Journal of Abnormal Psychology Copyright 2000 by the American Psychological Association, Inc.

2000, Vol. 109, No. 2, 335-340 0021-843X/00/$5.00 DOI: 10.1037//0021-843X.109.2.335

The Importance of Callous-Unemotional Traits for Extending the Concept

of Psychopathy to Children

Christopher T. Barry, Paul J. Frick, Tammy M. DeShazo, Monique G. McCoy, Mesha Ellis,
and Bryan R. Loney
University of Alabama

This study focused on the use of callous-unemotional (CU) traits to identify a subgroup of children with
both attention deficit/hyperactivity disorder (ADHD) and a conduct problem diagnosis (oppositional
defiant disorder [ODD] or conduct disorder [CD] who show characteristics similar to adults with
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

psychopathy. In a clinic-referred sample of children aged 6 to 13 years (N = 154), those with diagnoses
This document is copyrighted by the American Psychological Association or one of its allied publishers.

of both ADHD and ODD/CD were divided on the basis of teacher ratings of CU traits. Children high on
these traits showed features typically associated with psychopathy, such as a lack of fearfulness and a
reward-dominant response style. Furthermore, children with CU traits seemed less distressed by their
behavior problems. These findings are consistent with research on adults showing that impulsivity and
antisocial behavior alone are insufficient to document persons who fit the construct of psychopathy.

