Maltreatment and parenting in youth with primary and secondary callous-unemotional traits: Anxiety matters

Jessica J. Todorov; Gregor Kohls; Ruth Pauli; Jack Rogers; Anka Bernhard; Katharina Ackermann; Nora M. Raschle; Jules R. Dugre; Aranzazu Fernandez-Rivas; Miguel Angel Gonzalez-Torres; Amaia Hervas; Areti Smaragdi; Karen Gonzalez; Ágnes Vetró; Dimitris Dikeos; Arne Popma; Christina Stadler; Kerstin Konrad; Christine M. Freitag; Graeme Fairchild; Rory T. Devine; Stephane A. De Brito

doi:10.1002/jcv2.12266

Maltreatment and parenting in youth with primary and secondary callous-unemotional traits: Anxiety matters

Jessica J. Todorov, Gregor Kohls, Ruth Pauli, Jack Rogers, Anka Bernhard, Katharina Ackermann, Nora M. Raschle, Jules R. Dugre, Aranzazu Fernandez-Rivas, Miguel Angel Gonzalez-Torres, Amaia Hervas, Areti Smaragdi, Karen Gonzalez, Ágnes Vetró, Dimitris Dikeos, Arne Popma, Christina Stadler, Kerstin Konrad, Christine M. Freitag, Graeme FairchildRory T. Devine, Stephane A. De Brito

Research output: Contribution to journal › Article › peer-review

2 Citations (SciVal)

Abstract

Background: Youth with conduct disorder (CD) and high callous-unemotional (CU) traits are not a homogenous group and can be disaggregated into primary and secondary subgroups. However, there are inconsistencies in defining primary and secondary subgroups, with some studies using anxiety, others using maltreatment and still others using both features to identify subgroups. There is a paucity of work comparing primary and secondary subgroups with typically developing (TD) youth on experiences of maltreatment and parenting as well as a lack of studies investigating sex differences. Methods: In a large sample of TD youth (n = 946, 66% female) and youth with CD (n = 885, 60% female), we used latent profile analysis in youth with CD aged between 9 and 18 years to address four aims: (i) to demonstrate how primary and secondary subgroup membership differs when anxiety, maltreatment, or both are used as continuous indicators, (ii) to compare primary and secondary subgroups with TD youth on abuse and neglect measures, and (iii) to compare primary and secondary subgroups with TD youth on parenting experiences, and (iv) to examine whether the results were consistent across sexes. Results: Anxiety without maltreatment yielded the best fitting and most theoretically interpretable classification of primary and secondary subgroups across both sexes (Bayesian information criterion = 17832.33, Entropy = 0.75, Lo-Mendell-Rubin: p < 0.01). Compared with TD youth, youth with primary and secondary CU traits experienced greater levels of abuse and neglect (p < 0.001, η²_p = 0.04−0.16) and maladaptive parenting practices (p < 0.001, η²_p = 0.04−0.13). Youth with primary and secondary CU traits were equally high on levels of abuse, neglect, and maladaptive parenting (all p values >0.05). Conclusions: We provide evidence that anxiety and maltreatment cannot be used interchangeably to identify youth with primary versus secondary CU traits. Anxiey yielded the best fitting and most theoretically interpretable classifications across both sexes. Our results signify the need for researchers and clinicians to adopt a unified approach to defining primary and secondary subgroups of CU traits using anxiety in both sexes.

Original language	English
Article number	e12266
Journal	JCPP Advances
Volume	5
Issue number	2
Early online date	11 Jun 2025
DOIs	https://doi.org/10.1002/jcv2.12266
Publication status	Published - 30 Jun 2025

Data Availability Statement

The data presented in this article is not openly available but are available on reasonable request in line with the consortiums' data sharing policy. Requests to access the data should be directed to Stephane De Brito: [email protected]

Acknowledgements

The authors thank all members of the FemNAT-CD consortium for their contributions to the project. We would also like to thank our participants, their families, and the teachers, clinicians, social workers, foster carers, and other professionals who generously gave their time to assist with recruitment and to participate in the study.

Funding

The present study is part of the FemNAT-CD consortium study was funded by the European Commission's Seventh Framework Programme (FP7/2007–2013) under Grant Agreement no. 602407 (FemNAT-CD coordinator: Christine M. Freitag, University Hospital, Goethe University Frankfurt). Nora M. Raschle receives funding by the Hochschulmedizin Zurich (HMZ, STRESS) and the University of Zurich Research Priority Program 'Adaptive Brain Circuits in Development and Learning (URPP AdaBD). JRD is holder of a postdoctoral fellowship from the Canadian Institutes of Health Research (MFE-181885). During the writing of this manuscript, SADB was supported by a grant from the Economic and Social Research Council (grant ES/V003526/1).

