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Thinking about Others’ Minds: Mental State Inference in Boys with Conduct Problems and Callous-Unemotional Traits

Thinking about Others’ Minds: Mental State Inference in Boys with Conduct Problems and... Children with conduct problems (CP) and high levels of callous-unemotional traits (CP/HCU) have been found to have an intact ability to represent other minds, however, they behave in ways that indicate a reduced propensity to consider other people’s thoughts and feelings. Here we report findings from three tasks assessing different aspects of mentalising in 81 boys aged 11–16 [Typically developing (TD) n = 27; CP/HCU n = 28; CP and low levels of callous-unemotional traits (CP/LCU) n =26]. Participants completed the Movie Assessment of Social Cognition (MASC), a task assessing ability/propensity to incorporate judgements concerning an individual’s mind into mental state inference; provided a written description of a good friend to assess mind-mindedness; and completed the Social Judgement Task (SJT), a new measure assessing mentalising about antisocial actions. Boys with CP/HCU had more difficulty in accurately inferring others’ mental states in the MASC than TD and CP/ LCU boys. There were no group differences in the number of mind-related comments as assessed by the mind-mindedness protocol or in responses to the SJT task. These findings suggest that although the ability to represent mental states is intact, CP/ HCU boys are less likely to update mental state inferences as a function of different minds. . . . Keywords Conduct problems Callous-unemotional traits Mentalising Adolescent males Introduction criminality in adulthood (Frick 2016; Rivenbark et al. 2018; Wertz et al. 2018). They require more support from specialist Children with conduct problems (CP) display a range of anti- education provisions, have increased use of health and social social behaviours including bullying and manipulation, phys- care services, and increased contact with the criminal justice ical aggression, and violation of societal rules and norms system which creates a significant financial burden for society (Frick 2016). Children with CP have a greater risk of physical (D’Amico et al. 2014;Frick 2016; Scott et al. 2001). This has and mental health problems, difficulties with personal rela- created an impetus for earlier and more targeted intervention tionships, as well as reduced employment and increased strategies to halt the development of CP for the good of the individual and society (Rivenbark et al. 2018; Stellwagen and Electronic supplementary material The online version of this article Kerig 2013). (https://doi.org/10.1007/s10802-020-00664-1) contains supplementary Considerable research has demonstrated that children with material, which is available to authorized users. CP are a heterogeneous group and one way of understanding the heterogeneity of CP behaviours is to consider the role of * Ruth Roberts callous-unemotional (CU) traits (Frick et al. 2014; Frick and r.roberts@ucl.ac.uk Viding 2009; Viding and McCrory 2015). Children with CP and high levels of CU (CP/HCU) display a callous lack of Division of Psychology and Language Sciences, University College remorse and guilt and marked deficits in empathy (Frick London, 26 Bedford Way, London WC1H 0AP, UK et al. 2014; Viding and McCrory 2015) and are thought to Department of Experimental Psychology, University of Oxford, be at an increased risk of developing psychopathy in adult- Oxford OX1 3PS, UK hood (Frick et al. 2014; Frick and Viding 2009). Children with MRC Social, Genetic & Developmental Psychiatry Centre, Institute CP/HCU not only display impulsive and reactive antisocial of Psychiatry, Psychology & Neuroscience, King’s College London, actions, but also commit calculated acts of aggression with De Crespigny Park, Denmark Hill, London SE5 8AF, UK 4 little regard for other people’s feelings (Frick et al. 2014; University of Manitoba, 66 Chancellors Cir, Blair et al. 2014; Pardini and Byrd 2012). In contrast, children Winnipeg, Manitoba R3T 2N2, Canada 1280 J Abnorm Child Psychol (2020) 48:1279–1290 with CP and low levels of CU (CP/LCU) do not have pro- in the light of what is known about the behaviour of children nounced deficits in empathy and remorse and often commit with CP/HCU. They are able to successfully manipulate acts of aggression that have clear environmental triggers, such others for personal gain, which would not be possible without as perceived threat or frustration (Frick and Viding 2009;Blair the ability to mentalise, however, they display clear deficits et al. 2014). Measurement of CU traits (termed ‘Limited resonating with others’ feelings. Prosocial Emotions’) was included in the latest edition of the Although the basic ability to mentalise has been found to be Diagnostic and Statistical Manual of Mental Disorders 5th intact, behaviours of children with CP/HCU suggest that they Edition (DSM-5) as a specifier for children with Conduct have a reduced propensity to mentalise (Viding and McCrory Disorder (American Psychiatric Association 2013). 2019). They tend to be more self-focused and can aggress A substantial amount of work has focussed on how chil- even when someone is showing distress, especially if they dren with CP/HCU process emotional signals from others. stand to gain something (Jones et al. 2010; Pardini et al. Children with CP/HCU have been found to have difficulties 2003). A recent study by Drayton et al. (2018) has found that in processing emotional information, such as, having reduced adult psychopaths can deliberately take the perspective of neural responses when viewing other people in pain others, which may help them to manipulate others, but do (Lockwood et al. 2013), reduced neural and behavioural re- not always spontaneously do so. Drayton et al. (2018)pro- sponses to laughter (O’Nions et al. 2017), and difficulties in posed that this pattern of functioning may enable individuals responding to and resonating with other people’s fear and with psychopathy to avoid processing the emotional conse- sadness (Blair et al. 2014; Frick et al. 2014; Lozier et al. quences of their antisocial behaviour towards other people or 2014; Viding et al. 2012). These difficulties, particularly dif- even orienting to other people’s needs in the first place. It ficulties with resonating with other people’s emotions, might seems that individuals with psychopathy can take on the per- in part explain why children with CP/HCU are able to engage spective of others when it helps them achieve a goal but ignore in acts of aggression and violence and why they do not form it when it is not useful to them. In other words, part of the typical affiliative relationships (Blair et al. 2014;Viding and reason why individuals with psychopathy (or at risk of devel- McCrory 2019). oping psychopathy) may so readily be able to prioritise Another important aspect of social and emotional process- ‘looking after number one’ could be due to their reduced ten- ing involves mentalising, which is the ability to understand the dency to consider other minds and/or make mental state infer- thoughts, intentions and feelings of other people (Fonagy and ences, while having the cognitive machinery to do so when it Allison 2012; Frith and Frith 2006). Mentalising is essential serves their own needs (Drayton et al. 2018). for all aspects of social interactions, allowing one to consider The aim of the current study was to assess mentalising not only one’s own perspective, but also the various perspec- using three different tasks. We administered the Movie tives of others (Choudhury et al. 2006). Several studies have Assessment of Social Cognition (MASC) which asks partici- reported that children with CP/HCU are able to make accurate pants to assess characters’ mental states after watching them mental state inferences when the mentalising task does not interacting in a video (Dziobek et al. 2006). This task was require the participants to consider affective content selected as it presents a variety of information and cues (so- (Anastassiou-Hadjicharalambous and Warden 2008;Jones cial, verbal, physical) and participants are asked to make as- et al. 2010;O’Nions et al. 2014;Schwenck et al. 2012). For sessments of thoughts, feelings, and intentions in ‘real-time’, example, Jones et al. (2010) found that CP/HCU children have similar to what one might encounter in real-life interactions difficulties with affective resonance, but not with cognitive with others (Sharp et al. 2011). It is thought to assess the perspective taking (i.e. mentalising without affective content), ability/propensity to incorporate judgements about the protag- with the opposite pattern reported for children on the autism onists’ minds into inferences about their mental states (e.g., spectrum. Children with CP/LCU did not differ from TD peers whether one updates one’s estimate of the likelihood a char- on either affective resonance or cognitive perspective taking acter will be suspicious of another character based on whether in this study. Other studies have reported similarly spared the former character is thought to be paranoid or easy-going; ability in making mental state inferences when children with Conway et al. 2019a, b). The MASC has previously been CP/HCU are not required to mentalise about emotions administered to a small sample of children with behaviour (Anastassiou-Hadjicharalambous and Warden 2008; problems in a mainstream school (Körner et al. 2009). In this Schwenck et al. 2012). Additionally, O’Nions et al. (2014) study, behaviour problems were associated with a reduced reported that children with CP/HCU show recruitment of sim- number of correct mentalising responses, however the rating ilar brain regions to TD peers when required to process sce- of behaviour problems was limited to teacher reports on a narios that require mentalising, but which do not have affec- single measure and no quantification of CU traits was provid- tive content, whereas children on the autism spectrum show ed (Körner et al. 2009). We also asked children to complete a reduced activity in brain regions associated with mentalising standardised mind-mindedness task, which assesses the ten- dency to think about the minds of peers that are relevant to the compared with TD peers. This pattern of findings makes sense J Abnorm Child Psychol (2020) 48:1279–1290 1281 participant. This task requires the participants to spontaneous- Although experimental findings indicate that individ- ly describe a good friend, with no restrictions or limitations on uals with or at risk of developing psychopathy have an their description. Previous research has found that young intact ability to represent other minds (Anastassiou- adults are more likely to make mind-related comments about Hadjicharalambous and Warden 2008; Jones et al. someone they know personally, rather than a stranger, with 2010;O’Nions et al. 2014;Schwencketal. 