The concept of psychopathy has proven to be quite important for
understanding antisocial behavior in adults (Cleckley, 1976). For
example, psychopathic traits have been shown to predict a partic-
ularly severe and violent pattern of antisocial behavior that has
been resistant to many intervention approaches (Hart, Kropp, &
Hare, 1988; Serin, 1993; Serin, Peters, & Barbaree, 1990). Fur-
thermore, the causes of antisocial behavior in individuals with
psychopathic traits may be different from the causes of antisocial
behavior in nonpsychopathic individuals (Hare, Hart, & Harpur,
1991; Lykken, 1995). As a result of this research, there has been
a growing interest in extending the concept of psychopathy to
children and adolescents to identify important causal factors early
in the development of these traits so that intervention programs can
be developed to intervene when these traits are hopefully more
malleable (Frick, 1998).
One important and influential effort to extend the concept of
psychopathy to children was made by Lynam (1996) in his review
of research on children who manifest the problems of inattention,
impulsivity, and overactivity often associated with a diagnosis of
attention deficit/hyperactivity disorder (ADHD) combined with
the severe conduct problems often associated with diagnoses of
oppositional defiant disorder (ODD) and conduct disorder (CD;
American Psychiatric Association, 1994). In his review, Lynam
(1996) provided evidence that children with both ODD/CD and
ADHD show a particularly severe form of antisocial behavior and
Christopher T. Barry, Paul J. Frick, Tammy M. DeShazo, Monique G.
McCoy, Mesha Ellis, and Bryan R. Loney, Department of Psychology,
University of Alabama, Tuscaloosa.
Paul J. Frick is now at the Department of Psychology, University of
New Orleans.
Work on this article was supported by Grant R29 MH55654-02 from the
National Institute of Mental Health.
Correspondence concerning this article should be addressed to Paul J.
Frick, the Department of Psychology, University of New Orleans, 2001
Geology and Psychology Building, New Orleans, Louisiana 70148. Elec-
tronic mail may be sent to pfrick@uno.edu.
335
a number of neuropsychological correlates (e.g., poor passive
avoidance learning, cortical underarousal, deficits in executive
functions) that make this group of children seem similar to adults
with psychopathy. In support of this theory, Lynam (1998) re-
ported that children from a community sample of 12- and 13-year-
old boys who were elevated on teacher ratings of both conduct
problems and ADHD symptoms tended to exhibit a number of
characteristics that have been associated with psychopathy (e.g.,
higher self-reported rates and variety of delinquency, poor passive
avoidance learning). Such characteristics were not associated with
either conduct problems alone or ADHD symptoms alone.
A second line of research that has attempted to extend the
concept of psychopathy to children comes from the work of Frick
and colleagues (Frick, 1998; Frick, Barry, & Bodin, in press). This
line of research attempts to identify childhood precursors to psy-
chopathy by focusing specifically on the callous and unemotional
(CU) traits (e.g., lack of guilt, absence of empathy, shallow and
constricted emotions) that have been hallmarks of conceptualiza-
tions of adult psychopathy (Cleckley, 1976). In support of this
method, children with conduct problems who also exhibit high
levels of CU traits display a greater severity and variety of anti-
social behavior and have more early contact with the police than
do children who exhibit conduct problems without CU traits
(Christian, Frick, Hill, Tyler, & Frazer, 1997). Furthermore, only
conduct-problem children with these traits show the reward-
dominant response style that characterizes the avoidance learning
deficits found in psychopathic adults (O'Brien & Frick, 1996), and
only these children who show the preference for thrill and adven-
ture seeking activities (i.e., fearlessness; Frick, O'Brien, Wootton,
& McBurnett, 1994) that have been critical to many theories of
psychopathic behavior (Lykken, 1995). Finally, and also consistent
with causal theories of psychopathic behavior, conduct-problem
children with CU traits are less likely to show intellectual deficits,
especially verbal deficits, than other children with conduct prob-
lems (Loney, Frick, Ellis, & McCoy, 1998), and their conduct
problems are less strongly associated with dysfunctional parenting
practices (Wootton, Frick, Shelton, & Silverthorn, 1997), further
 336 SHORT REPORTS
supporting the possibility of different causal mechanisms under-
lying their conduct problem behavior (Lykken, 1995).
Given the promising findings from both of these lines of re-
search, it is likely that an integration of these findings could be
very beneficial for advancing our knowledge of psychopathic traits
in children. For example, it is possible that, consistent with Ly-
nam's (1996) model, childhood precursors to psychopathy may be
found in children who show both ADHD and conduct problems.
However, consistent with Prick's (1998) model, it is possible that
the children within this group who also show high levels of CU
traits show many of the characteristics typically associated with
psychopathy. This possibility would be consistent with findings in
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
adult samples. Specifically, studies in prison samples consistently
This document is copyrighted by the American Psychological Association or one of its allied publishers.
have shown that most inmates meet criteria for antisocial person-
ality disorder (American Psychiatric Association, 1994) or score
high on the Impulsive/Deviant Lifestyle dimension (i.e., Factor 2)
of the Psychopathy Checklist—Revised (PCL-R; Hare et al.,
1990). Both of these constructs capture behaviors related to poor
impulse control and a chronic pattern of antisocial and criminal
behavior that make them analogous to children with both ADHD
and ODD/CD. However, in adult forensic samples, the subgroup of
impulsive and antisocial individuals who also show CU traits
exhibits an especially severe and violent pattern of antisocial
behavior and shows a unique pattern of emotional deficits that
have traditionally been associated with psychopathy (Hare et al.,
1991).
In this study, we provide initial tests of this integration by
dividing clinic-referred children who have both an ADHD diag-
nosis and a conduct-problem diagnosis (e.g., either ODD or CD)
into those high and low on CU traits. Using methodology similar
to Lynam's (1998), we based diagnoses and the measurement of
CU traits solely on teacher reports so that there was no overlap
between the method of group formation and the measurement of
