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Subgrouping children and adolescents with disruptive behaviors: symptom profiles and the role of callous–unemotional traits

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Abstract

Disruptive behavior during childhood and adolescence is heterogeneous and associated with several psychiatric disorders. The identification of more homogeneous subgroups might help identify different underlying pathways and tailor treatment strategies. Children and adolescents (aged 8–18) with disruptive behaviors (N = 121) and healthy controls (N = 100) were included in a European multi-center cognition and brain imaging study. They were assessed via a battery of standardized semi-structured interviews and questionnaires. K-means cluster-model analysis was carried out to identify subgroups within the group with disruptive behaviors, based on clinical symptom profiles, callous–unemotional (CU) traits, and proactive and reactive aggression. The resulting subgroups were then compared to healthy controls with regard to these clinical variables. Three distinct subgroups were found within the group with disruptive behaviors. The High CU Traits subgroup presented elevated scores for CU traits, proactive aggression and conduct disorder (CD) symptoms, as well as a higher proportion of comorbidities (CD + oppositional defiant disorder + attention deficit hyperactivity disorder (ADHD). The ADHD and Affective Dysregulation subgroup showed elevated scores for internalizing and ADHD symptoms, as well as a higher proportion of females. The Low Severity subgroup had relatively low levels of psychopathology and aggressive behavior compared to the other two subgroups. The High CU Traits subgroup displayed more antisocial behaviors than the Low Severity subgroup, but did not differ when compared to the ADHD and Affective Dysregulation subgroup. All three subgroups differed significantly from the healthy controls in all the variables analyzed. The present study extends previous findings on subgrouping children and adolescents with disruptive behaviors using a multidimensional approach and describes levels of anxiety, affective problems, ADHD, proactive aggression and CU traits as key factors that differentiate conclusively between subgroups.

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The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

We gratefully acknowledge and thank all the participants in this study and their families. We also thank the PhD students, post-doctoral researchers and research assistants involved in data collection.

Funding

Funding was provided by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement 602805 (Aggressotype) and 603016 (MATRICS). This manuscript reflects only the author’s view and the European Union is not liable for any use that may be made of the information contained herein.

Author information

Author notes

  1. Mireia Rosa-Justicia, Melanie C. Saam share first authorship.

  2. Ulrike M. E. Schulze, Josefina Castro-Fornieles share senior authorship.

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry and Psychology, Clinic Institute of Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain

    Mireia Rosa-Justicia & Roger Borràs

  2. Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital, University of Ulm, Ulm, Germany

    Melanie C. Saam & Ulrike M. E. Schulze

  3. Department of Child and Adolescent Psychiatry and Psychology, Clinic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, CIBERSAM, Barcelona, Spain

    Itziar Flamarique

  4. Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands

    Jilly Naaijen, Jeffrey C. Glennon, Marcel P. Zwiers & Jan K. Buitelaar

  5. Department of Child and Adolescent Psychiatry, University of Groningen Medical Center, Groningen, The Netherlands

    Andrea Dietrich, Pieter J. Hoekstra & Daniel Brandeis

  6. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

    Tobias Banaschewski, Pascal Aggensteiner & Daniel Brandeis

  7. Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK

    Michael C. Craig & Arjun Sethi

  8. Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK

    Paramala Santosh & Ilyas Sagar-Ouriaghli

  9. Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain

    Celso Arango & María José Penzol

  10. Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland

    Daniel Brandeis & Julia E. Werhahn

  11. Neuroscience Center Zurich, University and ETH Zurich, Zurich, Switzerland

    Julia E. Werhahn

  12. Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands

    Barbara Franke

  13. Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands

    Barbara Franke

  14. Donders Institute for Brain, Cognition and Behavior, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands

    Jilly Naaijen & Jan K. Buitelaar

  15. Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands

    Jan K. Buitelaar

  16. Department of Child and Adolescent Psychiatry and Psychology, Clinic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, University of Barcelona, CIBERSAM, IDIBAPS, Barcelona, Spain

    Josefina Castro-Fornieles

Authors
  1. Mireia Rosa-Justicia
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  2. Melanie C. Saam
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  3. Itziar Flamarique
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  4. Roger Borràs
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  6. Andrea Dietrich
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  7. Pieter J. Hoekstra
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  8. Tobias Banaschewski
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  9. Pascal Aggensteiner
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  10. Michael C. Craig
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  11. Arjun Sethi
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  12. Paramala Santosh
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  13. Ilyas Sagar-Ouriaghli
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  14. Celso Arango
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  18. Jeffrey C. Glennon
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  19. Barbara Franke
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  21. Jan K. Buitelaar
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  22. Ulrike M. E. Schulze
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  23. Josefina Castro-Fornieles
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Corresponding author

Correspondence to Josefina Castro-Fornieles.

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Conflict of interest

T Banaschewski has served in an advisory or consultancy role for Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Shire, and Infectopharm. He received conference support or speaker’s fee by Lilly, Medice, and Shire. He received royalties from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press; the present work is unrelated to these relationships. C Arango has been a consultant to or has received honoraria or grants from Acadia, Ambrosetti, Caja Navarra, CIBERSAM, Fundación Alicia Koplowitz, Forum, Instituto de Salud Carlos III, Gedeon Richter, Janssen Cilag, Lundbeck, Merck, Ministerio de Ciencia e Innovación, Ministerio de Sanidad, Ministerio de Economía y Competitividad, Mutua Madrileña, Otsuka, Roche, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovio and Takeda. D Brandeis serves as an unpaid scientific advisor for an EU-funded Neurofeedback trial unrelated to the present work. JC Glennon has acted as a consultant for Boehringer Ingelheim GmbH. B Franke received an educational speaking fee from Shire and Medice. JK Buitelaar has been a consultant to/member of the advisory board of, and a speaker for, Janssen Cilag BV, Eli Lilly, Takeda/Shire, Roche, Medice and Servier. He is not an employee of any of these companies, nor a shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, and royalties. UME Schulze serves as an unpaid ethics advisor for two EU-funded projects unrelated to the present work. She has received a speaker’s fee from Shire. The other authors do not report any biomedical financial interests or potential conflicts of interest.

Ethics approval

Ethical approval for the study was obtained from the local ethics committees for each site separately.

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Written informed consent was given by the participants and their parents or legal representatives.

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All authors provided formal written consent to publish before publication of the work.

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Rosa-Justicia, M., Saam, M.C., Flamarique, I. et al. Subgrouping children and adolescents with disruptive behaviors: symptom profiles and the role of callous–unemotional traits. Eur Child Adolesc Psychiatry 31, 51–66 (2022). https://doi.org/10.1007/s00787-020-01662-w

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