2012), their intimacy providing greater knowledge of and ease of access to behaviour suggests a reduced propensity to consider the person’s mental states (Meins et al. 2014). Children with others. At the cognitive level this may manifest as: i) a CP/HCU may not be motivated to mentalise about strangers reduced ability/propensity to incorporate mind type into unless they can personally gain something out of it, however it mental state inference (as assessed by the MASC); ii) a may be less effortful and more instrumentally useful for them reduced propensity to represent the minds of others (as to consider the minds of peers that they regularly interact with. indexed by the Mind Mindedness task); or iii) reduced Finally, we administered the Social Judgement Task (SJT), an ability to infer what other people think about them when illustrated mentalising task that asked the participants to report they engage in social transgressions (as assessed by the what other children would think about them, if they engaged SJT). The purpose of this study was to investigate each in a negative interaction with a fictional peer. The negative of these possibilities. interaction scenarios in the SJT were developed to assess whether acting antisocially may be, in part, explained by dif- ficulty in accurately predicting how the antisocial acts are viewed by others. This task provides insight into whether Method children with CP/HCU can infer what other people, specifi- cally peers, think when they engage in social transgressions Participants against others. The participants are also asked to report on the likelihood of committing acts described in the scenarios, pro- Families were recruited from the community in the greater viding a possible index of acting antisocially, despite knowing London area, via newspaper advertisements and from main- how it is viewed by others. stream schools and schools who provide alternative education We chose to focus on groups of boys with CP/HCU and CP/ for children with behavioural difficulties. One hundred and LCU instead of conducting continuous analyses for the follow- fifty-eight families were screened for participation. Sixty- ing reasons: 1) Effects of having distinct subgroups of children nine families did not participate (57 did not meet study with CP as divided on CU traits do not often emerge as inter- criteria; 6 CP and 3 TD families had scheduling problems; 1 actions and can instead lead to suppressor effects in correlation- CP and 2 TD children refused to participate). Eighty-nine al analyses (Frick 2012); 2) We know that bivariate normality families were included in the main study, however, 8 children does not apply to CP and CU distributions where high CU traits refused to take part in the mentalising tasks which left a total almost invariably denote high levels of CP, but not the other of 81 boys (aged 11–16 years) in the study. There was no way around (Fontaine et al. 2011). Dichotomizing leads to significant difference in child age between participants and reduction of power in the case of bivariate normality (Cohen non-participants (age obtained at screening), t (156) = 1.172, 1983), but we know that bivariate normality does not apply to p = 0.243. Participant characteristics are displayed in Table 1. CU traits and CP; 3) The median split approach has, in the past, The research was approved by the University College London successfully delineated groups of children with CP who have Research Ethics Committee (Project ID number: 0622/001). different cognitive-affective processing patterns – often in a Parents/caregivers and the boys were provided with informa- manner that would lead to the two groups cancelling each other tion sheets outlining the details of the study and were given an out if pooled into a single CP group for comparison with typ- opportunity to ask questions and seek clarification regarding ically developing children, or which do not necessarily emerge their participation. Parents/caregivers provided written in- in dimensional analysis in community samples that represent formed consent and written assent to participate was obtained the whole spectrum of scores. The child/group centric analyses from all boys. An experienced clinician provided training to also make it easier to interpret the translational relevance of researchers beforehand on how to sensitively work with boys findings, which is more challenging when examining potential with CP and their families. Exclusion criteria for child partic- suppressor effects. Some previous cross-sectional research has ipants included a formal diagnosis of autism spectrum disor- found higher mean levels of CU traits in older adolescents der, any reported neurological disorder, use of prescription (Essau et al. 2006), although this is not evident in longitudinal medication for behavioural difficulties, and cognitive ability data (Pardini and Loeber 2008). However, to ensure that age of <70 on a standardised cognitive assessment. Parent/ differences were not accounting for the findings, the groups caregivers were not subjected to any exclusion criteria. All were matched on age, with comparable representation across families were provided with a £50 honorarium to cover travel the age bands of the sample. expenses and lunch. 1282 J Abnorm Child Psychol (2020) 48:1279–1290 Table 1 Demographic data TD controls (n = 27) CP/LCU (n = 26) CP/HCU (n =28) Characteristics and Mean S.D. (Min- Mean S.D. (Min- Mean S.D. (Min- p value Post hoc* questionnaires Max) Max) Max) Child age (years) 14.37 1.43 (11–16) 14.57 1.65 (11–16) 14.71 1.23 (12–16) 0.678 Child IQ (full score, 91.48 11.45 (72–122) 93.46 12.63 (70–118) 88.70 11.11 (76–113) 0.338 two-subtest WASI) b,f Child ethnicity 16:4:7 8:4:14 20:3:5 0.033 SES 2.84 1.22 (1–5.5) 3.12 1.18 (1.25–5) 3.38 1.17 (1.5–5.5) 0.079 ICU 25.74 6.04 (13–38) 33.46 6.76 (15–42) 49.32 5.68 (43–63) 0.000 1 < 2 < 3 CASI Conduct disorder 0.78 0.75 (0–2) 6.12 2.88 (3–15) 13.36 6.52 (4–31) 0.000 1 < 2 < 3 CASI Attention deficit 12.4 9.36 (1–38) 24.17 12.27 (2–47) 28.56 12.55 (6–52) 0.000 1 < 2/3 hyperactivity disorder CASI Generalised anxiety disorder 4.77 4.49 (0–18) 6.81 3.86 (0–15) 10.19 4.56 (1–19) 0.000 1/2 < 3 CASI Major depressive episode 3.48 2.41 (2–13) 5.69 4.27 (2–17) 8.46 4.61 (2–19) 0.000 1/2 < 3 (BES) Cognitive empathy 35.55 3.08 (29–39) 35.12 4.70 (23–45) 32.85 5.22 (16–41) 0.061 (BES) Affective empathy 34.98 4.78 (27–46) 34.16 7.68 (20–49) 29.40 5.31 (22–41) 0.001 1/2 < 3 (IRI – PT) Perspective taking 14.96 4.14 (5–22) 13.85 5.64 (4–25) 10.89 4.90 (3–22) 0.009 1 > 3 (AQC) Alexithymia 15.37 6.53 (4–27) 15.49 6.63 (3–28) 14.95 6.81 (2–28) 0.952 TD, typically developing; CP/LCU, conduct problems and low levels of callous-unemotional traits; CP/HCU, conduct problems and high levels of callous-unemotional traits; S.D., standard deviation; WASI, Weschler Abbreviated Scale of Intelligence; SES, socio-economic status; ICU,Inventory of Callous-Unemotional Traits; CASI, Child and Adolescent Symptom Inventory; BES, Basic Empathy Scale; IRI-PT, Perspective taking subscale of the Interpersonal Reactivity Index; AQC, Alexithymia Questionnaire for Children *p < 0.05, Games -Howell post hoc comparison aAll p values obtained using Welch ANOVA, except child ethnicity (Chi-square) b Measures obtained at screening phase, parent report c Measures obtained at testing session, child report d Measures obtained at screening phase, parent and teacher report e Measures obtained at testing session, parent report f White:Black:Mixed/Other Measures met either parent or teacher severity cut-off (parent report = 4+ (ages 10–12) and 3+ (ages 13–16) or teacher report = 3+ (ages Screening Screening questionnaires assessing CP, CU traits, 10–12), 4+ (ages 13–14), and 6+ (ages 15–16)). These scores and psychopathology were completed by parents/caregivers are associated with a clinical diagnosis of conduct disorder and teachers to determine CP/HCU, CP/LCU, and TD groups (Gadow and Sprafkin 1998). Fifty-four boys meeting the prior to participation. Screening measures were scored by tak- screening criteria for CP were recruited for this study. ing the highest ratings from either the parent or teacher ques- CU traits were assessed using the Inventory of Callous- tionnaire for each item (Piacentini et al. 1992). There was a Unemotional Traits, which has been found to have good reli- statistically significant, moderate, positive correlation be- ability and validity (ICU; Essau et al. 2006). In our sample, the tween parent and teacher ratings of CP (CP: r (68) = 0.42, ICU had a high level of internal consistency as determined by p < 0.001) and CU (CU: r (68) = 0.49, p < 0.001). Teacher a Cronbach’s alpha of 0.92. Boys meeting CP criteria were ratings were unavailable for five boys with CP/HCU, seven assigned to CP/HCU and CP/LCU groups based on a median boys with CP/LCU and two TD boys. split of the ICU scores. Twenty-six boys met CP/LCU criteria CP was assessed using the Child and Adolescent Symptom with ICU scores less than or equal to 42 and twenty-eight boys Inventory (CASI-4R; Gadow and Sprafkin 2009) Conduct met criteria for CP/HCU with ICU scores greater than 42. Disorder scale (CASI-CD), a widely used measure demon- Other studies employing the median split approach to assign strating good reliability and validity (Sprafkin et al. 2002). boys with conduct problems into CP/HCU and CP/LCU In our sample, the CASI-CD had a good level of internal groups have reported median scores of the ICU ranging from consistency as determined by a Cronbach’s alpha of 0.83. 30 to 42 (Hodsoll et al. 2014; Jones et al. 2010;Martin-Key Inclusion for the CP group required that the CASI-CD score et al. 2017;O’Nions et al. 2017;Robertsetal. 2018; J Abnorm Child Psychol (2020) 48:1279–1290 1283 Schwenck et al. 2012; Sebastian et al. 2016; Sethi et al. 2018) et al. 2006). Using methods developed for older children, and a recent study has suggested that a score of 41 may rep- participants were asked to describe their close friend with resent a clinically meaningful cut-off for HCU (Docherty et al. open-ended, written responses to the following question: 2017). The median split of 42 in the current study is thus Please describe your good friend - no specific type of descrip- higher than or comparable to median split scores in previous tion is required, you should just write whatever comes into research and designates a group of children with extreme CU your head (Meins et al. 2006, 2008). Participants were not scores within clinically significant range (estimated to be restricted in the length of their description or the time it took within the top 5% of the population). to complete their response. The text was divided into seg- The Strengths and Difficulties Questionnaire (SDQ; ments and coded using the following exhaustive and exclusive Goodman 1997) was used to screen for emotional and behav- categories: Mind-minded (referencing feelings, emotions, in- ioural difficulties in the control participants. Twenty-seven tellect, or mental states of the person being described); boys met screening criteria for inclusion in the TD group, Behavioural (referencing activities, behaviours, or interac- scoring ≤2 on the CASI-CD, ≤38 on CU traits, and less than tions that were behavioural in nature); Physical (referencing 17 on the SDQ Total Difficulties subscale (outside the physical attributes, including age); and General (comments abnormal range as per SDQ scoring norms; Youth in Mind not belonging to any of the previous categories, such as length 2016), not meeting exclusion criteria. of friendship; or ambiguous statements, such as: ‘he’sgreat’) as detailed in the Mind-Mindedness Coding Manual (Meins Movie Assessment of Social Cognition (MASC; Dziobek et al. and Fernyhough 2015). Higher numbers of mind-related com- 2006) The MASC is a video-based assessment of mentalising. ments indicated greater mind-mindedness. Although mind- Participants viewed four characters (young adults, two males minded descriptions are not typically analysed for affective and two females, from White ethnic backgrounds) making content, for the purposes of this paper, mind-minded com- arrangements to meet up for dinner. The video is divided into ments were further categorised as being affective if they were short segments and at the end of each segment participants referencing their friend’s feelings or emotions. were presented with a multiple-choice question asking them to infer the mental state of one of the characters. The task Social Judgement Task (SJT) The SJT is a cartoon measure required participants to attend to verbal, social, and physical assessing child perception of their peers’ point of view about cues from the characters as one might typically do in real-life antisocial interactions. Participants were presented with a se- interactions (Sharp et al. 2011). The video was presented on a ries of five illustrated stories and asked to imagine that they Dell laptop using Psychopy software (Peirce 2007). have engaged in an instrumental antisocial interaction with a Participants selected one of four response options on the com- fictional peer (all fictional peers were depicted as adolescent puter keypad and were given as much time as needed to con- males from Black and White ethnic backgrounds). They were sider their response. In line with previous studies (Feyerabend given three