dependent variables. We then compared these groups on several
indices that theoretically are related to psychopathy and that are
similar to those used by Lynam (1998). These measures include a
measure of a reward-dominant response style, a measure of visual-
spatial reasoning, a measure of a child's preference for thrill and
adventure seeking activities, and a measure of anxiety. On the
basis of our model, we predicted that only those children with
ADHD and ODD/CD who also showed CU traits would show
characteristics that were consistent with the research on psycho-
pathic adults.
Method
Participants
The sample consisted of 154 children between the ages of 6 and 13 years
(M = 8.36, SD = 1.81) who were consecutive referrals to a university-
based outpatient diagnostic and referral service. This service provides
comprehensive psychological evaluations to children with severe emo-
tional, behavioral, or learning problems, who are then referred to appro-
priate mental health agencies for intervention. The sample was 78% Cau-
casian and 22% African American and approximately 78% male. More
details on this sample are provided elsewhere (Loney et al., 1998).
Measures
Diagnostic Interview Schedule for Children. The National Institute of
Mental Health Diagnostic Interview Schedule for Children, Version 2.3
(DISC 2.3; Shaffer, Fisher, Piacentini, Schwab-Stone, & Wicks, 1992) was
administered to each child's teacher to assess for the presence of all
symptoms included in the revised third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric
Association, 1987) criteria for ADHD, ODD, and CD.' Each child over 8
years old and all parents also were interviewed separately using the
DISC-2.3 to assess for the symptoms of DSM-III-R anxiety disorders (i.e.,
overanxious disorder, social phobia, simple phobia, and separation anxiety
disorder). Overall, 38% of the sample was over 8 years old, and this
percentage was fairly evenly distributed across clinic groups of interest,
ranging from 31% of the ADHD-only group to 50% of the ADHD-and-
ODD/CD high-CU group, ^(3, N = 152) = 2.32, ns. A combination of
parent and child reports, when both informants were available, was used
for analyses, on the basis of the recommendations of Piacentini, Cohen, and
Cohen (1992). The DISC-2.3 interviews were conducted by trained grad-
uate students or a licensed clinical psychologist and have been shown to
provide highly reliable symptom estimates (Loney et al., 1998).
Psychopathy Screening Device. We used the Psychopathy Screening
Device (PSD; Frick & Hare, in press) to assess CU traits in children. The
PSD is a 20-item questionnaire designed to assess characteristics associ-
ated with psychopathy, using the items from the PCL-R (Hare, 1991) to
define its content (see Frick et al., 1994, and Frick et al., in press). Items
on the PSD are scored on a 3-point scale ranging from 0 (not at all true)
to 2 (definitely true). Similar to the methodology used to diagnose ADHD,
ODD, and CD, only teachers' ratings were used to form groups on the basis
of high-CU scores. The CU scale from the PSD was based on a factor
analysis of clinic-referred children (Frick et al., 1994) and contains 6 items
(e.g., "Feels bad or guilty when he/she does something wrong," "Is con-
cerned about the feelings of others"). The coefficient alpha for these 6
items based on teacher report in this clinic sample was .68.
When psychopathic traits are measured with the PCL-R in adult forensic
samples, a cut-off score of 30 is established as having good predictive
validity and usually designates between 20% and 40% of forensic popu-
lations (Hare et al., 1991). Unfortunately, no similar cut-off score has been
well established for the childhood PSD (see Wootton et al., 1997, for a
rationale for considering psychopathy as a taxon rather than as a continu-
ous personality dimension). For the purposes of group formation in this
study, we used the cut-off score of 7 out of a possible score of 12, which
designates approximately the upper quartile of the clinic sample and which
1
Data collection began before the publication of the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Amer-
ican Psychiatric Association, 1994), which led to our use of DSM-lll-R
criteria to define ADHD, ODD, and CD. However, it is likely that our
results will be applicable to DSM-IV criteria for several reasons. First,
there is extensive overlap between DSM-III-R and DSM-IV in their
operationalizations of ODD and CD, with over 90% of the children
diagnosed by one criterion set being diagnosed by the other (Lahey,
Applegate, Barkley, et al., 1994). Second, the DSM-IV field trials indicated
that most children who met DSM-III-R criteria for CD but not the more
stringent DSM-IV criteria for CD exhibited sufficient conduct problems to
meet criteria for ODD. Therefore, the combined diagnostic category used
in our study likely captured the variations in severity that produced dis-
crepancies between the two versions of the DSM. Third, the more dramatic
change in the ADHD criteria from a single symptom list combining
inattentive, impulsive, and overactive behavior in DSM-III-R to a dual
symptom list dividing inattention—disorganization and impulsivity-
overactivity in DSM-IV was largely done to capture children with only
inattention and disorganization. The DSM—III-R category seemed to cap-
ture children with severe impulsive and overactive behaviors quite well
(Lahey, Applegate, McBurnett, et al., 1994), and it was this aspect of
ADHD that seemed most critical to our study focus.
 SHORT REPORTS
falls at the 90th percentile of a community sample of elementary-school-
aged children (Frick et al., in press).
Block Design. Scores on the Block Design subtest of the Wechsler
Intelligence Scale for Children-Revised (WISC-R; Wechsler, 1974) or the
third edition of the Wechsler Intelligence Scale for Children (WISC-HI;
Wechsler, 1991)2 were used as a measure of visual-spatial reasoning. This
subtest has been shown to differentiate adult inmates high on psychopathic
traits from other inmates (Smith, Arnett, & Newman, 1992).
Thrill and Adventure Seeking. We used the Thrill and Adventure
Seeking subscale (TAS) of the Sensation Seeking Scale for Children
(SSS-C; Russo et al., 1993) to measure participants' preferences for novel
and dangerous activities. On this scale, a child chooses between a pair of
statements to indicate which is more true of him or her. One statement
(e.g., "I enjoy the feeling of riding my bike fast down a big hill") describes
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
sensation seeking behaviors, whereas the other statement describes a pref-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
