understand the distinction between aloneness and loneliness, thereby demonstrating that
young children perceive loneliness as multidimensional. Thus, adopting the PALs self-
report instrument which measures multidimensional loneliness in young persons is
appropriate in the present research, which will be the first to examine loneliness in
children with C/U traits.
Loneliness and C/U Traits
To date there appears to be no research examining loneliness in children and
adolescents with C/U traits. Similarly, there appears to be no studies examining
loneliness in those with psychopathic traits, in community and clinical settings. Kimonis
et al. (2004), Munoz et al. (2008) and Poulin and Boivin (2000) each concluded that
46
children with elevated C/U traits do have friends, but there were ‘qualifiers’. For
example, in the Muñoz et al. (2008) study it was found that children and adolescents
aged 10 to 18 years, high in psychopathic traits, had relatively stable friendships.
However, while the “friends” of those high on psychopathic traits did not see these
friendships as unsupportive or conflictual, those with psychopathic traits reportedly saw
the relationships as conflictual. Munoz et al. (2008) interpreted this as meaning that
psychopathic traits are possibly related to misperceptions in relationships. When the
moderating factor of sex was examined, males high in psychopathic traits had more
reciprocal relationships compared with females, and the presence of at least one friend
from school acted as a protective factor against increasing delinquency. Barry et al.
(2008) found similar results in children, however the presence of psychopathic traits
negatively impacted relationships with peers over time (Barry et al., 2008).
Although there is little specific research examining loneliness and C/U traits, the
associated aggression found in those with C/U traits has been put forward as a reason
for the peer relationship problems and ensuing loneliness experienced. There is indeed
substantial evidence to support this premise because C/U traits designate a particularly
aggressive subgroup of children (Frick et al., 2013), who are characterised by
instrumental and premeditated aggression (Marsee & Frick, 2007). Even in pre-school
children as young as 3 years of age C/U traits have been associated with higher levels of
aggression. The next section will overview aggression in general, albeit it relatively
briefly, and then in the context of C/U traits.
Aggression
Antisocial behaviour and concomitant aggression is a major source of child and
adolescent referrals to mental health clinicians. Antisocial/aggressive individuals cost
47
society up to 10 times more than their healthy counterparts in aggregate health care and
social service expenditures (Blair, 2013a). Aggression has generally been considered to
be multidimensional (Dodge & Coie, 1987; Little et al., 2003; Raine et al., 2006) and
can differ in terms of function or form. That is, aggression can be viewed as impulsive
and anger-driven (variously termed reactive, hostile, and defensive aggression) or as
premeditated (variously termed proactive or instrumental aggression). It appears to be
the case that the expectation that attacking others will result in more positive outcomes
rather than negative ones, may be particularly salient for juveniles with high levels of
C/U traits (Pardini et al., 2003). The importance of also differentiating between physical
and verbal aggression, and whether these are proactive or reactive, particularly in
adolescent at-risk of developing psychopathic traits has been highlighted in numerous
research studies (see Houghton et al., 2010).
Forms of Aggression (Physical versus Verbal) and Functions of Aggression
(Proactive versus Reactive)
In the majority of children physical aggression is characterised by an initial increase
during their first three years and this is followed by a steady decline thereafter (Vitaro et
al., 2006). Longitudinal studies by a number of researchers (e.g., Brame, Nagin, &
Tremblay, 2001; Cote, Tremblay, Nagin, Zoccolillo, & Vitaro, 2002; Lacourse, Nagin,
Tremblay, Vitaro, & Claes, 2003; Nagin & Tremblay, 1999) have demonstrated that this
decline increases as the child ages and in only a small minority of children (i.e., life-
course persistent offenders) does the aggression remain stable and persist into childhood
and on into adolescence (Moffitt, 1993). No evidence appears to demonstrate that
children with low or moderate levels of physical aggression escalate to high levels of
physical aggression during middle childhood and through to adolescence (Brame et al.,
2001; Tremblay, 2000). In their longitudinal study with children aged 2 to 11 years,
48
Cote, Vaillancourt, Le Blanc, Nagin and Tremblay (2006) found that in toddlerhood,
aggression was commonly used but this decreased in just over 50% of the sample.
About 33% initially exhibited a low level of physical aggression and continued to show
this at 11 years of age. However, approximately16% of the sample showed a high and
stable level of physical aggression, and by age 11 years this high-aggression group
demonstrated considerably more aggression than the children from the other groups.
These results were interpreted as providing a level of support for Tremblay’s (2000)
view that normative development results in children learning alternatives to physical
aggression.
On the other hand, Vitaro et al. (2006) postulated that aggressive behaviour may not
decline as children grow older but rather changes its form across development. For
example, physical aggression changes to relational aggression as verbal and cognitive
capacities develop, particularly because it is a more socially acceptable way for young
people to achieve their desired goals or seek revenge. Cote et al. (2007) supported
Vitaro et al’s. (2006) premise by pointing to their findings showing that 14.2% of
children in their sample evidenced a moderate, desisting trajectory of physical
aggression with a rising trajectory of indirect aggression, from early to middle
childhood. In other words, children who use physical aggression in early childhood
may, with development, change their aggressive style to one of indirect aggression.
With regard to verbal aggression, there seems to be considerable conceptual overlap
with reference to the terms “verbal aggression” and “relational aggression”. Generally,
verbal aggression is defined as the practice of name calling, mocking, teasing, and the
use of verbal threats (Bauman & Del Rio, 2006) and has been subsumed under the
aggression categories of “direct verbal” (Bjorkqvist, Lagerspetz, & Kaukiainen, 1992),
49
“direct overt” (Scheithauer, Hayer, Petermann, & Jugert, 2006), or simply “direct” or
“overt” aggression (Golmaryami & Barry, 2010). Conversely, the indirect use of verbal
aggressive behaviour such as gossiping, spreading rumours, and telling lies to hurt
others, has been considered as “indirect” or “covert” forms of aggressive behaviour
(Card et al., 2008) or classified as “relational aggression” (Scheithauer et al., 2006).
Relational aggression has been defined as the purposeful manipulation of or damage to
peer relationships, with the intent to harm others (Crick, 1996).
Aggression has also been differentiated based on underlying functions or motivation
(Dodge & Coie, 1987; Vitaro et al., 2006). The distinction between proactive and
reactive aggression (because they appear to be distinct dimensions of aggression with
different theoretical underpinnings), especially among adolescents with psychopathic-
like traits (Forth & Book, 2010), is important because of the different aetiological
pathways to aggression (see Blair et al., 2005; Crick & Dodge, 1996; Dodge, 1991; Fite
et al., 2010; Raine et al., 2006). Proactive aggression (also known as instrumental,
predatory aggression) is related to social learning theory (Bandura, 1973, 1977), in
which aggression is driven by reinforcement (e.g., anticipated rewards) that comes with
the perpetration of aggressive acts (Vitaro et al., 2006). Proactive aggression tends to be
premeditated, not preceded by a strong emotional response (Glenn & Raine, 2009), and
is a purposeful and coercive behaviour that serves the purpose of obtaining a desired
external goal or object. Conversely, reactive aggression is associated with frustration-
aggression theory (see Dollard, Miller, Doob, Mowrer, & Sears, 1939; Berkowitz, 1962,
1993). In this theory aggression is an impulsive, hostile, and emotional-driven reaction
in response to a perceived threat or provocation (e.g., in the context of a heated
argument: Glenn & Raine, 2009). Reactive aggression therefore involves unplanned,
enraged attacks on an object perceived to be the source of the threat or frustration.
50
Anger often accompanies reactive aggression, which is initiated without regard for any
potential goal or object (e.g., obtaining possessions of victims, acquiring money for
drugs, or elevating one’s status within the hierarchy: Blair, 2008).
Although proactive and reactive aggression have been found to be highly correlated
(Dodge & Coie, 1987), factor analytic studies support their distinction (e.g., Little et al.,
2003; Poulin & Boivin, 2000) and their association with different psychosocial
outcomes (see Card & Little, 2006 for a meta-analytic review; Fite et al., 2010; Fite,
Vitulano et al., 2010). According to Anderson and Bushman (2002) although proactive
and reactive aggression both have the proximate goal of harm, they may have different
ultimate goals - reactive aggression may carry the ultimate goal of inflicting harm,
whereas proactive aggression my carry the ultimate goal of personal gain.
Gender Differences in Aggression
Investigations examining gender differences in aggression have generally examined the
form the aggression takes (direct, overt, and physical compared to indirect or relational)
rather than the function (proactive compared to reactive). Although physical and
indirect aggression has been found to be exhibited by both boys and girls (Broidy et al.,
2003; Cote et al., 2006), the research evidence suggests that boys are more likely to use
physical and overt aggression (e.g., kicking, hitting, and threatening) whereas girls use
relational aggression (Bjorkqvist et al., 1992; Crapanzano, Frick, & Terranova, 2010;
Crick & Grotpeter, 1995; Ostrov & Keating, 2004). Girls also tend to employ more non-
relational (direct) verbal aggression than boys (e.g., name calling and racist remarks:
Scheithauer et al., 2006).
51
Card et al. (2008) conducted a meta-analytic study of aggression in children and
adolescents that sought to identify gender differences between direct and indirect
aggression. Hurtful manipulation and gossip-spreading, often through covert means,
was categorised as indirect aggression, and hitting, pushing and overt verbal attacks as
direct aggression. Findings revealed that boys displayed more direct aggression than
girls, but no meaningful differences between boys and girls were found for indirect
aggression. Card et al. (2008) concluded that indirect aggression was equally enacted by
boys and girls. These gender differences do not appear to be consistent until somewhere
between the ages of three and six years however (Loeber & Hay, 1997), with boys
showing higher rates of physical aggression (Card et al., 2008; Cote et al., 2006; Crick,
Casas, & Mosher, 1997), a relationship that appears to continue from toddlerhood to
late childhood. Scheithauer et al. (2006) found that physical aggression declined after
peaking in Grade Eight (13 to 14 years of age), while non-relational verbal aggression
and relational aggression peaked in Grade Nine (15 to 16 years of age).
Gender differences in the trajectory that aggression takes from childhood to adolescence
was investigated by Broidy et al. (2003). Boys and girls were found to become
increasingly different in terms of the type of aggression they use over the ages from two
to eight years. With regard to the predictive value of aggression, it was found that
physical and non-physical forms of aggression in childhood were only predictive of
later violent delinquency in boys. From their review of studies, Archer and Coyne
(2005) concluded that sex differences in indirect aggression become larger (in favour of
girls) at around ages 8 to 11 years, reaching their peak in adolescence. In a longitudinal
study of children over a period of six years, Cote et al. (2007) found that across
childhood, the relative levels of physical and indirect aggression became more
differentiated. That is, the typical pattern for girls was for physical aggression to
52
decrease and indirect aggression to increase with age, such that by middle childhood
girls’ and boys’ patterns of aggression had become differentiated.
Peer Rejection and Aggression
Children and adolescents who deviate from developmental norms and display elevated
aggression have been found to be at risk for long term, serious antisocial outcomes and
social rejection (Dodge, Coie, Pettit, & Price, 1990; Parker & Asher, 1987). Dodge et al.
(2003), in their series of inter-related, longitudinal studies of children aged from 5 to 12
years (Kindergarten to Grade Seven) found several important relationships between
rejection and aggression. In an initial study rejection was operationalized through a
process of peer ratings where participants rated each other on a five-point scale. In the
period between Grade One and Grade Five, children who were rejected in Grade One
were rated by teachers to have aggression-levels twice as high as children who had not
been rejected in Grade One. With children rejected in Grade Two, the outlook appeared
worse, with these children displaying three times the level of teacher-rated violence and
aggression by Grade Five. In the second study in the series Dodge et al. (2003) found
peer rejection to be related to the growth of reactive aggression, rather than proactive
aggression, in the age group aged five to eight years. It was argued that this suggested
the relationship between rejection and aggression is stronger for reactive than proactive
aggression and that this is possibly because rejection creates a provocative stress, which
is associated with reactive aggression rather than proactive aggression.
In examining the effect of long-term rejection (from ages five to eight years) Dodge et
al. (2003) discovered that it was only in the group of children who initially showed
aggressive behaviours above the median that long-term rejection was associated with an
increase in aggressive behaviour. In addition, children who initially showed aggression
53
above the median (at five years of age) but were not rejected by their peer group, did not
show elevated levels of aggression at eight years of age, suggesting that peer acceptance
offers a protective effect. Furthermore, a group of initially non-aggressive children (at
age five years) were not found to become more aggressive following peer rejection (at
eight years of age). It therefore appears that the outcome of peer rejection depends to
some degree on the characteristics of the child.
This series of studies produced key findings relevant to the investigation of aggression
and peer rejection in children. First, early peer-group rejection is associated with
antisocial behaviour in the middle primary school years. Second, this effect occurs only
in children whose initial level of aggression is above the median. These effects occurred
in boys and girls, and much of the peer rejection could be accounted for by social
information processing aspects, which were themselves related to peer rejection. That is,
rejection by peers influences the way children respond to social cues. The experience of
rejection seems to increase hyper-vigilance to hostile cues and increase the likelihood of
the use of aggressive responses.
Lansford, Malone, Dodge, Pettit and Bates (2010) suggested the existence of an
interrelationship between aggression, social information processing, and rejection such
that a “series of reciprocal and mediated transactions” occur over time. (Lansford et al.,
2010, p.593). Rejection by peers limits the opportunity for social learning thus leading
to more rejection. Applying the model of social information processing, described by
Crick and Dodge (1994) to aggression, Lansford et al. (2010) explicated the steps that
result in an aggressive act. At the first step of the model, encoding problems occur due
to hyper-vigilance to hostile cues, thus increasing the likelihood of an aggressive
response. Hyper-vigilant children tend to have fewer alternative, socially appropriate
54
responses. Having confidence in their aggressive responses means that subsequent
responses are likely to be aggressive (Dodge, Bates, & Pettit, 1990).
Not all research has found the existence of aggression in child and adolescent peer
groups to be related to rejection. Cairns, Cairns, Neckerman, Gest and Gariepy (1988)
for example, found that although aggressive children have been classed as “rejected” in
terms of social status, these children may still be “popular” amongst some peers. They
pointed to students who are both high on popularity and also on peer-dislike, and
referred to them as “controversial”. These “controversial” children have been suggested
to typically represent a proportion of preadolescent boys (Rodkin, Farmer, Pearl, & Van
Acker, 2000). Newcomb, Bukowski and Pattee (1993), in their meta-analysis, noted that
a small proportion of children, termed “controversial” in their peer status, evidenced
aggressive behaviour, but were also socially accepted. It was subsequently suggested
that these children compensated for their aggressive behaviour with well-developed
cognitive and social skills. Moreover, in a study of 10- and 13-year-old boys and girls,
Cairns et al. (1988) found that highly aggressive children often had meaningful
friendships.
Different forms and functions of aggression have differential influences on interpersonal
relationships. Vaillancourt and Hymel (2006) examined the role of overt physical and
relational aggression and social status in 11- to 17-year-olds. Findings revealed a
complexity among the relationships between these variables in adolescent groups,
which suggested that the social relevance of aggressive behaviour is likely to vary
across different school cultures, with aggression level being important in its relative
rather than absolute context. Furthermore, the findings demonstrated the role aggression
takes in defining adolescents as popular and powerful, and that within this
55
developmental stage, the interrelationships between aggression, gender, and
socioeconomic status defines social status.
Hawley’s (2003) study of the role of aggression in children’s and adolescents’ peer
relationships found socially adaptive aspects to aggression and that children and
adolescents with moderately aggressive characteristics were also liked and central in
their social milieu. Among German children in Grades 5 through to 10 a group of
children were identified who exhibited coercive behaviour, but also showed prosocial
behaviour and were liked by their peers. It was evident from this study that the peer
group will tolerate a degree of proactive aggression if it is accompanied by sufficient
prosocial skill. Prinstein and Cillensen (2003) also found among 15- to 17- year-olds,
that although proactively aggressive students achieved a high social status, they were
not well liked. Reactive aggression, however, was not correlated with popularity but
predicted low social preference
In a meta-analytic review conducted by Newcomb et al. (1993) the results of 41 studies
on aggression and sociometric status involving children aged five to 12 years were
aggregated. The results indicated that aggressive behaviour was related to social
rejection but it also played a role in popular social status. It was suggested by the
researchers that aggression was related to rejection when it was not accompanied by
socially skilled behaviours. Interestingly, a group of children who were characterised by
peer nominations of both “popular” and “disliked”, and who had been termed
“controversial”, showed a combination of higher than average levels of both aggression
and social skills.
56
The role of physical and relational aggression on friendship selection was examined by
Dijkstra, Berger and Lindenberg (2011) using a longitudinal social network analysis
design. In a 10- to 12-year-old age group, gender-matching was found to be more
important as the basis on which friendships were formed than aggression-matching,
although friendship groupings of highly aggressive males appeared to be the result of a
default grouping of children who were left out of less aggressive groupings. According
to Rulison, Gest and Loken (2013), among 11- to 13-year-olds in their study, physically
aggressive adolescents were actively chosen as friends. Girls, when they made cross
gender friendships, were more likely to choose aggressive boys as friends, and
aggressive adolescents influenced their friends to become more aggressive. However,
peer nominations were employed in this research to identify physically aggressive
adolescents. Participants were asked to identify those who “start fights” and “hit or pick
on others” and it is possible that this method of identifying physical aggression may
actually be identifying proactive aggression rather than the retaliation/frustration based
reactive aggression. Previous studies have found reactive and proactive aggression to
have different associations with social relationships (Prinstein & Cillenssen, 2003). This
underscores the importance of specifying the aggressive behaviours investigated, as the
research evidence supports the contention that the distinction between proactive and
reactive aggression is important when considering the influence of aggressive behaviour
on peer relationships, and specifically peer rejection.
Aggression and C/U Traits
There is a substantial body of research linking C/U traits and aggression. Children and
adolescents with C/U traits have been found to show a unique relationship to
aggression. In particular, C/U traits have been strongly associated with proactive
aggression. This pattern is evident with youth from community samples (Barry et al.,
57
2007; Fanti et al., 2009; Mayberry & Espelage, 2007; Munoz et al., 2008), detained
youth (Flight & Forth, 2007; Kruh et al., 2005; Marsee & Frick, 2007), children from
community samples (Kimonis et al., 2006; Raine et al., 2006) and referred children
(Enebrink et al., 2005; Fite et al, 2009). A number of other studies have also established
a link between instrumental, or proactive violence and psychopathic traits in children
and adolescents (Barry et al., 2007; Fite et al., 2009; Flight & Forth, 2007; Kimonis et
al., 2006; Kruh et al., 2005; Mayberry & Espelage, 2007; Raine et al., 2006).
Children and adolescents with C/U traits view aggression as producing positive
consequences (Pardini et al., 2003) and they have little regard for the negative impact
their behaviours have on others (Jones et al., 2010). Pardini and Byrd (2012) found, in
their study of fourth- and fifth-grade students, that children exhibiting C/U traits,
compared to children not displaying these characteristics, saw aggression as an effective
means of social interaction, minimising the potential (that aggression has) to cause
harm, and they were less concerned about punishment for their antisocial behaviour.
This strongly supports the relationship of C/U traits to proactive aggression, a finding
further supported by the results from a study of adjudicated adolescents and their social-
cognitive processes and aggression (Pardini et al., 2003). Findings demonstrated that
youth with C/U traits clearly focused on the usefulness of aggression for its
effectiveness in producing rewards.
Of particular relevance to the current research, Blair (2007a) highlighted that consistent
with the notion of a link between psychopathy (C/U traits being a central element) and
aggression, several studies have demonstrated that adult psychopathic criminals are
more likely to engage in predatory (i.e., proactive) violence, while non-psychopathic
violent criminals are more likely to engage in reactive violence (Serin, 1991;
58
Williamson, Hare, & Wong, 1987). During adolescence, proactive aggressiveness is an
indicator of a psychopathic-like personality, whereas reactive aggression is not
(Pulkkinen, 1996; Raine et al., 2006). Raine et al. (2006), for example, found that
proactive aggression is characterised by psychopathic-like traits, delinquency, and
serious violent offending at adolescence (Mage = 16 years); while reactive aggression is
characterised by impulsivity, hostility, social anxiety, and lack of close friends. In a
follow up (from adolescence to early adulthood) of the participants in the Raine et al.
(2006) study, Fite et al. (2010) reported that at adulthood (Mage = 26 years), reactive
aggression was associated with negative emotionality (i.e., anxiety) while in contrast,
proactive aggression was related to psychopathic features and antisocial behaviour. In
other work, Marsee, Silverthorn and Frick (2005) reported stronger associations
between psychopathic-like traits and relational aggression in female children and
adolescents, compared to males.
Extensive research by Blair and colleagues (Blair, 2003, 2004, 2005, 2007a, 2007b,
2010, 2011, 2013a; Blair et al., 2001; Blair et al., 2006) has led to a proposal of a
neurological distinction between instrumental or proactive aggression and reactive
aggression. This research suggests that the use of proactive aggression in individuals
with psychopathic traits is due to neurobiologically based differences in these
individuals, which disrupts classical and operant conditioning, thereby preventing the
effect of aversive stimuli, such as victim distress and fear, to reduce the behaviours,
which elicit them. This process may be implicated in the lack of reaction to distressed
facial expressions shown by individuals with psychopathic traits. Aggressive children
who do not have C/U traits show increased reactivity to angry faces, whereas children
with C/U traits have difficulty recognizing distress cues (Dadds et al., 2006). When bias
in social information processing suggests that aggression will result in a desired
59
outcome and that the negative consequences that result are not a deterrent, but a viable
means to an end in the absence of empathy or conscience, these children see aggression
as an effective method of asserting dominance over others (Pardini et al., 2003).
According to Pardini and Byrd (2012) children with elevated C/U traits are unlikely to
relate victim suffering to their aggression, despite displaying the ability to interpret the
intentions of others.
Recent conceptualisations of juvenile psychopathy have focussed on C/U traits and their
relationship to the various forms of aggression (e.g., Barry et al., 2007; Barry, Frick, &
Killian, 2003). Surprisingly, Barry et al. (2007) reported that C/U traits were not related
to reactive or proactive aggression. As C/U traits can be interpreted as aggressive
behaviour towards other for personal gain, and C/U is theoretically related to proactive
aggression, this finding was unexpected and difficult to interpret.
Van Baardewijk, Vermeiren, Stegge and Doreleijers (2011) investigated self-reported
psychopathic traits and aggression in a sample of 159, 9-12 year olds and when they
controlled for the overlap between proactive and reactive aggression (thereby separating
the two and creating pure measures of proactive and reactive aggression), only the
relationship between psychopathic traits and proactive aggression remained. This is in
line with other findings in adult, adolescent and child psychopathy research
demonstrating psychopathic traits to be related to both types of aggression, but
particularly to premeditative, goal-directed and cold blooded proactive forms of
aggression not shared by those with low psychopathic traits (Flight & Forth, 2007;
Porter & Woodworth, 2006; Waschbusch & Willoughby, 2008).
In a study comprising a sample of detained adolescent girls, Marsee and Frick (2007)
found that reactive overt aggression was uniquely associated with emotional
60
dysregulation and anger due to provocation, while proactive overt aggression was
uniquely related to C/U traits. In this study reactive and proactive relational aggression
were found to show similar relationships with emotional dysregulation, anger to
provocation, and C/U traits as did reactive and proactive overt aggression. This appears
to support the theory put forward by Dodge and colleagues (Dodge & Frame, 1982;
Dodge & Coie, 1987; Dodge & Crick, 1990; Dodge et al., 2003; Dodge, Pettit,
McClaskey, Brown, & Gottnan, 1986), which explained aggression in terms of a social
information-processing theory that described competent social functioning. Applying
this model to aggressive children and empirically evaluating it, Dodge and Crick (1990)
concluded that information processing deficits leading to a bias in the interpretation of
the benign and ambiguous actions of others as hostile, results in reactive aggression.
These researchers concluded that the processing mechanism responsible for this is a
hostile attribution bias. According to the model, proactive aggression occurs as a result
of the anticipation of positive outcomes from aggressive actions. That is, proactive
aggression is deliberately used as an instrument to achieve desired outcomes.
Smithmyer, Hubbard and Simons (2000) investigated the relationship of proactive
aggression to underlying social cognitive beliefs and found support for their hypothesis
that (when the influence of reactive aggression is statistically removed) expecting
positive outcomes for aggressive acts is a belief that uniquely underlies proactive
aggression. Hubbard (2001) further explored this relationship with groups of 8- to 10-
year-old boys and found that reactive aggression was related to dyadic social
experience, rather than trait-like characteristics, and proactive aggression was related to
actor- and partner-driven factors. That is, characteristics of the group may influence the
use of reactive aggression, but the use of proactive aggression is related to the
61
characteristics of the individual and the characteristics of the target that may influence
expectations of a positive outcome to the aggressor from the aggressive act.
According to Marsee and Frick (2007) it is when proactive and reactive aggression are
present that children show the emotional and cognitive characteristics associated with
proactive aggression. Card and Little (2006) reported reactive aggression to be related
to internalising problems; low pro-social behaviour; low social preference and peer
acceptance; higher peer rejection; and victimization, whereas proactive aggression was
related to greater delinquency and peer rejection. In conclusion, psychological
maladjustment was found to be more strongly related to reactive aggression than to
proactive aggression.
In summary, the research reviewed in this second chapter has posed a number of
questions regarding children with C/U traits. It has also shown the existence of
relationships between C/U traits, loneliness, aggression and friendships. The majority of
studies to date have utilized teacher or parent reports as measures of these variables but
these do not provide an accurate insight into the subjective dispositions (e.g., lack of
empathy) that can only be obtained first hand; in this case, from the children
themselves. Developing age appropriate measures is therefore important for accurate
screening, and potential early identification and intervention (Lynam et al., 2009).
Moreover, to understand the full breadth of the manifestation of C/U traits, there is a
need to focus on non-forensic samples (Hare, 1999). Schools are appropriate places to
conduct research with young children with C/U traits because understanding the
developmental trajectories in younger community samples unaffected by incarcerations,
provides the best opportunities for developing effective treatments (Lynam, 1997).
Despite concerns such as the potential for response distortion and lack of
62
comprehensive content validity (Asscher et al., 2011) self-report measures are an
economical and effective means of obtaining an accurate insight into the subjective
dispositions that can be difficult to obtain from third parties such as teachers and parents
(Andershed, 2010). The current research, therefore, has strong justification for the use
of self-report instruments as it focuses on community samples of young children, who
themselves are perhaps the most reliable informants of their own actions.
Research Questions
Based on the aims of the proposed research, and in view of the literature reviewed in
this chapter, seven research questions have been developed:
Research Question 1: What are the critical shortcomings of current instruments used in
assessing C/U traits in children? (Study One)
Research Question 2: Can an instrument be developed, and its psychometric properties
established, to measure C/U traits in children? (Study Two)
Research Question 3: What is the factor structure of the newly developed instrument?
(Study Two)
Research Question 4: Are there differential patterns of C/U traits, aggression, and
loneliness in children? (Study Three)
Research Question 5: What are the similarities and differences regarding C/U traits,
aggression, and loneliness in children, as represented in case study profiles? (Study
Four)
63
Research Study 6: Does the newly developed instrument have educational utility and
does it, along with the measures of loneliness and aggression, produce meaningful
profiles? (Study Four)
Research Question 7: Are children with C/U traits, alone, aggressive, and unwanted?
(Studies Three and Four).
64
CHAPTER THREE
STUDY ONE: THE DEVELOPMENT OF THE CHILDREN’S AFFECTIVE
TRAITS INVENTORY
The objectives of Study One were to examine the theoretical perspective of Callous and
Unemotional Traits (C/U) and then develop a new instrument suitable for assessing
these traits in children. This was conducted in three separate yet inter-related phases.
Phase I comprised (i) a critical review of the research literature; (ii) a critical review of
current instruments which contained items used in the assessment of C/U traits; and (iii)
a critical review of the Inventory of Callous Unemotional Traits (ICU) (Frick: ICU,
2004), which is the most recent and promising of instruments developed. Phase II
focussed on the pooling, selection and rewording of relevant items from the literature
and scales that were reviewed. During this phase a panel of three academics with
expertise and knowledge of C/U traits and its diagnostic criteria was convened for
consultation. Still within Phase II, postgraduate educational psychology students and
three teachers and psychologists in Primary Behaviour Centres (for children with
challenging behaviours) provided feedback on the face and content appropriateness of
the newly developed scale. Overall, this phase resulted in a draft instrument, which was
pilot tested with children in Phase III.
Phase I: Reviewing the Literature and Instruments
Although the field of C/U traits has received considerable attention in adult and
adolescent populations, relatively limited work has been conducted with children. Of
this limited research almost all has been completed primarily within the construct of
psychopathy or psychopathic traits. Consequently there are few existing instruments
that have been specifically developed to solely measure C/U traits in children. As C/U
65
traits form the core of almost all measures of psychopathy used in populations of adults,
youths, and children alike and in both community and adjudicated settings, it was
decided that measures of psychopathy should be reviewed, along with the most
comprehensive and promising (and seemingly only) instrument developed to measure
C/U traits, namely the ICU (Frick: ICU, 2004).
The research literature shows that C/U traits describes a personality style characterised
by a lack of guilt or remorse, a lack of empathy, a lack of concern about performance,
and shallow or deficient affect. This cluster of characteristics is invariably included,
along with the other personality dimensions of impulsive and irresponsible behavioural
style, and arrogant and deceitful interpersonal style (Andershed et al., 2002; Houghton
et al., 2013) in the construct of psychopathy. It is, however, C/U traits that has been
described by many researchers as being the central feature of psychopathy (see Frick et
al., 2000). Within this review of the literature a number of instruments were identified
that have been used to assess C/U traits. To be included in the review of instruments the
following criteria were applied: Instruments had to assess the presence of C/U traits,
come from research published in a peer reviewed journal, and have qualities suitable for
use with children. From the application of the criteria, four instruments were identified,
namely: The Youth Psychopathic traits Inventory (YPI; Andershed et al., 2002), The
Youth Psychopathic traits Inventory-Child Version (YPI-CV; van Baadewijk et al.,
2008), The Constellation of Affective and Interpersonal Behaviours Screening
Instrument (CAIBSI; Houghton et al., 2013), and The Inventory of Callous
Unemotional traits (ICU; Frick, 2004). These instruments will now be described, albeit
relatively briefly.
