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Narcissism and Callous-Unemotional Traits Prospectively Predict Child Conduct Problems a

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Kristen L. Jezior , Meghan E. McKenzie & Steve S. Lee

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Department of Psychology, University of California, Los Angeles Published online: 04 Feb 2015.

Click for updates To cite this article: Kristen L. Jezior, Meghan E. McKenzie & Steve S. Lee (2015): Narcissism and Callous-Unemotional Traits Prospectively Predict Child Conduct Problems, Journal of Clinical Child & Adolescent Psychology, DOI: 10.1080/15374416.2014.982280 To link to this article: http://dx.doi.org/10.1080/15374416.2014.982280

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Journal of Clinical Child & Adolescent Psychology, 0(0), 1–12, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1537-4416 print=1537-4424 online DOI: 10.1080/15374416.2014.982280

Narcissism and Callous-Unemotional Traits Prospectively Predict Child Conduct Problems Kristen L. Jezior, Meghan E. McKenzie, and Steve S. Lee

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Department of Psychology, University of California, Los Angeles

Although narcissism and callous-unemotional (CU) traits are separable facets of psychopathy, their independent prediction of conduct problems (CP) among young children is not well known. In addition, above-average IQ was central to the original conceptualization of psychopathy, yet IQ is typically inversely associated with youth CP. We examined narcissism and CU traits as independent and prospective predictors of oppositional defiant disorder (ODD), conduct disorder (CD), and youth self-reported antisocial behavior, as well as their moderation by IQ. At baseline, parents and teachers separately rated narcissism and CU traits in 188 6-to-10-year-old children (47.9% non-White; 69.1% male; M ¼ 7.34 years, SD ¼ 1.09) with (n ¼ 99) and without (n ¼ 89) attention-deficit=hyperactivity disorder (ADHD). Approximately 2 years later, parents and teachers separately rated youth ODD and CD symptoms, and youth self-reported antisocial behavior. With control of baseline ADHD and ODD=CD symptoms, narcissism and CU traits independently and positively predicted ODD and CD symptoms at follow-up. IQ did not moderate any CP predictions from baseline narcissism or CU traits. These preliminary findings suggest that individual differences in narcissism and CU traits, even relatively early in development, are uniquely associated with emergent CP. Findings are considered within a developmental framework and the multiple pathways underlying the heterogeneity of CP are discussed.

Conduct problems (CP), including oppositional defiant disorder (ODD) and conduct disorder (CD), are among the most common mental health referrals for schoolaged youth (Loeber, Burke, Lahey, Winters, & Zera, 2000). Consisting of diverse behavior problems such as hostility, defiance, aggression, and property destruction, lifetime prevalence rates of ODD and CD are 10.2% and 9.5%, respectively (Nock, Kazdin, Hiripi, & Kessler, 2006, 2007). Collectively, CP show strong predictive validity with respect to important outcomes such as antisocial personality disorder, substance abuse, depression, incarceration, and death by homicide and suicide (Lahey, Loeber, Burke, & Applegate, 2005; Loeber, Farrington, Stouthamer-Loeber, & Van Kammen, 1998). Furthermore, across 7 years, the average public health cost exceeds $70,000 per child with CD (Foster & Jones, 2005). Thus, by virtue of their Correspondence should be addressed to Steve S. Lee, Department of Psychology, UCLA, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563. E-mail: [email protected]

clinical and public health significance, understanding the development and consequences of CP are a major scientific priority. Crucially, identification of early predictors of CP will facilitate innovations in the development of intervention and prevention programs for significant CP. Despite their predictive validity, there is considerable heterogeneity among youth with CP. Although ODD precedes CD for many youth, most youth with ODD do not develop subsequent CD (Loeber, 1991). Furthermore, ODD consists of potentially important subtypes where ‘‘affective’’ (e.g., irritable) dimensions are more strongly associated with comorbid internalizing problems and behavioral dimensions are associated with externalizing problems (Burke, Hipwell, & Loeber, 2010; Drabick & Gadow, 2012; Rowe, Costello, Angold, Copeland, & Maughan, 2010; Stringaris & Goodman, 2009a, 2009b). Individual differences in psychopathic traits have refined the taxonomy of CP. Callousunemotional (CU) traits, defined by low empathy, lack