erence against sensation seeking behaviors (e.g., "Riding my bike fast
down a hill is scary for me"). Although we administered the entire SSS-C
to the clinic sample, we used only the TAS scale in analyses, because this
scale seems to reflect the aspect of sensation seeking that is most closely
related to the personality dimensions of fearlessness and harm avoidance
(Levenson, Kiehl, & Fitzpatrick, 1995; Watson & Clark, 1984) and it is
these aspects of anxiety that have been conceptually linked to psychopathy
(Lilienfeld, 1994). The coefficient alpha for this subscale in this sample
was .76. Children who scored above the upper quartile of the sample (i.e., 9
out of a possible 12) on the TAS were considered to show a clear
preference for thrill and adventure seeking activities (see Kagan, 1997, for
a rationale for considering TAS as a taxon rather than as a continuous
personality dimension).
Reward-dominance computer task. We assessed a reward-dominant
response style using the paradigm employed in previous research with
adults (e.g., Newman, Patterson, & Kosson, 1987) and children (Daugherty
& Quay, 1991). A more complete description of the task can be found
elsewhere (O'Brien & Frick, 1996; O'Brien, Frick, & Lyman, 1994). The
task consisted of four games, and participants were allowed to earn prizes
on the basis of their scores across all four games. In each game, a stimulus
(card, door, box, or fisherman) appeared on the screen and the child chose
whether to press a key to view the other side of the stimulus or to press a
key to stop the game. For each game, there was a successful outcome or an
unsuccessful outcome on the other side of the stimulus. Each child began
with 50 points, and a point was either added or taken away, depending on
the outcome of each trial. The proportion of successful outcomes across
each successive 10 trials decreased from 90% to 0% over 100 trials. The
total number of trials played was recorded and was used as a dependent
variable in the analyses. Studies have shown that adults with psychopathic
traits, once they establish a reward-oriented response set (e.g., high rates of
reward trials early in the games), are more likely to continue playing
despite the increasing ratio of punished to rewarded trials (Newman et al.,
1987).3
Procedure
All children in the study were referred to an outpatient diagnostic and
referral service for a comprehensive psychological evaluation. Each child
was accompanied to the evaluation by at least one custodial parent, which
in the vast majority of cases was his or her mother. Each child gave assent
and each parent gave informed consent for all of the information to be used
anonymously in research. Parents were told that the use of information for
research was strictly voluntary and would not affect the clinical services
they received. After consent was obtained, a brief background interview
with the parent was conducted, followed by the DISC-2.3 structured
interview. While the parent was completing these measures, the child was
administered either the WISC-R or the WISC-ffl, followed by the child
version of the DISC-2.3, the reward-dominance computer task, and the
SSS-C. The SSS-C was read to all children to equate for different reading
337
levels. Within 2 weeks of the evaluation, the child's primary teacher was
contacted over the phone and administered the teacher version of the
DISC-2.3 by the same interviewer who had administered it to the child and
to his or her parent. In addition, the teacher version of the PSD was mailed
to each child's teacher along with a self-addressed stamped envelope.
Results
On the basis of the teacher version of the DISC-2.3, we initially
formed three groups of children. The first group (n = 68), a clinic
control group, consisted of children who were referred for emo-
tional, behavioral, or learning problems but did not meet the
criteria, according to their teachers, for either ADHD, ODD, or
CD. Another group of children (n = 58) met the criteria for ADHD
but not for ODD/CD, and a third group (n - 28) met the criteria
for both ADHD and ODD/CD, according to teacher report. Con-
sistent with past research using clinic-referred samples of pread-
olescent children (Abikoff & Klein, 1992), there were very few
children (n = 3) who met criteria for ODD/CD but not for ADHD.
These children were excluded from further analyses. The most
common diagnosis in the clinic control children was an anxiety
disorder (50%), on the basis of either parent or child report on the
DISC-2.3, although this diagnosis was also common in the
ADHD-only (41%) and ADHD-and-ODD/CD (60%) groups as
well, ^(2, N = 152) = 3.20, ns. The three diagnostic groups
differed on the proportion of children who were elevated on their
teacher's report of CU traits, with 57% of the ADHD-and-
ODD/CD group showing these elevations compared to 37% of the
ADHD-only group and 9% of the clinic control group, x*(2, N =
152) = 26.35, p < .001.
This latter finding is consistent with Lynam's (1996) contention
that the ADHD-and-ODD/CD group would be the one most likely
to contain those children who showed traits consistent with psy-
chopathy. However, to test the main study hypothesis that only
those children within this group who showed CU traits would
show characteristics typically associated with psychopathy, we
divided the ADHD-and-ODD/CD group into those children with
elevations on the CU scale of the PSD (n = 16) and those who did
not show these elevations (n = 12). The demographic character-
istics of the four groups are presented in Table 1. The only
demographic variable to differ across the four groups was full
scale intelligence, with the ADHD-and-ODD/CD low-CU group
scoring significantly lower, F(3, 149) = 2.6, p < .05, than the
other groups on their measured intelligence. Because of this dif-
ference in overall intelligence, we repeated all subsequent analyses
controlling for intelligence, using it as either a covariate in an
analysis of covariance for continuous dependent variables or as a
predictor in a logistic regression equation for dichotomous depen-
dent variables. Controlling for intelligence did not substantively
influence the results of any of the analyses.
2
At the early stages of data collection, the WISC-R was used as the
measure of intelligence (n = 68), with the remainder of the sample being
tested with the newer WISC-HI.
3
Although this response style has been variously labeled (e.g., response
perseveration, response modulation) in research, depending on the hypoth-
esized cognitive process underlying it, for the purposes of this study we
used the purely descriptive label of the reward-dominant response style
(see O'Brien & Frick, 1996, for further discussion).
 338 SHORT REPORTS