multiple choice options: (1) other children would et al. 2018; Newbury-Helps et al. 2017), items were grouped find the interaction acceptable, (2) other children would find into questions that assessed characters ‘intentions’ or cogni- the interaction unacceptable, or (3) a socially naive response tive mentalising (e.g. Why is Sandra saying this?; nine items) not focussed on the interaction. Participants were specifically and questions that assessed the ‘feelings’ of characters or af- directed to mentalise in this task, by imagining themselves as fective mentalising (e.g. What is Betty feeling?; eight items). the main character in the story and then thinking about what Three control questions asking participants about details of the their peers would think about them following the interaction. scene (e.g. How many adults were in the scene?) were also The task was not designed to assess any affective aspects of included to ensure that participants paid attention to the task. mentalising (participants were asked what peers would think As it is difficult to keep children with CP engaged in lengthy about them, rather than how peers would feel about them). assessments, the original task was shortened from forty-five The five antisocial scenarios were presented alongside ‘filler questions (plus 5 non-social control questions) to 17 questions scenarios’ (three positive and two neutral scenarios) in a (plus 3 non-social control questions). This decision was made pseudorandomised order. The ‘filler scenarios’ were included based on analysis of a large corpus of published and unpub- to avoid the possibility of participants making automated com- lished data indicating that the total score after 17 questions was putations about social norms, so that the participants had to correlated approximately 0.8 with the total score based on 45 consider each scenario individually. However, the antisocial questions (Shah et al. 2017). In this sample, Cronbach’salpha scenarios were the focus of this task. This task was validated for the shortened version of the task was 0.62. on a sample of 186 children from a mainstream secondary school in the Greater London area. The antisocial interactions Mind-Mindedness (Meins and Fernyhough 2015) Mind-mind- were found to have good internal consistency (α = 0.81) and edness was assessed via participants’ hand-written descrip- good construct validity as demonstrated by correlations be- tions of a person they considered to be a good friend (Meins tween ‘belief that peers would say negative interactions are 1284 J Abnorm Child Psychol (2020) 48:1279–1290 acceptable’ and CP (r (178) = 0.18, p <0.05) and CU (r conducted to examine differences between groups on the de- s s (175) = 0.24, p < 0.001). Full details of the development and mographic variables. Chi-square was computed to compare validation of the SJT and an example of an antisocial scenario groups on ethnicity. To further examine age matching within can be found in Online resource 1. the three groups of participants, age was grouped into three bands: 11–12 years (TD n =4; CP/LCU n =5, CP/HCU n = Additional Measures Boys completed the Wechsler 2), 13–14 years (TD n = 12; CP/LCU n = 10, CP/HCU n =12), Abbreviated Scale of Intelligence (WASI; Wechsler 1999) and 15–16 years (TD n = 11; CP/LCU n = 11, CP/HCU n = two-subtest version to assess cognitive ability. Parents/ 14). Chi-square was computed to compare groups on the three caregivers provided information about parental education age bands. A one-way Welch ANOVA was computed to com- (scored using the six output categories for educational pare differences in mean CU scores for the three age bands. attainment from the Office of National Statistics 2004)and employment (scored using the Office of National Statistics MASC A one-way ANOVA was computed to determine if the occupational coding tool: https://onsdigital.github.io/dp- groups differed on the ‘feelings’ (affective mentalising) and classification-tools/standard-occupational-classification/ ‘intentions’ (cognitive mentalising) questions and control ONS_SOC_occupation_coding_tool.html; Office for questions. Where overall significant group differences were National Statistics 2020) to determine family socio- found, Tukey’s post hoc analyses were computed to examine economic status (SES). Parents/caregivers completed the the differences between groups. Cohen’sdwascomputed to CASI-4R scales for attention deficit hyperactivity disorder quantify the difference between the groups. Analysis of co- (ADHD), generalised anxiety disorder (GAD), and major de- variance (ANCOVA) was computed to control for all vari- pressive episode (MDE) to assess for commonly occurring ables that were correlated with MASC performance or group comorbidities with CP. The CASI-4R subscales were found status, which included ADHD, GAD, MDE, BES cognitive, to have good internal consistency in this sample (CASI- BES affective, and IRI-PT. ADHD α = 0.96; CASI-GAD α = 0.86; CASI-MDE α =0. 84). To assess features that might explain mentalising differ- Mind-Mindedness Prior to conducting analysis, data entry was ences between groups, we obtained participants’ self-reported checked for accuracy and completeness. Any identifiable infor- affective and cognitive empathy using the Basic Empathy mation was removed. Data was segmented into statements prior Scale (BES; Jolliffe and Farrington 2006), perspective taking to coding. The entire data set was double coded by two raters using items from the Interpersonal Reactivity Index (IRI-PT; who were masked to the participant group status. Cohen’s Davis 1980), and alexithymic traits using the Alexithymia Kappa revealed a ‘substantial’ agreement between raters, κ = Questionnaire for Children (AQC; Rieffe et al. 2006). Good 0.824 (Landis and Koch 1977). To control for group differ- internal consistency was found for the BES, IRI-PT and AQC ences in verbosity, scores were computed as a percentage of in this sample (BES affective α = 0.82; BES cognitive α =0. the total number of statements (Meins and Fernyhough 2015). 79; IRI–PT α =0.76; AQC α = 0.77). See Table 1 for details A one-way ANOVA was computed to determine if the groups of the measures reported here. differed on any of the coding categories, as well as the number of affective mind-minded comments. Pearson chi-square was Procedure computed to determine if the groups differed on the percentage of mind-minded descriptions. Participants completed all assessments in a quiet testing room at University College London. Participants completed assess- SJT The number of acceptable, not acceptable and neutral ments independently from their parents/caregivers to ensure responses to the five antisocial scenarios was computed for their responses were confidential. As child participants could each participant. The scores for each scenario were binomially not be left unattended, a researcher was on hand to answer distributed (e.g. acceptable or not; not acceptable or not; neu- questions. The researcher monitored compliance on all tasks. tral or not) so a generalized linear model was computed to Participants watched the video using noise cancelling head- ascertain the effect of group on the odds of thinking that other phones to help minimise distraction. children would find the behaviour acceptable, unacceptable, or neutral. The generalised linear model assumes the odds of a Statistics subject saying something is acceptable (or not acceptable, or neutral) is the same across all five scenarios. To check this Demographics To examine the demographic characteristics of assumption, Fisher’s exact tests were computed to see if the the groups, a one-way Welch ANOVA was computed to com- groups differed on responding to any of the individual scenar- pare differences between the means for age, IQ, traits, CASI ios. ANOVA was computed to determine if the groups dif- CD, ADHD, GAD, and MDE subscales, BES, IRI-PT, AQC, fered in terms of their likelihood of committing the described and family SES. Games-Howell post hoc analyses were antisocial interactions. J Abnorm Child Psychol (2020) 48:1279–1290 1285 Results supplementary material Table 1). We then ran an ANCOVA entering all of the child variables that correlated with the Demographics MASC performance or group status (ADHD, GAD, MDE, BES cognitive, BES affective and IRI-PT). This analysis Demographic information is presented in Table 1.No differ- showed that the effect of group on MASC ‘intentions’ was ences were found between groups on age, IQ, or SES. The no longer statistically significant after adjusting for BES cog- groups differed on ethnicity, with the CP/LCU having fewer nitive F (2, 76) = 2.879, p =0.062. boys from white backgrounds and more boys from mixed ethnic backgrounds than the TD and CP/HCU groups. The Mind-Mindedness CP/HCU and CP/LCU had significantly higher ADHD scores than the TD group, but the two CP groups did not differ There was an overall group difference on total number of significantly from each other. The CP/HCU group had signif- statements, F (2, 78) = 3.358, p = 0.040, (TD M = 4.52; CP/ icantly higher levels of anxiety and depression than the TD LCU M =3.43; CP/HCU M = 3.54), however post hoc analy- and CP/LCU groups who did not differ on anxiety and depres- ses revealed no significant difference between any of the three sion. The CP/HCU group had significantly lower levels of groups. To control for verbosity, scores for each category affective empathy (as measured by the BES) and perspective were computed as a percentage of the total number of state- taking (as measured by the IRI-PT) than the TD and CP/LCU ments. No differences were found between groups on mind- groups, who did not differ on these measures. There were no minded descriptions of close friends, F (2, 78) = 1.063, p = statistically significant group differences on cognitive empa- 0.351; on affective mind-minded descriptions, F (2, 57) = thy (as measured by the BES) or alexithymia (as measured by 0.447, p = 0.642; on behavioural descriptions, F (2, 78) = the AQC). However, the group difference in the cognitive 0.838, p = 0.436; on physical descriptions, F (2, 78) = 2.557, empathy score (as measured by the BES) did approach signif- p = 0.084; and on general descriptions, F (2, 78) = 0.899, p = icance (p < 0.06) and CP/HCU had the lowest level of cogni- 0.411. No differences were found between groups on the tive empathy across the groups. No differences were found number of participants who generated no mind-minded de- between groups on the three age bands (i.e. 11–12 years, scriptions of their friend, X (2) = 2.906, p =0.234. 