Doctorate in Clinical Psychology: Main Research Portfolio
: 1) The association between callous-unemotional traits and substance use in childhood and adolescence: A systematic review and meta-analysis ; 2) Structured Clinical Management Problem-Solving Group: Evaluating the impact on client distress and functional impairment and identifying areas for improvement ; 3) Punishment and reward sensitivity as potential mechanisms explaining the relationship between childhood callous-unemotional traits and adolescent substance use.

  • Hanna Sakki

Student thesis: Doctoral ThesisDoctor of Clinical Psychology (DClinPsy)


Childhood callous-unemotional (CU) traits are associated with a neurocognitive response style of high reward and low punishment sensitivity, which may make these children particularly vulnerable to substance misuse. However, the mechanisms explaining the link between CU traits and substance use are poorly understood. This study aimed to investigate the influences of reward and punishment sensitivity between childhood CU traits and adolescent substance use. Using data from the UK Millennium Cohort Study, mediation analyses were conducted to investigate the potential mediating effects of age 14 reward and punishment sensitivity on the relationships between age 11 CU traits and alcohol, cannabis, and other illicit drug use at age 17. Results found no direct effects of CU traits on substance use when accounting for gender, baseline alcohol use, poverty, emotional symptoms, conduct problems, hyperactivity, and verbal ability at age 11. However indirect effects of increased reward sensitivity on the relationship between CU traits and increased use were seen for alcohol, cannabis, and other drugs. There was a significant indirect effect of reduced punishment sensitivity on the relationship between CU traits and increased alcohol use, but not cannabis or other substance use. Findings suggest that reward and punishment sensitivity may have independent effects on the decision-making processes contributing to adolescent substance use. Prevention and early intervention for substance use should consider modifying intervention strategies to fit the needs of older children and adolescents with a callous interpersonal style and a neurocognitive profile characterized by a high drive for rewards and low risk aversion.
Key words: Callous-unemotional traits, alcohol, cannabis, drugs, reward sensitivity, punishment sensitivity
Date of Award10 Oct 2022
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorJennifer Allen (Supervisor), Michelle St Clair (Supervisor), Emma Griffith (Supervisor) & Lisa O'Leary (Supervisor)

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