Table 1
Group Comparisons of Means for Demographic and Main Study Variables

ADHD and ADHD and

Clinic control ADHD only ODD/CD low ODD/CD high
Variable (« == 68) (n = 58) CU (n = 12) CU (n = 16)

Demographics
Age 8.53 (1.94) 8.03 (1.70) 8.47 (2.19) 8.81 (1.39)
Gender (% male) 70.60 86.20 75.00 81.30
Ethnicity (% African American) 19.10 15.50 41.70 37.50
Duncan's socioeconomic index 38.73 (26.67) 36.85 (24.00) 28.86 (18.74) 29.79 (19.31)
Full scale IQ* 95.22a(14.06) 93.65a (11.01) 84.42b (9.73) 93.38a(10.53)
Main study
Thrill and adventure seeking 25.00a 40.70a,b 20.00a,b 56.30b
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

(% elevated)*
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Block design 8.91 (3.42) 7.72 (2.97) 7.08 (3.26) 7.88 (3.42)
Trials played on reward- 242.14a(85.60) 236.2 l a (81.37) 202.91a (98.16) 306.38b(63.48)
dominance task**
Anxiety symptoms* 3.41. (3.17) 3.41. (3.56) 6.33b (3.63) 4.25a (3.92)

Note. Means with different subscripts were significantly different in pairwise comparisons using Tukey's
procedure for continuous variables or pairwise chi-square tests for dichotomous variables. ADHD = attention
deficit/hyperactivity disorder; ODD = oppositional defiant disorder; CD = conduct disorder. Standard devia-
tions are in parentheses.
*p<.05. **p<.01.