13–14 years, 15–16 years) X (4) = 1.92, p = 0.75. There were no significant differences in CU scores across the three age SJT bands F (2, 78) = 1.48, p =0.233. Results did not reveal any group differences for any of the MASC individual antisocial interaction scenarios (Table 2), which meant that we were able to group these items for analysis. “Intentions” vs “Feelings” There was an overall group differ- As detailed in Table 3, there was no effect of group on re- ence on the mean proportion of correctly identified ‘intentions’ sponses to the antisocial interaction scenarios (i.e. group was questions, F (2, 78) = 5.448, p = 0.006, (TD M = 0.70; CP/LCU not affecting the likelihood of indicating that peers would find M = 0.67; CP/HCU M = 0.52). Post hoc analysis revealed sta- the antisocial scenario acceptable, unacceptable, or neutral). tistically significant differences between CP/HCU and TD Groups did not differ on likelihood of committing the de- groups, with a large effect size (p =0.009; d = 0.853) and be- scribed negative actions, F (2, 75) = 1.845, p = 0.165, (TD tween CP/HCU and CP/LCU groups, with medium effect size M = 8.148; CP/LCU M = 9.76; CP/HCU M =10.15). (p =0.029; d = 0.671). The groups did not differ significantly on the ‘feelings’ questions, F (2, 78) = 0.737, p = 0.482, (TD M =0.57; CP/LCU M = 0.56; CP/HCU M = 0.52), but it ap- Discussion peared that all groups struggled with the ‘feelings’ items, rang- ingfrom52 to57% correctonthese items. Boys with CP/HCU had difficulty mentalising (as compared with TD and CP/LCU boys) when they performed a complex, Control Questions The three groups did not differ significantly ecologically valid task which indexed the ability/propensity to on the three control questions, F (2, 78) = 0.75, p =0.475. All incorporate judgements about another’s mind type into infer- groups performed well on the control questions (TD M =2.70; ences about their mental state (the MASC task). However, CP/LCU M = 2.54; CP/HCU M = 2.50) indicating good atten- they did not differ from TD boys in their propensity to repre- tion to the task. sent the minds of their friends when asked to describe them, or in their ability to understand that other children would think Covariate Analysis We examined how group membership, negatively about someone committing antisocial acts. Boys child characteristics and task performance related to each oth- with CP/LCU did not differ from TD boys on performance er using Spearman’s Rho correlation analysis (See electronic in any of the three tasks. These findings provide a more 1286 J Abnorm Child Psychol (2020) 48:1279–1290 Table 3 Generalised linear model predicting likelihood of beliefs about SJT negative interaction scenarios Wald df p Peers would say acceptable 0.150 2 0.928 Peers would say unacceptable 0.076 2 0.963 Peers would say neutral 2.979 2 0.232 1 2 Goodness of fit (Pearson’s X (a: 1.109; b: 1.176; c: 1.141)) did not indicate over dispersion As the distribution of responses was different for scenarios two and four as compared to scenarios one, three, and five (see Table 2), the analysis was repeated excluding scenarios two and four. This did not change the findings; no effect of group on responding (acceptable, unacceptable, or neutral) was found nuanced picture of mentalising in boys with CP. Overall, they are in line with prior studies suggesting an intact ability to mentalise in children with CP, including those with CP/ HCU, especially if there is no requirement to consider other people’s feelings. These findings also suggest that despite having the ability, boys with CP/HCU may have a reduced propensity to mentalise than their peers. They may only de- ploy this ability spontaneously if it does not require them to process complex information or if it is of instrumental benefit to themselves. In line with our hypotheses, boys with CP/HCU had diffi- culty with the MASC task, in particular with the ‘intentions’ questions (assessing cognitive mentalising). MASC, unlike most assessments of mentalising, depicts people interacting in real life situations. Task performance depends on the ability/propensity to incorporate information about each char- acter’s mind in order to make accurate mental state inferences during an observed ‘live’ interaction (Conway et al. 2019b; Dziobek et al. 2006). The effect of group on the ‘intentions’ questions was no longer significant after adjusting for cogni- tive empathy (as measured by the BES cognitive scale). Although the groups only showed a trend level difference on BES cognitive empathy, the CP/HCU boys had the lowest scores on this measure and the BES cognitive empathy scale taps into ability/propensity to incorporate information about other people’s minds to make accurate mental state inferences. It therefore follows that cognitive empathy would be having effect on correct responding to ‘intentions’ or cognitive items in the MASC as both are focussed on understanding the per- spective of others. CP/HCU children may not be interested in others’ minds unless other people are instrumentally valuable, or they have a mind that is vulnerable or easy to manipulate. It could also be that the characteristics of children with CP/HCU mean that they will experience a restricted range of social interactions with other people, which may in turn reduce the number of types of mind to which CP/HCU children are ex- posed. While CP/HCU boys had clear difficulties with the ‘intentions’ questions in the MASC, they did not significantly Table 2 Fisher’s exact (and item counts) for acceptable, not acceptable, and neutral responses on the five ‘negative’ SJT scenarios by group Scenario one (Queue) Scenario two (Crisps) Scenario three (Art) Scenario Four (Fun fair) Scenario five(Treats) Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral TD 2 17 7 12 14 0 4 21 2 12 11 4 2 21 4 CP/LCU2 193 7 153 4 192 16 9 0 3 211 CP/HCU 2 22 3 11 13 3 5 20 2 17 9 1 1 24 2 Total = 77 p = 0.163 Total = 78 p = 0.307 Total = 79 p =1.00 Total =79 p = 0.235 Total = 79 p = 0.575 J Abnorm Child Psychol (2020) 48:1279–1290 1287 differ from TD or CP/LCU participants in spontaneously discarding the potential displeasure of the researcher given mentalising about ‘feelings’ (affective mentalising). that there was nothing tangible to be gained by reporting that Although this may seem surprising, it is important to note that they would be likely to act as the story described. It is not all groups had difficulties with the ‘feelings’ questions and it is adaptive to act in an antisocial way at all times, as this is likely likely that no group differences emerged because of a floor to preclude taking maximal advantage of someone. effect. It would, therefore, be inappropriate to conclude that boys with CP/HCU do well in spontaneously mentalising about feelings (in fact their rate of mentalising about feelings Limitations was very similar to their rate of mentalising about intentions). Instead, it appears that adolescent boys from similar SES A number of limitations should be noted. There is a need to backgrounds and of similar cognitive ability all show low extend the study of spontaneous mentalising in CP/HCU in levels of spontaneous mentalising about emotions. several ways. We currently have a poor understanding of fac- Boys with CP/HCU showed reduced spontaneous tors that may impact the degree of mentalising. We need to mentalising about the interactions of strangers in the MASC assess the ability to incorporate inferences as to others’ mind task, but there were no group differences when boys were into mental state inferences with tasks explicitly designed to asked to spontaneously mentalise about a friend. CP/HCU do so (Conway et al. 2019b). Studies are needed that admin- boys appear similar to CP/LCU and TD peers in their propen- ister measures of social motivation, or which manipulate the sity to represent friends’ minds. This may be explained by the instrumental benefits of mentalising, to see how these vari- greater knowledge one has about friends rather than someone ables influence performance in tasks of spontaneous with whom there is no personal relationship (Meins et al. mentalising like the MASC. Furthermore, we need to develop 2014). Familiarity makes it easier to represent the mental more tasks that assess propensity, rather than ability to states of friends. CP/HCU boys may also be more motivated mentalise and administer these simultaneously to children to represent the minds of friends, as understanding friends’ with CP/HCU and comparison groups. Although we matched point of view could be instrumentally valuable, if for no other the groups on age, future studies may want to explore how reason than for successful manipulation. It may also be that mentalising changes as a function of age in children with CU. CP/HCU have a similar mind type to their friends which An important task for future research will be to consider the makes it easier to infer mental states (Conway et al. 2019b). role of trauma and anxiety when assessing affective responses There were no group differences on affective mind-minded in children with CU as recent research has found differential comments, but as was found with the MASC where all groups responses to affective stimuli in children with high levels of had difficulty with the ‘feelings’ questions, all groups had low trauma/anxiety and high levels of CU (Meffert et al. 2018). levels of mentalising about their friends’ feelings and emo- Finally, we only assessed boys and it will be important to see tions. It would, therefore, be inaccurate to conclude that CP/ whether these difficulties extend to girls with CP/HCU. HCU boys are inclined to consider their friends feelings when describing them. Although the CP/HCU group had difficulty with the MASC task, they had an intact ability to infer the thoughts Conclusions of others regarding engagement in antisocial actions. Boys with CP/HCU knew just as well as typically developing boys This study has the advantage of examining mentalising in that peers would find antisocial acts unacceptable. This indi- three different ways which allows for refinement of under- cates that they can understand what is wrong and more criti- standing of mentalising in boys with CP/HCU. Overall, our cally how that is perceived by their peers. The SJT task does findings suggest that boys with CP/HCU can successfully not require any inference of others’ feelings and it may be represent mental states when doing so does not require pro- helpful for future research studies to include an affective com- cessing of complex information or when there is some poten- ponent to explore whether group differences occur when chil- tial instrumental advantage. They may find it easier or be more dren are asked how they might feel if they acted as the anti- motivated to mentalise about peers or people their own age, as social story described or how peers would feel about them if mentalising about peers typically has instrumental value. they acted antisocially. Interestingly, CP/HCU boys were not Although the capacity to mentalise is intact, which is neces- more likely to say they would act antisocially, as described in sary to be able to manipulate others, the reduced propensity to the story, than their TD or CP/LCU peers. It is instrumentally incorporate the mind of the other into mental state inference valuable to consider the thoughts of others with regard to may allow CP/HCU boys to ignore the negative emotional antisocial actions and only execute such actions when the consequences of their antisocial behaviour. This warrants fur- outcome is judged to be sufficiently valuable to discard the ther investigation with experimental tasks that vary the mind displeasure of others. In this case, it may not have been worth type and motivational context. 1288 J Abnorm Child Psychol (2020) 48:1279–1290 Acknowledgment This study was supported by a grant from the UK Davis, M. H. (1980). A multidimensional approach to individual differ- Medical Research Council (MR/K014080/1) awarded to Professors Essi ences in empathy. JSAS Catalog of Selected Documents in Viding (Principal Investigator) and Eamon McCrory (Co-Principal Psychology,10. Investigator) and by a grant from the Economic and Social Research Docherty, M., Boxer, P., Huesmann, L. R., O'Brien, M., & Bushman, B. Council (ES/N018850/1) awarded to Professor Essi Viding (Principal (2017). Assessing callous-unemotional traits in adolescents: Investigator). 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Attribution 4.0 International License, which permits use, sharing, Introducing MASC: A movie for the assessment of social cognition. adaptation, distribution and reproduction in any medium or format, as Journal of Autism and Developmental Disorders, 36(5), 623–636. long as you give appropriate credit to the original author(s) and the https://doi.org/10.1007/s10803-006-0107-0. source, provide a link to the Creative Commons licence, and indicate if Essau, C. A., Sasagawa, S., & Frick, P. J. (2006). Callous-unemotional changes were made. The images or other third party material in this article traits in a community sample of adolescents. Assessment, 13(4), are included in the article's Creative Commons licence, unless indicated 454–469. https://doi.org/10.1177/1073191106287354. otherwise in a credit line to the material. 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Developmental risk for psychopathy Publisher’sNote Springer Nature remains neutral with regard to juris- introduction: Characteristics and diagnosis of psychopathy. In A. dictional claims in published maps and institutional affiliations. Thapar, D. Pine, J. Leckman, S. Scott, M. Snowling, & E. Taylor (Eds.), Rutter’s child and adolescent psychiatry (Sixth ed., pp. 966– http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Abnormal Child Psychology Springer Journals