66
The Youth Psychopathic Traits Inventory (YPI; Andershed et al., 2002) is a 50 item
self-report questionnaire specifically designed with screening in mind, and is primarily
aimed at the assessment of psychopathic features in adolescents from the general
population. To reduce social desirability bias, the YPI assesses these features indirectly,
describing feelings and opinions as competences rather than deficiencies, and in a way
making them likely to be viewed as positive or neutral traits by psychopathic
individuals (see Andershed et al., 2002). The 50 items making up the YPI are divided
into 10 subscales, each of five items, utilising a 4-point Likert scale with the responses
“Does Not Apply At All”, “Does Not Apply Well”, “Applies Fairly Well”, and “Applies
Very Well”. In the YPI psychopathy is conceptualised as being represented by three
factors, which are named: Grandiose-Manipulative (made up of the subscales dishonest
charm, grandiosity, lying and manipulation); Callous-Unemotional (made up of the
subscales callousness, unemotionality, and remorselessness); and Impulsive-
Irresponsible (made up of the subscales impulsiveness, thrill-seeking, and
irresponsibility). This factor structure has been found consistently across studies (see
Pihet, Suter, Meylan, & Schmid, 2014).
The YPI total score and three scale scores have demonstrated satisfactory psychometric
properties in a number of studies using the original Swedish version, or its translation
into English or Dutch (see Colins, Noom, & Vanderplasschen, 2012; Seals, Sharp, Ha,
& Michonski, 2012). However, the internal reliabilities reported for the Callousness
subscale have remained low (ranging from .32 to .58) in many studies. In a recent study
examining the YPI factor structure, Pihet et al. (2014) reported problems with the
Callousness subscale. When the average alpha across the Pihet et al. (2014) study was
combined with those from seven other studies (based on nearly 4,700 adolescents
comprising community and clinical samples) the alpha for Callousness was only .54.
67
The Youth Psychopathic Traits Inventory – Child Version (YPI-CV: van Baardewijk et
al., 2008) is an adaptation of the YPI (Andershed et al., 2002) and was developed by
rewording and simplification of the original items for suitability with 9- to 12-year-olds.
The structure of the original YPI (as described earlier) was retained, as were the
response options and its presentation in a self-report format. Therefore, the YPI-CV
items were not considered separately from the YPI in the development of the C/U traits
measure in the present research. However, the YPI-CV items were scrutinised to assist
with potential rewording of items for the new measure. Van Baardewijk et al. (2008)
found the items of the YPI-CV mapped onto the same three factors as the YPI, however
the best fit was achieved by removing the subscale labelled Lying. The internal
consistencies for the scales, including the C/U traits scale, have been found to be
satisfactory: Grandiose-Manipulative .89, Callous-Unemotional .80, Impulsive-
irresponsible .85 (see Van Baardewijk et al. (2008). However, the YPI-CV involved the
downward extension of the adolescent Youth Psychopathic traits Inventory (YPI:
Andershed et al., 2002), a procedure that has been open to criticism in other research
(see Houghton et al., 2013). Nevertheless, the YPI-CV has shown good stability. For
example, van Baardewijk, Vermeiren, Stegge and Doreleijers (2011) investigated the
18-month stability of self-reported psychopathic traits using the YPI-CV in a sample of
159, 9-12 year olds. The intraclass correlation coefficients were satisfactory for the
YPI-CV total score (.73), and the Callous-Unemotional (.63), Grandiose-Manipulative
(.59) and Impulsive-Irresponsible (.76) dimensions indicating moderate to high stability
over a period of 18 months. However, once again the instrument was assessing more
than C/U traits, which meant the C/U subscale was less than comprehensive in its item
content.
68
The Constellation of Affective and Interpersonal Behaviours Screening Instrument
(CAIBSI; Houghton et al., 2013) is a scale consisting of 26 items designed to screen for
psychopathic-like traits in Australian community based children and adolescents aged
five to 17 years. The CAIBSI, which is described in more detail on page 40 of this
thesis, built on the earlier development of the Child and Adolescent Psychopathy
Screening Instrument (CAPSI: see Cordin, 2007). This was achieved by further
reviewing previously existing instruments (Antisocial Process Screening Device
[APSD; Frick & Hare, 2001]; the Hare Psychopathy Checklist: Youth Version,
[PCL:YV; Forth et al., 2003]; the Psychopathic Personality Inventory, [PPI; Lilienfeld
& Andrews, 1996]; the Child Psychopathy Scale, [CPS; Lynam, 1997]; the Strengths
and Difficulties Questionnaire, [SDQ; Goodman, 1997]; the Millon Adolescent Clinical
Inventory, [MACI; Millon, & Davis, 1993]; and the Self -Report Psychopathy Scale,
Hare, 1990) and utilising suitable items from these. In addition, new items were
developed. The most recent version of the CAIBSI, developed through confirmatory
factor analysis (Houghton et al., 2013) includes a C/U subscale comprising six items.
The Inventory of Callous Unemotional Traits (ICU: Frick, 2004) is the most promising
of instruments developed specifically to assess C/U traits in adolescents. It is based on
the Antisocial Processes Screening Device (ASPD: Frick & Hare, 2001) and offers the
most comprehensive assessment of C/U traits to date. The four items of the APSD that
loaded consistently on the Callous-Unemotional factor in clinic and community samples
were expanded with six new items for each (of the four) original item (three similarly
positive worded items and three similarly negative worded items). The resulting 24
items are placed on a four point rating scale ranging from 0 (not at all true) to 3
(definitely true). As detailed earlier in this chapter there have been a number of
evaluations of the ICU and all have confirmed its factor structure (see Essau, et al.,
69
2006; Fanti et al., 2009; Roose et al., 2010) and reported moderate to satisfactory
coefficient alphas. Thus, there is a growing body of evidence supporting the ICU as a
promising assessment instrument.
In support of the ICU, it addresses three limitations identified in the ASPD, namely that
it (i.e., APSD) (i) has a very small number of items assessing C/U traits, (ii) the ASPD
uses a three-point Likert scale, which provides a limited range of responses and a
middle point to which respondents often gravitate, and (iii) most of the items are
worded in the same direction, which may induce a response-set. To date, however, there
appears to have been very few applications of the ICU with children. C/U traits are
more associated with the childhood onset trajectory of severe conduct problems and are
one component of the features indicative of adolescents and adult psychopathy (Cooke
& Michie, 1997). Thus, the validation of appropriate measures for this age group is
necessary if the development of preventive interventions is to be forthcoming.
The characteristics of the instruments measuring C/U traits and reviewed in this chapter
are summarized in Table 3.1.
70
Table 3.1 Summary of Instruments Reviewed that Measure Callous Unemotional Traits
Instrument Age Range/Grade Number of Items Population Studied Response Option Informant
The Youth Psychopathic traits Inventory (YPI; Andershed, Kerr et al., 2002)
12 to 20 years 50 Non-referred youth
4 (applies very well) 3 (applies fairly well) 2 (does not apply well) 1 (does not apply at all)
Self-report measure of psychopathic
traits
The Youth Psychopathic Traits Inventory – Child Version (YPI-CV;
van Baadewijk et al., 2008) 9 to 12 years 50 Non-referred children
4 (applies very well) 3 (applies fairly well) 2 (does not apply well) 1 (does not apply at all)
Self-report measure of psychopathic
traits
The Constellation of Affective and Interpersonal Behaviours Screening
Instrument (CAIBSI; Houghton et al., 2013)
5 to 17 years 29 Normative school
sample and detention sample
3 (definitely true) 2 ( ) 1 ( ) 0 (definitely not true)
Self-report screening for
psychopathic traits in Australian children and adolescents
The Inventory of Callous Unemotional traits (ICU; Frick, 2004)
12 to 18 years 24 Normative sample and
offender sample
3 (definitely true) 2 ( ) 1 ( ) 0 (not true at all)
Self-report screening measure
of callous unemotional traits
in adolescents
71
Phase II: Creating the Item Pool
From the instruments reviewed, an initial item pool of 48 items was generated as shown
in Table 3.2. The 15 items from the YPI were those from the Remorselessness,
Unemotionality and Callousness subscales which, using factor analysis were found to
form one factor labelled Callous/Unemotional (Andershed et al., 2002; Larsson et al.,
2007). The nine items from the CAIBSI were those items loading on the C/U factor. All
24 items from the ICU were included as this instrument measures C/U traits
exclusively. The item pool was checked by a second, independent person.
Table 3.2 Source of the 48 initial items for the draft CU Scale.
Item Description Source
1 To feel guilty and remorseful about things you have done that have hurt other people is a sign of weakness.
YPI
2 I have the ability not to feel guilt and regret about things that I think other people would feel guilty about.
YPI
3 When someone finds out about something that I’ve done wrong I feel more angry than guilty.
YPI
4 To feel guilt and regret when you have done something wrong is a waste of time.
YPI
5 I seldom regret things I have done even if others feel they are wrong.
YPI
6 I usually feel calm when other people are scared. YPI 7 What scares others usually doesn’t scare me. YPI 8 To be nervous and worried is a sign of weakness. YPI 9 I don’t let my feelings affect me as much as people’s feelings
seem to affect them. YPI
10 I don’t understand how people can be touched enough to cry by looking at things on TV or a movie.
YPI
11 I think crying is s sign of weakness even if no one sees you. YPI 12 When others have problems it is often their own fault therefore
one should not help them. YPI
13 I often become sad or moved by watching sad things on TV or film.
YPI
14 I usually become sad when seeing others crying or being sad. YPI 15 It is important for me not to hurt people’s feelings.
YPI
72
Table 3.2 Source of the 48 initial items for the draft CU Scale.
Item Description Source 16 I show respect for those in authority. CAIBSI 17 I am willing to help others when they need help. CAIBSI 18 I feel bad when I do something wrong. CABSI 19 I feel that when others have problems it is often their own fault
therefore we should not help them. CAIBSI
20 I do not care about adult approval or praise. CAIBSI 21 I take responsibility for my behaviour. CAIBSI 22 I fulfil the promises I make to others. CAIBSI 23 I have used my charm to use others. CAIBSI 24 I have been told I do not know the difference between right and
wrong. CAIBSI
25 I do not show my emotions to others. ICU 26 I express my feelings openly. ICU 27 I hide my feelings from others. ICU 28 It’s easy for others to tell how I am feeling. ICU 29 I’m very expressive and emotional. ICU 30 I do not care about doing things well. ICU 31 I do not like to put the time into doing things well. ICU 32 I do not feel remorseful when I do something wrong. ICU 33 I do not care about being on time. ICU 34 I do not care if I get into trouble. ICU 35 I seem very cold and uncaring to others. ICU 36 The feelings of others are important to me. ICU 37 I do not care who I hurt to get what I want. ICU 38 I am concerned about the feelings of others. ICU 39 I work hard on everything I do. ICU 40 I always try my best. ICU 41 42
I care how well I do at school or work. I do not show my emotions to others
ICU ICU
43 I do things to make others feel good. ICU 44 I apologise (say “I am sorry”) to persons I hurt. ICU 45 I feel bad or guilty when I do something wrong. ICU 46 I easily admit to being wrong. ICU 47 48
I try not to hurt other’s feelings. What I think is “right” and “wrong” is different from what other people think.
ICU ICU
A refining process of the item pool was then undertaken by convening a panel
comprising three academics with knowledge and expertise in child developmental
psychopathology, C/U traits and measurement and a practising psychologist. This panel
met with the researcher with the aim of identifying duplicate items and items not
73
relevant to the age group in the research (i.e., seven- to 12-year-olds) for potential
removal. The panel members were provided with the item pool prior to the meeting.
During a one-hour meeting eight items were removed because they were not relevant to
the population in the study or were duplicate items. This left a pool of 40 items (see
Table 3.3). These items were then put into a questionnaire document format.
Table 3.3 Source of the 40 items for the draft CU Scale following Panel Refinement. Scale Items YPI CAIBSI ICU
I do not care about doing things well • I keep the promises I make to others • I do not care if I get into trouble • I care how well I do at school • I do not like to put the time into doing
things well •
I feel bad or guilty when I do something wrong
•
I easily admit to being wrong • I hide my feelings from others • I usually become sad when seeing others
crying or being sad •
I do not care about being on time • I am willing to help others when they need
help •
I do not feel sorry when I do something wrong I do not show my emotions to others
• •
I get upset when I see an animal getting hurt I do not understand how people can cry
about things they watch on TV or a movie •
I show respect for those in authority (e.g. Parents, teachers, police)
•
I have been told that I do not know the difference between right and wrong
•
I do not care about adult approval or praise • The feelings of others are not important to
me •
I feel that when others have problems it is their own fault therefore we should not help them
•
I have used my charm to use others •
74
Scale Items YPI CAIBSI ICU I work hard on everything I do •
I do not show my emotions to others • It is easy for others to tell how I am feeling • I think crying is a sign of weakness even if
no-one sees you •
I take responsibility for my behaviour • I show my feelings openly • I often become sad when I see sad things on
TV or movies •
It is hard for me to see why someone else gets upset
I try not to hurt other’s feelings • I always try my best • I hardly ever regret things I have done even
if others feel they are wrong •
I am concerned about the feelings of others • I apologise (say I am sorry) to people I hurt • I do not get scared by things that usually
scare others •
I do things to make others feel good • I do not let my feelings affect me as much
as other people’s feelings seem to affect them
•
I usually feel calm when other people are scared What I think is “right” and “wrong” is different from what other people think
• •
I am very expressive and emotional • I seem very cold and uncaring to others • I do not care who I hurt to get what I want •
To check the face and content appropriateness of the draft questionnaire it was
presented to 20 students in the final year of their Master of Educational Psychology
professional training degree programme along with three teacher/psychologists
employed in primary behaviour centres. These three individuals were females and had
between 5 and 15 years of experience working with mainstream primary school children
referred to behaviour centres because of their challenging behavioural problems
(primarily physical aggression against staff and or peers). These individuals were
invited to provide both written and verbal comments about the draft questionnaire and
its items. The feedback received suggested several modifications were necessary.
75
Specifically, almost all of the students commented on the unsuitability of the wording of
two items with regard to their use with children. As a result some rewording occurred:
The item “I do not feel remorseful when I do something wrong” was changed to “I do
not feel sorry when I do something wrong”; and the item “I care how well I do at school
and work” was modified to “I care how well I do at school.” This latter item was
modified because children of this age rarely, if ever, engage in work.
The postgraduate students commented that the response option format - a four point
Likert response format anchored with the descriptors Not True of Me (scored 0),
Sometimes Not True of Me (= 1), Sometimes True of Me (= 2), and True of Me (= 3) was
appropriate. To assist respondents it was decided to include an example statement
instruction (i.e., “read each statement carefully and think how well they describe you”
and then “put a tick in the one box that best describes you”).
Phase III: Pilot Study and Initial Validation of the Instrument
Method
Participants and Settings
Thirty children (15 males and 15 females) randomly selected from each of Grades
Three, Four, Five, Six and Seven, from two separate randomly selected primary schools
(15 children per school, three from each year group) in the metropolitan area of the
Western Australian capital city of Perth, completed the newly developed draft
instrument. One school was located in a low to middle socio economic status (SES) area
and the other in a middle SES area as determined by an index defined at the postcode
level from the Australian Bureau of Statistics (2008). The ages of the children ranged
from 7 to 13 years (Mage = 11.8 years). Of the 30, seven had records detailing
antisocial behaviour ranging from general disruptive behaviour in the classroom
76
through to physical aggression against peers. To obtain the sample of N = 30 for the
pilot, the principals of the two schools were invited to randomly select 10 children from
each of the Year groups (potential n = 100, 50 per school). Three students from each of
the grade levels in each of the two schools were then randomly selected to form the
sample of 30.
Instrumentation
The draft instrument, tentatively titled the Children’s Affective Traits Inventory
(ChATI) (reproduced in Appendix A) consisted of 40 items, which measure the
essential characteristics of C/U traits in children. Participants responded on a 4-point
scale anchored with the descriptors Not True of Me (scored 0), Sometimes Not True of
Me (= 1), Sometimes True of Me (= 2), and True of Me (= 3), with higher scores on the
instrument being indicative of higher levels C/U.
Procedure
Prior to the research being conducted, permission was obtained from the Human
Research Ethics Committee of the administering institution and the key stakeholders.
Following approval the principals of the two randomly identified schools was contacted
by telephone and at this time the researcher explained the objectives of the research and
then asked if the principals would be interested in participating. Both agreed and so
written information describing the research was provided to the principals, who then
randomly selected the children to whose parents information sheets and consent forms
would be sent. Parents of selected children were provided with an information sheet that
assured them of their child’s (and their own) confidentiality and anonymity. A consent
form (reproduced in Appendix D) was also provided. Data were only obtained from
77
participants whose parents had given their consent. From the returned consent forms (n
= 58) 30 children were randomly selected to participate.
Results
Data Analyses
The data were analysed with Microsoft Office Excel (Microsoft Corporation, 2007) and
the spss statistical package, IBM Incorporated, 2010). Initially, a thorough visual
examination of the data set was undertaken to determine the amount of missing data or
anomalies in the data set. No missing data were evident. Next, the psychometric
properties of the instrument (i.e., the item affectivity, the item discrimination, and the
internal reliability) were examined separately.
The visual examination of the data matrix indicated that this matrix comprised 30 rows
(corresponding to the 30 children) and 40 columns (corresponding to the 40 scale
items). A total ChATI score was then calculated for each of the 30 children by summing
the responses to the 40 scale items. This resulted in scores ranging from 0 to 120. Next,
the sum total for each of the 40 scale items was calculated by summing the item
responses (i.e., 0, 1, 2, or 3) for each of the 30 children, thereby yielding a value of 0 to
90.
For item analyses in the ChATI, items were assessed using Kline's (2000) dual criteria:
(a) a satisfactory q-value of between .2 and .8 for item affectivity and (b) a correlation
of the item with the total score beyond .3 for item discrimination. This was followed by
a measure of the reliability of the instrument with Cronbach's alpha coefficient, utilising
Nunnally and Bernstein's (1994) recommended criterion of .70 and above.
78
Item Affectivity
The index of item affectivity is the proportion of the total participants who found it
difficult to endorse the item (Osterlind, 1989). To calculate the item affectivity, the
participant’s (n = 30) individual item responses in the Microsoft Office Excel data
matrix were summed to create a sum total for each ChATI item, thereby yielding a
value ranging from 0 to 90. The sum totals were converted to a proportion (i.e., p-
values) of the maximum sum total attainable on that item. The complementary
proportions (i.e., q-values) of the p-values, which represent the item affectivity of the
items, were then computed before being sorted by ascending q-values. The item
affectivity of the 40 ChATI items ranged from .37 to .84, indicating that all items
exceeded Kline’s lower recommended item affectivity range (>.2) while three exceeded
the upper item affectivity range (< .8). It was therefore necessary to examine some of
the items. As shown in Table 3.4, items with q values above .8, indicating items that
were difficult to endorse, were Items 6 (“I feel bad or guilty when I do something
wrong” – reverse scored), 30 (“I always try my best” – reversed scored) and 40 (“I do
not care who I hurt to get what I want”). There were no items below the .2 cut-off point,
which would have indicated items that were easy to endorse. Figure 3.2 provides a
pictorial representation of the placement of example items within the .2 to .8 range.
79
Table 3.4. Item Affectivity of the Draft Children’s Affective Traits Inventory (ChATI).
Item q Item q
1 .68 21 .74 2 .68 22 .49 3 .69 23 .49 4 .74 24 .59 5 .73 25 .72 6 .82 26 .46 7 .62 27 .40 8 .49 28 .66 9 .47 29 .70 10 .73 30 .82 11 .67 31 .59 12 .73 32 .68 13 .76 33 .68 14 .59 34 .28 15 .73 35 .77 16 .62 36 .37 17 .73 37 .46 18 .64 38 .46 19 .72 39 .64 20 .74 40 .84
Problem items are shown in shaded grey.
80
.70
.65
.60
.55
.50
.45
.40
.35
.30
.25
Item 1. I do not care about doing things well Item 2. I keep the promises I make to others
Item 5. I do not like to put the time into doing things well
Item 9. I usually become sad when seeing others crying or being sad
14. I do not understand how people can cry about things they watch on TV or a movie
Item 18. The feelings of others are not important to me
Item 26. I show my feelings openly
Item 7. I easily admit to being wrong
Item 11. I am willing to help others when they need help
Item 24. I think crying is a sign of weakness even if no-one sees you
Item 27 I often become sad when I see sad things on TV or movies
Item 20. I have used my charm to use others
Item 22. I do not show my emotions to others Item 23. It is easy for others to tell how I am feeling
Item 28. It is hard for me to see why someone else gets upset
Item 8. I hide my feelings from others
Figure 3.1. Examples of item affectivity (q-values) from the ChATI. 81
Item Discrimination
The item discrimination for each of the 40 ChATI items was then assessed by
computing the Pearson Product-Moment Correlation coefficient (r). The item
discrimination represents the degree to which the responses obtained for a particular
item correlate with the participants’ total scores on the instrument (Streiner & Norman,
1995; Sax, 1997) and expresses quantitatively the magnitude and direction of the
relationship. The magnitude of the correlation coefficient can range in value from +1 to
-1, with the numerical part of the correlation coefficient describing the magnitude of the
correlation; that is, the higher the number the greater the correlation. Ideally, the item
discrimination indices should be a correlation coefficient of .30 or above (Kline, 2000;
Pallant, 2007). Items with discrimination indices of less than .30 reflect items that need
to be either rejected or revised. Positive discrimination indices denote that participants
who highly endorse these items will have a higher total score on that measure, relative
to participants who do not; conversely, negative discrimination indices are indicative of
problematic items, as participants who highly endorse these items will have lower total
scores, instead of a higher total score on that measure.
Table 3.5 presents the discrimination power of these items, which ranged from -.011 to
.74. Twenty-five of the 40 items showed acceptable positive discrimination power of
.30 or higher. Thirteen items, however, had a discriminatory power of less than .3.
Further investigation of these items was hence necessary regarding their retention or
removal. The item discrimination values as well as means and standard deviations for
the 40 items are shown in Table 3.5.
82
Table 3.5 Discrimination of Children’s Affective Traits Inventory Items (n = 30)
Item M SD Item Discrimination (r)
1 .97 .99 .421* 2 .97 1.07 .507** 3 .93 1.31 .266 4 .77 1.10 .452* 5 .80 .99 .178 6 .53 .86 .427* 7 1.13 1.07 .501** 8 1.53 1.14 .086 9 1.60 1.16 .386* 10 .80 1.06 .600** 11 1.00 1.20 .656** 12 .8 1.13 .394* 13 .73 1.01 .287 14 1.23 1.22 .421* 15 .80 1.09 .405* 16 1.13 1.25 .257 17 .80 1.03 .216 18 1.07 1.11 .403* 19 .83 1.02 .422* 20 .77 1.04 .566** 21 .77 .93 .566** 22 1.53 1.14 .238 23 1.53 1.25 -.011 24 1.23 1.22 .280 25 .83 1.12 .584** 26 1.63 1.07 .205 27 1.80 1.28 .313 28 1.03 .96 .186 29 .90 1.03 .740** 30 .53 .87 .545** 31 1.23 1.10 .175 32 .97 .99 .547** 33 .97 1.13 .736** 34 1.87 .97 -.007 35 .70 .88 .514** 36 1.90 .96 .049 37 1.63 1.16 .365* 38 1.63 1.10 .487** 39 1.07 1.11 .606** 40 .47 .82 .577**
Note. *p < .05 (2 tailed). **p < .01 (2-tailed). Items with low and/or negative correlation are shaded in grey.
In considering the retention or removal of any of the C/U items, the item affectivity and
discrimination indices were examined together and interpreted in the light of their
theoretical relevance. Table 3.6 shows the item affectivity and discrimination indices for
83
the Children’s Affective Traits Inventory. As can be seen, three items (Item 6: “I feel
bad or guilty when I do something wrong”; Item 30: “I always try my best”; and Item
40: “I do not care who I hurt to get what I want”) were found to have item affectivity
>.8, however their discrimination values were acceptable and they had high theoretical
relevance. It was therefore decided that they should be retained. Item 6 deals with guilt,
which is an important element of a callous and unemotional interpersonal style (Frick &
Moffitt, 2010; Roose et al., 2010). Item 30 addresses another key aspect of C/U traits,
specifically a lack of concern about performance (Frick & Moffitt, 2010). Item 40
addresses the callous lack of empathy, which is also a key aspect of C/U traits.
With reference to the Item Discrimination indices 14 items attained values below the .3
recommended cut off. These items were examined closely with regard to their
affectivity scores and theoretical validity for potential removal. The items subsequently
removed were item 23 (“It is easy for others to tell how I am feeling” - discrimination
coefficient of -.011), item 34 (“I do not get scared by things that usually scare others” -
discrimination coefficient of -.007), item 5 (“I do not like to put the time into doing
things well” - discrimination coefficient of .178), item 36 (“I do not let my feelings
affect me as much as other people’s feelings seem to affect them” - discrimination
coefficient of .049). This left a total of 36 items.
With reference to other potential problematic items an examination of the item
affectivity and discrimination scores together along with their theoretical relevance
suggested they should be retained. Specifically, Item 16 (“What I think is right and
wrong is different from what other people think”), Item 27 (“I do not let my feelings
control me), Item 3 (“I do not care if I get into trouble.”), Item 17 (“I do not care about
adult approval or praise.”), and Item 31 (“I hardly ever regret things I have done even
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if others feel they are wrong”) refer to lack of concern about performance, which is an
important element of C/U traits as described by Frick and Moffitt (2010). Items 8 (“I
hide my feelings from others.”), 22 (“I do not show my emotions to others.”), 24 (“I
think crying is a sign of weakness even if no one sees you.”), and 26 (“I show my
feelings openly” - reverse scored) indicate shallow or deficient affect (Frick & Moffitt,
2010; Roose et al., 2010). Items 13 (“I get upset when I see an animal getting hurt” -
reverse scored) and 28 (“It’s hard for me to see why someone else gets upset”) indicate
a lack of empathy, another key element of C/U traits (Frick & Moffitt, 2010; Roose et
al., 2010).
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Table 3.6 Item Affectivity and Discrimination Values for the Children’s Affective Traits Inventory
Item
Item Discrimination
(r)
Item
Affectivity (q)
1
.421
.68
2 .507 .68 3 .266 .69 4 .452 .74 5 .178 .73 6 .427 .82 7 .501 .62 8 .086 .49 9 .386 .47 10 .600 .73 11 .656 .67 12 .394 .73 13 .287 .76 14 .421 .59 15 .405 .73 16 .257 .62 17 .216 .73 18 .405 .64 19 .422 .72 20 .566 .74 21 .566 .74 22 .238 .49 23 -.011 .49 24 .280 .59 25 .584 .72 26 .205 .46 27 .563 .40 28 .186 .66 29 .740 .70 30 .545 .82 31 .175 .59 32 .547 .68 33 .736 .68 34 -.007 .38 35 .514 .77 36 .049 .37 37 .365 .46 38 .487 .46 39 .606 .64 40 .577 .84
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Reliability of the Scale
The Cronbach’s alpha coefficient was computed to establish the degree of internal
reliability of the 36 retained ChATI items, to ascertain that these items were measuring
the same underlying construct, namely, C/U traits. The overall alpha coefficient of the
ChATI was .94 and therefore greater than >.7 as recommended by Nunnally and
Berstein (1994). This demonstrated satisfcatory internal reliability of the 36 items.
Inspection of the “Cronhach’s alpha if item deleted” (presented in Table 3.7), which is
the impact of removing each item from the scale, suggested there would not be any
substantial improvement in the internal reliability of the scale with the deletion of any
single item.
Table 3.7 Cronbach’s Alpha if Item Deleted.
Item Cronbach's
Alpha if Item Deleted
Item Cronbach's
Alpha if Item Deleted
Item Cronbach's
Alpha if Item Deleted
Chati1 .94 Chati15 .94 Chati29 .91 Chati2 .92 Chati16 .92 Chati30 .93 Chati3 .93 Chati17 .91 Chati31 .94 Chati4 .91 Chati18 .94 Chati32 .94 Chati6 .92 Chati19 .93 Chati33 .93 Chati7 .91 Chati20 .94 Chati35 .92 Chati8 .92 Chati21 .94 Chati37 .94 Chati9 .91 Chati22 .94 Chati38 .94 Chati10 .92 Chati24 .93 Chati39 .94 Chati11 .93 Chati25 .93 Chati40 .94 Chati12 .90 Chati26 .92 Chati13 .92 Chat27 .91 Chati14 .94 Chati28 .92
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Readability of the Scale
The readability levels of the ChATI were measured using The Flesch-Kincaid Grade
Level (i.e., the number of years of education required to understand a standard reading
passage) and The Flesch Reading Ease (i.e., the difficulty level of reading a normal
reading passage) (see Flesch, 1948; Microsoft Corporation, 2003). The ChATI was
considered appropriate, comprehensible and easy (Reading Ease = 85.9; a score of 80
and above indicates an “easy to a very easy” reading passage) for Australian school
students enrolled in Grade Three (Flesch-Kincaid Grade Level; age 7 years and above).
In summary, the purpose of Study One, which was to develop and conduct a
preliminary validatation of a self-report measure of C/U traits in children (tentatively
titled the ChATI), was achieved. Unlike many other studies this present work examined
the item functioning of the new instrument using affectivity (i.e., items which
participants consistently find easy or difficult to endorse: see Osterlind, 1989) and
discrimination indexes (i.e., the degree to which the responses obtained for a particular
item correlate with the participants’ total scores on the instrument: Sax, 1997; Streiner
& Norman, 1995). Using Kline's (2000) dual criteria four items were found to be
unsatisfactory and so they were deleted. The resulting Cronbach’s alpha coefficient was
satisfactory (α = .94). In the second study in this thesis the 36-item instrument will be
further validated through confirmatory factor analysis and then utilised to test for
differences among mainstream primary school children.