We compared the four groups on the percentage of each
group with elevations on the TAS, and the results of these
comparisons are also shown in Table 1. There was a significant
effect in the chi-square analyses, \2(2, N = 152) = 7.97, p <
.05, with pairwise comparisons showing that only the ADHD-
and-ODD/CD high-CU group differed from the clinic control
group. In fact, the ADHD-and-ODD/CD low-CU group had the
lowest percentage of individuals showing clear preferences for
thrill and adventure seeking activities. There was also a signif-
icant group effect in a one-way analysis of variance (ANOVA)
comparing the groups on the number of trials played on the
computerized reward-dominance task, F(3, 149) = 4.10, p <
.01. As illustrated in Table 1, the ADHD-and-ODD/CD
high-CU group played significantly more trials than any of the
other groups on this computer task. One final difference that
emerged between groups was the number of anxiety symptoms,
on the basis of parent and child reports from the DISC-2.3
interviews, F(3, 149) = 2.77, p < .05. Pairwise comparisons
indicated that the ADHD-and-ODD/CD low-CU group exhib-
ited the highest rate of anxiety of any of the groups. When
symptoms for the specific anxiety disorders were run sepa-
rately, the analyses using symptoms of overanxious disorder
and simple phobia as the dependent variables reached signifi-
cance, suggesting that symptoms of these disorders primarily
accounted for the overall effect of anxiety symptoms. The one
comparison in which no significant effects emerged across
groups was on the Block Design subtest measuring visual-
spatial abilities.
The results presented in Table 1 do not indicate whether high
rates of CU traits in the absence of ADHD and ODD/CD
diagnoses are associated with the dependent variables used in
this study. Our clinic-referred sample was not the optimal one
with which to conduct this test because (a) all children were
referred for emotional, behavioral, or learning problems even if
they did not cross a diagnostic threshold and (b) the number of
children in the clinic control group who were elevated on these
traits was quite small (n = 6). However, to begin exploring this
important issue, we conducted a series of 2 X 3 ANOVAs with
elevations on CU traits and diagnostic group status (clinic
control, ADHD, and ADHD and CD) as the two factors. Several
significant findings emerged from these analyses. First, on the
reward-dominance task, there was a significant interaction be-
tween CU traits and diagnostic status, F(l, 143) = 3.59, p <
.05. This was due to the fact that children in the ADHD-and-
ODD/CD high-CU group clearly played the most trials on this
task (M = 306.40, SD = 63.00) compared to children in any of
the other cells of the design (means ranging from 203.00 to
244.00). However, the main effect for CU traits also approached
significance, F(l, 143) = 3.56,^ < .06, suggesting that overall,
children high on CU traits tended to play more trials on this
task, irrespective of their diagnostic group status. Second, when
the number of anxiety symptoms was used as a dependent
variable, there was a significant main effect for diagnostic
status, F(2, 147) = 4.73, p < .01, and the interaction between
CU traits and diagnostic status approached significance, F(2,
147) = 2.76, p < .07. Inspection of the means suggested that
children with ADHD-and-ODD/CD had higher rates of anxiety
symptoms, irrespective of the presence of CU traits. However,
this effect was moderated somewhat by the presence of CU
traits (see Table 1). Finally, the analyses using full scale intel-
ligence as the dependent variable resulted in a significant in-
teraction between diagnostic status and elevations on CU traits,
F(2, 146) = 3.37, p < .05, with no main effects approaching
significance. This interaction was due to the much lower full
scale intelligence in the ADHD-and-ODD/CD group
(M = 84.40, SD = 9.70) than in any of the other cells of the
ANOVA design (means ranging from 90.00 to 96.00).
 SHORT REPORTS
Discussion
Our findings support Lynam's (1996) contention that children
who show symptoms of ADHD in combination with severe con-
duct problems are most likely to also show features associated with
psychopathy. However, also consistent with Prick's (1998) con-
ceptualization, it was only those children within this group who
also showed high rates of CU traits who exhibited these features.
Only children high on CU traits showed a preference for thrill and
adventure seeking activities (i.e., fearlessness) and were more
likely than other clinic-referred children to show a reward-
dominant response style, both of which have been critical to many
theories of psychopathy (Lykken, 1995). Furthermore, both of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
these behavioral patterns could reflect an underlying deficit in
behavior inhibition (Kagan, Reznick, & Snidman, 1987), which
has been linked to deficits in children's early development of guilt
and empathy (Kochanska, 1993).
Despite having significant behavioral difficulties, the group high
on CU traits did not show elevated levels of anxiety symptoms
compared to other clinic groups, whereas those children with
ADHD and severe conduct problems who were low on CU traits
showed the highest levels. This finding is consistent with the view
that symptoms of DSM-IV (American Psychiatric Association,
1994) anxiety disorders are highly related to trait anxiety or to the
negative affectivity that is often experienced because of the ex-
pectation of negative events (Lilienfeld, 1994). Furthermore, our
findings suggest that children high on CU traits, despite showing
high rates of conduct problems and the negative events often
associated with them (e.g., peer rejection, discipline confronta-
tions), are not as distressed by these behaviors as children with
conduct problems who do not show these traits. This failure to be
distressed, despite showing quite problematic behavior, is again
consistent with findings for adults with psychopathic traits, who
also tend to score lower on measures of negative affectivity than