Thinking about Others’ Minds: Mental State Inference in Boys with Conduct Problems and Callous-Unemotional Traits

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Springer Journals
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Copyright © The Author(s) 2020
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0091-0627
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1573-2835
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10.1007/s10802-020-00664-1
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Abstract

Children with conduct problems (CP) and high levels of callous-unemotional traits (CP/HCU) have been found to have an intact ability to represent other minds, however, they behave in ways that indicate a reduced propensity to consider other people’s thoughts and feelings. Here we report findings from three tasks assessing different aspects of mentalising in 81 boys aged 11–16 [Typically developing (TD) n = 27; CP/HCU n = 28; CP and low levels of callous-unemotional traits (CP/LCU) n =26]. Participants completed the Movie Assessment of Social Cognition (MASC), a task assessing ability/propensity to incorporate judgements concerning an individual’s mind into mental state inference; provided a written description of a good friend to assess mind-mindedness; and completed the Social Judgement Task (SJT), a new measure assessing mentalising about antisocial actions. Boys with CP/HCU had more difficulty in accurately inferring others’ mental states in the MASC than TD and CP/ LCU boys. There were no group differences in the number of mind-related comments as assessed by the mind-mindedness protocol or in responses to the SJT task. These findings suggest that although the ability to represent mental states is intact, CP/ HCU boys are less likely to update mental state inferences as a function of different minds. . . . Keywords Conduct problems Callous-unemotional traits Mentalising Adolescent males Introduction criminality in adulthood (Frick 2016; Rivenbark et al. 2018; Wertz et al. 2018). They require more support from specialist Children with conduct problems (CP) display a range of anti- education provisions, have increased use of health and social social behaviours including bullying and manipulation, phys- care services, and increased contact with the criminal justice ical aggression, and violation of societal rules and norms system which creates a significant financial burden for society (Frick 2016). Children with CP have a greater risk of physical (D’Amico et al. 2014;Frick 2016; Scott et al. 2001). This has and mental health problems, difficulties with personal rela- created an impetus for earlier and more targeted intervention tionships, as well as reduced employment and increased strategies to halt the development of CP for the good of the individual and society (Rivenbark et al. 2018; Stellwagen and Electronic supplementary material The online version of this article Kerig 2013). (https://doi.org/10.1007/s10802-020-00664-1) contains supplementary Considerable research has demonstrated that children with material, which is available to authorized users. CP are a heterogeneous group and one way of understanding the heterogeneity of CP behaviours is to consider the role of * Ruth Roberts callous-unemotional (CU) traits (Frick et al. 2014; Frick and r.roberts@ucl.ac.uk Viding 2009; Viding and McCrory 2015). Children with CP and high levels of CU (CP/HCU) display a callous lack of Division of Psychology and Language Sciences, University College remorse and guilt and marked deficits in empathy (Frick London, 26 Bedford Way, London WC1H 0AP, UK et al. 2014; Viding and McCrory 2015) and are thought to Department of Experimental Psychology, University of Oxford, be at an increased risk of developing psychopathy in adult- Oxford OX1 3PS, UK hood (Frick et al. 2014; Frick and Viding 2009). Children with MRC Social, Genetic & Developmental Psychiatry Centre, Institute CP/HCU not only display impulsive and reactive antisocial of Psychiatry, Psychology & Neuroscience, King’s College London, actions, but also commit calculated acts of aggression with De Crespigny Park, Denmark Hill, London SE5 8AF, UK 4 little regard for other people’s feelings (Frick et al. 2014; University of Manitoba, 66 Chancellors Cir, Blair et al. 2014; Pardini and Byrd 2012). In contrast, children Winnipeg, Manitoba R3T 2N2, Canada 1280 J Abnorm Child Psychol (2020) 48:1279–1290 with CP and low levels of CU (CP/LCU) do not have pro- in the light of what is known about the behaviour of children nounced deficits in empathy and remorse and often commit with CP/HCU. They are able to successfully manipulate acts of aggression that have clear environmental triggers, such others for personal gain, which would not be possible without as perceived threat or frustration (Frick and Viding 2009;Blair the ability to mentalise, however, they display clear deficits et al. 2014). Measurement of CU traits (termed ‘Limited resonating with others’ feelings. Prosocial Emotions’) was included in the latest edition of the Although the basic ability to mentalise has been found to be Diagnostic and Statistical Manual of Mental Disorders 5th intact, behaviours of children with CP/HCU suggest that they Edition (DSM-5) as a specifier for children with Conduct have a reduced propensity to mentalise (Viding and McCrory Disorder (American Psychiatric Association 2013). 2019). They tend to be more self-focused and can aggress A substantial amount of work has focussed on how chil- even when someone is showing distress, especially if they dren with CP/HCU process emotional signals from others. stand to gain something (Jones et al. 2010; Pardini et al. Children with CP/HCU have been found to have difficulties 2003). A recent study by Drayton et al. (2018) has found that in processing emotional information, such as, having reduced adult psychopaths can deliberately take the perspective of neural responses when viewing other people in pain others, which may help them to manipulate others, but do (Lockwood et al. 2013), reduced neural and behavioural re- not always spontaneously do so. Drayton et al. (2018)pro- sponses to laughter (O’Nions et al. 2017), and difficulties in posed that this pattern of functioning may enable individuals responding to and resonating with other people’s fear and with psychopathy to avoid processing the emotional conse- sadness (Blair et al. 2014; Frick et al. 2014; Lozier et al. quences of their antisocial behaviour towards other people or 2014; Viding et al. 2012). These difficulties, particularly dif- even orienting to other people’s needs in the first place. It ficulties with resonating with other people’s emotions, might seems that individuals with psychopathy can take on the per- in part explain why children with CP/HCU are able to engage spective of others when it helps them achieve a goal but ignore in acts of aggression and violence and why they do not form it when it is not useful to them. In other words, part of the typical affiliative relationships (Blair et al. 2014;Viding and reason why individuals with psychopathy (or at risk of devel- McCrory 2019). oping psychopathy) may so readily be able to prioritise Another important aspect of social and emotional process- ‘looking after number one’ could be due to their reduced ten- ing involves mentalising, which is the ability to understand the dency to consider other minds and/or make mental state infer- thoughts, intentions and feelings of other people (Fonagy and ences, while having the cognitive machinery to do so when it Allison 2012; Frith and Frith 2006). Mentalising is essential serves their own needs (Drayton et al. 2018). for all aspects of social interactions, allowing one to consider The aim of the current study was to assess mentalising not only one’s own perspective, but also the various perspec- using three different tasks. We administered the Movie tives of others (Choudhury et al. 2006). Several studies have Assessment of Social Cognition (MASC) which asks partici- reported that children with CP/HCU are able to make accurate pants to assess characters’ mental states after watching them mental state inferences when the mentalising task does not interacting in a video (Dziobek et al. 2006). This task was require the participants to consider affective content selected as it presents a variety of information and cues (so- (Anastassiou-Hadjicharalambous and Warden 2008;Jones cial, verbal, physical) and participants are asked to make as- et al. 2010;O’Nions et al. 2014;Schwenck et al. 2012). For sessments of thoughts, feelings, and intentions in ‘real-time’, example, Jones et al. (2010) found that CP/HCU children have similar to what one might encounter in real-life interactions difficulties with affective resonance, but not with cognitive with others (Sharp et al. 2011). It is thought to assess the perspective taking (i.e. mentalising without affective content), ability/propensity to incorporate judgements about the protag- with the opposite pattern reported for children on the autism onists’ minds into inferences about their mental states (e.g., spectrum. Children with CP/LCU did not differ from TD peers whether one updates one’s estimate of the likelihood a char- on either affective resonance or cognitive perspective taking acter will be suspicious of another character based on whether in this study. Other studies have reported similarly spared the former character is thought to be paranoid or easy-going; ability in making mental state inferences when children with Conway et al. 2019a, b). The MASC has previously been CP/HCU are not required to mentalise about emotions administered to a small sample of children with behaviour (Anastassiou-Hadjicharalambous and Warden 2008; problems in a mainstream school (Körner et al. 2009). In this Schwenck et al. 2012). Additionally, O’Nions et al. (2014) study, behaviour problems were associated with a reduced reported that children with CP/HCU show recruitment of sim- number of correct mentalising responses, however the rating ilar brain regions to TD peers when required to process sce- of behaviour problems was limited to teacher reports on a narios that require mentalising, but which do not have affec- single measure and no quantification of CU traits was provid- tive content, whereas children on the autism spectrum show ed (Körner et al. 2009). We also asked children to complete a reduced activity in brain regions associated with mentalising standardised mind-mindedness task, which assesses the ten- dency to think about the minds of peers that are relevant to the compared with TD peers. This pattern of findings makes sense J Abnorm Child Psychol (2020) 48:1279–1290 1281 participant. This task requires the participants to spontaneous- Although experimental findings indicate that individ- ly describe a good friend, with no restrictions or limitations on uals with or at risk of developing psychopathy have an their description. Previous research has found that young intact ability to represent other minds (Anastassiou- adults are more likely to make mind-related comments about Hadjicharalambous and Warden 2008; Jones et al. someone they know personally, rather than a stranger, with 2010;O’Nions et al. 2014;Schwencketal. 