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CHAPTER FOUR
STUDY TWO: ASSESSING CALLOUS UNEMOTIONAL TRAITS IN
CHILDREN - FURTHER VALIDATION OF THE ChATI
The preceding chapter described the development and construction of the items and
preliminary validation of the psychometric properties (i.e., item affectivity, item
discrimination, and internal reliabilities) of the new self-report measure of C/U traits.
This fourth chapter reports Study Two, which extends the validation of the instrument
by confirming its factor structure with a larger sample size (n = 268).
Method
Participants and Settings
Two hundred and sixty eight children (138 males, 115 females, [15 unknown])
randomly selected from Grades Three (age seven to eight years) to Seven (age 12 years)
in three separate primary schools in the metropolitan area of Perth, the capital city of
Western Australian participated. Of the 268 participants, 39 were in Grade Three, 44 in
Grade Four, 63 in Grade Five, 47 in Grade Six, and 47 were in Grade Seven. (The grade
levels of 28 were not provided.) Participant’s ages ranged from 7.6 years to 12.8 years
years. For purposes of data analyses, 146 of the sample were classified as lower primary
school (i.e., Grades Three, Four, and Five: Aged 7 to 10 years) and 96 were classified as
upper primary school (i.e., Grades Six and Seven: Aged 11 to 13 years).
The schools, none of which were included in the preliminary validation study, were
located in low and low-middle socioeconomic status areas as determined by an index
defined at the postcode level from the Australian Bureau of Statistics (2008).
89
Instrumentation
The initial development and validation of the instrument which resulted in a 36 item
self-report scale with a four point Likert scale anchored with the descriptors Not true of
Me (scored 0), Sometimes Not True of Me (= 1), Sometimes True of Me (= 2), and True
of Me (= 3) was described in detail in the previous chapter.
Procedure
Approval for the research was obtained from the Human Research Ethics Committee of
the administering institution. Permission for the research had already been obtained
from the key stakeholders involved. In addition, it was ensured that all procedures
complied with the ethical standards of the Australian Psychological Society Code of
Ethics (2007) (Australian Psychological Society, 2007). Initially, six primary schools
were randomly selected (two located in high SES, two in middle SES and two in low
SES areas) from within the metropolitan region of Perth, the capital city of Western
Australia. The principals of these schools were approached to gauge their interest in
participating in the research and of the six, three volunteered to participate. (At the time
of the research statewide testing was taking place and this was offered as the reason for
not participating in the three who declined.) Of the three state primary schools that
comprised the sample, one was located in a middle SES area and two were in low SES
areas. The schools varied in size with a range of student enrolments being from 130 to
280.
An information sheet explaining the purpose and nature of the study, along with an
assurance of confidentiality and a consent form were then sent home to the parents of all
students in each of one randomly selected class across the grade levels three to seven in
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each of the participating schools. To be included in the study required both students and
their parents signed the consent to participate form. Overall, there was a positive
response rate of 63%. (The information sheet provided to principals is shown in
Appendix B. The information letter provided to parents is shown in Appendix C. The
parents’ consent form is shown in Appendix D.)
The draft instrument was subsequently administered by the researcher, who has full
psychologist registration. Prior to administration all children were verbally informed
about the nature of the study and assured of confidentiality and anonymity of their
responses. Children were also informed that they could withdraw from the study at any
time without prejudice. None of the children chose to do so. Participants were then
requested to complete the instrument without peer discussion. They were also informed
that should they encounter any problems with any of the questions, they should raise
their hand to obtain support from the researcher. These same instructions and format of
delivery was consistent across all classes. On average, each administration took
approximately 20 minutes.
Data analysis
First, based on previous research, a confirmatory factor analysis of the most viable and
promising model of C/U traits was conducted using AMOS 19.0, namely a three-factor
model. The three factors were based on the current research literature and the most
promising of contemporary instruments - the ICU (Frick, 2004). The three latent
variables (Uncaring, Callousness, and Unemotional) were modelled to be independent
but correlated. Four indices to assess the goodness of fit of a first-order measurement
model were used: The comparative fit index (CFI: above .95 indicates good fit, above
.90 indicates adequate fit), the root mean-square error or approximation (RMSEA: .05
or less indicates good fit, .08 or less indicates adequate fit), the CMIN/DF (lower than
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2-3 indicates good fit: Carmines & McIver, 1981), and chi-square (non-significant
values represent good fit). To improve model fit, items were incrementally dropped.
Once the best-fit model was arrived at, the equivalence of the measurement model
across gender and across school-stage was evaluated. Finally, differences in mean levels
of the final factor model were examined across gender and age using ANOVA.
Results
As can be seen in Figure 4.1 the three-factor 36-item model fit indices showed mixed
support for the three-factor model. The χ2 test [χ2 (df = 592) = 1233.183, p < .001] and
the CFI (.72) both indicated a poor fit of the data to the hypothesised model, but the
CMIN/DF ratio (2.083) and the RMSEA (.064) indicated acceptable fit. It can be seen
in the Regression Weights shown in Table 4.1 that all factor loadings for the three-
factor model were significant with the exception of those for Unemotional. In addition,
CU Factor #13, #19 and #25 were also non-significant. Table 4.2, which shows the
Standardised Regression Weights for the three-factor model, reveals that the factor
loadings ranged from .130 (Factor Callous [CU]: #13) to .822 (Factor Uncaring: #31).
The inter-correlations between the three factors were Callous – Unemotional (.391),
Unemotional – Uncaring (.296), and Callous – Uncaring (.947).
A competing one factor model was tested and the model fit indices showed mixed
support. The χ2 test [χ2 (df = 135) = 314.465, p < 0.001], the CFI (.76), and NFI (.66)
indicated poor fit of the data to the model, but the CMIN/DF ratio (2.39) and RMSEA =
.071 (90 % CI: .060, .80) indicated acceptable fit. The Regression Weights indicated
four were non-significant and the Standardised Regression Weights revealed factor
loadings ranged from .138 to .629 (six were below .3).
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Figure 4.1 The 36-item Three-Factor Model Fit Indices.
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Table 4.1. Regression weights for the three-factor model
Item Estimate S.E. C.R.
p
33 <--- Unemotional 1.184 .544 2.178 .029 24 <--- Unemotional 1.071 .519 2.063 .039 21 <--- Unemotional 2.356 .912 2.584 .010 7 <--- Unemotional 1.960 .772 2.537 .011 4 <--- Uncaring 1.000 5 <--- Uncaring .927 .122 7.571 *** 6 <--- Uncaring .783 .127 6.158 *** 20 <--- Uncaring 1.078 .120 9.017 *** 27 <--- Uncaring 1.056 .117 9.034 *** 28 <--- Uncaring 1.127 .125 9.018 *** 31 <--- Uncaring 1.228 .120 10.219 *** 32 <--- Uncaring .857 .102 8.441 *** 9 <--- CU 1.525 .301 5.073 *** 11 <--- CU 1.276 .265 4.817 *** 30 <--- CU 1.390 .262 5.300 *** 25 <--- CU .659 .217 3.034 .002 17 <--- CU 1.344 .272 4.944 *** 8 <--- CU .740 .215 3.441 *** 1 <--- CU 1.000 3 <--- CU 1.213 .255 4.752 *** 36 <--- Uncaring .809 .117 6.925 *** 35 <--- Uncaring .627 .126 4.971 *** 18 <--- CU 1.455 .277 5.256 *** 23 <--- CU 1.361 .254 5.364 *** 10 <--- CU .962 .199 4.848 *** 2 <--- CU .749 .181 4.133 *** 14 <--- CU 1.461 .273 5.354 *** 12 <--- CU 1.019 .226 4.517 *** 26 <--- Unemotional 1.131 .538 2.101 .036 19 <--- CU .388 .210 1.850 .064 16 <--- CU 1.307 .267 4.904 *** 15 <--- CU 1.160 .272 4.260 *** 13 <--- CU .415 .217 1.910 .056 22 <--- Unemotional 2.552 .988 2.584 .010
Note: No critical ratios are stated for the respective first factor loadings because these were fixed to unity to scale the latent variables.
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Table 4.2. Standardised regression weights for the three-factor model
Item
Factor Estimate
34 <--- Unemotional .226 33 <--- Unemotional .271 24 <--- Unemotional .244 21 <--- Unemotional .528 7 <--- Unemotional .462 4 <--- Uncaring .606 5 <--- Uncaring .545 6 <--- Uncaring .429 20 <--- Uncaring .687 27 <--- Uncaring .685 28 <--- Uncaring .685 31 <--- Uncaring .822 32 <--- Uncaring .626 9 <--- CU .527 11 <--- CU .464 30 <--- CU .593 25 <--- CU .223 17 <--- CU .494 8 <--- CU .264 1 <--- CU .364 3 <--- CU .450 36 <--- Uncaring .491 35 <--- Uncaring .353 18 <--- CU .576 23 <--- CU .615 10 <--- CU .472 2 <--- CU .349 14 <--- CU .609 12 <--- CU .407 26 <--- Unemotional .250 19 <--- CU .131 16 <--- CU .485 15 <--- CU .366 13 <--- CU .130 22 <--- Unemotional .524
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Sixteen items were then incrementally dropped, each time dropping the lowest loading
item to improve model fit. This procedure ceased when none were loading below .3.
The 20 items that remained, shown in Figure 4.2, were all from the established ICU
(Frick, 2004). The χ2 test [χ2 (df = 167) = 380.09, p < .001] and the CFI (.85) both
indicated a poor fit of the data to the hypothesised model, but the CMIN/DF ratio (2.28)
and the RMSEA (.07, 90% confidence interval [CI]: .06, .08) indicated acceptable fit.
Figure 4.2 The 20-Item Three-Factor Model Fit Indices
Examining the factor loadings across all items, one was below .3 (“I do not show my
emotions to others”, loading = .27). In addition, the internal reliability for the associated
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factor (Unemotional) was poor (α = .47). Removing the item with the low loading did
not improve the scale reliability and, in fact, further reduced it (α = .44). Other
measurement models (a two factor model as shown below) pertaining to these traits
(e.g., as found in the CAIBSI: Houghton et al., 2013) cluster the Callous and
Unemotional traits together, so a model where the four Unemotional items were loaded
on the Callous factor was tried. However, this did not improve fit, χ2 (df = 169) =
417.43, p < .001, CFI = .82, CMIN/DF = 2.47, RMSEA = .07, 90% CI: .07, .08) and the
four Unemotional items all had very low loadings (.08 to .23). This model, shown in
Figure 4.3, was not therefore accepted as a viable alternative.
Figure 4.3. Two-factor model with the four unemotional items loaded on C/U
Therefore, the four item Unemotional scale was deleted and the 16-item model
reassessed. This marginally decreased the levels of fit: χ2 (df = 103) = 280.32, p < .001,
CFI = .86, CMIN/DF = 2.72, RMSEA = .08, 90% CI: .07, .09).
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In order to further improve fit, the item descriptors were reviewed to evaluate whether
items were similar enough to justify correlating their associated errors. In this way eight
pairs of errors were calculated: “I do not care if I get into trouble” and “I do not feel
sorry when I do something wrong”; “I do not care if I get into trouble” and “I do not
care about being on time”; “The feelings of others are not important to me” and “I do
not care who I hurt to get what I want”; “I do not care who I hurt to get what I want”
and “I seem very cold an uncaring to others”; “I apologise (say I am sorry) to people I
hurt” and “I try not to hurt others’ feelings”; “I try not to hurt others’ feelings” and “I
am concerned about the feelings of others”; “I always try my best” and “I work hard on
everything I do”; “I seem very cold an uncaring to others” and “I apologise (say I am
sorry) to people I hurt”. This model achieved satisfactory levels of fit: χ2 (df = 95) =
221.63, p < .001, CFI = .90, CMIN/DF = 2.33, RMSEA = .07, 90% CI: .06, .08). It can
be seen in the Regression Weights shown in Table 4.3 that all factor loadings for the
two-factor model were significant. All factor loadings associated with this model are
shown in Table 4.4.
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Figure 4.4. Two-Factor Model With Fit Indices and Eight Correlated Items
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Table 4.3. Regression weights for the 16 item two-factor model
Item Estimate S.E. C.R.
p
RQ4 <--- Uncare 1.000 RQ5 <--- Uncare .933 .123 7.583 *** RQ6 <--- Uncare .781 .128 6.117 *** RQ20 <--- Uncare 1.032 .119 8.681 *** RQ27 <--- Uncare 1.016 .119 8.538 *** RQ28 <--- Uncare 1.074 .124 8.662 *** RQ31 <--- Uncare 1.203 .122 9.875 *** RQ32 <--- Uncare .854 .102 8.385 *** Q9 <--- CU 1.521 .283 5.376 *** Q11 <--- CU 1.400 .263 5.316 *** RQ30 <--- CU 1.210 .226 5.347 *** Q17 <--- CU 1.292 .252 5.130 *** Q1 <--- CU 1.000 Q3 <--- CU 1.170 .239 4.899 *** Q35 <--- CU .997 .227 4.399 *** Q36 <--- CU 1.274 .241 5.292 ***
Note: No critical ratios are stated for the respective first factor loadings because these were fixed to unity to scale the latent variables.
100
Table 4.4 Factor Loadings and Factor Score Weightsa for the 16 item ChATI.
Item Description
Factor Loadings (Factor score weight)
1 2 Factor 1: Callous (α = .77)
I do not care about doing things well .41 (.041) I do not care if I get into trouble .49 (.030)
I do not care about being on time .59 (.064) I do not feel sorry when I do something wrong .57 (.067) The feelings of others are not important to me .53 (.057) I am concerned about the feelings of others ® .58 (.085) I seem very cold and uncaring to others .42 (.041) I do not care who I hurt to get what I want .58 (.069)
Factor 2: Uncaring (α = .85)
I care how well I do at school ® .62 (.081) I feel bad or guilty when I do something wrong .56 (.064) I easily admit to being wrong ® .44 (.040) I work hard on everything I do ® .67 (.075) I try not to hurt others’ feelings ® .67 (.090) I always try my best ® .67 (.070) I apologise (say I am sorry) to people I hurt ® .82 (.215) I do things to make others feel good ® .64 (.104)
® = Reverse scored item aFactor score = (Item 1 Score x Item 1 Factor Score Weight) + (Item 2 Score x Item 2 Factor Score Weight) … + (Item 8 x Item 8 Factor Score Weight).
Invariance of the first-order measurement model across gender and age Invariance
was assessed incrementally to examine the equivalence of factor loadings, correlations
between latent factor scores, and variance in factor scores across the groups. In each
case, a model constraining the two groups to be equivalent was compared to previous
models. For example, the first comparison was between a model where factor loadings
were constrained (to be equivalent across boys and girls), and the null model (where
they are free to vary across boys and girls). Change in chi-square (∆χ2) was used to
assess the relative merits of the competing models, with a significant ∆χ2 indicating that
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the unconstrained model should be accepted (i.e., indicating that there DO exist
differences across the groups on the relevant parameters).
Gender. There was a non-significant difference between the unconstrained model and
the model constraining factor loadings to be equal across boys and girls, ∆χ2 (df = 14) =
10.10, p = .755. This indicates that boys and girls do not differ in this regard. This was
then compared to the constrained model, which still allowed factor-score variances to
differ across boys and girls, with one where those variances were constrained. Again, no
difference was evident across the two groups: ∆χ2 (df = 2) = 1.03, p = .598. Finally, this
(constrained factor loadings and constrained factor variances, but unconstrained factor
covariance) was compared with one where the covariance between both factors was
constrained. This comparison provided support for the existence of a gender difference:
∆χ2 (df = 1) = 9.08, p = .003. The correlation between the two factors was stronger for
boys (r = .88) than for girls (r = .58).
Age. Two age groups were created by comparing students in Grades Three, Four and
Five (N=146) with those in Grades Six and Seven (N=94) as no other split created
groups of adequate size to permit the multiple groups analyses. There was a non-
significant difference between the unconstrained model and the model constraining
factor loadings to be equal across younger and older students, ∆χ2 (df = 13) = 12.53, p =
.485. This indicates that these groups do not differ in this regard.
A model where all factor loadings were constrained to be the same across younger and
older participants, and which allowed the factor score variances to differ, was then
compared with a model where those variances were constrained. No difference was
evident across the two groups: ∆χ2 (df = 2) = 1.52, p = .467. Finally, this model (all
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constrained factor loadings except one, and constrained factor variances, but
unconstrained factor covariance) was compared with a model where the covariance
between both factors was constrained (See Table 4.5.). This comparison provided
support for the existence of a school-stage difference: ∆χ2 (df = 1) = 7.61, p = .006. The
correlation between the two factors was weaker among younger (r = .66) than older
students (r = .92).
Table 4.5 Fit Indices for Models Assessing Invariance Across Gender and Age.
Invariance variable
Model
CMIN/DF
CFI
RMSEA (90%CI)
Gender 1. Unconstrained 2.03*** .851 .064 (.055, .073)
2. Constrained Factor Loadings 1.94*** .854 .061 (.052, .070)
3. Constrained Factor Loadings and Constrained Variances
1.93***
.854
.061 (.052, .070)
4. Constrained Factor Loadings, Variances, and Covariances
1.96***
.848
.062 (.053, .071)
Age 1. Unconstrained 1.88*** .868 .061 (.051, .071)
2. Constrained Factor Loadings 1.83*** .868 .059 (.049, .068)
3. Constrained Factor Loadings and Constrained Variances
1.82***
.868
.059 (.049, .068)
4. Constrained Factor Loadings, Variances, and Covariances
1.84***
.863
.060 (.050, .069)
Effects of gender and age on factor scores. Using the formula W = BS-1, where B is
the matrix of covariances between the unobserved and observed variables, and S is the
matrix of covariances among the observed variables, AMOS 19.0 calculated factor
score weights for each of the items based on the accepted measurement model. To use
these, each participant’s score on each item was multiplied by the factor score weight
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for that item, and this was then added to a similar score for the following item, and so
on. Mean scores are shown by gender and school-stage in Table 4.6.
Table 4.6 Means (and Standard Deviations) by Gender and School-Stage.
Gender School-Stage Callous Uncaring
Male Grades 3, 4, & 5 0.40 (0.32) 0.51 (0.55)
Grades 6 & 7 0.47 (0.32) 0.67 (0.57)
Female Grades 3, 4, & 5 0.30 (0.29) 0.35 (0.49)
Grades 6 & 7 0.39 (0.32) 0.58 (0.49)
To examine the effects of gender (male vs. female) and school-stage (Grades Three,
Four and Five vs. Grades Six and Seven) two separate two-way independent ANOVAs
were conducted, one for each factor score. For Callousness, neither the main effects nor
the interaction were significant. For Uncaring, there was a small, significant effect of
school-stage, F (1, 205) = 6.13, p = .014, ηp2 = .03. This indicates that older children
have significantly higher scores on Uncaring than younger children. Neither the gender
main effect nor the gender x school-stage interaction, were significant.
Discussion
The main aim of the present study was to examine the structure and correlates of C/U
traits in young mainstream children using a newly developed instrument. That children
as young as nine years old are able to reliably report on these dimensions (see van
Baardewijk et al., 2008) was another reason why a self-report measure was developed.
This is not to say, however, there are no disadvantages associated with self-report,
particularly with those characterised by psychopathic traits, and particularly C/U traits
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(e.g., response distortion, lack of insight into nature of problems) (Lilienfeld & Fowler,
2006; Salekin & Lynam, 2010).
Using CFA, measurement models were compared and in line with previous studies and
the research literature (see Frick, 2004; Essau et al., 2006; Fanti et al., 2009; Kimonis et
al., 2008; Roose et al., 2010), initially a three-factor model (Callousness, Uncaring, and
Unemotional) was tested. This was followed by tests of one and two factor models.
Unlike previous research, the CFA in the present study captured two dimensions of
behaviour using the ChATI that fit the data best. One factor (Uncaring) was
representative of a lack of caring about one’s performance in tasks and for others’
feelings. The second factor (Callous) captured behaviour that included a lack of
empathy, guilt and remorse, and an absence of emotional expression. A major
difference between the present study and the majority of previous studies is the age of
the participants. That is, the sample consisted of mainstream and younger (7.6 to 12.8
years compared to 12- to 20-year-olds) children.
Although the two-factor model was superior to the three-factor model, 13 of the 16
items in the former were from the three-factor bifactor model of the ICU (Frick, 2004).
None of the five items making up the ICU Unemotional factor (i.e.,” I do not show my
feelings to others”, “I express my feelings openly”, “I hide my feelings from others”,
“It is easy for others to tell how I am feeling”, and “I am very expressive and
emotional”) loaded onto the present ChATI two-factor model. Furthermore, the ICU
items “I care about how well I do at school or work” (Uncaring factor), and “I do not
feel remorseful when I do something wrong”, “I do not care who I hurt to get what I
want”, and “I am concerned about the feelings of others” (Callousness) did not load
onto the two-factor model. It is possible that many of the children in the sample were at
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an age whereby they could not “feel” the (affective) emotions of others (as proposed by
Dadds et al., 2009; Munoz et al., 2011). Furthermore, they may not have had the
experience to be able to attribute these emotions to themselves or others (see Widen &
Russell, 2010). That there was no differentiation between the Callousness and
Unemotional factors may be indicative that these young children had not reached a
sufficient point in their course of development to differentiate these categories into more
narrow ones (Widen & Russell, 2008).
The two-factor model was invariant across gender, supporting factor structure
equivalence across the two groups. Essau et al. (2006) reported gender differences in
ICU subscale scores consistent with past research indicating that men tend to score
higher than women on all dimensions of psychopathy, including C/U traits. The present
findings did show that with regards to age, there was a small significant effect, with
older children have significantly higher scores on Uncaring (i.e., a lack of caring about
one’s performance in tasks and for others’ feelings) than younger children. This is
consistent with developmental findings that during early adolescence rebelliousness and
antisocial attitudes become more common (Moffitt, 1993).
It must be acknowledged and taken into consideration when interpreting the findings
that the present results are based solely on self-report data and that corroborative
information such as file data and observations might enhance reliability. Nevertheless,
self-report is an effective means of obtaining an accurate insight into the subjective
dispositions that can be difficult to obtain from third parties such as teachers and parents
(Andershed, 2010; Frick, Barry, & Kamphaus, 2009; Houghton et al., 2013). Indeed, the
validity of self-report on psychopathology and personality tends to increase from
childhood to adolescence whereas parental and teacher report decreases for this period
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(Essau et al., 2006). This present study was purely school-based and, therefore, only
children attending school were assessed. Children assessed with elevated C/U traits,
such as those in clinical, institutional or referral-based settings should, therefore, be
included in future studies so that distribution of C/U trait scores using the ChATI can be
compared. Furthermore, to obtain adequate fit to the data, eight pairs of errors had to be
correlated which, although substantially less than the 25 correlated error terms in the
initial test of the most promising instrument to date – the ICU by Essau et al. (2006) -
suggests the factor structure of the ChATI needs to be replicated in other samples.
In summary, the instrument that the present study sought to develop was reduced to 16
items of the 24 items making up the ICU (Frick, 2004). The ICU was specifically
designed to address the limitations in previous measures of C/U and in doing so, to
provide a comprehensive assessment of C/U traits in young people. Although research
has consistently provided evidence of three factors for adolescents this was not the case
for younger children in this study. Thus, the data presented here represent a strong case
for the continued use of the 16 item ChATI with children aged 7 to 12 years, in order to
build on its potential and to support its further development.
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CHAPTER FIVE
STUDY THREE: DIFFERENTIAL PATTERNS OF CALLOUSNESS AND
UNCARING, LONELINESS, AND AGGRESSION IN MAINSTREAM
PRIMARY SCHOOL CHILDREN
The aims of Study Three were to (i) detect the differential patterns of children’s callous
and uncaring (measured using the ChATI), aggression and loneliness; and (ii) develop
specific profiles of children scoring highly on both the Callous and Uncaring variables
(or one of either depending on findings). To this end, in Phase I two separate groups of
primary school students (i.e., upper primary and lower primary ages) completed a series
of measures. Following this in Phase II, three case studies were conducted to further
investigate the profiles of children who scored highly on both the Callous and Uncaring
variables, (or either). The instruments employed in Phase I, namely the ChATI, CASA
and PALs, were used to produce empirical based profiles of children and these profiles
were then further developed through semi-structured interviews conducted with the staff
responsible for these students in schools.
Phase I: Differential Patterns of Primary School Children’s Callous and Uncaring,
Aggression, and Loneliness
Method
Participants and settings
The participants in this study were 180 primary school students (76 males and 104
females) aged 7.25 years to 13.0 years (Mage = 10.70, SD = 1.3 years), attending six
state primary schools located in the metropolitan area of Perth, the capital city of
Western Australia. Of the six schools, one was in a high socioeconomic status area, four
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were in middle socioeconomic status areas, and one was in a low socioeconomic status
area as determined by an index defined at the postcode level from the Australian Bureau
of Statistics (2008). For the purpose of data analyses the participants were assigned to
either lower primary school (represented by ages 7, 8 and 9 years) or upper primary
school (represented by ages 10, 11 and 12 years) groups. This resulted in the following
composition: Lower Primary = 99 (44 males, 55 females) and Upper Primary = 81 (32
males, 49 females).
Instrumentation
Three instruments were administered to the participants: The Children’s Affective
Traits Inventory (ChATI); The Child and Adolescent Scale of Aggression (CASA; Tan,
2011) and The Perth A-Loneness Scale (PALs: Houghton et al., 2014a).
The development and validation of the Children’s Affective Traits Inventory (ChATI)
was described in detail in the previous chapters. Briefly, the results of the analyses
conducted indicated that a two-factor structure represented by an eight-item Callous
scale and an eight-item Uncaring scale fit adequately to the data. All items are rated on
a four point Likert scale anchored with the descriptors Not true of Me (scored 0),
Sometimes Not True of Me (= 1), Sometimes True of Me (= 2), and True of Me (= 3).
The Child and Adolescent Scale of Aggression (CASA: Tan, 2011) is a brief 20-item
self-report inventory designed to assess physical and verbal proactive and reactive
aggressive behaviours in mainstream school children and adolescents. It was developed
from previously established instruments, namely, the Aggression Questionnaire (Buss &
Warren, 2000), the Revised Teacher-Rating Scale for Reactive and Proactive
Aggression (Brown, Atkins, Osborne, & Milnamow, 1996), the Overt Aggression Scale
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(Yudofsky, Silver, Jackson, Endicott, & Williams, 1986) and the Child and Adolescent
Psychopathy Screening Instrument (Cordin, 2007). In addition, the CASA is based on
interviews with educators in mainstream school settings, behaviour centres, juvenile
detention centres, and school psychologists. Higher scores in the measure indicate
higher levels of aggression. The most recent factor analysis (Tan, 2011) yielded four
distinct dimensions: Physical-Proactive (six items), Verbal-Proactive (five items),
Verbal-Reactive (five items) and Physical-Reactive (four items) aggression with high
levels of internal reliability: Overall alpha = .92. The Cronbach’s alpha coefficients of
the four subscales were: Physical-Proactive (α = .87), Verbal-Proactive (α = .80),
Verbal-Reactive (α = .78), and Physical-Reactive (α = .82) (see Tan, 2011). To date,
this appears to be one of the only instruments specifically and systematically developed
to measure both the physical-verbal forms and proactive-reactive functions of
aggression in Australian school-aged school students.
The Perth A-Loneness Scale (PALs; Houghton et al., 2014a) was specifically developed
to measure multidimensional loneliness in children and adolescents. Its development
included a comprehensive examination of the appropriate literature and an analysis of
14 existing instruments, from which items for potential inclusion were carefully chosen.
The items were selected based on Marangoni and Ickes (1989) recommendations that
measurement scales must contain items “capable of assessing actual or perceived
deficits in (i) different types of social relationships, (ii) different qualitative dimensions
within these different social relationships, and (iii) the number and frequency of
different social contacts” (p. 107). Participants respond using a six-point scale
represented by the descriptors never, rarely, sometimes, often, very often, always, with
higher scores suggestive of higher levels of feelings of loneliness.
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Initial exploratory factor analysis with data supplied by 694, 10-18 year olds (Mage =
13.01 years) established four factors represented by 24 items (explaining 42% of the
total variance) with satisfactory Cronbach’s alphas: Friendship Related Loneliness (i.e.,
having reliable, trustworthy supportive friends α = .86); Isolation (i.e., having few
friends or believing that there was no one around offering support α = .80); Positive
Attitude to Solitude (i.e., positive aspects and benefits of being alone such as relaxing,
happiness α = .78) and Negative Attitude to Solitude (i.e., negative aspects of being
alone such as time dragging, unhappiness, isolation α = .77). Competing measurement
models evaluated using confirmatory factor analysis with data from 380 10 to 18 year
olds provided strong support for the superiority of the four factor model (CFI = .92,
RMSEA = .05).
A subsequent study involving 235 adolescents (ages 10.0-16 years, Mage = 13.8 years)
confirmed the superiority of the first-order model (CFI = .92, RMSEA = .06)
represented by the four correlated factors. The Cronbach’s alpha coefficients were again
acceptable for each subscale Friendship Related Loneliness (i.e., α = .91; Isolation α =
.80; Positive Attitude to Solitude α = .86; and Negative Attitude to Solitude α = .80).
Test-retest reliability (9 months apart) with 250 participants to examine the stability of
the loneliness dimensions over time revealed correlation coefficients of: Friendship
Related Loneliness .61, Isolation .59, Negative Attitude to Solitude .67 and Positive
Attitude to Solitude .64 (all p < .01).