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JEZIOR, McKENZIE, LEE

of guilt, and shallow emotions, are positively associated with more severe and persistent externalizing problems (e.g., official police contact, parental antisocial personality disorder; Christian, Frick, Hill, Tyler, & Frazer, 1997) as well as greater resistance to intervention (Hawes & Dadds, 2007). CU traits are also frequently stable (Obradovic´, Pardini, Long, & Loeber, 2007), highly heritable (Viding, Blair, Moffitt, & Plomin, 2005), and associated with atypical empathic neural responses and neural connectivity (Decety, Michalska, Akitsuki, & Lahey, 2009; Marsh et al., 2013). Thus, individual differences in CU traits critically improve understanding of the otherwise substantial heterogeneity across different forms of CP; moreover, identifying psychopathic traits early in development may facilitate efforts to detect youth at-risk for severe and persistent antisocial behavior. Whereas the validity of childhood CU traits is well-established, the literature has largely ignored individual differences in other facets of psychopathic traits, especially early in development. Despite replicated factor analytic evidence in children (Frick, Bodin, & Barry, 2000; Vitacco, Rogers, & Neumann, 2003) and adults (Few, Miller, & Lynam, 2013) that narcissism is a central component of psychopathy, relatively few studies have simultaneously evaluated the predictive utility of narcissism and CU traits (Cooke & Michie, 2001; Kosson, Cyterski, Steuerwald, Neumann, & Walker-Matthews, 2002; Salekin, Leistico, Neumann, DiCicco, & Duros, 2004). Characterized by bragging about one’s own abilities and accomplishments, thinking oneself is better or more important than others, and making fun of others, preliminary evidence suggested that childhood narcissism was uniquely associated with attention-deficit= hyperactivity disorder (ADHD), ODD, and CD (C. T. Barry, Frick, & Killian, 2003; Frick et al., 2000). Narcissism also significantly incremented predictions of aggression, delinquency, and internalizing problems, even with control of CU traits, impulsivity, and self-esteem (Bushman & Baumeister, 1998; Washburn, McMahon, King, Reinecke, & Silver, 2004). Similarly, in a high-risk school-based sample, narcissism predicted self-reported delinquency beyond CU traits, impulsivity, parenting, and earlier CP (C. T. Barry, Frick, Adler, & Grafeman, 2007). However, many of these studies consisted of older youth, thus preventing inferences about the predictive validity of psychopathic traits early in development and specifically with respect to early-onset CP, which are associated with more significant risk factors (Moffitt & Caspi, 2001). Finally, in a cross-sectional study, narcissism, but not CU traits, was strongly associated with childhood reactive and proactive aggression, controlling for other facets of psychopathy and other key covariates (e.g., self-esteem; T. D. Barry et al., 2007). Thus, although CU traits and narcissism are central to

