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Psychopathy as Predictor and Moderator of Multisystemic Therapy Outcomes among Adolescents Treated for Antisocial Behavior

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Abstract

Objective

The aim of the present study was to determine whether psychopathic traits act as a predictor and/or moderator of the effectiveness of Multisystemic Therapy (MST).

Method

The sample included N = 256 adolescents (188 boys and 68 girls) referred for conduct problems, randomized to MST or Treatment As Usual (TAU). The mean age was 16 years (SD = 1.31). Assessments were carried out before and immediately after treatment (6 months later). Three psychopathic traits (callous/unemotional traits, narcissism, and impulsiveness) were assessed with parent reports. Adolescents and parents were informants on externalizing problems.

Results

MST was more effective than TAU in decreasing externalizing problems for the “lower callous/unemotional” and “lower narcissism” group, but not for the “high callous/unemotional” and “high narcissism” group (moderators). Impulsiveness was found to predict more post-treatment externalizing problems rated by adolescents (predictor), but not more post-treatment externalizing problems rated by parents.

Conclusions

These findings point out the clinical relevance of adequately assessing psychopathic traits in adolescents referred for treatment of antisocial behaviour, and identifying those adolescents who show high levels of these traits. It is important to tailor MST specifically to meet the needs of juveniles with high levels of callous/unemotional traits and high levels of narcissism to obtain the same level of effectiveness as with juveniles scoring lower on these traits.

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Notes

  1. Because reliance on sample specific distributions of psychopathic traits may limit the generalizability of the findings, we conducted additional analyses using the results of the only study by Roose et al. (2009) that assessed the APSD and ICU in a Dutch (community) sample of adolescents (n = 455). In these analyses we used a cut off score that was based on the criterion of one standard deviation above the mean provided by this study to indicate the “high psychopathy” group (whereas the rest was the “lower psychopathy” group). Given the fact that this was a convenience sample, these scores cannot be considered norm scores, but the consistency of the results across analyses conducted with different cut off scores would increase confidence in the presented results. The additional analyses indeed showed a similar pattern of findings. More impulsiveness at pretest was found to predict more externalizing problems after treatment as rated by parents as well as adolescents (F = 6.03, p < 0.05 and F = 12.93, p < 0.01, respectively). Callous/unemotional traits and narcissism moderated the effect of intervention on externalizing problems rated by parents as well as adolescents (F = 4.48, p < 0.05 and F = 7.54, p < 0.01 for callous/unemotional traits, respectively; F = 11.95, p < 0.01 and F = 6.01, p < 0.05 for narcissism, respectively). Detailed information regarding these additional analysis is available from the corresponding author.

References

  • Achenbach, T. M. (1991a). Manual for the child behavior checklist and 1991 CBCL profile. Burlington: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M. (1991b). Manual for the youth self-report and 1991 YSR profile. Burlington: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Asscher, J. J., Deković, M., Van der Laan, P. H., Prins, P. J. M., & Van Arum, S. (2007). Implementing randomized experiments in criminal justice settings: An evaluation of multisystemic therapy (MST) in the netherlands. Journal of Experimental Criminology, 3, 113–129.

    Article  Google Scholar 

  • Asscher, J.J., Deković, M., Manders, W.A., Van der Laan, P.H., Prins, P.J.M., & Dutch MST Cost Effectiveness Research Group (2012). A randomized controlled trial of the effectiveness of Multisystemic Therapy in The Netherlands: Post-treatment changes and moderator effects. Manuscript submitted for publication.

  • Bijttebier, P., & Decoene, S. (2009). Assessment of psychopathic traits in children and adolescents: Further validation of the Antisocial Process Screening Device and the Childhood Psychopathy Scale. European Journal of Psychological Assessment, 25, 157–163.

    Article  Google Scholar 

  • Butler, S., Baruch, G., Hickey, N., & Fonagy, P. (2011). A randomized controlled trial of Multisystemic Therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 1220–1235.

    Article  PubMed  Google Scholar 

  • Cooke, D. J., Michie, C., & Hart, S. (2006). Facets of clinical psychopathy: Toward clearer measurement. In C. J. Patrick (Ed.), The handbook of psychopathy (pp. 91–106). New York: Guilford Press.