More recently, Houghton, Roost, Carroll and Brandtman (2014b) evaluated competing
measurement models of loneliness (using the PALs) in children with and without
Attention Deficit Hyperactivity Disorder. The items were again best represented by four
correlated factors, and this model represented satisfactory levels of fit. The CMIN/DF
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ratio (1.644), the CFI (.90), and the RMSEA = .06 (90 % CI: 0.05, 0.07) all indicated
good fit (Hu & Bentler, 1999). The internal reliability coefficients were: Friendship
Loneliness: α = .88; Negative Attitude to Aloneness: α = .79; Isolation Loneliness: α =
79; and Positive Attitude to Solitude: α = .77.
Procedure
Approval for the research was obtained from the Human Research Ethics Committee of
the University of Western Australia and The Education Department of Western
Australia. Fourteen primary schools were randomly selected across the metropolitan
area of Perth, Western Australia and then approached to ascertain their interest in
participating in the research. Of the 14 schools, 6 agreed to participate. The researcher
subsequently met with each of the principals of the schools (separately) where the
purpose and nature of the research was explained. In addition, the potential benefits of
the research findings to primary schools, teachers, and students were discussed. All six
principals agreed to participate and so an information sheet explaining the purpose and
nature of the research along with an invitation to participate and consent form and an
assurance of confidentiality was sent home to the parents of children in Grades Two to
Seven. (One school only agreed to send the information to parents of three children.)
The overall response rate was approximately 64%.
All questionnaires were administered to participants in their regular classrooms by the
researcher at agreed times designated by the respective schools as interfering minimally
with the participants’ daily routines. Each administration was conducted under clearly
formulated procedures to ensure standardisation across classrooms and schools. Prior to
instrument administration participants were verbally informed by the researcher about
the nature of the study. They were also assured of the anonymity of their responses. All
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participants were also reminded that if they wanted to withdraw from the study at any
time they could do so without prejudice. Finally, participants were requested not to talk
with their peers during the administration and that should they encounter any problems
with any of the questions, they were to raise their hand to obtain support from the
researcher. This was done to ensure the results reflected the thoughts of the individual
and not a social consensus. On average the instruments took approximately 30 minutes
to complete.
Results
The internal reliability coefficients using Cronbach’s alpha for the various instruments
was satisfactory: ChATI C/U α = .88; ChATI Uncaring α = .79; Child and Adolescent
Scale of Aggression CASA (Physical-Proactive α = .85, Verbal-Proactive α = .81,
Verbal-Reactive α = .77, and Physical-Reactive α = .84); Perth A-Loneness Scale PALs
(Friendship Related Loneliness α = .86; Isolation α = 80; Negative Attitude to Solitude
α = .79; and Positive Attitude to Solitude: α = .76).
A Multivariate Analyses of Variance (MANOVA) was conducted to establish whether
significant differences exist between males and females and upper and lower primary
school aged children in their forms of callous and uncaring, aggression and loneliness.
The MANOVA investigated the effect of Gender (Male, Female) and Age (Lower v
Upper) on the two variables of the ChATI, four variables of the CASA and four
variables of the PALs. The Wilks’ Lambda criterion was used to evaluate multivariate
significance and univariate F tests were conducted when significant multivariate effects
were obtained. Multivariate and Univariate F values were determined to be significant
using Bonferroni adjusted alpha levels of .025, .0125, and .0125 for the ChATI, CASA
and PALs variables respectively, to control for Type 1 errors. Effect sizes are reported.
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Callous and Uncaring, Aggression and Loneliness, Gender and Age.
A 2 × 2 (Gender × Age) between-subjects MANOVA on the dependent variables of the
ChATI, CASA and PALs revealed no main interaction effects for Gender × Age F (10,
165) = 1.729, p = .078, partial η2 = .09. There were, however, multivariate main effects
of Gender, F (10, 165) = 2.432, p = .010, partial η2 = .13 and Age, F (10, 165) = 2.286,
p = .010, partial η2 = .12. Using the Bonferroni adjusted alpha levels of .025, .0125, and
.0125 for the ChATI, CASA and PALs variables respectively none of the Univariate
values for any of the variables reached statistical significance, however. The univariate
F tests and observed means for the main effects of Gender and Age are shown in Tables
5.1 and 5.2.
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Table 5.1 Univariate F Statistics, Observed Means, and Standard Deviations for Dependent Variables with Gender as the Independent Variable.
Dependent variable Mean
square F
p
Partial
η2
Male
Mean (SD)
Female
Mean (SD)
ChATI
Callous
.365
1.497
.223
.009
1.50 (.46)
1.42 (.51)
Uncaring .844 2.869 .092 .016 1.82 (.58) 1.69 (.51)
PALs
Friendship Loneliness
.417
.843
.360
.005
3.80 (.75)
3.88 (.68)
Isolation 2.132 2.531 .113 .014 2.74 (.88) 2.99 (.95)
Positive Attitude Solitude 1.322 2.651 .105 .015 2.96 (.70) 3.16 (.71)
Negative Attitude
Solitude .247 .527 .469 .003 3.20 (.71) 3.29 (.66)
CASA
Physical Proactive
.001
.006
.937
.000
0.16 (.53)
0.14 (.44)
Physical Reactive 1.862 5.367 .022 .030 0.41 (.67) 0.21 (.51)
Verbal Proactive .013 .055 .814 .000 0.12 (.49) 0.14 (.49)
Verbal Reactive .586 2.055 .153 .012 0.50 (.61) 0.38 (.48)
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Table 5.2 Univariate F Statistics, Observed Means, and Standard Deviations for the Dependent Variables with Age (Upper versus Lower Primary school) as the Independent Variable.
Dependent variable Mean
square F
p
Partial
η2
Lower
Mean (SD)
Upper
Mean (SD)
ChATI
Callous
.060
.252
.616
.001
1.49 (.53)
1.41 (.44)
Uncaring .009 .031 .861 .000 1.78 (.64) 1.73 (.42)
PALs
Friendship Loneliness
2.658
5.374
.022
.030
3.94 (.78)
3.71 (.61)
Isolation .234 .278 .599 .002 2.88 (.97) 2.90 (.87)
Positive Attitude Solitude .270 .414 .521 .002 3.09 (.85) 3.10 (.58)
Negative Attitude
Solitude .014 .029 .865 .000 3.27 (.74) 3.22 (.58)
CASA
Physical Proactive
.524
2.223
.138
.013
0.21 (.57)
0.09 (.33)
Physical Reactive .374 1.077 .310 .006 0.26 (.61) 0.33 (.57)
Verbal Proactive .262 1.078 .301 .006 0.17 (.57) 0.09 (.35)
Verbal Reactive .003 .010 .921 .000 0.43 (.63) 0.44 (.41)
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Phase II: Differential Case Study Profiles of Children with High Scores on Callous
and Uncaring Subscales
The purpose of this phase was to employ the ChATI (developed in this thesis) to
identify individual children high on both Callousness and Uncaring and then produce
empirical profiles in conjunction with their associated aggression and loneliness data.
To identify potential case studies, scores that were 1.5 standard deviations above the
mean score on both the Callous and Uncaring subscales were identified. For the Callous
subscale the Mean = 1.40 (SD = .44); with the +1.5 SD this converted to a Mean = 2.06.
For the Uncaring subscale the Mean = 1.64 (SD = .50) with +1.5 SD, this converted to a
Mean = 2.39. On inspection of the data 24 children exceeded these scores, but of these
only five met the criteria of exceeding the Mean by +1.5 SD for both scales. However,
for various reasons two of the children were not available. Therefore, this phase of
Study Three generated the empirical profiles of three case studies, which were further
developed through semi-structured interviews conducted with the principal teacher of
the child and an examination of the official school records (where permissible). In doing
so, the educational utility of the ChATI was examined and a more comprehensive
understanding of each case was developed.
Case Studies
Briefly, case studies enable the researcher to make a detailed examination of an
individual, a group, or a phenomenon (Yin, 2003). With the potential to generate rich
subjective data, case studies aid in the development of theory and empirically testable
hypotheses (Gall, Gall, & Borg, 2007). In this present study, a semi-structured interview
was undertaken with each of the case study child’s principal teacher to gather their
knowledge of, and perceptions and opinions about the selected cases. This method of
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semi-structured interviewing allowed the researcher and the staff member to engage in a
dialogue whereby the interviewer was guided by a schedule of topics or questions but
was able to explore and probe interesting areas that arose (Potter & Hepburn, 2005).
This method is particularly useful in eliciting information about attitudes, opinions,
values, beliefs, and/or behaviours (Gillham, 2000). The questions for the semi-
structured interviews in this study were based upon the measures administered in Study
Three (Chapter Five) and on the findings emanating from them.
Method
Participants and Setting
Initially, five children from the six participating Western Australian primary schools
were identified on the basis of their C/U and Uncaring scale scores (obtained in the
previous phase of this study using ChATI) for inclusion in the second phase of this
study. That is, their scores were the highest of all participants in the previous phase for
C/U and Uncaring scales and were 1.5 SD above mean. However, of the five, two were
not available due to moving to other schools out of Western Australia. Consequently,
three children (two females and one male) from Grades Three, Five and Seven (8 to 12
years of age) from two Western Australian primary schools who met the inclusion
criterion were included to in the second phase of this study.
The respective principal teachers (two females and one male who had taught the child
for the whole of the school year) participated in separate semi-structured individual
interviews. The mean level of education experience of these three teachers was 9.4
years (range = 1 to 25 years). The individual interview with the staff members was
conducted in a room specially set aside for this purpose at each of the respective
schools. Seating during the interview was informal and the interviewer made extensive
field notes during the interview.
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Materials
A standard interview format comprising 18 open-ended questions was employed for
each case study. Questions were used to solicit the staff members’ views pertaining to
the identified children comprising the case studies. Specifically, information was sought
about (i) the child’s behaviour at school, (ii) the nature of the child’s peer friendships,
(iii) the types of aggression (if demonstrated), (iv) the nature of any Callous and
Uncaring behaviours, and (v) any issues of loneliness. (Appendix F illustrates the semi-
structured yet open-ended interview question format.) At specific times during the
interview, the researcher referred to the empirical profiles generated in the previous
studies for each case to elicit additional information. The profiles for each of the three
children, generated from the self-report empirical instruments are presented in Figures
5.1, 5.2 and 5.3.
Procedure
Permission to conduct this research was obtained from the Human Research Ethics
Committee of the administering university and also from the principals and teachers (to
be interviewed) of the schools where the children were enrolled. Permission had
previously been obtained from the parents who were informed that their child’s data
might be used to further investigate the area under investigation. Contact with the
participating schools had been established during Phase I of Study Three and therefore
for this final phase the researcher continued liaising with the school principal and
participating teacher. During an initial telephone call to each of the school principals the
researcher requested permission to approach the principal teacher of the children who
had participated in Phase I of Study Three and who had been identified for the case
studies. Each of the principals gave permission and so the researcher made contact with
the teachers at which time a mutually agreed day and time for the interviews was
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arranged. At the commencement of each interview the researcher introduced herself and
then explained that the purpose of the research was to find out more about the case
study child in the light of the empirical profiles previously generated. At this time the
teachers were assured that any information provided or comments made would remain
completely confidential and that no one would be identified at any time. A request was
then made that field notes be taken by the researcher during the interview. At the same
time, participants were also assured that all of the information documented in the field
notes would be securely stored in the university for a period of seven years before being
destroyed and that no other person (other than the researcher) would have access to
them. None of the teachers objected to field notes being taken and so the interviews
commenced.
Because information was being sought on specific children (i.e., the case study) taught
by each teacher the case had to be verbally identified. Given this it was ensured that all
procedures complied with the ethical standards of the Australian Psychological Society
Code of Ethics (2007) (Australian Psychological Society, 2007).
To begin with the researcher engaged the teachers in general conversation about the
child and his/her day to day school experiences. Following this the researcher moved
into the interview questions, each of which were asked in the same order (as outlined in
Appendix F) for each teacher. During certain interview questions the researcher referred
to the case study’s empirical profile, which was printed for the teacher to comment.
(Teachers were not provided with copies of the profiles of the cases at any time.) For
example, the researcher might say, “As you can see in this profile, this child self-reports
as being aggressive (and comments would be made about the proactive and/or reactive
nature of this aggression). Have you witnessed or heard of any acts of aggression
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involving this child?” If participants digressed from the question at hand when
responding, they were allowed to continue but were then guided back to the interview
questions by the researcher when the opportunity arose. On average, the interviews
lasted for approximately 35 minutes. Information regarding the child’s antisocial
behaviour, as detailed in official school records, was also sought at this time (e.g., has
the child been suspended from school; what was the official school recorded behaviour
that led to suspension; has he/she been involved in any other behaviour problems that
have been recorded).
Data Analyses
Initially, the empirical profiles of each of the case studies, based on the subscale scores
of the three instruments completed in Phase I of Study Three, were generated using
Microsoft Office Excel (Microsoft Corporation, 2007) and analysed. This provided
profiles showing levels of: callousness and uncaring; physical-proactive, physical-
reactive, verbal-proactive, and verbal-reactive aggression; and friendship related
loneliness, isolation, negative attitude to solitude and positive attitude to solitude.
The interview data gathered for each individual case was checked, read several times to
familiarise the researcher with its content, key ideas, and phrases and then a report of
each case was constructed. Concepts relating to each case study and the subscales of the
three instruments were noted. The empirical profile findings were then juxtaposed with
the interview information and official school records data to generate as detailed a
profile for each individual as possible. The cases studies are now presented.
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Results
Case Study One
Case Study One (participant #66) is a Grade Six female aged 10.5 years. School records
indicate that this young female had many behavioural issues and a history of suspension
from school, especially for “showing disrespect to teachers” (primarily specialist
teachers for music and sport), “having a bad attitude to school” and “excessive and
inappropriate talking”.
Empirical Findings
The empirical profile for Case One (participant #66) is illustrated in Figure 5.1. As can
be seen, this young female recorded high scores on the Callous and Uncaring factors,
suggesting that she has specific deficiencies in affective experience (absence of guilt,
constrictive display of emotion) and interpersonal style (failure to show empathy,
callous use of others for one’s own gain).
Figure 5.1. Empirical Profile of Case Study One (Participant #66)
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With regard to loneliness, Case #66 scored relatively highly on all four variables. The
profile shows that like many other females in the study (total sample M = 3.80) she (M
= 3.67) reported having reliable, trustworthy supportive friends (Friendship Related
Loneliness), but at the same time she believed that she had few friends and that there
was no one around offering support (Isolation M = 3.00). This score is comparable to
the other females (M = 2.99). With reference to solitude, this young female has
somewhat mixed views in that she reports some positives to spending time on her own
(i.e., Positive Attitude to Solitude, M = 2.67), but her score is considerably lower than
other females in the study (M = 3.16). At the same time Case #66 reported that when
she is on her own she experiences boredom, time drags, she is unhappy and wishes there
was a friend at hand (Negative Attitude to Solitude, M = 2.33). However, Case #66
seems to fare better when on her own compared to the other females in the sample
whose sores were much higher (M = 3.29), thereby demonstrating higher levels of
negative attitude to solitude.
Case #66 self-reports an aggression profile characterised by relatively low levels of all
four types of aggression. The profile shows that reactive aggression is reported at a
higher level than proactive aggression. In line with this, the higher mean level of verbal
reactive aggression (M = 1.60), is very much supportive of the official school records
which shows this as a key reason for suspensions from school. The mean score for Case
#66 is much higher than the mean for the other females in the main sample (M = 0.38).
This young female also self-reports a level of verbal proactive aggression (M = 0.40)
suggesting that she initiates aggression by spreading gossip and rumours about others or
by telling lies about others behind their back to get what she wants. Once again this
level is higher than that reported by the other girls (M = 0.14). In addition, Case #66
also self-reported higher levels of physical reactive aggression (M = 1.00) and physical
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proactive aggression (M = 0.67) compared to the other girls (M = 0.21 and M = 0.16,
respectively).
Case Interview
Callous and Uncaring. According to the principal teacher of Case #66 her (i.e.,
Case #66) teachers described her as being “naughty and talkative” with a “poor attitude
and as not caring how she acts and whether she gets into trouble”. Overall, the
principal teacher reported that this young female had an attitude that typified a belief
that getting into trouble in school was “all fun and games”. While the teacher was quite
clear (and this is substantiated by other teacher reports) that this female was a behaviour
problem she also showed another side to her character and “can be kind and positive
and can have a joke” and “that she is capable of doing her work in class”. Furthermore,
in contrast to what the empirical profile suggested, Case #66 seems to have a caring and
sensitive side to her character. For example, according to her principal teacher, “she
volunteers to help younger weaker readers”, “she seeks out help for others”, and that
“she can be truthful and honest in certain circumstances”. However, the teacher
qualified these statements by adding that Case #66 “cannot be responsible for her
actions”. When asked whether anything in particular stands out about this young female
the teacher replied without hesitation “her determination, stubbornness, inability to
think about the consequences of her actions” and that she can be a bit of a “Jekyll and
Hyde”.
This last comment is interesting given the high scores that Case #66 evidenced for
Callousness and Uncaring in the empirical profile. Specifically, when asked about a
time when this young female may have been concerned about the feelings of others, the
teacher reported that Case #66 “friend was leaving and she was sad and wanted to sit
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next to her”. However, the teacher also commented that at the same time Case #66 was
squabbling with her and was not particularly nice to her as a friend who was leaving.
Furthermore, the Uncaring factor on the empirical profile seems to be borne out by Case
#66 frequent “not caring how she acts and whether she gets into trouble”.
Friendships/loneliness. The empirical profile of Case #66 reveals a somewhat
mixed picture with regards to friendships/loneliness and this is borne out by the teacher
interview data. Specifically, the teacher reported that this young female “interacts well
with others”, and can be “the life of the party and outgoing”; at the same time, however,
she can easily “turn on her friends”. At the beginning of the school year this young
female “had a group of friends, was popular, but by the end of the year the friends had
become more discerning and she became isolated”. Indeed, the teacher reported that at
the time of this interview many of the “friends” had left the friendship group and this
young female found herself with girls who “push the boundaries”. According to the
teacher some girls in the class were “attracted to her due to her popularity”. On the
other hand, this attraction might be because when disputes or altercations arise, Case
#66 “puts her back up”, “stands her ground” and “backs up her friends”. Again the
teacher reiterated that with regard to friendships, this young female can be a bit of a
“Jekyll and Hyde”. Case #66 affiliations were not limited to her same sex peers and the
teacher reported that she (i.e., Case #66) had been frequently involved in “flirtatious
behaviour with a boy who was very naughty and who had a record of problematic
behaviour; this developed in to a boyfriend/girlfriend relationship”.
The interview data seems to support the attitudes that this young female has towards
spending time on her own. For example, she reported a relatively positive attitude to
solitude, suggesting that she does enjoy solitary activities, which allow her to engage in
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self-reflection. Moreover, it seems that this can result in positive outcomes because the
teacher commented that Case #66 works really well when on her own and “if there are
no disruptions she is a B grade student”.
Aggression. The empirical profile showed that Case #66 presented primarily with
verbal reactive aggression and the official school records show that almost all of her
inappropriate behaviour was characterized by rapid impulsive aggressive verbal
responses such as “I don’t care”. This was especially evident when disciplined by
teachers for her unacceptable behaviour. When the teacher was asked if she had
witnessed any acts of aggression by this student, she replied that Case #66 was
“verbally nasty but not physically”. This is not in keeping with the self-reported
physical aggression shown in the empirical profile and it may be that Case #66 uses any
physical aggression in a more covert nature.
Concluding Comments. This young female seems to have a need for friendships
but may lack the necessary skills to maintain these friendships. The empirical profile
suggests that Case #66 has supportive trustworthy friends, but also that she believes that
she has no real friends to turn to (i.e., Isolation Factor). Thus, she may view her
friendships as temporary and for the purpose of meeting her own ends. Indeed, other
girls within the friendship group appear to retreat from Case #66 because of her
(mainly) verbal aggression. The teachers seemed to be unaware of her physical
aggression, suggesting that she may conduct this less publicly and consequently as the
teacher surmised “she flies under the radar”. Moreover, it may be that the “Jekyll and
Hyde” character the teacher frequently referred to meant that peers were always
uncertain of how their actions would be interpreted and consequently whether any social
interactions might be aggressive in nature. Both the empirical findings and the interview
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data are in accordance that this young female presents with aspects of Callousness,
Uncaring and Aggression. Of particular concern is that she meets two key elements for
Callousness and Uncaring, namely she does not feel remorseful when she does
something wrong, and that she does not care who she hurts to get what she wants (i.e.,
gets along with other girls really well but then turns on them in a nasty manner).
Case Study Two
Case Study Two (participant #46) is a Grade Four male aged nine years. Official school
records show that although this young boy has had numerous behavioural issues and
had been referred to a school psychologist (reasons for referral unknown) he has not
been suspended from school. Teachers describe him as “sulky and broody”.
Empirical Findings
This young male demonstrated a high level of Callousness and a relatively high
Uncaring factor score, suggesting deficiencies in affective experience (absence of guilt,
constrictive display of emotion) and interpersonal style (failure to show empathy,
callous use of others for one’s own gain) (see Figure 5.2).
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Figure 5.2. Empirical Profile of Case Study Two (participant #46)
As can be seen in Figure 5.2 Case #46 demonstrates a mixed profile with reference to
loneliness. He scored relatively highly on three of the four variables, but his positive
attitude to solitude score was the lowest of the four loneliness dimensions. The specific
profile shows that Case #46 reported having similar levels of Friendship Related
Loneliness (M = 3.50) (i.e., having reliable, trustworthy supportive friends) as his male
peers (M = 3.80) and he also reported that he has few friends and that there is no one
around offering support (Isolation M = 2.83). (This latter figure is similar to that of his
male peers: M = 2.73.) With reference to solitude, Case #46 self-reported a lower level
(M = 2.0) of Positive Attitude to Solitude compared to his peers (M = 2.96), which
suggests that he may have some difficulties recognising the benefits of spending time on
his own. In addition, this young male has slightly higher levels (M = 3.50) than his
peers (M = 3.20) for Negative Attitude to Solitude, which suggests that when alone, he
finds that time drags and he wishes there was a friend at hand.
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Case #46 self-reported low levels of aggression for all four types, with the highest level
found in Physical Reactive Aggression (M = 1.75), which is higher than that of his male
peers (M = 0.41). This young male also reported some Physical Proactive Aggression
(M = 0.33) and Verbal Reactive Aggression (M = 0.60), both of which are greater than
that of his peers (M = 0.16 and M = .50, respectively). This suggests a young boy whose
physical aggression tends to be spontaneous and impulsive, but with the possibility that
there may be a degree of premeditation.
Case Interview
Callous and Uncaring. This case was described by teachers as being “well
behaved”, “a character in the classroom who is not invisible”, with a tendency to “sulk
and become moody, especially if things are not going his way”. The principal teacher
being interviewed stated that the overall consensus among teachers was that Case #46
was “bright, compliant with a positive attitude towards school and learning”. However,
the principal teacher mentioned that Case #46 could become “moody” in class. In
addition, he had been involved in “aggressive incidents in previous school years”. The
teacher was adamant that Case #46 “took pride in his work, tried his best and put much
effort into the things he did”.
When asked specifically about this young male’s caring and sensitive side towards his
peers and others, the teacher responded that “none was evident”, which seems
potentially supportive of the empirical profile shown in Figure 5.2. Furthermore, the
teacher said that it “was very difficult” to judge if this young male was concerned about
the feelings of others. When probed further about this young male’s affective side, the
teacher said there was “no reason to think he wasn’t truthful” and that she would give
him responsible jobs to carry out. When asked whether there is anything in particular
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that stands out about this young male the teacher focused on his relationship with his
younger sibling, saying that, “he hated his younger sibling, seemed very resentful and
that this was a worry at times”. These comments and the one in particular pertaining to
there being no indication of a caring and sensitive side is interesting given that this
young person was identified on the basis of high scores for Callousness and Uncaring in
the empirical profile.
Friendships. The empirical profile was suggestive of a young male who has
reliable, trustworthy supportive friends but who may have some difficulties when
spending time on his own and wishing there was a friend at hand during these periods of
time. This present empirical profile appears to be borne out by the teacher interview
data, that is, “he has friends, but it is a rather tumultuous group”, and very often Case
Study #46 “falls out with his peers and often he would split them all up”. This is
interesting given that the principal teacher stated that this young male “did not like to
spend time alone”. The principal teacher also clarified that Case #46 was a member of
“the same little group – a little clique”, was “confident in the way he approached
others” and that “none of the other kids avoided him”.
Aggression. The empirical profile showed that Case #46 presented primarily with
reactive type aggression. Although school records show that there had been incidents of
aggressive behaviour in the past, the specifics of these incidents had not been detailed.
According to the principal teacher this young male “didn’t get physical, didn’t take
things into his own hands but would tell someone what he thought”. This is at odds with
Case #46 self-reported aggression. When disciplined by teachers this young male was
known to be “compliant and as someone who did not dwell on the disciplinary event;
however he became sulky”.
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Concluding Comments. This young male is characterised as moody with a
tendency to sulk by his teachers. What became clear through the interview was Case
#46 propensity to “divide his peer group”, even though he does not like to spend time
alone. By dividing the peer group, the teacher acknowledged that Case #46 appeared to
be “left with the same little group”. In many ways this appears reminiscent of the
affective experience (constrictive display of emotion) and interpersonal style (use of
others for one’s own gain) associated with the construct of Callous Unemotionality.
Teachers in general seemed to be unaware of his physical aggression, rather citing
consistently his moody and sulky behaviour. It may be that this young male indulges in
physical altercations but in a less public manner. While both the empirical findings and
the interview data are in accordance that this young male presents with aspects of
Callousness, Uncaring and Aggression of particular pronouncement is the affective
experience (constrictive display of emotion) element.
Case Study Three
Case Study Three (participant #15) is a Grade Four female, aged 8.11 years. Official
school records indicate that this young female has no recorded behavioural issues and
she has never been suspended from school. However, she has only been a member of
the school for one year. Overall, the teachers report that she is a quiet girl with some
possible learning difficulties.
Empirical Findings
As can be seen in Figure 5.3 Case #15 self-reported a high level of Callousness and
Uncaring, thereby suggesting that specific deficiencies in affective experience (absence
of guilt, constrictive display of emotion) and interpersonal style (failure to show
empathy, callous use of others for one’s own gain).
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With regard to loneliness, Case #15 recorded a profile that appeared to be substantially
different to that of her female peers. For example, unlike other females in the total
sample for Friendship Related Loneliness (M = 3.80), Case #15 (M = 2.50) recorded
having fewer reliable, trustworthy supportive friends. At the same time she (M = 1.50)
recorded that she has more friends around who offer support compared to her peers
(Isolation) (M = 2.99).
With reference to solitude, this young female has a substantially higher mean score for
Positive Attitude to Solitude (M = 4.50) compared to her female peers (M = 3.16),
demonstrating that for her there are positives to being alone. This is borne out by her
lower score for Negative Attitude to Solitude (M = 2.20) (e.g., when alone time drags,
get bored, become unhappy, and wish there was a friend at hand) compared to other
females (M = 3.29).
Figure 5.3. Empirical Profile of Case Study Three (participant #15).
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Case #15 self-reported aggression in all four types and these were higher than those of
her female peers in the total sample. This young female was substantially higher in
mean levels of both types of proactive aggression: Proactive Physical Aggression (M =
1.50) and Proactive Verbal Aggression (M = 2.20) compared to female peers (M = 0.14
and M = 0.14, respectively). This is also true of reactive aggression: Reactive Physical
Aggression (M = 0.50) and Reactive Verbal Aggression (M = 0.60) compared to female
peers (M = 0.41 and M = 0.50, respectively). This seems to suggest a young female who
primarily initiates aggression (proactive) by spreading gossip and rumours about others,
telling lies about others behind their back to get what she wants, and also by carrying
out premeditated physical aggression. In addition, the self-reported reactive aggression
suggests an individual who is also aggressive in a spontaneous manner.
Case Interview
Callous and Uncaring. Case #15 is described by her teachers in general as being
“quiet” “shy” and “even timid” with “lots of difficulties with learning”. Overall, the
principal teacher reported that this young female had only been in the school for just
over a year and had not required “much discipline”. However, the teacher clarified that
Case #15 could “quite easily slip under the radar”. In contrast to what the empirical
profile suggested, this young female is said to have a “caring side” to her behaviour
towards her peers. The principal teacher could not however, provide any examples of
this when asked to. Furthermore, the principal teacher reported that Case #15 is “a
responsible student”, “with a nice nature”, and is “responsible about her schoolwork –
“even though she has had difficulties”. A recurrent theme that did emerge throughout
the interview with the teacher was that of anxiety. The principal teacher made frequent
references to Case #15 being “especially nervous and anxious”. When asked what
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stands out about this child, the teacher replied “nothing really except high anxiety levels
and her being a worrier”.
This last comment is interesting given that in forensic samples of adults and
adolescents, there is evidence to suggest that there may be distinct variants of
psychopathy marked by the presence or absence of significant levels of anxiety. Recent
research suggests that psychopathic traits (of which C/U traits are a key element) can
co-occur with elevated levels of anxiety and that the aetiology of psychopathic
personality may be different for those individuals with co-occurring anxiety (Kimonis,
Frick, Cauffman, Goldweber, & Skeem, 2012; Humayun, Kahn, Frick, & Viding,
2014). However, there is a scarcity of investigations regarding potential differences
between those with high levels of C/U traits with and without elevated anxiety in non-
forensic samples of pre-adolescent children.
Friendships. The empirical profile for Case #15 revealed a clear picture of
someone who enjoys spending time alone and who does not feel isolated from others.
This is borne out by the information garnered from the principal teacher interview.
Specifically, the teacher reported that this young female “has good relationships with
peers”, with many peers “seemingly attracted to her”, but she “has one good friend in
class who she is particularly close to”. When asked how Case #15 interacts with peers
the teacher replied, “well she is not outgoing or a leader but she seems to have good
relationships with them”. Interestingly, the teacher also reported that this young female
“does not spend much time alone” which is supportive of the self-reported (empirical)
low levels of isolation.