psychopathy, their independent and prospective prediction of differentiated measures of CP (e.g., ODD, CD) has yet to be adequately characterized in young children and with stringent control of key covariates (e.g., ADHD). Adequate control of ADHD is crucial given the centrality of impulsivity to ADHD, CP, and psychopathy. Not only may examining psychopathic traits early in development help identify youth at risk for persistent CP, but probing differentiated measures of psychopathy (i.e., CU traits vs. narcissism) may help refine heterogeneity within CP. Examining the covariation of IQ, psychopathic traits, and CP early in development has considerable potential to advance knowledge. Although Cleckley (1976) originally conceptualized high IQ as a key component of psychopathy, this formulation may have disproportionately reflected his well-educated and socioeconomically advantaged sample (Hare & Neumann, 2008). For example, the association between IQ and psychopathy in adults is inconsistent (Hart, Forth, & Hare, 1990; Johansson & Kerr, 2005); in children, IQ is typically inversely associated with CP (Lynam, Moffitt, & Stouthamer-Loeber, 1993; White, Moffitt, & Silva, 1989). Thus, the association of IQ and youth psychopathy remains poorly understood, which may partially reflect that psychopathy is multidimensional. Among clinic-referred children, verbal IQ deficits were specific to children with CP only, relative to youth with CP and CU traits (Loney, Frick, Ellis, & McCoy, 1998). In another study, narcissism was positively associated with IQ, whereas CU traits were marginally negatively associated with IQ (Fontaine, Barker, Salekin, & Viding, 2008). IQ has also been theorized to fundamentally differentiate unsuccessful from successful psychopaths (i.e., individuals who manifest psychopathic traits but elude the criminal justice system; Gao & Raine, 2010), suggesting that it may meaningfully moderate the association of psychopathic traits and CP. However, despite the plausibility of IQ  psychopathic trait interactions with respect to emergent CP, relatively few studies have examined this directly. Mun˜oz, Frick, Kimonis, and Aucoin (2008) reported a significant interaction between CU traits and verbal IQ in predictions of delinquency where youth with elevated CU traits and high verbal IQ exhibited the greatest violent delinquency. However, the association was based on cross-sectional data from incarcerated adolescent boys, thus limiting its generalizability. Moreover, inferences about predictions of CP over time from psychopathic traits  IQ interactions cannot be made. In a recent study, narcissism was unrelated to verbal IQ, but was inversely associated with nonverbal IQ; no interactions with IQ were observed with respect to predictions of CP (Allen, Briskman, Humayun, Dadds, & Scott, 2013). Given that there are relatively few prospective studies of young children, we

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PSYCHOPATHY AND CHILD CONDUCT PROBLEMS

contend that future research must prioritize understanding the predictive validity of individual differences in psychopathic traits early in development to satisfactorily characterize the development of different CP. Not only are narcissism and CU traits in young children understudied, but remarkably few studies have examined their independent association with respect to emergent CP as well as their potential moderation by IQ. To improve traction on the predictive validity of childhood CU traits and narcissism, we conducted a 2-year prospective follow-up study of an ethnically diverse sample of 6- to 10-year-old children with (n ¼ 99) and without (n ¼ 89) ADHD. We hypothesized that baseline (i.e., Wave 1) CU traits and narcissism would each independently and positively predict multi-informant (i.e., parent, teacher, youth self-report) measures of Wave 2 CP (i.e., ODD symptoms, CD symptoms, and youth self-reported antisocial behavior), controlling for baseline ADHD and ODD=CD. We also separately examined potential narcissism  IQ and CU traits  IQ interactions; however, given the modest literature, we did not propose any directional hypotheses therein.

METHOD Participants Participants were 188 ethnically diverse children (52.1% Caucasian; 5.9% African American; 8.5% Hispanic; 3.7% Asian; 20.7% mixed; 9.0% other or unknown; 69.1% male) children with (n ¼ 99) and without ADHD (n ¼ 89). During their initial visit (i.e., Wave 1), children were 6 to 10 years old (M ¼ 7.34, SD ¼ 1.09); they were 7 to 13 years old (M ¼ 9.63, SD ¼ 1.30) when they completed their follow-up visit approximately 2 years later (i.e., Wave 2). Children were recruited from referrals from local mental health service providers and pediatric offices, as well as advertisements in local schools and public locations in an urban area of Southern California. Participants were required to live with at least one biological parent at least half-time, be enrolled in school full-time, and be fluent in English. Exclusion criteria for all participants included a Full Scale IQ (IQ) less than 70, an autism spectrum, seizure, or neurological disorder. Parents were administered the Diagnostic Interview Schedule for Children, 4th edition (DISC-IV; Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000), a fully structured diagnostic interview including questions on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR) criteria including age of onset, cross-situational impairment, etc. (American Psychiatric Association, 2000). All diagnostic information for the sample, including ADHD proband status