    Google Scholar 

  • Curry, J., Rohde, P., Simons, A., Silva, S., Vitiello, B., Kratochvil, C., et al. (2006). Predictors and moderators of acute outcome in the treatment for adolescents with depression study (TADS). Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1427–1439.

    Article  PubMed  Google Scholar 

  • Deković, M., Asscher, J. J., Manders, W. A., Prins, P. J. M., & Van der Laan, P. H. (2012). Within-Intervention Change: Mediators of Intervention Effects During Multisystemic Therapy. Journal of Consulting and Clinical Psychology, 4, 574–587.

    Article  Google Scholar 

  • Dillard, C.L., Salekin, R.T., Randall, T., Barker, E.D., & Grimes, R.D. (2012). Psychopathy in adolescent offenders: An item response theory study of the Antisocial Process Screening Device-self report and the Psychopathy checklist: Youth version. Personality Disorders: Theory, Research, and Treatment, X, XX

  • Dolan, M., & Doyle, M. (2007). Psychopathy: Diagnosis and implications for treatment. Psychiatry, 6, 404–408.

    Article  Google Scholar 

  • Essau, C.A., Sasagawa, S., & Frick, P.J. (2006). Callous-unemotional traits in a community samples of adolescents. Assessment, 13, 454–469. doi: 10.1177/1073191106287354

  • Frick, P. J. (2004). Inventory of callous–unemotional traits. New Orleans: Unpublished rating scale, University of New Orleans.

    Google Scholar 

  • 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 disorder. Developmental Psychology, 39, 246–260.

    Article  PubMed  Google Scholar 

  • Frick, P. J., & Dickens, C. (2006). Current perspectives on conduct disorder. Current Psychiatry Reports, 8, 59–72.

    Article  PubMed  Google Scholar 

  • Frick, P. J., & Hare, R. D. (2001). The antisocial processes screening device. Toronto: Multi-Health Systems.

    Google Scholar 

  • 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, 49, 359–375.

    Article  PubMed  Google Scholar 

  • Gardner, F., Hutchings, J., Bywater, T., & Whitaker, C. (2010). Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention. Journal of Clinical Child and Adolescent Psychology, 39, 568–580.

    Article  PubMed  Google Scholar 

  • Graham, J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60, 549–576.

    Article  PubMed  Google Scholar 

  • Gretton, H. M., Hare, R. D., & Catchpole, R. E. H. (2004). Psychopathy and offending from adolescence to adulthood: A 10-year follow-up. Journal of Consulting and Clinical Psychology, 72, 636–645.

    Article  PubMed  Google Scholar 

  • Hare, R. D., Hart, S. D., & Harpur, T. J. (1991). Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of Abnormal Psychology, 100, 391–398.

    Article  PubMed  Google Scholar 

  • 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, 737–741.

    Article  PubMed  Google Scholar 

  • Henggeler, S. W. (2011). Efficacy studies to large-scale transport: The development and validation of Multisystemic Therapy programs. Annual Review of Clinical Psychology, 7, 351–381.

    Article  PubMed  Google Scholar 

  • Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year followup of multisystemic therapy with substance abusing and dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868–874.

    Article  PubMed  Google Scholar 

  • Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford.

    Google Scholar 

  • Kimonis, E. R., Frick, P. J., Skeem, J. L., Marsee, M. A., Cruise, K., Munoz, L. C., et al. (2008). Assessing callous-unemotional traits in adolescent offenders: Validation of the Inventory of Callous-Unemotional Traits. International Journal of Law and Psychiatry, 31, 241–252.

    Article  PubMed  Google Scholar 

  • Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Pychiatry, 59, 877–883.

    Article  Google Scholar 

  • Langton, C. M., Barbaree, H. E., Harkins, L., & Peacock, E. J. (2006). Sex offender’s response to treatment and its association with recidivism as a function of psychopathy. Sexual Abuse: A Journal of Research and Treatment, 18, 99–120.

    Google Scholar 

  • Letourneau, E. J., Henggeler, S. W., Boduin, C. M., Schewe, P. A., McCart, M. R., et al. (2009). Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23, 89–102.

    Article  PubMed  Google Scholar 

  • Loeber, R., Burke, J., & Pardini, D. A. (2009). Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry, 50, 133–142.

    Article  PubMed  Google Scholar 

  • Newman, J. P., & Wallace, J. F. (1993). Diverse pathways to deficient self-regulation: Implications for disinhibitory psychopathology in children. Clinical Psychology Review, 13, 688–720.