2012), their intimacy providing greater knowledge of and ease of access to behaviour suggests a reduced propensity to consider the person’s mental states (Meins et al. 2014). Children with others. At the cognitive level this may manifest as: i) a CP/HCU may not be motivated to mentalise about strangers reduced ability/propensity to incorporate mind type into unless they can personally gain something out of it, however it mental state inference (as assessed by the MASC); ii) a may be less effortful and more instrumentally useful for them reduced propensity to represent the minds of others (as to consider the minds of peers that they regularly interact with. indexed by the Mind Mindedness task); or iii) reduced Finally, we administered the Social Judgement Task (SJT), an ability to infer what other people think about them when illustrated mentalising task that asked the participants to report they engage in social transgressions (as assessed by the what other children would think about them, if they engaged SJT). The purpose of this study was to investigate each in a negative interaction with a fictional peer. The negative of these possibilities. interaction scenarios in the SJT were developed to assess whether acting antisocially may be, in part, explained by dif- ficulty in accurately predicting how the antisocial acts are viewed by others. This task provides insight into whether Method children with CP/HCU can infer what other people, specifi- cally peers, think when they engage in social transgressions Participants against others. The participants are also asked to report on the likelihood of committing acts described in the scenarios, pro- Families were recruited from the community in the greater viding a possible index of acting antisocially, despite knowing London area, via newspaper advertisements and from main- how it is viewed by others. stream schools and schools who provide alternative education We chose to focus on groups of boys with CP/HCU and CP/ for children with behavioural difficulties. One hundred and LCU instead of conducting continuous analyses for the follow- fifty-eight families were screened for participation. Sixty- ing reasons: 1) Effects of having distinct subgroups of children nine families did not participate (57 did not meet study with CP as divided on CU traits do not often emerge as inter- criteria; 6 CP and 3 TD families had scheduling problems; 1 actions and can instead lead to suppressor effects in correlation- CP and 2 TD children refused to participate). Eighty-nine al analyses (Frick 2012); 2) We know that bivariate normality families were included in the main study, however, 8 children does not apply to CP and CU distributions where high CU traits refused to take part in the mentalising tasks which left a total almost invariably denote high levels of CP, but not the other of 81 boys (aged 11–16 years) in the study. There was no way around (Fontaine et al. 2011). Dichotomizing leads to significant difference in child age between participants and reduction of power in the case of bivariate normality (Cohen non-participants (age obtained at screening), t (156) = 1.172, 1983), but we know that bivariate normality does not apply to p = 0.243. Participant characteristics are displayed in Table 1. CU traits and CP; 3) The median split approach has, in the past, The research was approved by the University College London successfully delineated groups of children with CP who have Research Ethics Committee (Project ID number: 0622/001). different cognitive-affective processing patterns – often in a Parents/caregivers and the boys were provided with informa- manner that would lead to the two groups cancelling each other tion sheets outlining the details of the study and were given an out if pooled into a single CP group for comparison with typ- opportunity to ask questions and seek clarification regarding ically developing children, or which do not necessarily emerge their participation. Parents/caregivers provided written in- in dimensional analysis in community samples that represent formed consent and written assent to participate was obtained the whole spectrum of scores. The child/group centric analyses from all boys. An experienced clinician provided training to also make it easier to interpret the translational relevance of researchers beforehand on how to sensitively work with boys findings, which is more challenging when examining potential with CP and their families. Exclusion criteria for child partic- suppressor effects. Some previous cross-sectional research has ipants included a formal diagnosis of autism spectrum disor- found higher mean levels of CU traits in older adolescents der, any reported neurological disorder, use of prescription (Essau et al. 2006), although this is not evident in longitudinal medication for behavioural difficulties, and cognitive ability data (Pardini and Loeber 2008). However, to ensure that age of <70 on a standardised cognitive assessment. Parent/ differences were not accounting for the findings, the groups caregivers were not subjected to any exclusion criteria. All were matched on age, with comparable representation across families were provided with a £50 honorarium to cover travel the age bands of the sample. expenses and lunch. 1282 J Abnorm Child Psychol (2020) 48:1279–1290 Table 1 Demographic data TD controls (n = 27) CP/LCU (n = 26) CP/HCU (n =28) Characteristics and Mean S.D. (Min- Mean S.D. (Min- Mean S.D. (Min- p value Post hoc* questionnaires Max) Max) Max) Child age (years) 14.37 1.43 (11–16) 14.57 1.65 (11–16) 14.71 1.23 (12–16) 0.678 Child IQ (full score, 91.48 11.45 (72–122) 93.46 12.63 (70–118) 88.70 11.11 (76–113) 0.338 two-subtest WASI) b,f Child ethnicity 16:4:7 8:4:14 20:3:5 0.033 SES 2.84 1.22 (1–5.5) 3.12 1.18 (1.25–5) 3.38 1.17 (1.5–5.5) 0.079 ICU 25.74 6.04 (13–38) 33.46 6.76 (15–42) 49.32 5.68 (43–63) 0.000 1 < 2 < 3 CASI Conduct disorder 0.78 0.75 (0–2) 6.12 2.88 (3–15) 13.36 6.52 (4–31) 0.000 1 < 2 < 3 CASI Attention deficit 12.4 9.36 (1–38) 24.17 12.27 (2–47) 28.56 12.55 (6–52) 0.000 1 < 2/3 hyperactivity disorder CASI Generalised anxiety disorder 4.77 4.49 (0–18) 6.81 3.86 (0–15) 10.19 4.56 (1–19) 0.000 1/2 < 3 CASI Major depressive episode 3.48 2.41 (2–13) 5.69 4.27 (2–17) 8.46 4.61 (2–19) 0.000 1/2 < 3 (BES) Cognitive empathy 35.55 3.08 (29–39) 35.12 4.70 (23–45) 32.85 5.22 (16–41) 0.061 (BES) Affective empathy 34.98 4.78 (27–46) 34.16 7.68 (20–49) 29.40 5.31 (22–41) 0.001 1/2 < 3 (IRI – PT) Perspective taking 14.96 4.14 (5–22) 13.85 5.64 (4–25) 10.89 4.90 (3–22) 0.009 1 > 3 (AQC) Alexithymia 15.37 6.53 (4–27) 15.49 6.63 (3–28) 14.95 6.81 (2–28) 0.952 TD, typically developing; CP/LCU, conduct problems and low levels of callous-unemotional traits; CP/HCU, conduct problems and high levels of callous-unemotional traits; S.D., standard deviation; WASI, Weschler Abbreviated Scale of Intelligence; SES, socio-economic status; ICU,Inventory of Callous-Unemotional Traits; CASI, Child and Adolescent Symptom Inventory; BES, Basic Empathy Scale; IRI-PT, Perspective taking subscale of the Interpersonal Reactivity Index; AQC, Alexithymia Questionnaire for Children *p < 0.05, Games -Howell post hoc comparison aAll p values obtained using Welch ANOVA, except child ethnicity (Chi-square) b Measures obtained at screening phase, parent report c Measures obtained at testing session, child report d Measures obtained at screening phase, parent and teacher report e Measures obtained at testing session, parent report f White:Black:Mixed/Other Measures met either parent or teacher severity cut-off (parent report = 4+ (ages 10–12) and 3+ (ages 13–16) or teacher report = 3+ (ages Screening Screening questionnaires assessing CP, CU traits, 10–12), 4+ (ages 13–14), and 6+ (ages 15–16)). These scores and psychopathology were completed by parents/caregivers are associated with a clinical diagnosis of conduct disorder and teachers to determine CP/HCU, CP/LCU, and TD groups (Gadow and Sprafkin 1998). Fifty-four boys meeting the prior to participation. Screening measures were scored by tak- screening criteria for CP were recruited for this study. ing the highest ratings from either the parent or teacher ques- CU traits were assessed using the Inventory of Callous- tionnaire for each item (Piacentini et al. 1992). There was a Unemotional Traits, which has been found to have good reli- statistically significant, moderate, positive correlation be- ability and validity (ICU; Essau et al. 2006). In our sample, the tween parent and teacher ratings of CP (CP: r (68) = 0.42, ICU had a high level of internal consistency as determined by p < 0.001) and CU (CU: r (68) = 0.49, p < 0.001). Teacher a Cronbach’s alpha of 0.92. Boys meeting CP criteria were ratings were unavailable for five boys with CP/HCU, seven assigned to CP/HCU and CP/LCU groups based on a median boys with CP/LCU and two TD boys. split of the ICU scores. Twenty-six boys met CP/LCU criteria CP was assessed using the Child and Adolescent Symptom with ICU scores less than or equal to 42 and twenty-eight boys Inventory (CASI-4R; Gadow and Sprafkin 2009) Conduct met criteria for CP/HCU with ICU scores greater than 42. Disorder scale (CASI-CD), a widely used measure demon- Other studies employing the median split approach to assign strating good reliability and validity (Sprafkin et al. 2002). boys with conduct problems into CP/HCU and CP/LCU In our sample, the CASI-CD had a good level of internal groups have reported median scores of the ICU ranging from consistency as determined by a Cronbach’s alpha of 0.83. 30 to 42 (Hodsoll et al. 2014; Jones et al. 2010;Martin-Key Inclusion for the CP group required that the CASI-CD score et al. 2017;O’Nions et al. 2017;Robertsetal. 2018; J Abnorm Child Psychol (2020) 48:1279–1290 1283 Schwenck et al. 2012; Sebastian et al. 2016; Sethi et al. 2018) et al. 2006). Using methods developed for older children, and a recent study has suggested that a score of 41 may rep- participants were asked to describe their close friend with resent a clinically meaningful cut-off for HCU (Docherty et al. open-ended, written responses to the following question: 2017). The median split of 42 in the current study is thus Please describe your good friend - no specific type of descrip- higher than or comparable to median split scores in previous tion is required, you should just write whatever comes into research and designates a group of children with extreme CU your head (Meins et al. 2006, 2008). Participants were not scores within clinically significant range (estimated to be restricted in the length of their description or the time it took within the top 5% of the population). to complete their response. The text was divided into seg- The Strengths and Difficulties Questionnaire (SDQ; ments and coded using the following exhaustive and exclusive Goodman 1997) was used to screen for emotional and behav- categories: Mind-minded (referencing feelings, emotions, in- ioural difficulties in the control participants. Twenty-seven tellect, or mental states of the person being described); boys met screening criteria for inclusion in the TD group, Behavioural (referencing activities, behaviours, or interac- scoring ≤2 on the CASI-CD, ≤38 on CU traits, and less than tions that were behavioural in nature); Physical (referencing 17 on the SDQ Total Difficulties subscale (outside the physical attributes, including age); and General (comments abnormal range as per SDQ scoring norms; Youth in Mind not belonging to any of the previous categories, such as length 2016), not meeting exclusion criteria. of friendship; or ambiguous statements, such as: ‘he’sgreat’) as detailed in the Mind-Mindedness Coding Manual (Meins Movie Assessment of Social Cognition (MASC; Dziobek et al. and Fernyhough 2015). Higher numbers of mind-related com- 2006) The MASC is a video-based assessment of mentalising. ments indicated greater mind-mindedness. Although mind- Participants viewed four characters (young adults, two males minded descriptions are not typically analysed for affective and two females, from White ethnic backgrounds) making content, for the purposes of this paper, mind-minded com- arrangements to meet up for dinner. The video is divided into ments were further categorised as being affective if they were short segments and at the end of each segment participants referencing their friend’s feelings or emotions. were presented with a multiple-choice question asking them to infer the mental state of one of the characters. The task Social Judgement Task (SJT) The SJT is a cartoon measure required participants to attend to verbal, social, and physical assessing child perception of their peers’ point of view about cues from the characters as one might typically do in real-life antisocial interactions. Participants were presented with a se- interactions (Sharp et al. 2011). The video was presented on a ries of five illustrated stories and asked to imagine that they Dell laptop using Psychopy software (Peirce 2007). have engaged in an instrumental antisocial interaction with a Participants selected one of four response options on the com- fictional peer (all fictional peers were depicted as adolescent puter keypad and were given as much time as needed to con- males from Black and White ethnic backgrounds). They were sider their response. In line with previous studies (Feyerabend given three multiple choice options: (1) other children would et al. 2018; Newbury-Helps et al. 2017), items were grouped find the interaction acceptable, (2) other children would find into questions that assessed characters ‘intentions’ or cogni- the interaction unacceptable, or (3) a socially naive response tive mentalising (e.g. Why is Sandra saying this?; nine items) not focussed on the interaction. Participants were specifically and questions that assessed the ‘feelings’ of characters or af- directed to mentalise in this task, by imagining themselves as fective mentalising (e.g. What is Betty feeling?; eight items). the main character in the story and then thinking about what Three control questions asking participants about details of the their peers would think about them following the interaction. scene (e.g. How many adults were in the scene?) were also The task was not designed to assess any affective aspects of included to ensure that participants paid attention to the task. mentalising (participants were asked what peers would think As it is difficult to keep children with CP engaged in lengthy about them, rather than how peers would feel about them). assessments, the original task was shortened from forty-five The five antisocial scenarios were presented alongside ‘filler questions (plus 5 non-social control questions) to 17 questions scenarios’ (three positive and two neutral scenarios) in a (plus 3 non-social control questions). This decision was made pseudorandomised order. The ‘filler scenarios’ were included based on analysis of a large corpus of published and unpub- to avoid the possibility of participants making automated com- lished data indicating that the total score after 17 questions was putations about social norms, so that the participants had to correlated approximately 0.8 with the total score based on 45 consider each scenario individually. However, the antisocial questions (Shah et al. 2017). In this sample, Cronbach’salpha scenarios were the focus of this task. This task was validated for the shortened version of the task was 0.62. on a sample of 186 children from a mainstream secondary school in the Greater London area. The antisocial interactions Mind-Mindedness (Meins and Fernyhough 2015) Mind-mind- were found to have good internal consistency (α = 0.81) and edness was assessed via participants’ hand-written descrip- good construct validity as demonstrated by correlations be- tions of a person they considered to be a good friend (Meins tween ‘belief that peers would say negative interactions are 1284 J Abnorm Child Psychol (2020) 48:1279–1290 acceptable’ and CP (r (178) = 0.18, p <0.05) and CU (r conducted to examine differences between groups on the de- s s (175) = 0.24, p < 0.001). Full details of the development and mographic variables. Chi-square was computed to compare validation of the SJT and an example of an antisocial scenario groups on ethnicity. To further examine age matching within can be found in Online resource 1. the three groups of participants, age was grouped into three bands: 11–12 years (TD n =4; CP/LCU n =5, CP/HCU n = Additional Measures Boys completed the Wechsler 2), 13–14 years (TD n = 12; CP/LCU n = 10, CP/HCU n =12), Abbreviated Scale of Intelligence (WASI; Wechsler 1999) and 15–16 years (TD n = 11; CP/LCU n = 11, CP/HCU n = two-subtest version to assess cognitive ability. Parents/ 14). Chi-square was computed to compare groups on the three caregivers provided information about parental education age bands. A one-way Welch ANOVA was computed to com- (scored using the six output categories for educational pare differences in mean CU scores for the three age bands. attainment from the Office of National Statistics 2004)and employment (scored using the Office of National Statistics MASC A one-way ANOVA was computed to determine if the occupational coding tool: https://onsdigital.github.io/dp- groups differed on the ‘feelings’ (affective mentalising) and classification-tools/standard-occupational-classification/ ‘intentions’ (cognitive mentalising) questions and control ONS_SOC_occupation_coding_tool.html; Office for questions. Where overall significant group differences were National Statistics 2020) to determine family socio- found, Tukey’s post hoc analyses were computed to examine economic status (SES). Parents/caregivers completed the the differences between groups. Cohen’sdwascomputed to CASI-4R scales for attention deficit hyperactivity disorder quantify the difference between the groups. Analysis of co- (ADHD), generalised anxiety disorder (GAD), and major de- variance (ANCOVA) was computed to control for all vari- pressive episode (MDE) to assess for commonly occurring ables that were correlated with MASC performance or group comorbidities with CP. The CASI-4R subscales were found status, which included ADHD, GAD, MDE, BES cognitive, to have good internal consistency in this sample (CASI- BES affective, and IRI-PT. ADHD α = 0.96; CASI-GAD α = 0.86; CASI-MDE α =0. 84). To assess features that might explain mentalising differ- Mind-Mindedness Prior to conducting analysis, data entry was ences between groups, we obtained participants’ self-reported checked for accuracy and completeness. Any identifiable infor- affective and cognitive empathy using the Basic Empathy mation was removed. Data was segmented into statements prior Scale (BES; Jolliffe and Farrington 2006), perspective taking to coding. The entire data set was double coded by two raters using items from the Interpersonal Reactivity Index (IRI-PT; who were masked to the participant group status. Cohen’s Davis 1980), and alexithymic traits using the Alexithymia Kappa revealed a ‘substantial’ agreement between raters, κ = Questionnaire for Children (AQC; Rieffe et al. 2006). Good 0.824 (Landis and Koch 1977). To control for group differ- internal consistency was found for the BES, IRI-PT and AQC ences in verbosity, scores were computed as a percentage of in this sample (BES affective α = 0.82; BES cognitive α =0. the total number of statements (Meins and Fernyhough 2015). 79; IRI–PT α =0.76; AQC α = 0.77). See Table 1 for details A one-way ANOVA was computed to determine if the groups of the measures reported here. differed on any of the coding categories, as well as the number of affective mind-minded comments. Pearson chi-square was Procedure computed to determine if the groups differed on the percentage of mind-minded descriptions. Participants completed all assessments in a quiet testing room at University College London. Participants completed assess- SJT The number of acceptable, not acceptable and neutral ments independently from their parents/caregivers to ensure responses to the five antisocial scenarios was computed for their responses were confidential. As child participants could each participant. The scores for each scenario were binomially not be left unattended, a researcher was on hand to answer distributed (e.g. acceptable or not; not acceptable or not; neu- questions. The researcher monitored compliance on all tasks. tral or not) so a generalized linear model was computed to Participants watched the video using noise cancelling head- ascertain the effect of group on the odds of thinking that other phones to help minimise distraction. children would find the behaviour acceptable, unacceptable, or neutral. The generalised linear model assumes the odds of a Statistics subject saying something is acceptable (or not acceptable, or neutral) is the same across all five scenarios. To check this Demographics To examine the demographic characteristics of assumption, Fisher’s exact tests were computed to see if the the groups, a one-way Welch ANOVA was computed to com- groups differed on responding to any of the individual scenar- pare differences between the means for age, IQ, traits, CASI ios. ANOVA was computed to determine if the groups dif- CD, ADHD, GAD, and MDE subscales, BES, IRI-PT, AQC, fered in terms of their likelihood of committing the described and family SES. Games-Howell post hoc analyses were antisocial interactions. J Abnorm Child Psychol (2020) 48:1279–1290 1285 Results supplementary material Table 1). We then ran an ANCOVA entering all of the child variables that correlated with the Demographics MASC performance or group status (ADHD, GAD, MDE, BES cognitive, BES affective and IRI-PT). This analysis Demographic information is presented in Table 1.No differ- showed that the effect of group on MASC ‘intentions’ was ences were found between groups on age, IQ, or SES. The no longer statistically significant after adjusting for BES cog- groups differed on ethnicity, with the CP/LCU having fewer nitive F (2, 76) = 2.879, p =0.062. boys from white backgrounds and more boys from mixed ethnic backgrounds than the TD and CP/HCU groups. The Mind-Mindedness CP/HCU and CP/LCU had significantly higher ADHD scores than the TD group, but the two CP groups did not differ There was an overall group difference on total number of significantly from each other. The CP/HCU group had signif- statements, F (2, 78) = 3.358, p = 0.040, (TD M = 4.52; CP/ icantly higher levels of anxiety and depression than the TD LCU M =3.43; CP/HCU M = 3.54), however post hoc analy- and CP/LCU groups who did not differ on anxiety and depres- ses revealed no significant difference between any of the three sion. The CP/HCU group had significantly lower levels of groups. To control for verbosity, scores for each category affective empathy (as measured by the BES) and perspective were computed as a percentage of the total number of state- taking (as measured by the IRI-PT) than the TD and CP/LCU ments. No differences were found between groups on mind- groups, who did not differ on these measures. There were no minded descriptions of close friends, F (2, 78) = 1.063, p = statistically significant group differences on cognitive empa- 0.351; on affective mind-minded descriptions, F (2, 57) = thy (as measured by the BES) or alexithymia (as measured by 0.447, p = 0.642; on behavioural descriptions, F (2, 78) = the AQC). However, the group difference in the cognitive 0.838, p = 0.436; on physical descriptions, F (2, 78) = 2.557, empathy score (as measured by the BES) did approach signif- p = 0.084; and on general descriptions, F (2, 78) = 0.899, p = icance (p < 0.06) and CP/HCU had the lowest level of cogni- 0.411. No differences were found between groups on the tive empathy across the groups. No differences were found number of participants who generated no mind-minded de- between groups on the three age bands (i.e. 11–12 years, scriptions of their friend, X (2) = 2.906, p =0.234. 