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(i.e., ADHD vs. non-ADHD comparison), was ascertained via the DISC-IV. 52.9% of youth met diagnostic criteria for ADHD at baseline, 29.8% for ODD, 3.2% for CD, and 37.8% for any anxiety disorder according to the DISC-IV (see Table 1). To avoid potentially exaggerating diagnostic group differences, non-ADHD comparison children were allowed to meet diagnostic criteria for mental disorders other than ADHD. All participants were recruited, screened, and assessed using identical procedures. Procedures At baseline (i.e., Wave 1), interested families completed an initial telephone screening based on the inclusion and exclusion criteria just listed. Rating scales were TABLE 1 Descriptive Statistics of Key Variables

Variable Age Sex (% Male) Race-Ethnicity (% Caucasian) Wave 1 Parent-Report % ADHD Diagnosis (DISC) % ODD Diagnosis (DISC) % CD Diagnosis (DISC) % Any Anxiety Disorder Diagnosis (DISC) ADHD Symptoms (DBD) ODD Symptoms (DBD) CD Symptoms (DBD) Narcissism (With Item 15) Narcissism (Without Item 15) CU Traits Wave 2 Parent-Report ODD Symptoms (DBD) CD Symptoms (DBD) Wave 1 Teacher-Report ADHD Symptoms (DBD) ODD Symptoms (DBD) CD Symptoms (DBD) Narcissism (With Item 15) Narcissism (Without Item 15) CU Traits Wave 2 Teacher-Report ODD Symptoms (DBD) CD Symptoms (DBD) Youth-Report Wave 1 IQ Wave 2 Self-Reported Antisocial Behavior

M (SD) or % of Sample

MinimumMaximum

n

7.34 (1.09) 69.1% 52.1%

6–10 — —

188 188 180

— — — —

187 188 188 188

0–51 0–21 0–15 0–13 0–11 0–10

188 188 188 184 180 184

0–20 0–8

183 183

0–53 0–24 0–25 0–11 0–9 0–10

120 120 120 141 141 141

2.81 (3.78) 0.64 (1.46)

0–16 0–9

90 90

107.34 (14.83) 5.15 (5.29)

70–144 0–27

188 120

52.9% 29.8% 3.2% 37.8% 21.07 6.10 1.57 3.19 2.17 2.91

(13.45) (4.84) (2.25) (2.71) (2.40) (1.94)

4.82 (4.15) 0.91 (1.41) 17.06 3.77 1.31 2.38 1.92 4.26

(15.22) (5.71) (3.16) (2.71) (2.33) (2.46)

Note: ADHD ¼ attention-deficit=hyperactivity disorder; DISC ¼ diagnostic interview schedule for children-IV; symptoms ¼ 0–3 rating  number of symptoms; ODD ¼ oppositional defiant disorder; CD ¼ conduct disorder; DBD ¼ Disruptive Behavior Disorder Rating Scale; CU ¼ callous-unemotional traits; IQ ¼ estimate of Wechsler Intelligence Scale for Children, Fourth Edition, Full Scale IQ.