Funders	Funder number
Economic and Social Research Council	ES/V003526/1

Keywords

anxiety
callous-unemotional traits
conduct disorder
FemNAT-CD
maltreatment
parenting
primary and secondary CU traits

ASJC Scopus subject areas

Psychology (miscellaneous)
Psychiatry and Mental health
Developmental and Educational Psychology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1002/jcv2.12266Licence: CC BY

Cite this

Todorov, J. J., Kohls, G., Pauli, R., Rogers, J., Bernhard, A., Ackermann, K., Raschle, N. M., Dugre, J. R., Fernandez-Rivas, A., Gonzalez-Torres, M. A., Hervas, A., Smaragdi, A., Gonzalez, K., Vetró, Á., Dikeos, D., Popma, A., Stadler, C., Konrad, K., Freitag, C. M., ... De Brito, S. A. (2025). Maltreatment and parenting in youth with primary and secondary callous-unemotional traits: Anxiety matters. JCPP Advances, 5(2), Article e12266. https://doi.org/10.1002/jcv2.12266

Todorov, JJ, Kohls, G, Pauli, R, Rogers, J, Bernhard, A, Ackermann, K, Raschle, NM, Dugre, JR, Fernandez-Rivas, A, Gonzalez-Torres, MA, Hervas, A, Smaragdi, A, Gonzalez, K, Vetró, Á, Dikeos, D, Popma, A, Stadler, C, Konrad, K, Freitag, CM, Fairchild, G, Devine, RT & De Brito, SA 2025, 'Maltreatment and parenting in youth with primary and secondary callous-unemotional traits: Anxiety matters', JCPP Advances, vol. 5, no. 2, e12266. https://doi.org/10.1002/jcv2.12266

@article{c4690de472b4438d9edeecc853ff18c5,

title = "Maltreatment and parenting in youth with primary and secondary callous-unemotional traits: Anxiety matters",

abstract = "Background: Youth with conduct disorder (CD) and high callous-unemotional (CU) traits are not a homogenous group and can be disaggregated into primary and secondary subgroups. However, there are inconsistencies in defining primary and secondary subgroups, with some studies using anxiety, others using maltreatment and still others using both features to identify subgroups. There is a paucity of work comparing primary and secondary subgroups with typically developing (TD) youth on experiences of maltreatment and parenting as well as a lack of studies investigating sex differences. Methods: In a large sample of TD youth (n = 946, 66% female) and youth with CD (n = 885, 60% female), we used latent profile analysis in youth with CD aged between 9 and 18 years to address four aims: (i) to demonstrate how primary and secondary subgroup membership differs when anxiety, maltreatment, or both are used as continuous indicators, (ii) to compare primary and secondary subgroups with TD youth on abuse and neglect measures, and (iii) to compare primary and secondary subgroups with TD youth on parenting experiences, and (iv) to examine whether the results were consistent across sexes. Results: Anxiety without maltreatment yielded the best fitting and most theoretically interpretable classification of primary and secondary subgroups across both sexes (Bayesian information criterion = 17832.33, Entropy = 0.75, Lo-Mendell-Rubin: p < 0.01). Compared with TD youth, youth with primary and secondary CU traits experienced greater levels of abuse and neglect (p < 0.001, η2p = 0.04−0.16) and maladaptive parenting practices (p < 0.001, η2p = 0.04−0.13). Youth with primary and secondary CU traits were equally high on levels of abuse, neglect, and maladaptive parenting (all p values >0.05). Conclusions: We provide evidence that anxiety and maltreatment cannot be used interchangeably to identify youth with primary versus secondary CU traits. Anxiey yielded the best fitting and most theoretically interpretable classifications across both sexes. Our results signify the need for researchers and clinicians to adopt a unified approach to defining primary and secondary subgroups of CU traits using anxiety in both sexes.",

keywords = "anxiety, callous-unemotional traits, conduct disorder, FemNAT-CD, maltreatment, parenting, primary and secondary CU traits",

author = "Todorov, {Jessica J.} and Gregor Kohls and Ruth Pauli and Jack Rogers and Anka Bernhard and Katharina Ackermann and Raschle, {Nora M.} and Dugre, {Jules R.} and Aranzazu Fernandez-Rivas and Gonzalez-Torres, {Miguel Angel} and Amaia Hervas and Areti Smaragdi and Karen Gonzalez and {\'A}gnes Vetr{\'o} and Dimitris Dikeos and Arne Popma and Christina Stadler and Kerstin Konrad and Freitag, {Christine M.} and Graeme Fairchild and Devine, {Rory T.} and {De Brito}, {Stephane A.}",

year = "2025",

month = jun,

day = "30",

doi = "10.1002/jcv2.12266",

language = "English",

volume = "5",

journal = "JCPP Advances",

issn = "2692-9384",

publisher = "John Wiley and Sons Inc.",

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TY - JOUR

T1 - Maltreatment and parenting in youth with primary and secondary callous-unemotional traits

T2 - Anxiety matters

AU - Todorov, Jessica J.

AU - Kohls, Gregor

AU - Pauli, Ruth

AU - Rogers, Jack

AU - Bernhard, Anka

AU - Ackermann, Katharina

AU - Raschle, Nora M.