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Aggression. The empirical profile showed that Case #15 presented primarily with
Proactive Aggression, particularly Proactive Verbal Aggression. In some way this is
antithetical to the principal teacher’s reports of a “very quiet and shy girl”. However,
when probed further an interesting profile began to emerge. For example, Case #15 is a
person who has not been involved in any inappropriate behaviour and the principal
teacher said that she could not “recall any times where she had been involved in any
altercations”. The teacher even went as far as to state that “because of her nature it is
not applicable to discuss how she responds when involved in any inappropriate
behaviour”. When asked if Case #15 had ever been in a situation where she had had to
say sorry for doing something wrong, the teacher replied emphatically “no”. On the
other hand, and although pure conjecture - given the proactive side to her aggression - it
may be that Case #15 initiates her aggression (spreads rumours, tells lies about others
behind their back) and does not get caught. Indeed, the teacher did comment on a
number of occasions that this individual “slips under the radar”.
Concluding Comments. This young female seems to find positives from spending
time on her own, as evidenced in both the empirical data and the teacher interview
information. Moreover, although she appears to have one specific friend, she does not
report feeling isolated from her peers. Like others who were identified with higher
scores of Callousness and Uncaring, this young female also “flies under the radar”.
While the empirical findings show a young female high on Callousness, Uncaring and
Proactive Aggression, the principal teacher paints the opposite, namely a caring friendly
child, but with high levels of anxiety.
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Overall Summary
This overall summary will attempt to highlight the salient points regarding the affective
and interpersonal traits, and the elements of loneliness and aggression of the three cases.
No reference will be made to the research literature reviewed earlier in Chapter Two
since the final chapter in this thesis seeks to bring all of the research findings together to
develop a more coherent understanding of young children’s Callous Unemotional traits,
aggressive behaviours and patterns of loneliness.
Overall, the multivariate analysis of variance conducted in Phase I of Study Three
revealed were no significant differences between children’s Callousness and Uncaring
scores, and aggression and loneliness according to Age and Sex. When children with
scores 1.5 SD above the mean for Callousness or Uncaring were identified to form a
sample for Phase II of the study, a sample of 24 children was generated. Of these, five
scored 1.5 SD above the mean on Callousness and Uncaring. Due to inter-state school
transfers only three of these individuals were still in their schools. Given that interviews
were to be conducted regarding their behaviour it was decided that information should
only be sought about those children that were still within their schools. Given that the
two students who transferred had left the school some six months prior to the interviews
it was possible that the principal teacher’s recall might have been less reliable.
The empirical profiles for the three cases juxtaposed in Figure 5.4 show similarities
between two of the cases, but also quite a different profile with the third. Thus, finding a
commonality between all three appears difficult. For example, for loneliness there were
quite marked differences in the profiles of all three, with the exception of Friendship
Related Loneliness. All three children self-reported having friends they could trust and
turn to. Case Study Three (#15) scored lower than the other two cases on this subscale,
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however. Although two of the three cases reported higher levels of Positive Attitude to
Solitude (i.e., Case Study One [#66] and Case Study Three [#15]) there was a
substantial difference between their scores. For Case Study Two (#46) the opposite was
true with higher scores for Negative Attitude to Solitude. Where there is some level of
similarity is in the aggression profiles, with all three cases self-reporting higher scores
on Reactive Aggression and two of the three receiving high scores for Proactive
Aggression. (All three received high scores on at least one of the Proactive Aggression
subscales i.e., proactive physical or verbal aggression.)
Figure 5.4. Empirical Profiles for the Three Case Studies.
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The question then is what, if anything sets children with higher scores on Callousness
and Uncaring apart from others? From the empirical assessments it seems very little is
the answer, although there is some similarity in the loneliness profiles compared to the
other variables. The teacher interviews, however, do shed some light on possible
common elements between the three cases. For example, all three were noted by
teachers as having insufficiencies in the affective domain of their functioning, including
“being a Jekyll and Hyde” (Case Study One, #66), “sulky and moody” (Case Study
Two, #46), and “shy and timid and flying under the radar” (Case Study Three, #15).
Loneliness and interactions with peers also had a common theme. All three were said to
be popular and to have friends, but from the principal teacher’s information it appeared
that the cases divided their peer group/friends or isolated themselves from the group.
For example Case Study One’s friends “became discerning (as the school term
progressed) and she “became isolated from them”. Similarly, Case Study Two “has
friends but he would split them all up”. Case Study Three had relationships with peers,
but he only “really only has one good friend”.
The research into psychopathic traits of which dysfunctional affective/interpersonal
traits (C/U traits) is a key element, may provide some assistance with this. Individuals
with psychopathic traits aspire to dominate and manipulate others for their own gains
(Hare, 1999) and as such, their friendships tend to be short-lived (Foulkes, Seara-
Cardoso, Rogers, & Viding, 2014). Indeed, young adults with high levels of
dysfunctional C/U traits do not value affiliations (Foulkes et al., 2014), while
adolescents with similar profiles are characterised by shorter-term friendships (Munoz
et al., 2008). While there is no evidence of psychopathic traits in the three case studies,
they do present with high levels of Callousness and Uncaring, which are strongly
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associated with psychopathy. Thus, there is the possibility that the peer group
interactions were manipulative and goal oriented.
The second area where there appears to be a common theme within the three case
individuals is their proactive aggression, and in particular physical aggression. All of
the principal teachers interviewed seemed to be unaware of the physical aggression that
each of the three cases self-reported. For example for Case Study One the teacher
reported that the student “was verbally nasty but not physically”. Case Study Two’s
principal teacher stated that her male student “did not get physical, didn’t take things
into his own hands”. Case Study Three’s principal teacher answered “not applicable” to
the question regarding how her student responded when involved in altercations
“because of her nature”. This final case is particularly interesting because the student
self-reported the highest levels of Proactive Physical and Proactive Verbal Aggression
(by some considerable way) of the three case studies. Proactive aggression is associated
with C/U traits (Marsee & Frick, 2007) and is known to occur in the absence of
provocation and is often used for dominance over others or to gain something (Dodge &
Coie, 1987). A cluster analysis by Anrade, Sorge, Na and Wharton-Shukster (2015)
with 6-12 year olds revealed children with C/U traits could be differentiated from others
and within their own group via reactive and proactive aggression. This latter point may
also have some traction given the point made earlier regarding the use of others in short-
lived friendships. That the principal teachers interviewed had all spent at least one year
as the full time classroom teacher of their respective cases also raises questions about
how they were unaware of the physical aggression reported by their charges.
(Alternatively, it is possible that all three children were exaggerating their use of
physical aggression.)
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The final chapter in this thesis will attempt to integrate all of the findings from the
studies conducted in this thesis to develop a more coherent understanding of children
who present with C/U traits or in this case Callous and and Uncaring traits.
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CHAPTER SIX
GENERAL DISCUSSION
This final chapter of the thesis discusses the findings and implications arising from the
research conducted over the three separate yet inter-related studies. In each of the earlier
chapters reporting the findings of the studies, brief discussions were presented, which
interpreted the results. This final chapter presents a general discussion, which attempts
to interpret the overall findings from the investigations conducted and then juxtapose
these into the literature critically reviewed in Chapter Two.
Overall, the research presented in this thesis details the development of a self-report
instrument to measure callous and unemotional traits (C/U), and then an investigation
into the differential patterns of C/U traits, aggression and loneliness in mainstream
children. The research was conducted to address the question of whether children with
C/U traits were (as suggested in the thesis title) alone, aggressive and unwanted. This
final chapter discusses and interprets the findings obtained from the analyses of data
gathered from children. Finally, in terms of the research conducted, the empirical
profiles and interview findings from a series of case studies are discussed in the light of
the previous findings. Following this, the educational implications of the findings from
the current research are presented along with an acknowledgement of any limitations.
Possible directions for future research are then offered.
To examine C/U traits, aggression and loneliness, a series of research questions were
formulated and then studies were specifically designed and executed to address these
questions. Specifically, the first three research questions were centred on the
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development and validation of a self-report instrument. Evaluating C/U traits via self-
report presents its own challenges such as asking individuals about his/her own
disregard for others, and deceitful and desirable responding (Ansel et al., 2015).
However, it was important to utilise self-report because there is currently “no clear
evidence for a gold standard self-report measure of C/U traits” (Ansel et al., 2015,
p.214). Supportive of using self-report measures is the established findings that the
validity of self-report on psychopathology and personality has been shown to increase
with age from childhood to adolescence (Essau et al., 2006). Furthermore, there is a
need for efficient, reliable and valid measures of C/U traits (Kimonis et al., 2008; Roose
et al., 2010) which require little training in their administration (Ansel et al., 2015).
This is not to say that teacher and parent reports are unreliable. At least five studies
have utilized confirmatory factor analytic methods to determine whether parents and
teachers can reliably distinguish C/U traits from other, more commonly assessed
dimensions of disruptive behaviour such as hyperactivity/impulsivity, inattention,
oppositional defiance, and conduct problems. For example, Dadds, Fraser, Frost and
Hawes (2005) with a community sample of children, aged four to nine years, found that
parents distinguished C/U traits from hyperactivity, conduct, emotional and peer
problems. Similarly, Pardini, Obradovic and Loeber (2006) reported that C/U traits
could be distinguished from hyperactivity, inattention, and conduct problems across
first, fourth and seventh graders. Using the Pittsburgh Girls Study data Loeber et al.
(2009) found that parents (but not teachers) distinguished C/U traits from other
dimensions of disruptive behaviour. Finally, two studies (Hyde et al., 2013;
Willoughby, Waschbusch, Moore, & Propper, 2011) made use of subsets of items from
the preschool version of the Achenbach System of Empirically Based Assessment
(ASEBA) to screen for C/U traits. Both studies reported that parents could distinguish
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C/U traits from other dimensions of disruptive behaviour in children as young as three
years of age. These studies also provided a strong empirical basis for considering C/U
as a distinct dimension of behaviour (see Willoughby et al., 2014).
Andershed et al. (2002) argued that obtaining an accurate insight into the subjective
dispositions of individuals can be difficult to obtain from third parties, such as teachers
and parents, while van Baardewijk et al. (2008) argued that teacher- and/or parent-report
formats leave the child’s perspective out of consideration. Young people can be
valuable informants as they have unique insights into their personality and behaviour in
a way that other informants do not (Ansel et al., 2015) and therefore the decision was
made to develop a self-report measure.
To this end two research questions were formulated to determine: the critical
shortcomings of current instruments used in assessing C/U traits in children; and
whether a self-report instrument could be developed to measure C/U traits in children
and its psychometric properties established. To address these questions the first study in
the thesis comprised three separate yet interrelated phases. Phase I critically reviewed
the research literature and extant instruments used to measure C/U traits. Phase II
created an item pool, which was refined through a process of: review by a panel of
academics with knowledge of developmental child psychopathology and measurement;
a review of C/U assessment and measurement; and presentation to postgraduate
Educational Psychology professional training degree-programme students, teachers, and
registered psychologists employed in behaviour centres. Phase III conducted an initial
validation of the new instrument to assess C/U traits in mainstream children using item
affectivity and discrimination indices.
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The review of research literature and instruments in Phase I revealed a dearth of
instruments specifically developed to measure C/U traits. With reference to Research
Question 1: What are the critical shortcomings of current instruments used in assessing
C/U traits in children? only one instrument explicitly measured C/U traits, yet even this
reported limited applications (and reporting of its psychometric properties) solely with
children, despite the importance of these traits in identifying a group of children at
particular risk of severe behaviour problems (see Frick & White, 2008). Furthermore, of
the five instruments identified from the review as containing items suitable for assessing
the presence of C/U traits in children, four were developed to measure psychopathy
(within which C/U is a core element), which is a constellation of three personality
dimensions: an Arrogant and Deceitful Interpersonal Style (e.g., lying, manipulation,
glibness, and superficial charm); a Deficient Affective Experience (e.g., a lack of guilt
and remorse, shallow affect and callousness); and an Impulsive and Irresponsible
Behavioural Style (e.g., impulsiveness and excitement seeking; Cooke & Michie, 2001;
Cooke, Michie, Hart, & Clark, 2004; Johnstone & Cooke, 2004). Thus, these
instruments were developed to assess a wider construct than C/U traits.
Another shortcoming was that none of the identified instruments were for use with
children, and none are purely in a self-report format - notwithstanding the documented
advantages of self-report for gaining insight into core affective traits and subjective
dispositions (e.g., lack of empathy and lack of caring) and knowledge of covert acts
(Loney et al., 2003; Raine et al., 2006). Given the strong evidence showing that C/U
traits alone (Moran et al., 2009), and in combination with conduct problems, are
associated with more severe forms of antisocial behaviour (e.g., Rowe et al., 2010),
having appropriate screening measures for use with community mainstream populations
is of great importance. Consequently, it was deemed necessary to develop an instrument
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from a review of the research literature and through a comprehensive examination of
existing instruments measuring C/U traits.
Even with the documented shortcomings the instruments identified from the review
provided a sound base from which to begin developing a new instrument. Specifically, a
total of 48 items from the reviewed instruments were identified as assessing C/U traits,
or its underlying deficit - empathy - and so these items were included in the initial item.
A panel of experts (academics) and practitioners, working in the field, established the
duplicity of items, along with the items’ face and content appropriateness. This resulted
in the removal of eight items. That a draft scale of 40 items was developed, to some
extent tentatively answered the first part of Research Question 2: Can an instrument be
developed, and its psychometric properties established, to measure C/U in children?
To address the second part of the research question, item functioning (i.e., item
affectivity, item discrimination, and internal reliability) was assessed in an initial
validation with 30 mainstream primary school children from Grades Three to Seven.
This statistical technique has not been commonly used in other studies involving
instrument development, where respondent’s subjective views pertaining to face and
content validity are more often relied upon. The outcome of this stringent and
systematic initial approach was a 36-item self-report draft instrument (titled the
Children’s Affective Traits Inventory – ChATI), which measures C/U traits in children.
When the internal reliability of the ChATI was assessed it was found to demonstrate
satisfactory internal reliability, with an alpha coefficient = .92. Furthermore, the
readability of the ChATI showed it was comprehensible for Australian school children
enrolled in Grade Three (seven years of age).
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Research Question 3 asked what is the factor structure of the newly developed
instrument? To further validate the psychometric properties of the new instrument
(ChATI) and confirm its factor structure, data were generated from a larger sample of
mainstream primary school children. Confirmatory Factor Analysis (CFA) (rather than
Exploratory Factor Analysis) was used, as CFA is a more sophisticated technique for
testing a theory about latent processes (Tabachnick & Fidell, 2007). Furthermore,
previous research, particularly by Frick and colleagues in the development and
preliminary validations of the most promising instrument to date, the Inventory of
Callous and Unemotional Traits (ICU), has consistently revealed a three-factor
structure, namely Callousness, Uncaring, and Unemotional (e.g., Essau et al., 2006;
Fanti et al., 2009; Kimonis et al., 2008; Roose et al., 2010). Furthermore, in a recent
Italian translation of the ICU (Ciucci et al., 2014) with Grade Six and Eight students, a
CFA largely supported the factor structure found in other samples with other
translations (Essau et al., 2006; Fanti et al., 2009; Kimonis et al., 2008; Roose et al.,
2010). That is, the best fitting model was one that specified an overarching Callous
Unemotional dimension and three sub-dimensions of Callousness, Uncaring, and
Unemotional.
Although Roose et al. (2010) have questioned the usefulness of the Unemotional
subscale, as it shows an association with neither antisocial behaviour nor prosocial
beliefs it still appears that a three-factor solution is consistently produced. This has been
with adolescent mainstream and offender populations across a range of countries.
However, the administration of the ICU and/or other instruments with mainstream
children in primary school settings appears scarce. Therefore, this present study offered
a unique contribution to the measurement of C/U traits in younger populations.
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In the present study, a three-factor model (Callousness, Uncaring, and Unemotional)
was tested, followed by tests of competing two- and one-factor models, respectively.
The CFA of the three-factor C/U model did not produce good model fit, however. The
two-factor model was superior to the three-factor model when items were incrementally
dropped. The outcome was, contrary to most previous research, a model capturing two
dimensions of behaviour that fit the data best. One factor (Uncaring a = .85) was
representative of a lack of caring about one’s performance in tasks and for other’s
feelings. The second factor (Callous a = .77) captured behaviour that included a lack of
empathy, guilt and remorse, and an absence of emotional expression. This different
factor structure is not unusual however. Factor solutions of C/U traits, other than that of
a three-factor structure, have been reported. For example, using the Antisocial Processes
Screening Device, (Frick & Hare, 2001), Frick et al. (1994) reported a two-factor
structure comprising Impulsivity/Conduct Problems (I/CP) and Callous/Unemotional
(C/U). Similarly, Forth et al. (1990) and Forth et al. (2003) reported a two-factor
solution (interpersonal/affective and socially deviant lifestyle), using The Psychopathy
Checklist: Youth Version. With specific reference to the ICU, Berg et al. (2013) reported
a two-factor structure in their further validation of the ICU. In their case, the data
supported the existence of a separation of C/U traits, into Callous and Unemotional
traits.
The Berg et al. (2013) findings are particularly relevant to the present findings because
the item comprising the ICU were the same as those in the ChATI following the initial
validations. However, in the present study (contrary to Berg et al., 2013) there was an
absence of a separate Unemotional factor. The absence of a separate Unemotional factor
is of interest because it reflects some suggestions from the research literature regarding
the development of empathy. Empathy is defined as a shared emotional response
147
resulting from a comprehension and appreciation of the emotional state of others (see
Eisenberg, Eggum, & Di Giunta, 2010). It is said to begin to develop in the second and
third years of life and to increase across early childhood (Eisenberg & Fabes, 1998).
Thus, the suggestion by Dadds et al. (2009) that lack of affective understanding may be
due to the age of the individual has some merit from this study’s findings. According to
Singer (2006), empathy undergoes developmental changes throughout the entire
lifespan. Second-order beliefs, or the ability to attribute a belief about another person’s
belief (as is required in answering an item such as “It is easy for others to tell how I am
feeling”) develop between the ages of 6 and 10 years. Given the importance of age and
the variation in which empathy develops it is possible that a proportion of the sample in
the present study may not have developed this capacity. Ezpeleta et al. (2013), in their
work with three- and four-year-old children, also highlighted Callous-Uncaring as the
construct of interest, as the Unemotional dimension did not load onto a general C/U
dimension; rather, it emerged as a separate dimension. It may be, as hypothesized
elsewhere, that many of the items on the ChATI (which are identical to those in the
ICU), appear to be assessing the “manifestation” of emotion rather than “felt” emotion
(e.g., “I seem very cold and uncaring to others”; “I hide my feelings from others”).
This again seems to point to age as an important factor, in that young children may
experience difficulties in differentiating between manifestation and felt emotion (see
Fanti & Centifanti, 2014).
According to Byrne (2004) research that focuses on multi-group comparisons such as in
the present study, should not assume “that the instrument of measurement is operating
in exactly the same way and that the underling construct being measured has the same
theoretical structure for each group under study” (p. 272). Byrne (2004) went on to
emphasise that one approach to address this issue of equivalence is to test for the
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invariance of both the items and the factor structure. In adhering to this, the resultant
two-factor model in the present research was found to be invariant across gender. This
finding is in line with a recent factor analytical study with a sample of middle-school
students (in Grades Six and Eight) by Ciucci et al. (2013). However, consistent with
past research, boys tended to score higher on most of the ChATI scales as in other
studies using the ICU (e.g., Essau et al., 2006; Viding, Simmonds, Petrides, &
Frederickson, 2009).
Contrary to Ciucci et al. (2013), the present findings revealed that older children had
higher scores on Uncaring (i.e., a lack of caring about one’s performance in tasks and
for others’ feelings) than younger children (a small significant effect). This is entirely
consistent with the extensive work of Moffitt and colleagues, however, who found that
during early adolescence rebelliousness and antisocial attitudes become more common
(see Moffitt, 1993, Moffitt & Caspi, 2001). The present findings suggest that C/U traits
within the primary school-aged mainstream population may have a different factorial
structure from that of adolescents. This finds some support from Rutter and Sroufe
(2000) who argued for heterotypic continuity. That is, a given disorder may be mani-
fested in different ways for different individuals across the developmental life course.
For example, although girls may have similar levels of C/U traits to boys, those traits
often do not manifest in antisocial or oppositional behaviour until adolescence, whereas
antisocial behaviour can manifest in childhood among boys. There is also the
consideration as argued by Frick et al. (2013) that there is substantial variability in the
level of stability of C/U traits. However, the research evidence is clear that it is more
common for children to show substantial decreases in C/U traits across development
than to show substantial increases (see Frick, Kimonis, Dandreaux, & Farell, 2003;
Lynam, Caspi, Moffitt, Loeber, & Stouthamer-Loeber, 2007; Pardini & Loeber, 2008).
149
Prior to examining the findings in relation to the specific constructs of aggression and
loneliness, it should be noted that the present research findings were generated from
data supplied by children from mainstream school settings and therefore the construct of
C/U traits needs to be understood within this context. That is, C/U traits (and in
particular a lack of empathy) have been hypothesized as the core of psychopathy by
many researchers (e.g., Blair, 2005; Frick et al., 2000; Frick & White, 2008; Kimonis et
al., 2008; Pardini et al., 2003). However, this finding has been generated predominantly
from forensic populations and it may be that C/U traits are not the central feature in
non-forensic mainstream school populations. That is, in the mainstream, student
population C/U may not be a predictor or antecedent of psychopathy, but a personality
trait that is possibly related to peer difficulties and behaviour problems in this
population.
The research evidence to date suggests a strong relationship exists between C/U traits
and aggression, even in (non-clinical) mainstream children (Raine et al., 2006).
According to Blair (2005) psychopathic traits (of which C/U is a key element) in adults
are related to increased levels of aggression, and uniquely increased instrumental or
proactive aggression. A number of studies have also established this link in children
(Barry et al., 2007; Fite et al., 2009; Mayberry & Espelage, 2007; Pardini & Byrd, 2012;
Pardini et al., 2003). Furthermore, individuals with elevated C/U traits: Show a more
severe, stable, and aggressive pattern of behaviour and are at increased risk for early
onset delinquency, and later antisocial behaviour (Frick & White, 2008); are likely to
take significant risks in their criminal and antisocial behaviour (White & Frick, 2010);
and are marked by a lack of emotion (Blair et al., 2006; Kimonis et al., 2008). Finally,
children with C/U traits display several core emotional deficits that potentially
undermine healthy social interactions (i.e., impairments in sharing in another’s feelings
150
[affective empathy]; difficulties in understanding another’s feelings [cognitive
empathy]; and difficulties recognizing other people’s displays of fear and sadness, as
communicated via facial expressions, tone of voice, and body gestures) (see Pasalich et
al., 2013). Consequently, children with C/U traits may have few friends (see Bukowski
et al., 2010) and are lonely.
The third study in this thesis tested for differential patterns of C/U, aggression, and
loneliness in children, according to their age and gender, in an attempt to answer the
question posed in the title of the thesis, that is, “are children with C/U alone, aggressive
and unwanted?” Given the findings of the main study in which a two factor structure of
the ChATI was established, this question should really be are children with callousness
and uncaring, alone, aggressive and unwanted?
With reference to loneliness and C/U traits no research has specifically examined this.
Thus, the present study is unique in that it presents the first evidence to date regarding
loneliness in relation to C/U traits. C/U traits have been shown to be related to peer
relationship problems (Waschbusch & Willoughby, 2008). Peer rejection, such as
experienced by those with C/U traits, has also been identified as a predictor of
externalizing behaviour, and more importantly for the present research, the strongest
negative influence of this is in the five-to nine-year-old age group (see Ladd, 2006).
Although it has been established that loneliness exists in childhood (see Asher &
Paquette, 2003; Houghton et al., 2014a), it has not been extensively studied in children
as young as those in the present research (Krause-Parello, 2008). Using the Perth A-
Loneness scale (PALs) with 10- to 17-year-olds Houghton et al. (2014a) showed
loneliness to be a multidimensional construct similar to that proposed by Goossens et
151
al., 2009). Houghton et al. (2014a) with Australian mainstream children and adolescents
revealed that females scored higher than males in terms of having reliable, trustworthy,
supportive friends (Friendship Related Loneliness); older students scored lower on
negative aspects of being alone (Negative Attitude to Solitude) such as boredom, time
dragging, unhappiness, and wishing there was a friend, and higher on seeing the
benefits of spending time on their own (Positive Attitude to Solitude).
In the present study, however, there were no differences in any aspects of loneliness,
whether participants were higher on Callous or Uncaring traits or not. Thus, it may be
that those with elevated levels of Callous and Uncaring traits are no lonelier than their
peers. Recent research by Houghton et al. (2014b) using the PALs also found no
significant differences between children with and without ADHD on any of the four
loneliness dimensions. (Again this study by Houghton et al., [2014b]) appears to be the
first that specifically examined loneliness in children with a psychopathology.) Similar
to those with C/U traits, children with ADHD are also known to experience greater
difficulties with peer friendships and peer interactions. Therefore, it could feasibly be
argued that children with Callous and Uncaring traits are no lonelier than those without
Callous and Uncaring traits. (This topic, in conjunction with aggression will be returned
to later in the thesis.) Given the presence of a psychopathology places children at
greater risk of loneliness and therefore at an increased propensity for adverse physical,
psychological, social and mental health problems (Lasgaard et al., 2011; Lasgaard,
Goossens & Elklitet, 2011; Mrug et al., 2012) it is important to investigate the construct
of loneliness in young children, particularly where there may be the added presence of
Callous and Uncaring traits.
With reference to aggression, there is strong evidence from longitudinal studies that
152
physical aggression decreases with age in almost all children (Brame et al., 2001; Cote
et al., 2002; Lacourse et al., 2003). Furthermore, it is only in a small minority (i.e., life-
course persistent offenders) that the aggression remains stable and persists into
childhood and adolescence (Moffitt, 1993). In populations characterised by
psychopathic features (in childhood, adolescence, and adulthood), however, there is a
consistent association with high levels of aggression (Porter & Woodworth, 2006).
More specifically, C/U traits being a key element of the constellation of affective and
interpersonal behaviours inherent in psychopathy, have long been associated with
higher levels of aggression in children from as young as the preschool stages (ages three
and four years: see Ezpeleta et al., 2013; 6-12 years Andrade et al., 2015). In the present
study there was a multivariate main effect for aggression, however, the univariate F
tests revealed no main effects according to gender and age. Physical reactive aggression
almost reached significance but the adjusted (more stringent) alpha levels precluded
this. Therefore, there were no differences between children’s functions and forms of
aggression across either gender, or the two age levels, on the basis of the presence of
Callous and Uncaring traits.
Interestingly, physical reactive aggression came close to statistical significance (boys
scored higher than girls) which would be in line with the growing evidence showing
boys in general are more likely to use physical and overt aggression (e.g., kicking,
hitting, and threatening) compared to girls (Crapanzano et al., 2010). However, with
regards to C/U traits, research tends to demonstrate an empirical link between this (i.e.,
C/U) and aggressive behaviour towards others for personal gains (i.e., proactive
aggression) (Frick et al., 2003). Moreover, proactive overt aggression has been uniquely
related to C/U traits (Marsee & Frick, 2007). Indeed, Andrade et al. (2015) found
among their sample of 6-12 year olds that those with high levels of C/U traits were also
153
highest on proactive aggression. This is conceptually important because C/U traits and
proactive aggression are seen as sharing similarities. That is, their actions are perceived
by others to be cold or uncaring (i.e., C/U) or as a display of power to achieve social
goals (i.e. proactive aggression). This is not to say that individuals with psychopathic
like traits (including C/U traits) do not also demonstrate reactive aggression (Flight &
Forth, 2007). Indeed, there is clear evidence from neuroimaging that suggests that
abnormalities in the orbitofrontal region of the prefrontal cortex found in those with
psychopathic traits may contribute to increases in reactive aggression (Anderson,
Bechara, Damasio, Tranel & Damasio, 1999; Blair, 2004, 2007a). The current research
findings, showing no differences in aggression across gender or between proactive and
reactive aggression seem to concur with arguments that proactive and reactive
aggression frequently co-occur, particularly in those with psychopathic traits or C/U
traits (see Bushman & Anderson, 2001). The present study adds to this research
evidence by showing no differences according to the two factors established among
primary school children, namely Callous and Uncaring traits.
It is possible that the sample recruited in the present study diminished any possible
differences because it was purely community school-based. Children in schools are on
the whole typically developing individuals and most children with psychopathologies
have been referred for assessment or transitioned to out of school off-campus settings.
Children in clinical, institutional, or referral-based settings may have presented with
greater levels of C/U traits and therefore provided a more accurate answer to the
question posed regarding aggression. It may also be the case that physical and verbal
aggression had not peaked and were at levels whereby thresholds did not show
differences. Supportive of this, Scheithauer et al. (2006) found that physical aggression
peaked in Grade Eight (13 to 14 years of age) and then declined, while non-relational
154
verbal aggression and relational aggression peaked in Grade Nine (15 to 16 years of
age). The children in the present study were younger than these grade level thresholds.
Therefore, in response to Research Question 4, there appears to be no differential
patterns Callous and Uncaring traits, aggression, and loneliness in mainstream children.
This is not to say that children with elevated levels of C/U traits are not in attendance at
mainstream primary schools. Based on prevalence data it is highly likely that the
number of these children is very small, which is why the analyses conducted did not
identify differential patterns within the sample. Therefore, in an attempt to address this
issue further and to answer Research Question 5 - What are the similarities and
differences regarding C/U, aggression, and loneliness in children - a series of case
studies was developed. Specifically, to produce a more comprehensive profile, three
children with scores 1.5 standard deviations above the mean score on both the Callous
and Uncaring factors established in Studies One and Two were identified. Empirical
profiles were generated for these children from the Study Three data. Then their
principal classroom teacher who had taught them for at least one year were interviewed
with reference to the (children’s) behaviour; from this an individual profile was
developed for each case. Not only did this produce a more comprehensive picture of
children with elevated levels of Callous and Uncaring traits, it also explored the subtle
differences alluded to in the empirical data. As a result, Research Question 6 which
asked: Does the newly developed instrument have educational utility and does it, along
with the measures of loneliness and aggression, produce meaningful profiles? was
answered.