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mailed to eligible families, and they were subsequently invited for in-person laboratory-based assessments. After obtaining parental consent and child assent, clinical psychology doctoral students or B.A.-level trained staff assessed children’s cognitive ability, academic achievement, and socio-emotional functioning, whereas a second member of the research staff concurrently interviewed parents about their child’s psychopathology. All interviewers were initially blind to the child’s diagnostic status, but the blind could not always be preserved given the extensive information gathered about the child. Parents (90% mothers) were asked to rate each child based on his or her unmedicated behavior. Approximately 85% of children were evaluated unmedicated (mostly stimulants) during the assessment. Families were compensated with $50 and a diagnostic report describing the child’s IQ, academic achievement, and DSM-IV-TR diagnoses. Upon the completion of the assessment, rating scales were mailed to the children’s teachers for completion. All study procedures were approved by the Institutional Review Board. Approximately 2 years after their initial assessment, families were invited back to the laboratory to participate in a follow-up assessment (i.e., Wave 2). Consisting of highly similar assessment procedures to those at Wave 1, relevant domains of inquiry at Wave 2 included family functioning, youth academic achievement, and child psychopathology. Approximately 89% of the initial Wave 1 sample was reevaluated at Wave 2. Participants in Wave 2 had significantly higher baseline ADHD status, t(33.45) ¼ 2.97, p < .01, and exhibited significantly more ODD symptoms, t(231) ¼ 2.08, p ¼ .04, according to the DISC-IV than families who refused participation or could not otherwise be evaluated at Wave 2. No other significant demographic or clinical factors (i.e., child age and sex, parent race-ethnicity, child ADHD symptoms, ODD diagnostic status, CD symptoms, CD diagnostic status, and parental depression) were observed between the Wave 2 sample and the original Wave 1 sample. All study procedures were approved by the Institutional Review Board. A total of 188 families had complete baseline and follow-up data (e.g., demographic, clinical, parent, teacher) for inclusion in the current study. Measures Psychopathic traits. At Wave 1, parents and teachers separately completed identical versions of the Antisocial Process Screening Device (APSD; Frick & Hare, 2001), a 20-item rating scale of three central facets of psychopathy: impulsivity=CP, narcissism, and CU traits. We analyzed the narcissism and CU traits factors but excluded impulsivity=CP given their redundancy with the CP outcomes. Narcissism subscale items on

the APSD include ‘‘His=her emotions seem shallow,’’ ‘‘Brags excessively about his=her abilities, accomplishments, or possessions,’’ ‘‘Uses or ‘cons’ other people to get what he=she wants,’’ ‘‘Teases or makes fun of other people,’’ ‘‘Can be charming at times, but in ways that seem insincere or superficial,’’ ‘‘Becomes angry when corrected or punished,’’ and ‘‘Seems to think he=she is better or more important than others people.’’ Given concern that narcissism items may overlap with ODD symptoms, we performed an exploratory factor analysis with all APSD and ODD items to determine if any narcissism items might better fit with the ODD factor (results available upon request). The narcissism item ‘‘Becomes angry when corrected or punished’’ fit the ODD factor better than the narcissism factor. Thus, the narcissism factor consisted of the sum of the remaining six narcissism items on the APSD. The CU traits factor consisted of the sum of six items: ‘‘Is concerned about how well he=she does at school= work’’ (R), ‘‘Is good at keeping promises’’ (R), ‘‘Feels bad or guilty when he=she does something wrong’’ (R), ‘‘Is concerned about the feelings of others’’ (R), ‘‘Does not show feelings or emotions,’’ and ‘‘Keeps the same friends’’ (R). Items were endorsed as not at all true, sometimes true, or definitely true and ranked 0–2, respectively. Parent- and teacher-rated narcissism have shown good reliability, whereas CU traits have shown modest reliability in multiple samples (Frick et al., 2000; see Kimonis et al., 2008 for a discussion of potential concerns with the APSD CU traits factor). Similar to the reliability shown in such samples, parent-rated narcissism and CU traits had Cronbach alphas of .80 and .60, respectively, whereas alphas were .81 and .69 for teacher ratings, respectively, in the current sample.

ADHD, ODD, and CD. At Wave 1 and Wave 2, ADHD, ODD, and CD symptoms were separately assessed by parents and teachers using identical versions of the Disruptive Behavior Disorders Rating Scale (PDBD and T-DBD; Pelham, Gnagy, Greenslade, & Milich, 1992). The P-=T-DBD is an evidence-based assessment of ADHD, ODD, and CD symptoms with excellent psychometric properties (Pelham, Fabiano, & Massetti, 2005). The measure consists of 18 ADHD items (e.g., ‘‘often fidgets with hands or feet or squirms in seat’’), 8 ODD items (e.g., ‘‘often argues with adults’’ and ‘‘often loses temper’’), and 15 CD items (e.g., ‘‘has been physically cruel to people’’ and ‘‘has deliberately destroyed others’ property’’). All items were rated from 0 to 3 (0 ¼ not at all,’’ 1 ¼ just a little, 2 ¼ ‘‘pretty much,’’ and 3 ¼ ‘‘very much’’). Because conduct problems, and especially CD symptoms are often infrequent in young children, we examined ODD and CD symptoms (i.e., 0–3 range for each item summed across all