AU - Dugre, Jules R.

AU - Fernandez-Rivas, Aranzazu

AU - Gonzalez-Torres, Miguel Angel

AU - Hervas, Amaia

AU - Smaragdi, Areti

AU - Gonzalez, Karen

AU - Vetró, Ágnes

AU - Dikeos, Dimitris

AU - Popma, Arne

AU - Stadler, Christina

AU - Konrad, Kerstin

AU - Freitag, Christine M.

AU - Fairchild, Graeme

AU - Devine, Rory T.

AU - De Brito, Stephane A.

PY - 2025/6/30

Y1 - 2025/6/30

N2 - Background: Youth with conduct disorder (CD) and high callous-unemotional (CU) traits are not a homogenous group and can be disaggregated into primary and secondary subgroups. However, there are inconsistencies in defining primary and secondary subgroups, with some studies using anxiety, others using maltreatment and still others using both features to identify subgroups. There is a paucity of work comparing primary and secondary subgroups with typically developing (TD) youth on experiences of maltreatment and parenting as well as a lack of studies investigating sex differences. Methods: In a large sample of TD youth (n = 946, 66% female) and youth with CD (n = 885, 60% female), we used latent profile analysis in youth with CD aged between 9 and 18 years to address four aims: (i) to demonstrate how primary and secondary subgroup membership differs when anxiety, maltreatment, or both are used as continuous indicators, (ii) to compare primary and secondary subgroups with TD youth on abuse and neglect measures, and (iii) to compare primary and secondary subgroups with TD youth on parenting experiences, and (iv) to examine whether the results were consistent across sexes. Results: Anxiety without maltreatment yielded the best fitting and most theoretically interpretable classification of primary and secondary subgroups across both sexes (Bayesian information criterion = 17832.33, Entropy = 0.75, Lo-Mendell-Rubin: p < 0.01). Compared with TD youth, youth with primary and secondary CU traits experienced greater levels of abuse and neglect (p < 0.001, η2p = 0.04−0.16) and maladaptive parenting practices (p < 0.001, η2p = 0.04−0.13). Youth with primary and secondary CU traits were equally high on levels of abuse, neglect, and maladaptive parenting (all p values >0.05). Conclusions: We provide evidence that anxiety and maltreatment cannot be used interchangeably to identify youth with primary versus secondary CU traits. Anxiey yielded the best fitting and most theoretically interpretable classifications across both sexes. Our results signify the need for researchers and clinicians to adopt a unified approach to defining primary and secondary subgroups of CU traits using anxiety in both sexes.

AB - Background: Youth with conduct disorder (CD) and high callous-unemotional (CU) traits are not a homogenous group and can be disaggregated into primary and secondary subgroups. However, there are inconsistencies in defining primary and secondary subgroups, with some studies using anxiety, others using maltreatment and still others using both features to identify subgroups. There is a paucity of work comparing primary and secondary subgroups with typically developing (TD) youth on experiences of maltreatment and parenting as well as a lack of studies investigating sex differences. Methods: In a large sample of TD youth (n = 946, 66% female) and youth with CD (n = 885, 60% female), we used latent profile analysis in youth with CD aged between 9 and 18 years to address four aims: (i) to demonstrate how primary and secondary subgroup membership differs when anxiety, maltreatment, or both are used as continuous indicators, (ii) to compare primary and secondary subgroups with TD youth on abuse and neglect measures, and (iii) to compare primary and secondary subgroups with TD youth on parenting experiences, and (iv) to examine whether the results were consistent across sexes. Results: Anxiety without maltreatment yielded the best fitting and most theoretically interpretable classification of primary and secondary subgroups across both sexes (Bayesian information criterion = 17832.33, Entropy = 0.75, Lo-Mendell-Rubin: p < 0.01). Compared with TD youth, youth with primary and secondary CU traits experienced greater levels of abuse and neglect (p < 0.001, η2p = 0.04−0.16) and maladaptive parenting practices (p < 0.001, η2p = 0.04−0.13). Youth with primary and secondary CU traits were equally high on levels of abuse, neglect, and maladaptive parenting (all p values >0.05). Conclusions: We provide evidence that anxiety and maltreatment cannot be used interchangeably to identify youth with primary versus secondary CU traits. Anxiey yielded the best fitting and most theoretically interpretable classifications across both sexes. Our results signify the need for researchers and clinicians to adopt a unified approach to defining primary and secondary subgroups of CU traits using anxiety in both sexes.

KW - anxiety

KW - callous-unemotional traits

KW - conduct disorder

KW - FemNAT-CD

KW - maltreatment

KW - parenting

KW - primary and secondary CU traits

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DO - 10.1002/jcv2.12266

M3 - Article

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VL - 5

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ER -

Maltreatment and parenting in youth with primary and secondary callous-unemotional traits: Anxiety matters

Abstract

Data Availability Statement

Acknowledgements

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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