A number of similarities were evident between the empirical data profiles and the
information obtained via teacher interview, especially regarding Callous and Uncaring
155
traits. The instruments were, therefore, seen to have satisfactory educational utility.
Making comparisons to other research findings is difficult since there appears to have
been few studies where profiles have been produced. All of the case studies presented
with certain characteristics associated with Callous and Uncaring traits, but it was the
teachers’ inability to recall examples of times or events where any of the students had
shown caring behaviours towards others that was most notable. All three teachers had
spent at least one year full time with their case children, yet they seemed surprised about
this, even though they used phrases such as “no real remorse”; “has no sensitive side”;
and “no evidence of a caring side”. These same teachers also made comments that in
many ways illustrate a side to the children that is, to some extent, common to all cases:
“is a bit of a Jekyll and Hyde”; “slips under the radar”; or is “moody and sulky”. These
characteristics have been identified in other interview based studies, but with early aged
adolescents in institutionalised forensic type settings (Cordin, 2007; Houghton et al.,
2010).
Each of the cases was also characterised by forms of aggression when in school, and the
teachers recalled that this tended to be more verbal and reactive against others. This
seems to fit closely with frustration-aggression theory as proposed by Dollard et al.
(1939) and refined by Berkowitz (1962, 1993). Specifically, this describes aggression as
an impulsive, hostile, and emotional-driven reaction in response to a perceived threat or
provocation (e.g., in the context of a heated argument; Glenn & Raine, 2009). The
aggressive behaviour is triggered by a threatening or frustrating event and involves
unplanned, enraged attacks on the object perceived to be the source of the threat or
frustration. The impulsive reactionary side of the case children identified by the teachers
(e.g., inability to think about consequences of actions) offers some support for this.
156
Conversely, there was also teacher interview information about the cases, indicating that
although each had friends, the case children tended to split up the friendship group,
subsequently isolating themselves from the group. It may be that this is an example of
proactive aggression, in which the aggression is driven by reinforcement (e.g.,
anticipated rewards) that comes with the perpetration of aggressive acts (see Vitaro et
al., 2006). Perhaps the proactive aggression on the part of the children was purposeful
and coercive and this resulted in their obtaining a desired external goal or object - in this
case the dividing of the group and resulting isolation and having “one really good
friend”.
There is research showing that C/U traits can be present without concomitant, serious
behaviour problems (Frick et al., 2000; Kumsta, Sonuga-Barke & Rutter, 2012; Rowe et
al., 2010). However, when this occurs there does appear to be some underlying
impairments in emotional and interpersonal responses related to the presence of C/U
traits. In one study involving a large sample of British children aged 5 to 16 years,
Rowe et al. (2010) found that 3% of the sample was within the category of having high
C/U traits with no CD diagnosis. Importantly, these children did show elevated levels of
behaviour problems compared to the group without C/U and CD, as well as lower levels
of pro-social behaviour, and elevated peer and emotional problems. Rowe et al. (2010)
concluded that even without apparent serious behaviour problems, children with C/U
traits are a group at risk of developing psychopathology. Adding further relevance to the
investigation of children who have C/U traits in the absence of apparent behaviour
problems, Musser, Galloway-Long, Frick and Nigg (2013) found that C/U traits
moderated emotional responding in children diagnosed with ADHD (but without CD).
The relevance of this research to the present research is the finding that C/U is
associated with reduced emotional response even in the absence of behaviour problems.
157
Thus, weight is added to the argument that C/U traits exist as a relatively independent
trait, with neurobiological underpinnings, that has far-reaching effects on interpersonal
relationships. Even without current behavioural evidence of adverse effects, the research
encourages provision to be made for individuals with C/U traits, as these traits forebode
future interpersonal difficulties and present a point of intervention. The final study in
the current research, utilising a case study approach, appears to indicate subtle, as-yet
not serious, indicators of future problems for the case children identified with elevated
Callous and Uncaring traits.
Limitations of the Research
Although the present research was conducted in a highly systematic and rigorous
manner, and appears to be the only studies to date focusing on C/U traits in children in
mainstream primary school settings, there are some limitations that must be
acknowledged. For example, almost all of the data were generated by self-reports.
Goossens and Beyers (2002) argued that sole reliance on self-report can give rise to the
issue of shared method variance. C/U traits, aggression and loneliness, however,
require insight into subjective dispositions that can be difficult to obtain from third
parties. According to Baldwin and Dadds (2007), parents and teachers have great
difficulty perceiving the internal world of their children, and children often have
difficulty reporting their internal states to their parents and teachers. That the reliability
of self-report increases as the child progresses towards adolescence (Frick et al., 2009;
Kamphaus & Frick, 2002) and correlations between self-report and clinical assessment
methods for assessing psychopathic traits (including C/U traits) tend be higher in
community populations than in clinical or forensic settings (Forth, Brown, Hart & Hare,
1996) offers strong support for the use of self-report. Moreover, Andershed et al. (2002)
and Raine et al. (2006) argue that self-reports of juvenile psychopathic traits and
158
aggression provide better insight into subjective dispositions (e.g., remorselessness,
grandiosity, and lack of empathy) and intrinsic motivations (e.g., proactive aggression),
which may be difficult others to assess and as such, avoid problems related to external
rater variance that are likely to complicate research. However, given the relatively
young age of the participants in this current research, future research should seek to
harness the optimal strategy and use two or more sources such as parents, educators or
clinicians (cf. Antshel, Faraone, & Gordon, 2014). This approach was utilised in the
final study of this thesis in which the empirical data were juxtaposed with teacher
interview data.
It is also acknowledged that Study Three was cross-sectional and involved a relatively
small sample size (n = 180). Furthermore, within this sample the number of children
with C/U traits was small. The absence of longitudinal data has been identified as a
shortcoming in research on psychopathy and more specifically C/U traits in children
and adolescents (see Farrington, 2005; Frick, Kimonis, et al., 2003; Loeber, 1991).
Furthermore, the absence of a forensic population made more meaningful comparisons
difficult. It must be noted, however, that recruiting children from forensic backgrounds
is difficult, especially in Western Australia where the number of institutionalized
children is small and access extremely limited. This limited access also applies to many
mainstream school settings in Western Australia. For example, to generate the
individual case study profiles strenuous efforts were made by the researcher to access
five children. However, high transient rates are characteristic among families in
Western Australia because of the type of employment opportunities (e.g., in the mining
and mineral industries) that exist. Consequently, two families had moved leaving only
three cases to be interviewed. Thus, not all aspects of those with Callous and Uncaring
159
traits could be examined in more detail. These are clearly issues that future research
should attempt to address.
Directions for Future Research
On the basis of the research conducted in the present thesis, a number of
recommendations can be put forward for future research. First, to more fully understand
the developmental trajectories of Callous and Uncaring traits (and possibly
Unemotional traits) among children, including the possibilities of there being a
transitional phase, longitudinal studies are necessary. Recruiting larger samples of
children may also permit the identification of larger numbers of children with C/U
traits, whose status can be differentiated by forms and functions of aggression and
loneliness. This would also allow more sophisticated statistical analyses using structural
equation modelling to be performed, which in turn may generate a greater
understanding of any causal inferences. It is also critical to administer the self-report
version of the C/U traits instrument developed here with more diverse samples,
including those in forensic settings. This recommendation is supported by Robins
(1978) who argued that “the more the populations studied differ, the wider the historical
eras they span, the more the details of the methods vary, the more convincing becomes
that replication” (p. 611). To develop a greater understanding of the association between
C/U traits and loneliness, future research might utilise social network analysis. This is a
promising method for capturing, mapping, and measuring the complexity (or absence)
of social relationships between people, groups, and organisations (Hawe, Webster, &
Shiell, 2004).
In conclusion, if the treatment of children with C/U traits is to be effective and the
developmental trajectory towards later serious antisocial behaviour prevented then
160
reliable instrumentation to assess C/U traits early in development is necessary. This is
important and goes to the very heart of the research and Research Question 7, which
asked are children with C/U traits, alone, aggressive, and unwanted? From the findings
of Studies Three and Four the answer appears to be “no”. However, this answer requires
a degree of caution and clarification. A major finding of the present research was that
the Unemotional factor did not form part of the factor structure representing C/U traits
in mainstream children, thereby suggesting that a more appropriate question should be
are children with Callous and Uncaring traits, alone, aggressive, and unwanted? While
the answer (based on the research findings here) is still “no” it may be, as suggested in
other research findings (e.g., Berg et al., 2010; Kimonis et al., 2008; Roose et al., 2010)
that unemotional features may not be a useful marker of C/U traits in children.
(Alternatively, perhaps additional clinical measures of C/U traits need to be
incorporated into the testing process?) What the present findings do suggest, in line with
Ansel et al. (2015), is that perhaps specific domains of C/U traits should be considered
in evaluations of particular forms of antisocial behaviour.
Finally, although one instrument (the ICU) offers promise in assessing C/U traits, the
findings of an analysis of data from four self-report instruments purporting to measure
C/U traits concluded that “the findings so far underscore the need to refine assessment
methods for C/U traits” (Ansel et al., 2015, p. 214). The present findings offer support
for this because the identification of children with C/U traits in educational settings and
the development, implementation and evaluation of effective intervention strategies for
these children requires reliable and rigorously developed measures. This is the first step
towards breaking the developmental trajectory towards serious antisocial and criminal
behaviour in adolescence and adulthood.
161
REFERENCES
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA Preschool Forms
and Profiles: An integrated system of multi-informant assessment. Burlington, VT:
University of Vermont Department of Psychiatry.
Andershed, H. (2010). Stability and change of psychopathic traits: what do we know? In
R. T. Salekin & D. R. Lynam (Eds.), Handbook of Child and Adolescent
Psychopathy (pp. 233–250). New York, NY: Guilford Press.
Andershed, H. A., Kerr, M., Stattin, H., & Levander, S. (2002). Psychopathic traits in
non-referred youths: A new assessment tool. In E. Blaauw & L. Sheridan (Eds.),
Psychopaths: Current International Perspectives (pp. 131–158). The Hague:
Elsevier.
Andershed, H., Gustafson, S. B., Kerr, M., & Stattin, H. (2002). The usefulness of self-
reported psychopathy-like traits in the study of antisocial behaviour among non-
referred adolescents. European Journal of Personality, 16(5), 383–402.
Andershed, H., Hodgins, S., & Tengström, A. (2007). Convergent validity of the Youth
Psychopathic Traits Inventory (YPI): association with the Psychopathy Checklist:
Youth Version (PCL: YV). Assessment, 14(2), 144–154.
Andershed, H., Kerr, M., & Stattin, H. (2002). Understanding the abnormal by studying
the normal. Acta Psychiatrica Scandinavica, 106(412), 75–80.
Anderson, C. A., & Bushman, B. J. (2002). Human aggression. Annual Review of
Psychology, 53, 27–51.
Anderson, S. W., Bechara, A., Damasio, H., Tranel, D., & Damasio, A. R. (1999).
Impairment of social and moral behavior related to early damage in human prefrontal
cortex. Nature Neuroscience, 2(11), 1032–1037.
162
Andrade, B., Sorge, G., Na, J., & Wharton-Shukster, E. (2015). Clinical profiles of
children with disruptive behaviors based on the severity of their conduct problems,
callous–unemotional traits and emotional difficulties. Child Psychiatry and Human
Development, 46, 567–576
Anstel, L., Barry, C., Gillen, T., & Herrington, L. (2015). An analysis of four self-report
measures of adolescent callous-unemotional traits: Exploring unique prediction of
delinquency, aggression, and conduct problems. Journal of Psychopathology and
Behavioral Assessment, 37, 207-216.
Antshel, K. M., Faraone, S. V, & Gordon, M. (2014). Cognitive Behavioral Treatment
Outcomes in Adolescent ADHD. Journal of Attention Disorders, 18(6), 483–495.
APA. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5 (5th
ed., p. 947). American Psychiatric Publishing.
Archer, J., & Coyne, S. M. (2005). An integrated review of indirect, relational, and
social aggression. Personality and Social Psychology Review : An Official Journal of
the Society for Personality and Social Psychology, Inc, 9(3), 212–230.
Asendorpf, J. B. (1993). Abnormal shyness in children. Journal of Child Psychology
and Psychiatry, and Allied Disciplines, 34(7), 1069–1081.
Asher, S. R., & Dodge, K. A. (1986). Identifying children who are rejected by their
peers. Developmental Psychology, 22(4), 444-449. .
Asher, S. R., & Paquette, J. A. (2003). Loneliness and peer relations in childhood.
Current Directions in Psychological Science, 12(3), 75–78.
Asher, S. R., & Wheeler, V. A. (1985). Children’s loneliness: a comparison of rejected
and neglected peer status. Journal of Consulting and Clinical Psychology, 53(4),
500–505.
Asscher, J. J., Van Vugt, E. S., Stams, G. J. J. M., Deković, M., Eichelsheim, V. I., &
Yousfi, S. (2011). The relationship between juvenile psychopathic traits, delinquency
163
and (violent) recidivism: A meta-analysis. Journal of Child Psychology and
Psychiatry and Allied Disciplines, 52(11), 1134–1143.
Australian Bureau of Statistics. (2008). An introduction to socio-economic indexes for
areas (SEIFA), 2006. Canberra: Author.
Australian Institute of Criminology. (2010). Australian crime: Facts and figures 2009.
Canberra: Author.
Bagwell, C. L., Newcomb, A. F., & Bukowski, W. M. (1998). Preadolescent friendship
and peer rejection as predictors of adult adjustment. Child Development, 69(1), 140–
153.
Baldwin, J. S., & Dadds, M. R. (2007). Reliability and validity of parent and child
versions of the multidimensional anxiety scale for children in community samples.
Journal of the American Academy of Child and Adolescent Psychiatry, 46(2), 252–
260.
Bandura, A. (1973). Aggression: A social learning analysis. New York, NY: Prentice-
Hall.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change.
Psychological Review, 84(2), 191–215.
Barker, E. D., Oliver, B. R., Viding, E., Salekin, R. T., & Maughan, B. (2011). The
impact of prenatal maternal risk, fearless temperament and early parenting on
adolescent callous-unemotional traits: A 14-year longitudinal investigation. Journal
of Child Psychology and Psychiatry and Allied Disciplines, 52(8), 878–888.
Barry, C. T., Frick, P. J., & Killian, A. L. (2003). The relation of narcissism and self-
esteem to conduct problems in children: a preliminary investigation. Journal of
Clinical Child and Adolescent Psychology : The Official Journal for the Society of
Clinical Child and Adolescent Psychology, American Psychological Association,
Division 53, 32(1), 139–152.
164
Barry, T. D., Barry, C. T., Deming, A. M., & Lochman, J. E. (2008). Stability of
Psychopathic Characteristics in Childhood: The Influence of Social Relationships.
Criminal Justice and Behavior, 35(2), 233-262.
Barry, T. D., Thompson, A., Barry, C. T., Lochman, J. E., Adler, K., & Hill, K. (2007).
The importance of narcissism in predicting proactive and reactive aggression in
moderately to highly aggressive children. Aggressive Behavior, 33, 185–197.
Bauman, S., & Del Rio, A. (2006). Preservice Teachers’ responses to bullying
scenarios: Comparing physical, verbal, and relational bullying. Journal of
Educational Psychology, 98(1), 219-321.
Benesch, C., Görtz-Dorten, A., Breuer, D., & Dopfner, M. (2014). Assessment of
callous-unemotional traits in 6 to 12 year-old children with Oppositional Defiant
Disorder/Conduct Disorder by parent ratings. Journal of Psychopathology and
Behavioral Assessment, 36(4), 519–529.
Berg, J. M., Lilienfeld, S. O., Reddy, S. D., Latzman, R. D., Roose, A., Craighead, L.
W., … Raison, C. L. (2013). The inventory of callous and unemotional traits: a
construct-validational analysis in an at-risk sample. Assessment, 20(5), 532–44.
Berkowitz, L. (1962). Aggression: A social psychological analysis (p. 361). New York,
NY: McGraw-Hill.
Berkowitz, L. (1993). Aggression: Its causes, consequences, and control. McGraw-Hill
series in social psychology (p. 485). New York, NY: McGraw-Hill.
Bezdjian, S., Raine, A., Baker, L. A, & Lynam, D. R. (2011). Psychopathic personality
in children: genetic and environmental contributions. Psychological Medicine, 41(3),
589–600.
Bierman, K. L., Smoot, D. L., & Aumiller, K. (1993). Characteristics of aggressive-
rejected, aggressive (nonrejected), and rejected (nonaggressive) boys. Child
Development, 64(1), 139–151.
165
Bierman, K. L., & Wargo, J. B. (1995). Predicting the longitudinal course associated
with aggressive-rejected, aggressive (nonrejected), and rejected (nonaggressive)
status. Development and Psychopathology, 7, 669–682.
Björkqvist, K. (1994). Sex differences in physical, verbal, and indirect aggression: A
review of recent research. Sex Roles, 30(3/4), 177–188
Bjrkoqvist, K., Lagerspetz, K. M. J., & Kaukiainen, A. (1992). Do girls manipulate and
boys fight? Developmental trends in regard to direct and indirect aggression.
Aggressive Behavior, 18, 117–127.
Blair, R. J. R. (1999). Responsiveness to distress cues in the child with psychopathic
tendencies. Personality and Individual Differences, 27(1), 135–145.
Blair, R. J. R. (2004). The roles of orbital frontal cortex in the modulation of antisocial
behavior. Brain and Cognition, 55(1), 198-208.
Blair, R. J. R. (2005). Applying a cognitive neuroscience perspective to the disorder of
psychopathy. Development and Psychopathology, 17(3), 865–91.
Blair, R. J. R. (2006). The emergence of psychopathy: Implications for the
neuropsychological approach to developmental disorders. Cognition, 101(2), 414–
442.
Blair, R. J. R. (2007a). The amygdala and ventromedial prefrontal cortex in morality
and psychopathy. Trends in Cognitive Sciences, 11(9), 387–392.
Blair, R. J. R. (2007b). Aggression, psychopathy and free will from a cognitive
neuroscience perspective. Behavioral Sciences and the Law, 25(2), 321–331.
Blair, R. J. R. (2008). Fine cuts of empathy and the amygdala: dissociable deficits in
psychopathy and autism. Quarterly Journal of Experimental Psychology, 61(1), 157–
170.
Blair, R. J. R. (2011). Commentary: Are callous unemotional traits all in the eyes?
Examining eye contact in youth with conduct problems and callous unemotional
166
traits - Reflections on Dadds et al. (2011). Journal of Child Psychology and
Psychiatry and Allied Disciplines, 52(3), 246–247.
Blair, R. J. R. (2013a). Commentary: Disregard for others: Empathic dysfunction or
emotional volatility? the relationship with future antisocial behavior - Reflections on
Rhee et al. (2013). Journal of Child Psychology and Psychiatry and Allied
Disciplines, 54(2), 167-168.
Blair, R. J. R. (2013b). The neurobiology of psychopathic traits in youths. Nature
Reviews. Neuroscience, 14(11), 786–799.
Blair, R. J. R., Budhani, S., Colledge, E., & Scott, S. (2005). Deafness to fear in boys
with psychopathic tendencies. Journal of Child Psychology and Psychiatry and
Allied Disciplines, 46(3), 327–336.
Blair, R. J. R., & Coles, M. (2000). Expression recognition and behavioural problems in
early adolescence. Cognitive Development, 15(4), 421-434.
Blair, R. J., Colledge, E., Murray, L., & Mitchell, D. G. (2001). A selective impairment
in the processing of sad and fearful expressions in children with psychopathic
tendencies. Journal of Abnormal Child Psychology, 29(6), 491–8.
Blair, R. J. R., Peschardt, K. S., Budhani, S., Mitchell, D. G. V, & Pine, D. S. (2006).
The development of psychopathy. Journal of Child Psychology and Psychiatry,
47(3-4), 262–275.
Boivin, M., Hymel, S., & Bukowski, W. M. (1995). The roles of social withdrawal, peer
rejection, and victimization by peers in predicting loneliness and depressed mood in
childhood. Development and Psychopathology, 7(4), 765.
Boivin, M., Poulin, F., & Vitaro, F. (1994). Depressed mood and peer rejection in
childhood. Development and Psychopathology, 6(3), 483.
167
Brame, B., Nagin, D. S., & Tremblay, R. E. (2001). Developmental trajectories of
physical aggression from school entry to late adolescence. Journal of Child
Psychology and Psychiatry, and Allied Disciplines, 42(4), 503–512.
Brennan, T. (1982). Loneliness at adolescence. In L. A. Peplau & D. Perlman (Eds.),
Loneliness: A sourcebook of current theory, research, and therapy (pp. 269–290).
New York, NY: Wiley.
Broidy, L. M., Nagin, D. S., Tremblay, R. E., Bates, J. E., Brame, B., Dodge, K. A., …
Vitaro, F. (2003). Developmental trajectories of childhood disruptive behaviors and
adolescent delinquency: a six-site, cross-national study. Developmental Psychology,
39(2), 222–245.
Brown, K., Atkins, M. S., Osborne, M. L., & Milnamow, M. (1996). A revised teacher
rating scale for reactive and proactive aggression. Journal of Abnormal Child
Psychology, 24(4), 473–480.
Bukowski, W., & Adams, R. (2005). Peer relationships and psychopathology: Markers,
moderators, mediators, mechanisms, and meanings. Journal of Clinical Child and
Adolescent Psychology, 34(1), 3–10.
Bukowski, W. M., Laursen, B., & Hoza, B. (2010). The snowball effect: friendship
moderates escalations in depressed affect among avoidant and excluded children.
Development and Psychopathology, 22(4), 749–757.
Burke, J. D., Waldman, I., & Lahey, B. B. (2010). Predictive validity of childhood
oppositional defiant disorder and conduct disorder: implications for the DSM-V.
Journal of Abnormal Psychology, 119(4), 739–51.
Burt, S., & Klump, K. (2013). Delinquent peer affiliation as an etiological moderator of
childhood delinquency. Psychological Medicine, 43(6), 1269–1278.
Bushman, B. J., & Anderson, C. A. (2001). Is it time to pull the plug on the hostile
versus instrumental aggression dichotomy? Psychological Review, 108(1), 273–279.
168
Buss, A. H., & Warren, W. L. (2000). Aggression Questionnaire: Manual. Los Angeles:
Western Psychological Services.
Byrd, A. L., Loeber, R., & Pardini, D. A. (2012). Understanding desisting and persisting
forms of delinquency: The unique contributions of disruptive behavior disorders and
interpersonal callousness. Journal of Child Psychology and Psychiatry and Allied
Disciplines, 53(4), 371–380.
Byrne, B. M. (2004). Testing for Multigroup Invariance Using AMOS Graphics: A
Road Less Traveled. Structural Equation Modeling: A Multidisciplinary Journal,
11(2), 272-300.
Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006).
Loneliness as a specific risk factor for depressive symptoms: cross-sectional and
longitudinal analyses. Psychology and Aging, 21(1), 140–151.
Cairns, R. B., Cairns, B. D., Neckerman, H. J., Gest, S. D., & Gariepy, J. L. (1988).
Social networks and aggressive behavior: Peer support or peer rejection?
Developmental Psychology, 24(6), 815-823.
Card, N. A., Stucky, B. D., Sawalani, G. M., & Little, T. D. (2008). Direct and indirect
aggression during childhood and adolescence: a meta-analytic review of gender
differences, intercorrelations, and relations to maladjustment. Child Development,
79(5), 1185–229.
Card, N. A., & Little, T. D. (2006). Proactive and reactive aggression in childhood and
adolescence: A meta-analysis of differential relations with psychosocial adjustment.
International Journal of Behavioral Development, 30(5), 466-480.
Carmines, E. & McIver, J. (1981). Analyzing models with unobservable variables:
Analysis of covariance structures. In G. Bohrnstedt & E. Borgatta (Eds.), Social
measurement: Current issues (pp. 65–115). Sage.
169
Carré, J. M., Hyde, L. W., Neumann, C. S., Viding, E., & Hariri, A. R. (2013). The
neural signatures of distinct psychopathic traits. Social Neuroscience, 8(2), 122–35.
Cassidy, J., & Asher, S. R. (1992). Loneliness and peer relations in young children.
Child Development, 63(2), 350–365.
Centifanti, L. C. M., & Modecki, K. (2013). Throwing caution to the wind: callous-
unemotional traits and risk taking in adolescents. Journal of Clinical Child and
Adolescent Psychology : The Official Journal for the Society of Clinical Child and
Adolescent Psychology, American Psychological Association, Division 53, 42(1),
106–19.
Chabrol, H., van Leeuwen, N., Rodgers, R. F., & Gibbs, J. C. (2011). Relations between
self-serving cognitive distortions, psychopathic traits, and antisocial behavior in a
non-clinical sample of adolescents. Personality and Individual Differences, 51(8),
887–892.
Chipuer, H. M. (2001). Dyadic attachments and community connectedness: Links with
youths’ loneliness experiences. Journal of Community Psychology, 29(4), 429–446.
Chipuer, H. M. (2004). Australian children’s understanding of loneliness. Australian
Journal of Psychology, 56(3), 147–153.
Ciucci, E., Baroncelli, A., Franchi, M., Golmaryami, F. N., & Frick, P. J. (2013). The
association between callous-unemotional traits and behavioral and academic
adjustment in children: Further validation of the Inventory of Callous-Unemotional
Traits. Journal of Psychopathology and Behavioral Assessment, 36(2), 189–200.
Cleckley, H. M. (1976). The Mask of Sanity: An Attempt to Clarify Some Issues about
the So-called Psychopathic Personality (p. 544). San Luis: Mosby.
Coie, J. D., Coppotelli, H., & Dodge, K. H. (1982). Dimensions and types of social-
status - A cross-age perspective. Developmental Psychology, 18(4), 557–570.
170
Coie, J. D., & Kupersmidt, J. B. (1983). A behavioral analysis of emerging social status
in boys’ groups. Child Development, 54, 1400–1416.
Coie, J. D., Lochman, J. E., Terry, R., & Hyman, C. (1992). Predicting early adolescent
disorder from childhood aggression and peer rejection. Journal of Consulting and
Clinical Psychology, 60(5), 783–92.
Colins, O. F., Noom, M., & Vanderplasschen, W. (2012). Youth Psychopathic Traits
Inventory-Short version: A further test of the internal consistency and criterion
validity. Journal of Psychopathology and Behavioral Assessment, 34, 476-486.
Coplan, R. J. & Bowker, J. (2013). The Handbook of Solitude. Psychological
Perspectives on Social Isolation, Social Withdrawal and Being Alone. London.
Wiley.
Cooke, D. J., & Michie, C. (1997). An item response theory analysis of the Hare
Psychopathy Checklist - Revised. Psychological Assessment, 9(1), 3-14.
Cooke, D. J., Michie, C., & Hart, S. D. (2006). Facets of clinical psychopathy. In C. J.
Patrick (Ed.), Handbook of Psychopathy (pp. 91–106). New York: Guildford Press.
Cooke, D. J., Michie, C., Hart, S. D., & Clark, D. A. (2004). Reconstructing
psychopathy: clarifying the significance of antisocial and socially deviant behavior in
the diagnosis of psychopathic personality disorder. Journal of Personality Disorders,
18(4), 337–357.
Cooke, D., & Michie, C. (2001). Refining the construct of psychopathy: Towards a
hierarchical model. Psychological Assessment, 13(2), 171–188.
Coplan, R. J., & Rubin, K. H. (2010). Social withdrawal and shyness in childhood:
History, theories, definitions, and assessments. In K. H. Rubin & R. J. Coplan (Eds.),
The development of shyness and social withdrawal (pp. 3–20). New York, NY:
Guildford Press.
171
Coplan, R. J., Ruhin, K. H., Fox, N. A., Calking, S. D., & Stewart, S. L. (1994). Being
alone, playing alone, and acting alone: Distinguishing among reticence and passive
and active solitude in young children. Child Development, 65(1), 129–137.
Cordin, R. (2007). Psychopathic-like-traits and aggression in suspended mainstream
school children and adolescents. Unpublished doctoral dissertation, The University
of Western Australia, Perth, Australia.
Côté, S. M., Vaillancourt, T., Barker, E. D., Nagin, D., & Tremblay, R. E. (2007). The
joint development of physical and indirect aggression: Predictors of continuity and
change during childhood. Development and Psychopathology, 19(1), 37–55.
Côté, S., Tremblay, R. E., Nagin, D., Zoccolillo, M., & Vitaro, F. (2002). The
development of impulsivity, fearfulness, and helpfulness during childhood: Patterns
of consistency and change in the trajectories of boys and girls. Journal of Child
Psychology and Psychiatry and Allied Disciplines, 43(5), 609–618.
Côté, S., Vaillancourt, T., LeBlanc, J. C., Nagin, D. S., & Tremblay, R. E. (2006). The
development of physical aggression from toddlerhood to pre-adolescence: A nation
wide longitudinal study of Canadian children. Journal of Abnormal Child
Psychology, 34(1), 71–85.
Cramer, K. M., & Barry, J. E. (1999). Conceptualizations and measures of loneliness: A
comparison of subscales. Personality and Individual Differences, 27(3), 491–502.
Crapanzano, A. M., Frick, P. J., & Terranova, A. M. (2010). Patterns of physical and
relational aggression in a school-based sample of boys and girls. Journal of
Abnormal Child Psychology, 38(4), 433–445.
Crick, N. R. (1996). The role of overt aggression, relational aggression, and prosocial
behavior in the prediction of children’s future social adjustment. Child Development,
67(5), 2317–2327.
172
Crick, N. R., Casas, J. F., & Mosher, M. (1997). Relational and overt aggression in
preschool. Developmental Psychology, 33(4), 579–588.
Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information-
processing mechanisms in children’s social adjustment. Psychological Bulletin,
115(1), 74-101.