antisocial adults without these traits (Hare et al., 1991).
The one finding that was not consistent with predictions was the
finding that a measure of nonverbal visual-spatial abilities did not
differ between the groups high and low on CU traits, as has been
the case in incarcerated adult samples (Smith et al., 1992). How-
ever, it is consistent with the findings of Lynam (1998), who
reported that children with ADHD symptoms and severe conduct
problems did not differ on these abilities from children with only
ADHD symptoms and only differed from normal control children.
In our study, there was no normal control group used in compar-
isons, only a clinic control group. These findings suggest that
deficits in visual-spatial abilities do not consistently differentiate
children with CU traits from other children with problems of
impulse control or antisocial behavior. Our findings did suggest,
however, that general intellectual deficits are specifically associ-
ated with conduct problems in children who are not high on CU
traits (see also Loney et al., 1998).
All of the interpretations made from this study need to be made
in light of several limitations. First, by using a clinic-referred
sample, we were not able to define a group with only an ODD or
CD diagnosis. Therefore, we were not able to directly test whether
this group would show a high level of CU traits or whether those
with CU traits and conduct problems but without the problems of
impulsivity associated with ADHD would show characteristics
consistent with psychopathic adults. The results of Lynam (1998)
339
using a community sample were mixed in this regard. Lynam
reported that children with conduct problems without ADHD
symptoms scored equally high on a measure of psychopathic traits
when compared to children high on both conduct problems and
ADHD symptoms. However, the pure conduct-problem group did
not show other characteristics that would make them seem analo-
gous to adult psychopaths (e.g., a reward-dominant response
style).
Another limitation of our study was a reliance on teacher
report to assess ADHD, ODD/CD and CU traits, whereas it is
typically recommended that researchers use multiple informants
to assess most forms of childhood psychopathology (Kamphaus
& Frick, 1996). We felt this method was justified to more
closely approximate the methodology used by Lynam (1998)
and to ensure that there was no overlap between the method of
group formation and the measurement of dependent variables,
some of which were based on child self-report (i.e., thrill and
adventure seeking) or a combination of parent and child report
(i.e., anxiety symptoms). In addition, some of the groups used
in comparisons, especially the two groups with ADHD and
ODD/CD diagnoses, were moderate in size (n = 12 and n = 16,
respectively), which could have limited our power to detect
group differences, especially in those comparisons using non-
parametric techniques. Therefore, our comparisons should be
considered conservative tests of potential differences between
these subgroups of children. A final limitation, and one that is
perhaps most crucial to this and other studies attempting to
define a childhood precursor to psychopathy (e.g., Lynam,
1998), is the lack of a long-term follow up to determine whether
children, even those who show features typically associated
with psychopathy, actually constitute the group most likely to
show psychopathy as adults. Such prospective longitudinal
studies are critical for providing the most compelling evidence
for which children are at most risk for showing psychopathic
traits as adults.
Despite the lack of longitudinal data, studies such as this one
and the one by Lynam (1998) are critical for designating groups
that may be at most risk for showing psychopathy in adults, so that
longitudinal studies can focus more closely on these groups. Fur-
thermore, even before a conclusive link can be made, it is clear that
children with features associated with psychopathy constitute a
group that is very severely impaired (Christian et al., 1997; Lynam,
1998) and that shows characteristics that could reflect unique
causal processes underlying its conduct problems (Frick, 1998). As
a result, interventions that are more specifically targeted to the
unique characteristics of this group may be more effective than
those that are designed for all children with severe conduct prob-
lems (see Frick, 1998, for a further discussion). Finally, the unique
contribution of this study is to illustrate that the combination of
problems of impulse control and antisocial behavior are not suf-
ficient to capture the construct of psychopathy in children, which
is consistent with the findings in adults (e.g., Hare et al., 1991).
Instead, it appears to be critical to also consider the presence of CU
traits, which have been the hallmark of most clinical descriptions
of psychopathy (Cleckley, 1976; Hare, 1994) but have been ig-
nored in most assessments of antisocial individuals across the life
span (Frick et al., in press; Hare et al., 1991).
 340 SHORT REPORTS
References
Abikoff, H., & Klein, R. G. (1992). Attention-deficit hyperactivity and
conduct disorder: Comorbidity and implications for treatment. Journal
of Consulting and Clinical Psychology, 60, 881-892.
American Psychiatric Association. (1987). Diagnostic and statistical man-
ual of mental disorders (3rd ed., revised). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical man-
ual of mental disorders (4th ed.). Washington, DC: Author.
Christian, R. E., Frick, P. J., Hill, N. L., Tyler, L., & Frazer, D. R. (1997).
Psychopathy and conduct problems in children: II. Implications for
subtyping children with conduct problems. Journal of the American
Academy of Child and Adolescent Psychiatry, 36, 233-241.
Cleckley, H. (1976). The mask of sanity (5th ed.). St. Louis, MO: Mosby.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Daugherty, T. K., & Quay, H. C. (1991). Response perseveration and
This document is copyrighted by the American Psychological Association or one of its allied publishers.
delayed responding in childhood behavior disorders. Journal of Child