    Article  Google Scholar 

  • Ogden, T., & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9, 77–83.

    Article  Google Scholar 

  • Oxford, M., Cavell, T. A., & Hughes, J. N. (2003). Callous/unemotional traits moderate the relation between ineffective parenting and child externalizing problems: A partial replication and extension. Journal of Clinical Child and Adolescent Psychology, 32, 577–585.

    Article  PubMed  Google Scholar 

  • Pardini, D., & Loeber, R. (2008). Interpersonal callousness trajectories across adolescence: Early social influences and adult outcomes. Criminal Justice and Behavior, 35, 173–196.

    Article  PubMed  Google Scholar 

  • Poythress, N. G., Douglas, K., Falkenbbach, D., Cruise, K., Lee, Z., Murrie, D. C., & Vitacco, M. (2006). Internal consistency and reliability of the self-report Antisocial Process Screening Device. Assessment, 13, 107–113.

    Article  PubMed  Google Scholar 

  • Roose, A., Bijttebier, P., Decoene, S., Claes, L., & Frick, P. (2009). Assessing the affective features of psychopathy in adolescence: A further validation of the inventory of callous and unemotional traits. Assessment, 17, 44–57. doi: 10.1177/1073191109344153

    Google Scholar 

  • Salekin, R. T., Rosenbaum, J., & Lee, Z. (2008). Child and adolescent psychopathy: Stability and change. Psychiatry, Psychology, and Law, 15, 224–236.

    Article  Google Scholar 

  • Salekin, R. T., Worley, C. B., & Grimes, R. D. (2010). Treatment of psychopathy: A review and brief introduction to the mental models approach. Behavioral Sciences & the Law, 28, 235–266.

    Article  Google Scholar 

  • Seagrave, D., & Grisso, T. (2002). Adolescent development and the measurement of juvenile psychopathy. Law and Human Behavior, 26, 219–239.

    Article  PubMed  Google Scholar 

  • Sundell, K., Hansson, K., Löfholm, C. A., Olsson, T., Gustle, L.-H., & Kadesjö, C. (2008). The transportability of Multisystemic therapy to Sweden: short-term results from a randomized trial of conduct-disordered youths. Journal of Family Psychology, 22, 550–560.

    Article  PubMed  Google Scholar 

  • Supplee, L. H., Kelly, B. C., MacKinnin, D. M., & Barofsky, M. Y. (2013). Introduction to the Special Issue: Subgroup analysis in prevention and intervention research. Prevention Science, 14, 107–110.

  • Verhulst, F.C., Koot, J.M., Akkerhuis, G.W., & Veerman, J.W. (1990). Praktische handleiding voor de CBCL . [CBCL manual] Van Gorcum, Assen/Maastricht.

  • 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, 143–150.

    Article  PubMed  Google Scholar 

  • Wang, R., Lagakos, S. W., Ware, J. H., Hunter, D. J., & Drazen, J. M. (2007). Statistics in medicine — Reporting of subgroup analyses in clinical trials. The New England Journal of Medicine, 357, 2189–2194.

    Article  PubMed  Google Scholar 

  • White, S. F., Cruise, K. R., & Frick, P. J. (2009). Differential correlates to self-report and parent report of callous-unemotional traits in a sample of juvenile sex offenders. Behavioral Science and the Law, 27, 910–928.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Utrecht University, Utrecht, the Netherlands

    Willeke A. Manders & Maja Deković

  2. University of Amsterdam, Amsterdam, the Netherlands

    Jessica J. Asscher & Pier J. M. Prins

  3. Free University Amsterdam, Amsterdam, the Netherlands

    Peter H. van der Laan

  4. University of Applied Science Arnhem Nijmegen, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands

    Willeke A. Manders

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  1. Willeke A. Manders
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  2. Maja Deković
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  3. Jessica J. Asscher
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Correspondence to Willeke A. Manders.

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Manders, W.A., Deković, M., Asscher, J.J. et al. Psychopathy as Predictor and Moderator of Multisystemic Therapy Outcomes among Adolescents Treated for Antisocial Behavior. J Abnorm Child Psychol 41, 1121–1132 (2013). https://doi.org/10.1007/s10802-013-9749-5

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