Crick, N. R., & Dodge, K. A. (1996). Social information-processing mechanisms in
reactive and proactive aggression. Child Development, 67(3), 993–1002.
Crick, N. R., & Grotpeter, J. K. (1995). Relational aggression, gender, and social-
psychological adjustment. Child Development, 66(3), 710–722.
Criss, M. M., Pettit, G. S., Bates, J. E., Dodge, K. A., & Lapp, A. L. (2002). Family
adversity, positive peer relationships, and children’s externalizing behavior: A
longitudinal perspective on risk and resilience. Child Development, 73(4), 1220–
1237.
Dadds, M. R., Fraser, J., Frost, A., & Hawes, D. J. (2005). Disentangling the underlying
dimensions of psychopathy and conduct problems in childhood: a community study.
Journal of Consulting and Clinical Psychology, 73(3), 400–10.
Dadds, M. R., Hawes, D. J., Frost, A. D. J., Vassallo, S., Bunn, P., Hunter, K., & Merz,
S. (2009). Learning to “talk the talk”: the relationship of psychopathic traits to
deficits in empathy across childhood. Journal of Child Psychology and Psychiatry,
50(5), 599–606.
Dadds, M. R., Perry, Y., Hawes, D. J., Merz, S., Riddell, A. C., Haines, D. J., &
Abeygunawardane, A. I. (2006). Attention to the eyes and fear-recognition deficits in
child psychopathy. The British Journal of Psychiatry, 189, 280–281.
Dadds, M. R., & Salmon, K. (2003). Punishment insensitivity and parenting:
temperament and learning as interacting risks for antisocial behavior. Clinical Child
and Family Psychology Review, 6(2), 69–86.
173
Dahlberg, K. (2007). The enigmatic phenomenon of loneliness. International Journal of
Qualitative Studies on Health and Well-Being, 2(4), 195–207.
De Brito, S. A., Mechelli, A., Wilke, M., Laurens, K. R., Jones, A. P., Barker, G. J., …
Viding, E. (2009). Size matters: increased grey matter in boys with conduct problems
and callous-unemotional traits. Brain : A Journal of Neurology, 132 (4), 843–52.
De Jong-Gierveld, J., & Raadschelders, J. (1982). Types of loneliness. In L. A. Peplau
& D. Perlman (Eds.), Loneliness: A sourcebook of current theory, research, and
therapy (pp. 105–119). New York, NY: Wiley.
De Wied, M., Van Boxtel, A., Matthys, W., & Meeus, W. (2012). Verbal, facial and
autonomic responses to empathy-eliciting film clips by disruptive male adolescents
with high versus low callous-unemotional traits. Journal of Abnormal Child
Psychology, 40(2), 211–223.
Deater-Deckard, K. (2001). Annotation: Recent research examining the role of peer
relationships in the development of psychopathology. Journal of Child Psychology
and Psychiatry, 42(5), 565–79.
Dijkstra, J. K., Berger, C., & Lindenberg, S. (2011). Do physical and relational
aggression explain adolescents’ friendship selection? The competing roles of
network characteristics, gender, and social status. Aggressive Behavior, 37(5), 417–
429.
DiTommaso, E., & Spinner, B. (1993). The development and initial validation of the
Social and Emotional Loneliness Scale for Adults (SELSA). Personality and
Individual Differences, 14(1), 127-134.
Dodge, K. A., Lansford, J. E., Burks, V. S., Bates, J. E., Pettit, G. S., Fontaine, R., &
Price, J. M. (2003). Peer rejection and social information-processing factors in the
development of aggressive behavior problems in children. Child Development, 74(2),
374–393.
174
Dodge, K. A. (1991). The structure and function of reactive and proactive aggression. In
D. Pepler & R. K. Rubin (Eds.), The Development and Treatment for Childhood
Aggression (pp. 201–218). Hillsdale, NJ: Erlbaum.
Dodge, K. A., Bates, J. E., & Pettit, G. S. (1990). Mechanisms in the cycle of violence.
Science (New York, N.Y.), 250(4988), 1678–1683.
Dodge, K. A., & Coie, J. D. (1987). Social-information-processing factors in reactive
and proactive aggression in children’s peer groups. Journal of Personality and Social
Psychology, 53(6), 1146–1158.
Dodge, K. A., Coie, J. D., Pettit, G. S., & Price, J. M. (1990). Peer status and aggression
in boys’ groups: developmental and contextual analyses. Child Development, 61(5),
1289–1309.
Dodge, K. A., & Crick, N. R. (1990). Social information-processing bases of aggressive
behavior in children. Personality and Social Psychology Bulletin, 16(1), 8-22.
Dodge, K. A., & Frame, C. L. (1982). Social cognitive biases and deficits in aggressive
boys. Child Development, 53(3), 620–635.
Dodge, K. A., Malone, P. S., Lansford, J. E., Miller, S., Pettit, G. S., & Bates, J. E.
(2009). A dynamic cascade model of the development of substance-use onset.
Monographs of the Society for Research in Child Development, 74(3), vii–119.
Dodge, K. A., Pettit, G. S., Bates, J. E., & Valente, E. (1995). Social information-
processing patterns partially mediate the effect of early physical abuse on later
conduct problems. Journal of Abnormal Psychology, 104(4), 632–643.
Dodge, K. A., Pettit, G. S., McClaskey, C. L., Brown, M. M., & Gottman, J. M. (1986).
Social Competence in Children. Monographs of the Society for Research in Child
Development, 51(2), 1–85.
175
Dodge, K., Coie, J., & Brakke, N. (1982). Behavior patterns of socially rejected and
neglected preadolescents: The roles of social approach and aggression. Journal of
Abnormal Child Psychology, 10(3), 389–410.
Dollard, J., Miller, N., Doob, L. W., Mowrer, O. H., & Sears, R. R. (1939). Frustration
and Aggression (p. 213). New Haven, CT: Yale University Press.
Doman, L. C. H., & Le Roux, A. (2010). Die oorsake van en bydraende faktore tot
eensaamheid - ’A literatuuroorsig. Tydskrif Vir Geesteswetenskappe, 50(2), 216–228.
Retrieved from http://www.scopus.com/inward/record.url?eid=2-s2.0-
77954000527&partnerID=tZOtx3y1
Eisenberg, N., Eggum, N. D., & Di Giunta, L. (2010). Empathy-related responding:
Associations with prosocial behavior, aggression, and intergroup relations. Social
Issues and Policy Review, 4(1), 143–180.
Eisenberg, N., & Fabes, R. A. (1998). Pro-social development. In N. Eisenberg & W.
Damon (Eds.), Handbook of child psychology, Vol. 3: Social, emotional and
personality development (5th ed., pp. 701–778). New York, NY: Wiley.
Enebrink, P., Andershed, H., & Långström, N. (2005). Callous-unemotional traits are
associated with clinical severity in referred boys with conduct problems. Nordic
Journal of Psychiatry, 59(6), 431–40.
Essau, C. A., Sasagawa, S., & Frick, P. J. (2006). Callous-unemotional traits in a
community sample of adolescents. Assessment, 13(4), 454–69.
Ezpeleta, L., de la Osa, N., Granero, R., Penelo, E., & Domènech, J. M. (2013).
Inventory of callous-unemotional traits in a community sample of preschoolers.
Journal of Clinical Child and Adolescent Psychology, 42(1), 91–105.
Fanti, K. A., Frick, P. J., & Georgiou, S. (2009). Linking callous-unemotional traits to
instrumental and non-instrumental forms of aggression. Journal of Psychopathology
and Behavioral Assessment, 31(4), 285–298.
176
Fanti, K. A., & Centifanti, L. C. M. (2014). Childhood callous-unemotional traits
moderate the relation between parenting distress and conduct problems over time.
Child Psychiatry & Human Development, 45(2), 173-184.
Farrington, D. P. (2005). The importance of child and adolescent psychopathy. Journal
of Abnormal Child Psychology, 33(2), 489–497.
Finger, E., Marsh, A., & Blair, K. (2012). Impaired functional but preserved structural
connectivity in limbic white matter tracts in youth with conduct disorder or
oppositional defiant disorder plus psychopathic traits. Psychiatry Research, 202(3),
239–244.
Fink, B., Tant, A., Tremba, K., & Kiehl, K. (2012). Assessment of psychopathic traits in
an incarcerated adolescent sample: A methodological comparison. Journal of
Abnormal Child Psychology, 40(6), 971–986.
Fite, P. J., Raine, A., Stouthamer-Loeber, M., Loeber, R., & Pardini, D. A. (2010).
Reactive and proactive aggression in adolescent males: Examining differential
outcomes 10 years later in early adulthood. Criminal Justice and Behavior, 37(2),
141-157.
Fite, P. J., Rubens, S. L., Preddy, T. M., Raine, A., & Pardini, D. A. (2014).
Reactive/proactive aggression and the development of internalizing problems in
males: the moderating effect of parent and peer relationships. Aggressive Behavior,
40(1), 69–78.
Fite, P. J., Stauffacher, K., Ostrov, J. M., & Colder, C. R. (2008). Replication and
extension of Little et al.’s (2003) forms and functions of aggression measure.
International Journal of Behavioral Development, 32(3), 238–242.
Fite, P. J., Stoppelbein, L., & Greening, L. (2009). Proactive and reactive aggression in
a child psychiatric inpatient population. Journal of Clinical Child and Adolescent
Psychology, 38(2), 199–205.
177
Fite, P. J., Vitulano, M., Wynn, P., Wimsatt, A., Gaertner, A., & Rathert, J. (2010).
Influence of perceived neighborhood safety on proactive and reactive aggression.
Journal of Community Psychology, 38(6), 757–768.
Flesch, R. (1948). A new readability yardstick. The Journal of Applied Psychology,
32(3), 221–233.
Flight, J. I., & Forth, A. E. (2007). Instrumentally violent youths: The roles of
psychopathic traits, empathy, and attachment. Criminal Justice and Behavior, 34(6),
739-751.
Fontaine, N. M. G., Rijsdijk, F. V, McCrory, E. J. P., & Viding, E. (2010). Etiology of
different developmental trajectories of callous-unemotional traits. Journal of the
American Academy of Child and Adolescent Psychiatry, 49(7), 656–664.
Fontaine, N. M. G., Rijsdijk, F. V., McCrory, E. J. P., & Viding, E. (2010). Etiology of
different developmental trajectories of callous-unemotional traits. Journal of the
American Academy of Child and Adolescent Psychiatry, 49(7).
Forth, A. E., & Book, A. S. (2010). Psychopathic traits in children and adolescents: The
relationship with antisocial behaviors and aggression. In R. T. Salekin & D. R.
Lynam (Eds.), Handbook of child adolescent psychopathy. (pp. 251–283). Guilford
Press.
Forth, A. E., Brown, S. L., Hart, S. D., & Hare, R. D. (1996). The assessment of
psychopathy in male and female noncriminals: Reliability and validity. Personality
and Individual Differences, 20(5), 531–543.
Forth, A. E., Hart, S. D., & Hare, R. D. (1990). Assessment of psychopathy in male
young offenders. Psychological Assessment, 2(3), 342–344.
Forth, A. E., Kosson, D. S., & Hare, R. D. (2003). Hare psychopathy checklist: Youth
version (PCL: YV). Toronto: Multi-Health Systems.
178
Foulkes, L., Seara-Cardoso, A., Neumann, C. S., Rogers, J. S. C., & Viding, E. (2014).
Looking after number one: Associations between psychopathic traits and measures of
social motivation and functioning in a community sample of males. Journal of
Psychopathology and Behavioral Assessment, 36(1), 22–29.
French, D. C., & Waas, G. A. (1985). Behavior problems of peer-neglected and peer-
rejected elementary-age children: parent and teacher perspectives. Child
Development, 56(1), 246–252.
Frick, P., Bodin, S., & Barry, C. (2000). Psychopathic traits and conduct problems in
community and clinic-referred samples of children: Further development of the
Psychopathy Screening Device. Psychological Assessment, 12(4), 382–393.
Frick, P. J. (2004). The Inventory of Callous-Unemotional Traits. Unpublished rating
scale. New Orleans, LA: University of New Orleans.
Frick, P. J. (2006). Developmental pathways to conduct disorder. Child and Adolescent
Psychiatric Clinics of North America, 15(2), 311–331.
Frick, P. J. (2012). Developmental pathways to conduct disorder: implications for future
directions in research, assessment, and treatment. Journal of Clinical Child and
Adolescent Psychology, 41(3), 378–89.
Frick, P. J., Barry, C. T., & Kamphaus, R. W. (2009). Clinical assessment of child and
adolescent personality (3rd ed.). New York, NY: Springer.
Frick, P. J., Cornell, A. H., Barry, C. T., Bodin, S. D., & Dane, H. E. (2003). Callous-
unemotional traits and conduct problems in the prediction of conduct problem
severity, aggression, and self-report of delinquency. Journal of Abnormal Child
Psychology, 31(4), 457–70.
Frick, P. J., Cornell, A. H., Bodin, S. D., Dane, H. E., Barry, C. T., & Loney, B. R.
(2003). Callous-unemotional traits and developmental pathways to severe conduct
problems. Developmental Psychology, 39(2), 246–260.
179
Frick, P. J., & Dickens, C. (2006). Current perspectives on conduct disorder. Current
Psychiatry Reports, 8(1), 59–72.
Frick, P. J., & Hare, R. D. (2001). The antisocial process screening device (APSD).
Toronto: Multi-Health Systems.
Frick, P. J., Kimonis, E. R., Dandreaux, D. M., & Farell, J. M. (2003). The 4 Year
stability of psychopathic traits in non-referred youth. Behavioral Sciences and the
Law, 21(6), 713–736.
Frick, P. J., & Marsee, M. A. (2006). Psychopathy and developmental pathways to
antisocial behavior in youth. In C. J. Patrick (Ed.), Handbook of Psychopathy (pp.
353–375). New York: Guildford Press.
Frick, P. J., & Moffitt, T. E. (2010). A proposal to the DSM-V Childhood Disorders and
the ADHD and Disruptive Behavior Disorders Work Groups to include a Specifier to
the Diagnosis of Conduct Disorder based on the presence of callous–unemotional
traits. Washington, DC: American Psychiatric Association. Retrieved from
http://www.dsm5.org/Proposed Revision Attachments/Proposal for Callous and
Unemotional Specifier of Conduct Disorder.pdf
Frick, P. J., O’Brien, B. S., Wooten, J. M., & McBurnett, K. (1994). Psychopathy and
conduct problems in children. Journal of Abnormal Psychology, 103(4), 700–707.
Frick, P. J., Ray, J. V, Thornton, L. C., & Kahn, R. E. (2013). Annual research review:
A developmental psychopathology approach to understanding callous-unemotional
traits in children and adolescents with serious conduct problems. Journal of Child
Psychology and Psychiatry, and Allied Disciplines, 55(6), 532–48.
Frick, P. J., Ray, J. V, Thornton, L. C., & Kahn, R. E. (2014). Can callous-unemotional
traits enhance the understanding, diagnosis, and treatment of serious conduct
problems in children and adolescents? A comprehensive review. Psychological
Bulletin, 140(1), 1–57.
180
Frick, P. J., & White, S. F. (2008). Research review: the importance of callous-
unemotional traits for developmental models of aggressive and antisocial behavior.
Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49(4), 359–
Galanaki, E. (2004). Are children able to distinguish among the concepts of aloneness,
loneliness, and solitude? International Journal of Behavioral Development, 28(5),
435–443.
Galanaki, E. P., Polychronopoulou, S. A., & Babalis, T. K. (2008). Loneliness and
social dissatisfaction among behaviourally at-risk children. School Psychology
International, 29(2), 214–229.
Gall, M. D., Gall, J. P., & Borg, W. R. (2007). Educational Research: An Introduction.
Boston: Pearson.
Gazelle, H., & Rubin, K. H. (2010). Social anxiety in childhood: bridging
developmental and clinical perspectives. New Directions for Child and Adolescent
Development, 2010(127), 1–16.
Gifford-Smith, M. E., & Brownell, C. A. (2003). Childhood peer relationships: Social
acceptance, friendships, and peer networks. Journal of School Psychology, 41(4),
235-284.
Gillham, B. (2000). The Research Interview. London: Continuum.
Glenn, A. L., & Raine, A. (2008). The neurobiology of psychopathy. Psychiatric
Clinics of North America, 31(3), 463-475.
Glenn, A. L., & Raine, A. (2009). Psychopathy and instrumental aggression:
Evolutionary, neurobiological, and legal perspectives. International Journal of Law
and Psychiatry, 32(4), 253–8.
Golmaryami, F. N., & Barry, C. T. (2010). The associations of self-reported and peer-
reported relational aggression with narcissism and self-esteem among adolescents in
a residential setting. Journal of Clinical Child and Adolescent Psychology : The
181
Official Journal for the Society of Clinical Child and Adolescent Psychology,
American Psychological Association, Division 53, 39(1), 128–133.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: a research note.
Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38(5), 581–6.
Goossens, L., & Beyers, W. (2002). Comparing measures of childhood loneliness:
internal consistency and confirmatory factor analysis. Journal of Clinical Child and
Adolescent Psychology : The Official Journal for the Society of Clinical Child and
Adolescent Psychology, American Psychological Association, Division 53, 31(2),
252–262.
Goossens, L., Lasgaard, M., Luyckx, K., Vanhalst, J., Mathias, S., & Masy, E. (2009).
Loneliness and solitude in adolescence: A confirmatory factor analysis of alternative
models. Personality and Individual Differences, 47(8), 890–894.
Hare, R. (1980). A Research Scale for the Assessment of Psychopathy in Criminal
Populations. Personality and Individual Differences, 1, 111–119.
Hare, R. D. (1991). The Self-Report Psychopathy Scale-II. Unpublished test.
Vancouver, BC: University of British Columbia.
Hare, R. D. (1999). Without Conscience: The Disturbing World of the Psychopaths
Among Us (p. 236). New York: Guildford Press.
Hare, R. D. (2003). The Hare Psychopathy Checklist - Revised manual (2nd ed.).
Toronto, Ontario, Canada: Multi-Health Systems.
Hare, R. D. (2006). Psychopathy: a clinical and forensic overview. The Psychiatric
Clinics of North America, 29(3), 709–724.
Hare, R. D., & Neumann, C. S. (2006). The PCL-R assessment of psychopathy:
Development, Structural Properties and New Directions. In C. J. Patrick (Ed.),
Handbook of Psychopathy (pp. 58–90). New York: Guildford Press.
182
Hare, R. D., & Neumann, C. S. (2008). Psychopathy as a clinical and empirical
construct. Annual Review of Clinical Psychology, 4, 217–246.
Hawe, P., Webster, C., & Shiell, A. (2004). A glossary of terms for navigating the field
of social network analysis. Journal of Epidemiology and Community Health, 58(12),
971–975.
Haas, S., Wascbusch, D., King, S., & Walsh, T. (2015). Examining the role of callous-
unemotional traits in the attributional styles and self-competence evaluations of
children with conduct problems and ADHD. Journal of Psychopathology and
Behavioral Assessment, 37, 196-206.
Hawes, D. J. & Dadds, M. R. (2005). The treatment of conduct problems in children
with callous-unemotional traits. Journal of Consulting and Clinical Psychology,
73(4), 737–41.
Hawkley, L. C., Browne, M. W., & Cacioppo, J. T. (2005). How can i connect with
thee? Let me count the ways. Psychological Science, 16(10), 798–804.
Hawkley, L. C., Gu, Y., Luo, Y. J., & Cacioppo, J. T. (2012). The mental representation
of social connections: Generalizability extended to Beijing adults. PLoS ONE, 7(9).
Hawley, P. H. (2003). Prosocial and coercive configurations of resource control in early
adolescence: A case for the well-adapted Machiavellian. Merrill-Palmer Quarterly,
49(3), 279-309.
Hay, D. F., Payne, A., & Chadwick, A. (2004). Peer relations in childhood. Journal of
Child Psychology and Psychiatry, 45(1), 84–108.
Heinrich, L. M., & Gullone, E. (2006). The clinical significance of loneliness: A
literature review. Clinical Psychology Review, 26(6), 695-798.
Herpers, P. C. M., Rommelse, N. N. J., Bons, D. M. a, Buitelaar, J. K., & Scheepers, F.
E. (2012). Callous-unemotional traits as a cross-disorders construct. Social
Psychiatry and Psychiatric Epidemiology, 47(12), 2045–64.
183
Houghton, S., Cordin, R., & Hopkins, S. (2010). Psychopathic-like traits and aggression
in Australian children and adolescents suspended from schools. In O. Sahin & J.
Maier (Eds.), Delinquency: Causes, reduction and prevention (pp. 177–196). New
York, NY: Nova Science.
Houghton, S., Hattie, J., Wood, L., Carroll, A., Martin, K., & Tan, C. (2014a).
Conceptualising Loneliness in Adolescents: Development and Validation of a Self-
report Instrument. Child Psychiatry and Human Development, 45(5), 604–616.
Houghton, S., Hunter, S. C., Khan, U., & Tan, C. (2013). Interpersonal and affective
dimensions of psychopathic traits in adolescents: development and validation of a
self-report instrument. Child Psychiatry and Human Development, 44(1), 51–69.
Houghton, S., Roost, E., Carroll, A., & Brandtman, M. (2014b). Loneliness in children
and adolescents with and without Attention-Deficit/Hyperactivity Disorder. Journal
of Psychopathology and Behavioral Assessment, 1–11.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure
analysis: Conventional criteria versus new alternatives. Structural Equation
Modeling: A Multidisciplinary Journal, 6(1), 1-55.
Hubbard, J. A. (2001). Emotion expression processes in children’s peer interaction: The
role of peer rejection, aggression, and gender. Child Development, 72(5), 22-45.
Hubbard, J. A., Dodge, K. A., Cillessen, A. H. N., Coie, J. D., & Schwartz, D. (2001).
The dyadic nature of social information processing in boys’ reactive and proactive
aggression. Journal of Personality and Social Psychology, 80(2), 268–280.
Humayun, S., Kahn, R. E., Frick, P. J., & Viding, E. (2014). Callous-unemotional traits
and anxiety in a community sample of 7-year-olds. Journal of Clinical Child and
Adolescent Psychology, 43(1), 36–42.
184
Hyde, L., & Shaw, D. (2013). Dimensions of callousness in early childhood: Links to
problem behavior and family intervention effectiveness. Development and
Psychopathology, 25(2), 347–363.
Hyde, L. W., Shaw, D. S., Gardner, F., Cheong, J., Dishion, T. J., & Wilson, M. (2013).
Dimensions of callousness in early childhood: links to problem behavior and family
intervention effectiveness. Development and Psychopathology, 25(2), 347–63.
Hymel, S., LeMare, L., Ditner, E., & Woody, E. Z. (1999). Assessing self-concept in
children: Variations across self-concept domains. Merrill-Palmer Quarterly, 45(4),
602-623.
Jobe-Shields, L., Cohen, R., & Parra, G. R. (2011). Patterns of change in children’s
loneliness: Trajectories from third through fifth grades. Merrill-Palmer Quarterly,
57(1), 25–47.
Johnstone, L., & Cooke, D. J. (2004). Psychopathic-like traits in childhood: Conceptual
and measurement concerns. Behavioral Sciences and the Law, 22(1), 103-125.
Jones, A. P., Happé, F. G. E., Gilbert, F., Burnett, S., & Viding, E. (2010). Feeling,
caring, knowing: different types of empathy deficit in boys with psychopathic
tendencies and autism spectrum disorder. Journal of Child Psychology and
Psychiatry, and Allied Disciplines, 51(11), 1188–1197.
Jones, A. P., Laurens, K. R., Herba, C. M., Barker, G. J., & Viding, E. (2009).
Amygdala hypoactivity to fearful faces in boys with conduct problems and callous-
unemotional traits. American Journal of Psychiatry, 166(1), 95–102.
Kahn, R. E., Frick, P. J., Youngstrom, E., Findling, R. L., & Youngstrom, J. K. (2012).
The effects of including a callous unemotional specifier for the diagnosis of conduct
disorder. Journal of Child Psychology and Psychiatry, 53(3), 271–282.
Kamphaus, R. W., & Frick, P. J. (2002). Clinical assessment of children’s personality
and behavior. New York, NY: Allyn and Bacon.
185
Keenan, K., Loeber, R., Zhang, Q., Stouthamer-Loeber, M., & van Kammen, W. B.
(1995). The influence of deviant peers on the development of boys’ disruptive and
delinquent behavior: A temporal analysis. Development and Psychopathology, 7,
715–726.
Keiley, M. K., Bates, J. E., Dodge, K. A., & Pettit, G. S. (2000). A cross-domain growth
analysis: Externalizing and internalizing behaviors during 8 years of childhood.
Journal of Abnormal Child Psychology, 28(2), 161–179.
Kimonis, E. R., Branch, J., Hagman, B., Graham, N., & Miller, C. (2013). The
psychometric properties of the Inventory of Callous-Unemotional Traits in an
undergraduate sample. Psychological Assessment, 25(1), 84–93.
Kimonis, E. R., Frick, P. J., & Barry, C. T. (2004). Callous-unemotional traits and
delinquent peer affiliation. Journal of Consulting and Clinical Psychology, 72(6),
956–966.
Kimonis, E. R., Frick, P. J., Boris, N. W., Smyke, A. T., Cornell, A. H., Farrell, J. M., &
Zeanah, C. H. (2006). Callous-unemotional features, behavioral inhibition, and
parenting: Independent predictors of aggression in a high-risk preschool sample.
Journal of Child and Family Studies, 15(6), 741–752.
Kimonis, E. R., Frick, P. J., Cauffman, E., Goldweber, A., & Skeem, J. (2012). Primary
and secondary variants of juvenile psychopathy differ in emotional processing.
Development and Psychopathology, 24(3), 1091-1103.
Kimonis, E. R., Frick, P. J., Fazekas, H., & Loney, B. R. (2006). Psychopathy,
aggression, and the processing of emotional stimuli in non-referred girls and boys.
Behavioral Sciences and the Law, 24(1), 21–37.
Kimonis, E. R., Frick, P. J., Skeem, J. L., Marsee, M. A., Cruise, K., Munoz, L. C., …
Morris, A. S. (2008). Assessing callous-unemotional traits in adolescent offenders:
186
validation of the Inventory of Callous-Unemotional Traits. International Journal of
Law and Psychiatry, 31(3), 241–52.
Kline, P. (2000). Handbook of psychological testing (2nd ed.). London: Routledge.
Kotler, J. S., & McMahon, R. J. (2005). Child psychopathy: Theories, measurement,
and relations with the development and persistence of conduct problems. Clinical
Child and Family Psychology Review, 8(4), 291–325.
Krause-Parello, C. A. (2008). Loneliness in the school setting. The Journal of School
Nursing, 24(2), 66–70.
Kruh, I. P., Frick, P. J., & Clements, C. B. (2005). Historical and personality correlates
to the violence patterns of juveniles tried as adults. Criminal Justice and Behavior,
32(1), 69–96.
Kumsta, R., Sonuga-Barke, E., & Rutter, M. (2012). Adolescent callous-unemotional
traits and conduct disorder in adoptees exposed to severe early deprivation. British
Journal of Psychiatry, 200(3), 197–201.
Kupersmidt, J. B., & Coie, J. D. (1990). Preadolescent peer status, aggression, and
school adjustment as predictors of externalizing problems in adolescence. Child
Development, 61(5), 1350–1362.
Lacourse, E., Nagin, D., Tremblay, R. E., Vitaro, F., & Claes, M. (2003).
Developmental trajectories of boys’ delinquent group membership and facilitation of
violent behaviors during adolescence. Development and Psychopathology, 15(1),
183–197.
Ladd, G. W. (2006). Peer rejection, aggressive or withdrawn behavior, and
psychological maladjustment from ages 5 to 12: An examination of four predictive
models. Child Development, 77(4), 822-846.
187
Ladd, G. W., & Burgess, K. B. (1999). Charting the relationship trajectories of
aggressive, withdrawn, and aggressive/withdrawn children during early grade school.
Child Development, 70(4), 910–929.
Ladd, G. W., Kochenderfer, B. J., & Coleman, C. C. (1996). Friendship quality as a
predictor of young children’s early school adjustment. Child Development, 67(3),
1103–1118.
Lahey, B. B., Rathouz, P. J., Van Hulle, C., Urbano, R. C., Krueger, R. F., Applegate,
B., … Waldman, I. D. (2008). Testing structural models of DSM-IV symptoms of
common forms of child and adolescent psychopathology. Journal of Abnormal Child
Psychology, 36(2), 187–206.
Lansford, J. E., Malone, P. S., Dodge, K. A., Pettit, G. S., & Bates, J. E. (2010).
Developmental cascades of peer rejection, social information processing biases, and
aggression during middle childhood. Development and Psychopathology, 22(3), 593–
602.
Larsson, H., Tuvblad, C., Rijsdijk, F. V, Andershed, H., Grann, M., & Lichtenstein, P.
(2007). A common genetic factor explains the association between psychopathic
personality and antisocial behavior. Psychological Medicine, 37(1), 15–26.
Lasgaard, M., Goossens, L., Bramsen, R. H., Trillingsgaard, T., & Elklit, A. (2011).
Different sources of loneliness are associated with different forms of
psychopathology in adolescence. Journal of Research in Personality, 45(2), 233-237.
Lasgaard, M., Goossens, L., & Elklit, A. (2011). Loneliness, depressive
symptomatology, and suicide ideation in adolescence: Cross-sectional and
longitudinal analyses. Journal of Abnormal Child Psychology, 39(1), 137–150.
Light, J. M., & Dishion, T. J. (2007). Early adolescent antisocial behavior and peer
rejection: a dynamic test of a developmental process. New Directions for Child and
Adolescent Development, (118), 77–89.
188
Lilienfeld, S. O., & Andrews, B. P. (1996). Development and preliminary validation of
a self-report measure of psychopathic personality traits in noncriminal population.
Journal of Personality Assessment, 66(3), 488–524.