Psychology and Psychiatry, 32, 453-461.
Frick, P. J. (1998). Conduct disorders and severe antisocial behavior. New
York: Plenum.
Frick, P. J., Barry, C. T., & Bodin, S. D. (in press). Applying the concept
of psychopathy to children: Implications for assessment of antisocial
children and adolescents. In C. B. Gacono (Ed.), The clinical and
forensic assessment of psychopathy: A practitioner's guide.
Frick, P. J., & Hare, R. D. (in press). The psychopathy screening device.
Toronto: Multi-Health Systems.
Frick, P. J., O'Brien, B. S., Wootton, J., & McBurnett, K. (1994). Psy-
chopathy and conduct problems in children. Journal of Abnormal Psy-
chology, 103, 700-707.
Hare, R. D. (1991). The Hare Psychopathy Checklist-Revised. Toronto:
Multi-Health Systems.
Hare, R. D. (1994). Without conscience: The disturbing world of psycho-
paths among us. New York: Simon & Schuster.
Hare, R. D., Harpur, T. J., Hakstian, A. R., Forth, A. E., Hart, S. D., &
Newman, J. P. (1990). The Revised Psychopathy Checklist: Descriptive
statistics, reliability, and factor structure. Psychological Assessment, 2,
338-341.
Hare, R. D., Hart, S. D., & Harpur, T. J. (1991). Psychopathy and the
DSM-IV criteria for the antisocial personality disorder. Journal of Ab-
normal Psychology, 100, 391-398.
Hart, S. D., Kropp, P. R., & Hare, R. D. (1988). Performance of male
psychopaths following conditional release from prison. Journal of Con-
sulting and Clinical Psychology, 56, 227-232.
Kagan, J. (1997). Temperament and the reactions to unfamiliarity. Child
Development, 68, 139-143.
Kagan, J., Reznick, S., & Snidman, N. (1987). The physiology and psy-
chology of behavioral inhibition in children. Child Development, 58,
1459-1473.
Kamphaus, R. W., & Frick, P. J. (1996). Clinical assessment of child and
adolescent personality and behavior. Boston: Allyn & Bacon.
Kochanska, G. (1993). Toward a synthesis of parental socialization and
child temperament in early development of conscience. Child Develop-
ment, 64, 325-347.
Lahey, B. B., Applegate, B., Barkley, R. A., Garfinkel, B., McBurnett, K.,
Kerdyk, L., Greenhill, L., Hynd, G. W., Frick, P. J., Newcorn, J.,
Biederman, J., Ollendick, T., Hart, E. L., Perez, D., Waldman, I., &
Shaffer, D. (1994). DSM-IV field trials for oppositional defiant disorder
and conduct disorder in children and adolescents. American Journal of
Psychiatry, 151, 1163-1171.
Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L.,
Hynd, G. W., Barkley, R. A., Newcorn, J., Jensen, P., Richters, J.,
Garfinkel, B., Kerdyck, L., Frick, P. J., Ollendick, T., Perez, D., Hart,
E. L., Waldman, L, & Shaffer, D. (1994). DSM-IV field trials for
attention-deficit/hyperactivity disorder in children and adolescents.
American Journal of Psychiatry, 151, 1673-1685.
Levenson, M. R., Kiehl, K. A., & Fitzpatrick, C. M. (1995). Assessing
psychopathic attributes in a noninstitutionalized population. Journal of
Personality and Social Psychology, 68, 151-158.
Lilienfeld, S. O. (1994). Conceptual problems in the assessment of psy-
chopathy. Clinical Psychology Review, 14, 17-38.
Loney, B. R., Frick, P. J., Ellis, M., & McCoy, M. G. (1998). Intelligence,
psychopathy, and antisocial behavior. Journal of Psychopathology and
Behavioral Assessment, 20, 231-247.
Lykken, D. T. (1995). The antisocial personalities. Hillsdale, NJ: Erlbaum.
Lynam, D. R. (1996). Early identification of chronic offenders: Who is the
fledgling psychopath? Psychological Bulletin, 120, 209-234.
Lynam, D. R. (1998). Early identification of the fledgling psychopath:
Locating the psychopathic child in the current nomenclature. Journal of
Abnormal Psychology, 107, 566-575.
Newman, J. P., Patterson, C. M., & Kosson, D. S. (1987). Response
perseveration in psychopaths. Journal of Abnormal Psychology, 96,
145-148.
O'Brien, B. S., & Frick, P. J. (1996). Reward dominance: Associations
with anxiety, conduct problems, and psychopathy in children. Journal of
Abnormal Child Psychology, 24, 223-239.
O'Brien, B. S., Frick, P. J., & Lynam, R. D. (1994). Reward dominance
among children with disruptive behavior disorders. Journal of Psycho-
pathology and Behavioral Assessment, 16, 131-145.
Piacentini, J. C., Cohen, P., & Cohen, C. (1992). Combining discrepant
diagnostic information from multiple sources: Are complex algorithms
better than simple ones? Journal of Abnormal Child Psychology, 20,
51-63.
Russo, M. F., Stokes, G. S., Lahey, B. B., Christ, M. A. G., McBurnett, K.,
Loeber, R., Stouthamer-Loeber, M., & Green, S. M. (1993). A sensation-
seeking scale for children: Further refinement and psychometric devel-
opment. Journal of Psychopathology and Behavioral Assessment, 15,
69-86.
Serin, R. C. (1993). Diagnosis of psychopathology with and without an
interview. Journal of Clinical Psychology, 49, 367-372.
Serin, R. C., Peters, R. D., & Barbaree, H. V. (1990). Predictors of
psychopathy and release outcome in a criminal population. Psycholog-
ical Assessment: A Journal of Consulting and Clinical Psychology, 2,
419-422.
Shaffer, D., Fisher, P., Piacentini, J. C., Schwab-Stone, M., & Wicks, J.
(1992). National Institute of Mental Health Diagnostic Interview Sched-
ule for Children: Version 2.3. New York: Columbia University.
Smith, S. S., Arnett, P. A., & Newman, J. P. (1992). Neuropsychological
differentiation of psychopathic and nonpsychopathic criminal offenders.
Personality and Individual Differences, 13, 1233-1243.
Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to
experience aversive emotional states. Psychological Bulletin, 98, 219-
235.
Wechsler, D. (1974). The Wechsler Intelligence Scale for Children (2nd
ed.). San Antonio: The Psychological Corporation.
Wechsler, D. (1991). The Wechsler Intelligence Scale for Children (3rd
ed.). San Antonio, TX: The Psychological Corporation.
Wootton, J. M., Frick, P. J., Shelton, K. K., & Silverthorn, P. (1997).
Ineffective parenting and childhood conduct problems: The moderating
role of callous—unemotional traits. Journal of Consulting and Clinical
Psychology, 65, 301-308.
Received March 26, 1999
Revision received June 29, 1999
Accepted June 30, 1999 •