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items) to maximize individual differences. ADHD symptoms were measured in the same fashion. Parent- and teacher-rated ADHD, ODD, and CD symptoms from the DBD were analyzed.

vandalism). However, only 29 items were analyzed given that three items were ‘‘never’’ endorsed in the entire sample. The frequency of behavior in the past 6 months was rated as ‘‘never,’’ ‘‘once,’’ ‘‘twice,’’ or ‘‘more often,’’ and rated 0 to 3, respectively. We utilized the total to estimate youth self-reported antisocial behavior (possible range ¼ 0–87). Descriptive statistics and intercorrelations for key variables are summarized in Table 1 and Table 2, respectively.

Cognitive ability. Three subtests from the Wechsler Intelligence Scale for Children–Fourth Edition were administered to each child at Wave 1: Vocabulary, Symbol Search, and Arithmetic (Wechsler, 2003). The scaled scores of these subtests were summed to estimate IQ. This composite estimate correlates highly with the IQ calculated from the full test battery in the normative sample (r ¼ .91; Sattler & Dumont, 2004). Verbal IQ was estimated by the Vocabulary subtest scaled score, which correlates highly with the Verbal Comprehension Index (r ¼ .91) (Sattler, 2008). Because results in the current study based on IQ and Verbal IQ were nearly identical, results based on IQ are reported.

Data analytic procedures. We evaluated child sex, age, race-ethnicity, parent’s education level, and family income as potential covariates in the study; however, given that they were unrelated to all CP outcomes, they were not further considered. Next, to improve the specificity of predictions of CP outcomes from narcissism and CU traits, all models controlled for Wave 1 ADHD symptoms from the P-DBD and T-DBD utilizing generalized estimating equations (GEE). Furthermore, controlling for ADHD also accounts for the case-control design and the fact that impulsivity is central to ADHD and psychopathy. The general data analytic approach consisted of fitting GEE with a negative binomial distribution specified to account for overdispersed means (i.e., sample variance greater than the sample mean) evident

Youth self-reported antisocial behavior. At Wave 2, youth completed the 32-item Self-Reported Antisocial Behavior (Loeber, Stouthamer-Loeber, Van Kammen, & Farrington, 1989) semistructured interview of youth delinquency and antisocial behavior (e.g., theft, aggression,

TABLE 2 Intercorrelation of Independent Variables, Covariates, and Dependent Variables Narc Narc W1 W1 P T

CU W1 P

CU W1 T

Narc W1 P 1 1 Narc W1 T .34 1 CU W1 P .31 .13 1 CU W1 T .21 .48 .18 IQ W1 Y .10 .13 .10 .16 ADHD Sx W1 P .45 .31 .48 .33 ADHD Sx W1 T .27 .53 .22 .47 ODD Sx W1 P .60 .47 .37 .29 .38 ODD Sx W1 T .27 .61 .06    .41 .42 .22 CD Sx W1 P .59 .29 CD Sx W1 T .27 .64 .10    .21 .34 .25 ADHD Sx W2 P .36 ADHD Sx W2 T .14 .14 .26 .26 ODD Sx W2 P .54 .28 .31 .24 ODD Sx W2 T .16 .18 .21 .29  .18 CD Sx W2 P .34 .12 .40 .34 CD Sx W2 T .16 .30 .21 Antisocial .14 .11 .04 .23 Behavior W2 Y

IQ W1 Y

1 .28 .23 .08 .01 .07 .02 .21 .19 .04

Narcissism and Callous-Unemotional Traits Prospectively Predict Child Conduct Problems.

Although narcissism and callous-unemotional (CU) traits are separable facets of psychopathy, their independent prediction of conduct problems (CP) amo...
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