Lilienfeld, S. O., & Fowler, K. A. (2006). The self-report assessment of psychopathy:
Problems, pitfalls, and promises. In C. J. Patrick (Ed.), Handbook of Psychopathy
(pp. 107–132). New York, NY: Guilford Press.
Little, T. D., Jones, S. M., Heinrich, C. C., & Hawley, P. H. (2003). Disentangling the
“whys” from the “whats” of aggressive behaviour. International Journal of
Behavioral Development, 27(2), 122–133.
Loeber, R. (1991). Antisocial behavior: more enduring than changeable? Journal of the
American Academy of Child and Adolescent Psychiatry, 30(3), 393–397.
Loeber, R., & Hay, D. (1997). Key issues in the development of aggression and
violence from childhood to early adulthood. Annual Review of Psychology, 48,
Loeber, R., Pardini, D. A., Hipwell, A., Stouthamer-Loeber, M., Keenan, K., &
Sembower, M. A. (2009). Are there stable factors in preadolescent girls’
externalizing behaviors? Journal of Abnormal Child Psychology, 37(6), 777–791.
Loney, B. R., Frick, P. J., Clements, C. B., Ellis, M. L., & Kerlin, K. (2003). Callous-
unemotional traits, impulsivity, and emotional processing in adolescents with
antisocial behavior problems. Journal of Clinical Child and Adolescent Psychology,
32(1), 66–80.
Lynam, D. (1997). Pursuing the Psychopath: Capturing the Fledgling Psychopath in a
Nomological Net. Journal of Abnormal Psychology, 106(3), 425–438.
Lynam, D. R., Caspi, A., Moffitt, T. E., Loeber, R., & Stouthamer-Loeber, M. (2007).
Longitudinal evidence that psychopathy scores in early adolescence predict adult
psychopathy. Journal of Abnormal Psychology, 116(1), 155–165.
189
Lynam, D. R., Charnigo, R., Moffitt, T. E., Raine, A., Loeber, R., & Stouthamer-
Loeber, M. (2009). The stability of psychopathy across adolescence. Development
and Psychopathology, 21(4), 1133–1153.
Lynam, D. R., & Gudonis, L. (2005). The development of psychopathy. Annual Review
of Clinical Psychology, 1, 381–407.
Marangoni, C., & Ickes, W. (1989). Loneliness: A theoretical review with implications
for measurement. Journal of Social and Personal Relationships, 6(1), 93-128.
Marcoen, A., & Goossens, L. (1993). Loneliness, attitude towards aloneness, and
solitude: Age differences and developmental significance during adolescence. In S.
Jackson & H. Rodriguez-Tome (Eds.), Adolescence and its social worlds (pp. 197–
227). Hillsdale, NJ: Lawrence Erlbaum Associates.
Marcoen, A., Goossens, L., & Caes, P. (1987). Loneliness in pre- through late
adolescence: Exploring the contributions of a multidimensional approach. Journal of
Youth and Adolescence, 16(6), 561–577.
Marsee, M. A., & Frick, P. J. (2007). Exploring the cognitive and emotional correlates
to proactive and reactive aggression in a sample of detained girls. Journal of
Abnormal Child Psychology, 35(6), 969–981.
Marsee, M. A., Silverthorn, P., & Frick, P. J. (2005). The association of psychopathic
traits with aggression and delinquency in non-referred boys and girls. Behavioral
Sciences and the Law, 23(6), 803–817.
Marsh, A., Finger, E., & Mitchell, D. (2008). Reduced amygdala response to fearful
expressions in children and adolescents with callous-unemotional traits and
disruptive behavior disorders. American Journal of Psychiatry, 165(6), 712–720
Mayberry, M. L., & Espelage, D. L. (2007). Associations among empathy, social
competence, and reactive/proactive aggression subtypes. Journal of Youth and
Adolescence, 36(6), 787–798.
190
McMahon, R. J., Witkiewitz, K., & Kotler, J. S. (2010). Predictive validity of callous–
unemotional traits measured in early adolescence with respect to multiple antisocial
outcomes. Journal of Abnormal Psychology, 119(4), 752–763.
McWhirter, B. T., Besett-Alesch, T. M., Horibata, J., & Gat, I. (2002). Loneliness in
high risk adolescents: The role of coping, self-esteem, and empathy. Journal of Youth
Studies, 5(1), 69-84.
Microsoft Corporation. (2003). Microsoft Office 2003 Professional [Computer
Software]. U.S.: Author.
Microsoft Corporation. (2007). Microsoft Office 2007 Professional [Computer
Software]. U.S.: Author.
Miller-Johnson, S., Lochman, J. E., Coie, J. D., Terry, R., & Hyman, C. (1998).
Comorbidity of conduct and depressive problems at sixth grade: Substance use
outcomes across adolescence. Journal of Abnormal Child Psychology, 26(3), 221–
232.
Millon, T., & Davis, R. D. (1993). The Millon Adolescent Personality Inventory and the
Millon Adolescent Clinical Inventory. Journal of Counseling and Development,
71(May/June), 570–574.
Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial
behavior: a developmental taxonomy. Psychological Review, 100(4), 674–701.
Moffitt, T. E., & Caspi, A. (2001). Childhood predictors differentiate life-course
persistent and adolescence-limited antisocial pathways among males and females.
Development and Psychopathology, 13(2), 355–75.
Moran, P., Rowe, R., Flach, C., Briskman, J., Ford, T., Maughan, B., … Goodman, R.
(2009). Predictive value of callous-unemotional traits in a large community sample.
Journal of the American Academy of Child and Adolescent Psychiatry, 48(11), 1079–
1084.
191
Mrug, S., Molina, B. S. G., Hoza, B., Gerdes, A. C., Hinshaw, S. P., Hechtman, L., &
Arnold, L. E. (2012). Peer rejection and friendships in children with Attention-
Deficit/Hyperactivity Disorder: contributions to long-term outcomes. Journal of
Abnormal Child Psychology, 40(6), 1013–1026.
Muñoz, L. C. (2009). Callous-unemotional traits are related to combined deficits in
recognizing afraid faces and body poses. Journal of the American Academy of Child
and Adolescent Psychiatry, 48(5), 554–562.
Muñoz, L. C., & Frick, P. J. (2007). The reliability, stability, and predictive utility of the
self-report version of the Antisocial Process Screening Device. Scandinavian Journal
of Psychology, 48(4), 299–312.
Muñoz, L. C., Kerr, M., & Besic, N. (2008). The peer relationships of youths with
psychopathic personality traits: A matter of perspective. Criminal Justice and
Behavior, 35(2), 212–227.
Muñoz, L. C., Qualter, P., & Padgett, G. (2011). Empathy and bullying: exploring the
influence of callous-unemotional traits. Child Psychiatry and Human Development,
42(2), 183–96.
Musser, E. D., Galloway-Long, H. S., Frick, P. J., & Nigg, J. T. (2013). Emotion
regulation and heterogenrity in Attention-Deficit/Hyperactivity Disorder. Journal of
the American Academy of Child and Adolescent Psychiatry, 52(2), 163–171.
Nagin, D., & Tremblay, R. E. (1999). Trajectories of boys’ physical aggression,
opposition, and hyperactivity on the path to physically violent and nonviolent
juvenile delinquency. Child Development, 70(5), 1181–1196.
Neumann, C. S., Kosson, D. S., Forth, A. E., & Hare, R. D. (2006). Factor structure of
the Hare Psychopathy Checklist: Youth Version (PCL: YV) in incarcerated
adolescents. Psychological Assessment, 18(2), 142–154.
192
Newcomb, A. F., Bukowski, W. M., & Pattee, L. (1993). Children’s peer relations: a
meta-analytic review of popular, rejected, neglected, controversial, and average
sociometric status. Psychological Bulletin, 113(1), 99–128.
Normand, S., Schneider, B. H., Lee, M. D., Maisonneuve, M. F., Kuehn, S. M., &
Robaey, P. (2011). How do children with ADHD (Mis)manage their real-life dyadic
friendships? A multi-method investigation. Journal of Abnormal Child Psychology,
39(2), 293–305.
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory. New York, NY:
McGraw-Hill.
Obradović, J., Pardini, D. A., Long, J. D., & Loeber, R. (2007). Measuring interpersonal
callousness in boys from childhood to adolescence: an examination of longitudinal
invariance and temporal stability. Journal of Clinical Child and Adolescent
Psychology, 36(3), 276–92.
Ollendick, T. H., Weist, M. D., Borden, M. C., & Greene, R. W. (1992). Sociometric
status and academic, behavioral, and psychological adjustment: a five-year
longitudinal study. Journal of Consulting and Clinical Psychology, 60(1), 80–87.
Osterlind, S. J. (1989). Constructing Test Items. Boston, MA: Kluwer.
Ostrov, J. M., & Keating, C. F. (2004). Gender differences in preschool aggression
during free play and structured interactions: An observational study. Social
Development, 13(2), 255–277.
Pallant, J. F. (2007). SPSS survival manual: A step by step guide to data analysis using
SPSS for windows (versions 15) (3rd ed.). Sydney: Allen & Unwin.
Pardini, D. (2011). Perceptions of social conflicts among incarcerated adolescents with
callous-unemotional traits: “you’re going to pay. It’s going to hurt, but I don't care.
Journal of Child Psychology and Psychiatry, and Allied Disciplines, 52(3), 248–55.
193
Pardini, D. A., & Loeber, R. (2008). Interpersonal callousness trajectories across
adolescence: Early social influences and adult outcomes. Criminal Justice and
Behavior, 35(2), 173-196.
Pardini, D. A., & Byrd, A. L. (2012). Perceptions of aggressive conflicts and others’
distress in children with callous-unemotional traits: I’ll show you who’s boss, even if
you suffer and I'll get in trouble. Journal of Child Psychology and Psychiatry, 53(3),
1–17.
Pardini, D., Lochman, J., & Frick, P. (2003). Callous/unemotional traits and social-
cognitive processes in adjudicated youths. Journal of the American Academy of
Child and Adolescent Psychiatry, 42(3), 1–9.
Pardini, D., Obradović, J., & Loeber, R. (2006). Interpersonal callousness,
hyperactivity/impulsivity, inattention, and conduct problems as precursors to
delinquency persistence in boys: A comparison of three grade-based cohorts. Journal
of Clinical Child and Adolescent Psychology, 35(1), 46–59.
Parker, J., & Asher, S. (1987). Peer relations and later personal adjustment: Are low-
accepted children at risk? Psychological Bulletin, 102(3), 357–389.
Parker, J. G., & Asher, S. R. (1993). Friendship and friendship quality in middle
childhood: Links with peer group acceptance and feelings of loneliness and social
dissatisfaction. Developmental Psychology, 29(4), 611–621.
Parsonage, M., Khan, L., & Saunders, A. (2014). Building a Better Future: The lifetime
costs of childhood behavioural problems and the benefits of early intervention (p.
44). London: Centre for Mental Health.
Pasalich, D. S., Waschbusch, D. A., Dadds, M. R., & Hawes, D. J. (2014). Emotion
socialization style in parents of children with callous-unemotional traits. Child
Psychiatry and Human Development, 45(2), 229–242.
194
Patrick, C. J. (2001). Emotional Processes in Psychopathy. In A. Raine & J. Sanmartin
(Eds.), Violence and Psychopathy (p. 202). New York: Springer.
Perlman, D., & Peplau, L. (1981). Toward a social psychology of loneliness. Personal
Relationships, (6), 31–55.
Phelps, E. A. (2006). Emotion and cognition: insights from studies of the human
amygdala. Annual Review of Psychology, 57, 27–53.
Pianta, R. C. (2001). Student-teacher relationship scale. Lutz, FL: Psychological
Assessment Resources Inc.
Pihet, S., Etter, S., Schmid, M., & Kimonis, E. R. (2014). Assessing callous-
unemotional traits in adolescents: Validity of the Inventory of Callous-Unemotional
Traits across gender, age, and community/institutionalized status. Journal of
Psychopathology and Behavioral Assessment, 1-15.
Pihet, S., Suter, M., Meylan, N., & Schmid, M. (2014). Factor structure of the Youth
Psychopathic Traits Inventory using the total score, three scale scores, and/or 10
subscale scores. Criminal Justice and Behavior, 41(10), 1214-1231.
Porter, S., & Woodworth, M. (2006). Psychopathy and Aggression. In C. J. Patrick
(Ed.), Handbook of psychopathy (pp. 481–494). Guilford Press.
Potter, J., & Hepburn, A. (2005). Qualitative interviews in psychology: problems and
possibilities. Qualitative Research in Psychology, 2(4), 281–307.
Poulin, F., & Boivin, M. (2000). Reactive and proactive aggression: evidence of a two-
factor model. Psychological Assessment, 12(2), 115–122.
Poythress, N. G., Dembo, R., Wareham, J., & Greenbaum, P. E. (2006). Construct
validity of the Youth Psychopathic Traits Inventory (YPI) and the Antisocial Process
Screening Device (APSD) with justice-involved adolescents. Criminal Justice and
Behavior, 33(1), 26–55.
195
Prinstein, M. J., & Cillessen, A. H. (2003). Forms and functions of adolescent peer
aggression associated with high levels of peer status. Merrill-Palmer Quarterly,
49(3), 310-342.
Pulkkinen, L. (1996). Proactive and reactive aggression in early adolescence as
precursors to anti- and prosocial behavior in young adults. Aggressive Behavior,
22(4), 241–257.
Qualter, P., Brown, S. L., Rotenberg, K. J., Vanhalst, J., Harris, R. A., Goossens, L., …
Munn, P. (2013). Trajectories of loneliness during childhood and adolescence:
Predictors and health outcomes. Journal of Adolescence, 36(6), 1283–1293.
Rabiner, D. L., Coie, J. D., Miller-Johnson, S., Boykin, A. M., & Lochman, J. E.
(2005). Predicting the persistence of aggressive offending of African American
males from adolescence into young adulthood: The importance of peer relations,
aggressive behavior, and ADHD symptoms. Journal of Emotional and Behavioral
Disorders, 13(3), 131–140.
Raine, A., Dodge, K., Loeber, R., Gatzke-Kopp, L., Lynam, D., Reynolds, C., … Liu, J.
(2006). The reactive-proactive aggression questionnaire: Differential correlates of
reactive and proactive aggression in adolescent boys. Aggressive Behavior, 32(2),
159–171.
Raine, A., & Yang, Y. (2006). Neural foundations to moral reasoning and antisocial
behavior. Social Cognitive and Affective Neuroscience, 1(3), 203–213.
Renshaw, P. D., & Brown, P. J. (1993). Loneliness in middle childhood: Concurrent and
longitudinal predictors. Child Development, 64(4), 1271.
Rhee, S. H., Friedman, N. P., Boeldt, D. L., Corley, R. P., Hewitt, J. K., Knafo, A., …
Zahn-Waxler, C. (2013). Early concern and disregard for others as predictors of
antisocial behavior. Journal of Child Psychology and Psychiatry and Allied
Disciplines, 54(2), 157–166.
196
Robins, L. N. (1978). Sturdy childhood predictors of adult antisocial behaviour:
replications from longitudinal studies. Psychological Medicine, 8(4), 611–622.
Robinson, E. A., Eyberg, S. M., & Ross, A. W. (1980). The standardization of an
inventory of child conduct problem behaviors. Journal of Clinical Child Psychology,
22–29.
Rodkin, P. C., Farmer, T. W., Pearl, R., & Van Acker, R. (2000). Heterogeneity of
popular boys: antisocial and prosocial configurations. Developmental Psychology,
36(1), 14–24.
Roose, A., Bijttebier, P., Claes, L., & Lilienfeld, S. O. (2011). Psychopathic traits in
adolescence: Associations with the revised Reinforcement Sensitivity Theory
systems. Personality and Individual Differences, 50(2), 201–205.
Roose, A., Bijttebier, P., Decoene, S., Claes, L., & Frick, P. J. (2010). Assessing the
affective features of psychopathy in adolescence: a further validation of the inventory
of callous and unemotional traits. Assessment, 17(1), 44–57.
Rose, A. J., & Asher, S. R. (2000). Children’s friendships. In C. Hendrick & S. S.
Hendrick (Eds.), Close relationships: A sourcebook (pp. 47–57). Thousand Oaks:
Sage Publications.
Rowe, R., Maughan, B., Moran, P., Ford, T., Briskman, J., & Goodman, R. (2010). The
role of callous and unemotional traits in the diagnosis of conduct disorder. Journal of
Child Psychology and Psychiatry and Allied Disciplines, 51(6), 688–695.
Rubin, K. H., Bukowski, W. M., & Parker, J. G. (2006). Peer interactions, relationships
and groups. In N. Eisenberg (Ed.), The Handbook of Child Psychology (6th ed., pp.
571–645). New York, NY: Wiley.
Rubin, K. H., Hymel, S., Lemare, L., & Rowden, L. (1989). Children experiencing
social difficulties: Sociometric neglect reconsidered. Canadian Journal of
Behavioural Science, 21(1), 94–111.
197
Rubin, K. H., Hymel, S., & Mills, R. S. (1989). Sociability and social withdrawal in
childhood: stability and outcomes. Journal of Personality, 57(2), 237–255.
Rubin, K. H., Bukowski, W. M., & Parker, J. G. (1998). Peer interactions, relationships,
and groups. In W. Damon & N. Eisenberg (Eds.), Handbook of child psychology,
Vol. 3: Social, emotional and personality development (pp. 619–700). New York,
NY: Wiley.
Rulison, K. L., Gest, S. D., & Loken, E. (2013). Dynamic social networks and physical
aggression: The moderating role of gender and social status among peers. Journal of
Research on Adolescence, 23(3), 437–449.
Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness
Scale: concurrent and discriminant validity evidence. Journal of Personality and
Social Psychology, 39(3), 472–480.
Russell, D., Peplau, L. A., & Ferguson, M. L. (1978). Developing a measure of
loneliness. Journal of Personality Assessment, 42(3), 290–294.
Russell, D. W. (1996). UCLA Loneliness Scale (Version 3): reliability, validity, and
factor structure. Journal of Personality Assessment, 66(1), 20–40.
Rutter, M., & Sroufe, L. A. (2000). Developmental psychopathology: concepts and
challenges. Development and Psychopathology, 12(3), 265–296.
Salekin, R. T., & Lynam, D. R. (2010). Handbook of child and adolescent psychopathy.
New York, NY: The Guildford Press.
Salvas, M. C., Vitaro, F., Brendgen, M., Lacourse, É., Boivin, M., & Tremblay, R. E.
(2011). Interplay between friends’ aggression and friendship quality in the
development of child aggression during the early school years. Social Development,
20(4), 645-663.
Sax, G. (1997). Principals of educational and psychological measurement and
evaluation (4th ed.). Belmont, CA: Wadsworth.
198
Scheithauer, H., Hayer, T., Petermann, F., & Jugert, G. (2006). Physical, verbal, and
relational forms of bullying among German students: Age trends, gender differences,
and correlates. Aggressive Behavior, 32(3), 261–275.
Schrum, C. L., & Salekin, R. T. (2006). Psychopathy in adolescent female offenders: an
item response theory analysis of the psychopathy checklist: youth version.
Behavioral Sciences & the Law, 24(1), 39–63.
Seals, R. W., Sharp, C., Ha, C., & Michonski, J. D. (2012). The relationship between
the youth psychopathic traits inventory and psychopathology in a US Community
sample of male youth. Journal of personality assessment, 94(3), 232-243.
Sebastian, C. L., McCrory, E. J. P., Cecil, C. A. M., Lockwood, P. L., De Brito, S. A.,
Fontaine, N. M. G., & Viding, E. (2012). Neural responses to affective and cognitive
theory of mind in children with conduct problems and varying levels of callous-
unemotional traits. Archives of General Psychiatry, 69(8), 814–822.
Serin, R. C. (1991). Psychopathy and violence in criminals. Journal of Interpersonal
Violence, 6(4), 423-431.
Shirtcliff, E. A., Vitacco, M. J., Graf, A. R., Gostisha, A. J., Merz, J. L., & Zahn-
Waxler, C. (2009). Neurobiology of empathy and callousness: implications for the
development of antisocial behavior. Behavioral Sciences & the Law, 27, 137–171.
Singer, T. (2006). The neuronal basis and ontogeny of empathy and mind reading:
Review of literature and implications for future research. Neuroscience and
Biobehavioral Reviews, 30(6), 855-863.
Smithmyer, C. M., Hubbard, J. A., & Simons, R. F. (2000). Proactive and reactive
aggression in delinquent adolescents: relations to aggression outcome expectancies.
Journal of Clinical Child Psychology, 29(1), 86–93.
199
Spangler, T., & Gazelle, H. (2009). Anxious solitude, unsociability, and peer exclusion
in middle childhood: A multitrait-multimethod matrix. Social Development, 18(4),
833–856.
Sterzer, P., Stadler, C., Poustka, F., & Kleinschmidt, A. (2007). A structural neural
deficit in adolescents with conduct disorder and its association with lack of empathy.
NeuroImage, 37(1), 335–342.
Streiner, D. L., & Norman, G. R. (1995). Health Measurement Scales: A practical guide
to their development and use. Oxford: Oxford University Press.
Tabachnick, B. G., & Fidell, L. S. (2007). Using Multivariate Statistics (5th ed.).
Boston: Allyn and Bacon.
Tan, C. S. C. (2011). Delinquency, Reputational Orientations, Psychopathic-Like
Traits, and Aggression: Extending Reputational Enhancement Theory to Adolescent
Loners. Unpublished PhD thesis. The University of Western Australia.
Teppers, E., Klimstra, T. A., Damme, C. Van, Luyckx, K., Vanhalst, J., & Goossens, L.
(2013). Personality traits, loneliness, and attitudes toward aloneness in adolescence.
Journal of Social & Personal Relationships, 30(8), 1045–1063.
Tremblay, R. E. (2000). The development of aggressive behavior during childhood:
what have we learned in the past century? International Journal of Behavior
Development, 24(2), 129–141.
Vaillancourt, T., & Hymel, S. (2006). Aggression and social status: The moderating
roles of sex and peer-valued characteristics. Aggressive Behavior, 32(4), 396–408.
van Baardewijk, Y., Stegge, H., Andershed, H., Thomaes, S., Scholte, E., & Vermeiren,
R. (2008). Measuring psychopathic traits in children through self-report. The
development of the Youth Psychopathic traits Inventory-Child Version. International
Journal of Law and Psychiatry, 31(3), 199–209.
200
VanderWeele, T. J., Hawkley, L. C., & Cacioppo, J. T. (2012). On the reciprocal
association between loneliness and subjective well-being. American Journal of
Epidemiology, 176(9), 777–84.
Véronneau, M. H., Vitaro, F., Brendgen, M., Dishion, T. J., & Tremblay, R. E. (2010a).
Transactional analysis of the reciprocal links between peer experiences and academic
achievement from middle childhood to early adolescence. Developmental
Psychology, 46(4), 773–790.
Viding, E. (2004). On the nature and nurture of antisocial behavior and violence. Annals
of the New York Academy of Sciences, 1036, 267–77.
Viding, E., Blair, R. J. R., Moffitt, T. E., & Plomin, R. (2005). Evidence for substantial
genetic risk for psychopathy in 7-year-olds. Journal of Child Psychology and
Psychiatry, and Allied Disciplines, 46(6), 592–7.
Viding, E., Fontaine, N. M. G., & McCrory, E. J. (2012). Antisocial behaviour in
children with and without callous-unemotional traits. Journal of the Royal Society of
Medicine, 105(5), 195–200.
Viding, E., Frick, P. J., & Plomin, R. (2007). Aetiology of the relationship between
callous-unemotional traits and conduct problems in childhood. British Journal of
Psychiatry, 190(SUPPL. 49).
Viding, E., Jones, A. P., Frick, P. J., Moffitt, T. E., & Plomin, R. (2008). Heritability of
antisocial behaviour at 9: do callous-unemotional traits matter? Developmental
Science, 11(1), 17–22.
Viding, E., Simmonds, E., Petrides, K. V., & Frederickson, N. (2009). The contribution
of callous-unemotional traits and conduct problems to bullying in early adolescence.
Journal of Child Psychology and Psychiatry and Allied Disciplines, 50(4), 471–481.
201
Vitacco, M. J., Rogers, R., & Neumann, C. S. (2003). The Antisocial Process Screening
Device: An examination of its construct and criterion-related validity. Assessment,
10(2), 143–150.
Vitaro, F., Barker, E. D., Boivin, M., Brendgen, M., & Tremblay, R. E. (2006). Do early
difficult temperament and harsh parenting differentially predict reactive and
proactive aggression? Journal of Abnormal Child Psychology, 34(5), 685–695.
Vitaro, F., Brendgen, M., & Barker, E. D. (2006). Subtypes of aggressive behaviors: A
developmental perspective. International Journal of Behavioral Development, 30(1),
12–19.
Vitaro, F., Gagnon, C., & Tremblay, R. E. (1990). Predicting stable peer rejection from
kindergarten to grade one. Journal of Clinical Child Psychology, 19(3), 257-264.
Waller, R., Gardner, F., Hyde, L. W., Shaw, D. S., Dishion, T. J., & Wilson, M. N.
(2012). Do harsh and positive parenting predict parent reports of deceitful-callous
behavior in early childhood? Journal of Child Psychology and Psychiatry, and Allied
Disciplines, 53(9), 946–53.
Waschbusch, D. A., Walsh, T. M., Andrade, B. F., King, S., & Carrey, N. J. (2007).
Social problem solving, conduct problems, and callous-unemotional traits in
children. Child Psychiatry and Human Development, 37(4), 293–305.
Waschbusch, D. A., & Willoughby, M. T. (2008). Attention-deficit/hyperactivity
disorder and callous-unemotional traits as moderators of conduct problems when
examining impairment and aggression in elementary school children. Aggressive
Behavior, 34(2), 139–153.
Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional
impairment in children and adolescents with ADHD and the impact on quality of life.
The Journal of Adolescent Health, 46(3), 209–217.
202
Weiss, E. M., Kohler, C. G., Nolan, K. A., Czobor, P., Volavka, J., Platt, M. M., …
Gur, R. C. (2006). The relationship between history of violent and criminal behavior
and recognition of facial expression of emotions in men with schizophrenia and
schizoaffective disorder. Aggressive Behaviour, 32, 187–194.
Weiss, R. S. (1973). Loneliness: the experience of emotional and social isolation.
Cambridge, MA: MIT Press.
White, S. F., & Frick, P. J. (2010). Callous-unemotional traits and their importance to
causal models of severe antisocial behavior in youth. In Handbook of Child and
Adolescent Psychopathy (pp. 135–155). Guilford Press; US.
Widen, S. C., & Russell, J. A. (2008). Children acquire emotion categories gradually.
Cognitive Development, 23(2), 291–312.
Widen, S. C., & Russell, J. A. (2010). The “disgust face” conveys anger to children.
Emotion, 10(4), 455–466.
Williamson, S., Hare, R. D., & Wong, S. (1987). Violence: Criminal psychopaths and
their victims. Canadian Journal of Behavioural Science, 19, 454–462.
Willoughby, M. T., Mills-Koonce, W. R., Gottfredson, N. C., & Wagner, N. (2014).
Measuring callous unemotional behaviors in early childhood: Factor structure and
the prediction of stable aggression in middle childhood. Journal of Psychopathology
and Behavioral Assessment, 36(1), 30–42.
Willoughby, M. T., Waschbusch, D. A., Moore, G. A., & Propper, C. B. (2011). Using
the ASEBA to screen for callous unemotional traits in early childhood: Factor
structure, temporal stability and utility. Journal of Psychopathology and Behavioral
Assessment, 33(1), 19–30.
Witvliet, M., Brendgen, M., Van Lier, P. A. C., Koot, H. M., & Vitaro, F. (2010). Early
adolescent depressive symptoms: Prediction from clique isolation, loneliness, and
203
perceived social acceptance. Journal of Abnormal Child Psychology, 38(8), 1045–
1056.
Wolf, S., & Centifanti, L. C. M. (2014). Recognition of pain as another deficit in young
males with high callous-unemotional traits. Child Psychiatry and Human
Development, 45, 422–432.
Yin, R. K. (2003). Applications of case study research (applied social research
methods) (4th ed.). Thousand Oaks: Sage Publications.
Younger, A. J., & Boyko, K. A. (1987). Aggression and withdrawal as social schemas
underlying children’s peer perceptions. Child Development, 58(4), 1094–1100.
Yudofsky, S. C., Silver, J. M., Jackson, W., Endicott, J., & Williams, D. (1986). The
overt aggression scale for the objective rating of verbal and physical aggression.
American Journal of Psychiatry, 143(1), 35–39.
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APPENDICES
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APPENDIX A – DRAFT CHILDREN’S AFFECTIVE TRAITS INVENTORY
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207
208
209
210
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APPENDIX B – INFORMATION SHEET FOR PRINCIPALS
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APPENDIX C – INFORMATION SHEET FOR PARENTS
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APPENDIX D – CONSENT FORM
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APPENDIX E – ASSESSMENT INSTRUMENT
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219
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221
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APPENDIX F – SEMI-STRUCTURED INTERVIEW QUESTIONS FOR CASE
STUDIES
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What is the child’s behaviour like in school?
Has the child been suspended or involved in any behaviour problems in school?
Has the child experienced any behaviour problems in earlier school grades?
What are the positive aspects about this child?
What is this child best at academically?
How does this child respond to teachers when disciplined?
Does this child have many friends?
Can you give us some details about this child’s friendship network?
How does this child get on with peers/ adults?
Does this child choose to spend any time alone?
Do other kids seem to avoid this child or are they attracted to him/her?
Have you witnessed or heard of any acts of aggression involving this child?
Has this child shown a caring and sensitive side to his/her peers?
Would you say this child is truthful and/or responsible?
Does this child care about how well he/she does at school?
Does this child put much effort into his/her schoolwork?
How does this child interact with peers?
How does this child respond when involved in altercations?
What is it about this child, if anything, that stands out to you?
Can you describe a time when the child has said sorry for doing something wrong?
Is the child someone who is concerned about the feelings of others?
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