13–14 years, 15–16 years) X (4) = 1.92, p = 0.75. There were no significant differences in CU scores across the three age SJT bands F (2, 78) = 1.48, p =0.233. Results did not reveal any group differences for any of the MASC individual antisocial interaction scenarios (Table 2), which meant that we were able to group these items for analysis. “Intentions” vs “Feelings” There was an overall group differ- As detailed in Table 3, there was no effect of group on re- ence on the mean proportion of correctly identified ‘intentions’ sponses to the antisocial interaction scenarios (i.e. group was questions, F (2, 78) = 5.448, p = 0.006, (TD M = 0.70; CP/LCU not affecting the likelihood of indicating that peers would find M = 0.67; CP/HCU M = 0.52). Post hoc analysis revealed sta- the antisocial scenario acceptable, unacceptable, or neutral). tistically significant differences between CP/HCU and TD Groups did not differ on likelihood of committing the de- groups, with a large effect size (p =0.009; d = 0.853) and be- scribed negative actions, F (2, 75) = 1.845, p = 0.165, (TD tween CP/HCU and CP/LCU groups, with medium effect size M = 8.148; CP/LCU M = 9.76; CP/HCU M =10.15). (p =0.029; d = 0.671). The groups did not differ significantly on the ‘feelings’ questions, F (2, 78) = 0.737, p = 0.482, (TD M =0.57; CP/LCU M = 0.56; CP/HCU M = 0.52), but it ap- Discussion peared that all groups struggled with the ‘feelings’ items, rang- ingfrom52 to57% correctonthese items. Boys with CP/HCU had difficulty mentalising (as compared with TD and CP/LCU boys) when they performed a complex, Control Questions The three groups did not differ significantly ecologically valid task which indexed the ability/propensity to on the three control questions, F (2, 78) = 0.75, p =0.475. All incorporate judgements about another’s mind type into infer- groups performed well on the control questions (TD M =2.70; ences about their mental state (the MASC task). However, CP/LCU M = 2.54; CP/HCU M = 2.50) indicating good atten- they did not differ from TD boys in their propensity to repre- tion to the task. sent the minds of their friends when asked to describe them, or in their ability to understand that other children would think Covariate Analysis We examined how group membership, negatively about someone committing antisocial acts. Boys child characteristics and task performance related to each oth- with CP/LCU did not differ from TD boys on performance er using Spearman’s Rho correlation analysis (See electronic in any of the three tasks. These findings provide a more 1286 J Abnorm Child Psychol (2020) 48:1279–1290 Table 3 Generalised linear model predicting likelihood of beliefs about SJT negative interaction scenarios Wald df p Peers would say acceptable 0.150 2 0.928 Peers would say unacceptable 0.076 2 0.963 Peers would say neutral 2.979 2 0.232 1 2 Goodness of fit (Pearson’s X (a: 1.109; b: 1.176; c: 1.141)) did not indicate over dispersion As the distribution of responses was different for scenarios two and four as compared to scenarios one, three, and five (see Table 2), the analysis was repeated excluding scenarios two and four. This did not change the findings; no effect of group on responding (acceptable, unacceptable, or neutral) was found nuanced picture of mentalising in boys with CP. Overall, they are in line with prior studies suggesting an intact ability to mentalise in children with CP, including those with CP/ HCU, especially if there is no requirement to consider other people’s feelings. These findings also suggest that despite having the ability, boys with CP/HCU may have a reduced propensity to mentalise than their peers. They may only de- ploy this ability spontaneously if it does not require them to process complex information or if it is of instrumental benefit to themselves. In line with our hypotheses, boys with CP/HCU had diffi- culty with the MASC task, in particular with the ‘intentions’ questions (assessing cognitive mentalising). MASC, unlike most assessments of mentalising, depicts people interacting in real life situations. Task performance depends on the ability/propensity to incorporate information about each char- acter’s mind in order to make accurate mental state inferences during an observed ‘live’ interaction (Conway et al. 2019b; Dziobek et al. 2006). The effect of group on the ‘intentions’ questions was no longer significant after adjusting for cogni- tive empathy (as measured by the BES cognitive scale). Although the groups only showed a trend level difference on BES cognitive empathy, the CP/HCU boys had the lowest scores on this measure and the BES cognitive empathy scale taps into ability/propensity to incorporate information about other people’s minds to make accurate mental state inferences. It therefore follows that cognitive empathy would be having effect on correct responding to ‘intentions’ or cognitive items in the MASC as both are focussed on understanding the per- spective of others. CP/HCU children may not be interested in others’ minds unless other people are instrumentally valuable, or they have a mind that is vulnerable or easy to manipulate. It could also be that the characteristics of children with CP/HCU mean that they will experience a restricted range of social interactions with other people, which may in turn reduce the number of types of mind to which CP/HCU children are ex- posed. While CP/HCU boys had clear difficulties with the ‘intentions’ questions in the MASC, they did not significantly Table 2 Fisher’s exact (and item counts) for acceptable, not acceptable, and neutral responses on the five ‘negative’ SJT scenarios by group Scenario one (Queue) Scenario two (Crisps) Scenario three (Art) Scenario Four (Fun fair) Scenario five(Treats) Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral Acceptable Not Acceptable Neutral TD 2 17 7 12 14 0 4 21 2 12 11 4 2 21 4 CP/LCU2 193 7 153 4 192 16 9 0 3 211 CP/HCU 2 22 3 11 13 3 5 20 2 17 9 1 1 24 2 Total = 77 p = 0.163 Total = 78 p = 0.307 Total = 79 p =1.00 Total =79 p = 0.235 Total = 79 p = 0.575 J Abnorm Child Psychol (2020) 48:1279–1290 1287 differ from TD or CP/LCU participants in spontaneously discarding the potential displeasure of the researcher given mentalising about ‘feelings’ (affective mentalising). that there was nothing tangible to be gained by reporting that Although this may seem surprising, it is important to note that they would be likely to act as the story described. It is not all groups had difficulties with the ‘feelings’ questions and it is adaptive to act in an antisocial way at all times, as this is likely likely that no group differences emerged because of a floor to preclude taking maximal advantage of someone. effect. It would, therefore, be inappropriate to conclude that boys with CP/HCU do well in spontaneously mentalising about feelings (in fact their rate of mentalising about feelings Limitations was very similar to their rate of mentalising about intentions). Instead, it appears that adolescent boys from similar SES A number of limitations should be noted. There is a need to backgrounds and of similar cognitive ability all show low extend the study of spontaneous mentalising in CP/HCU in levels of spontaneous mentalising about emotions. several ways. We currently have a poor understanding of fac- Boys with CP/HCU showed reduced spontaneous tors that may impact the degree of mentalising. We need to mentalising about the interactions of strangers in the MASC assess the ability to incorporate inferences as to others’ mind task, but there were no group differences when boys were into mental state inferences with tasks explicitly designed to asked to spontaneously mentalise about a friend. CP/HCU do so (Conway et al. 2019b). Studies are needed that admin- boys appear similar to CP/LCU and TD peers in their propen- ister measures of social motivation, or which manipulate the sity to represent friends’ minds. This may be explained by the instrumental benefits of mentalising, to see how these vari- greater knowledge one has about friends rather than someone ables influence performance in tasks of spontaneous with whom there is no personal relationship (Meins et al. mentalising like the MASC. Furthermore, we need to develop 2014). Familiarity makes it easier to represent the mental more tasks that assess propensity, rather than ability to states of friends. CP/HCU boys may also be more motivated mentalise and administer these simultaneously to children to represent the minds of friends, as understanding friends’ with CP/HCU and comparison groups. Although we matched point of view could be instrumentally valuable, if for no other the groups on age, future studies may want to explore how reason than for successful manipulation. It may also be that mentalising changes as a function of age in children with CU. CP/HCU have a similar mind type to their friends which An important task for future research will be to consider the makes it easier to infer mental states (Conway et al. 2019b). role of trauma and anxiety when assessing affective responses There were no group differences on affective mind-minded in children with CU as recent research has found differential comments, but as was found with the MASC where all groups responses to affective stimuli in children with high levels of had difficulty with the ‘feelings’ questions, all groups had low trauma/anxiety and high levels of CU (Meffert et al. 2018). levels of mentalising about their friends’ feelings and emo- Finally, we only assessed boys and it will be important to see tions. It would, therefore, be inaccurate to conclude that CP/ whether these difficulties extend to girls with CP/HCU. HCU boys are inclined to consider their friends feelings when describing them. Although the CP/HCU group had difficulty with the MASC task, they had an intact ability to infer the thoughts Conclusions of others regarding engagement in antisocial actions. Boys with CP/HCU knew just as well as typically developing boys This study has the advantage of examining mentalising in that peers would find antisocial acts unacceptable. This indi- three different ways which allows for refinement of under- cates that they can understand what is wrong and more criti- standing of mentalising in boys with CP/HCU. Overall, our cally how that is perceived by their peers. The SJT task does findings suggest that boys with CP/HCU can successfully not require any inference of others’ feelings and it may be represent mental states when doing so does not require pro- helpful for future research studies to include an affective com- cessing of complex information or when there is some poten- ponent to explore whether group differences occur when chil- tial instrumental advantage. They may find it easier or be more dren are asked how they might feel if they acted as the anti- motivated to mentalise about peers or people their own age, as social story described or how peers would feel about them if mentalising about peers typically has instrumental value. they acted antisocially. Interestingly, CP/HCU boys were not Although the capacity to mentalise is intact, which is neces- more likely to say they would act antisocially, as described in sary to be able to manipulate others, the reduced propensity to the story, than their TD or CP/LCU peers. It is instrumentally incorporate the mind of the other into mental state inference valuable to consider the thoughts of others with regard to may allow CP/HCU boys to ignore the negative emotional antisocial actions and only execute such actions when the consequences of their antisocial behaviour. This warrants fur- outcome is judged to be sufficiently valuable to discard the ther investigation with experimental tasks that vary the mind displeasure of others. In this case, it may not have been worth type and motivational context. 1288 J Abnorm Child Psychol (2020) 48:1279–1290 Acknowledgment This study was supported by a grant from the UK Davis, M. H. (1980). A multidimensional approach to individual differ- Medical Research Council (MR/K014080/1) awarded to Professors Essi ences in empathy. JSAS Catalog of Selected Documents in Viding (Principal Investigator) and Eamon McCrory (Co-Principal Psychology,10. Investigator) and by a grant from the Economic and Social Research Docherty, M., Boxer, P., Huesmann, L. R., O'Brien, M., & Bushman, B. Council (ES/N018850/1) awarded to Professor Essi Viding (Principal (2017). Assessing callous-unemotional traits in adolescents: Investigator). Professor Geoffrey Bird was supported by a grant from Determining cutoff scores for the inventory of callous and unemo- the Economic and Social Research Council (ES/R007527/1). tional traits. Journal of Clinical Psychology, 73(3), 257–278. https:// doi.org/10.1002/jclp.22313. Drayton, L. A., Santos, L. R., & Baskin-Sommers, A. (2018). Compliance with Ethical Standards Psychopaths fail to automatically take the perspective of others. Proceedings of the National Academy of Sciences of the United Conflict of Interest The authors declare that they have no conflict of States of America, 115, 201721903–201723307. https://doi.org/10. interest. 1073/pnas.1721903115. Dziobek, I., Fleck, S., Kalbe, E., Rogers, K., Hassenstab, J., Brand, M., Open Access This article is licensed under a Creative Commons Kessler, J.,Woike,J.K., Wolf,O.T., &Convit, A. (2006). Attribution 4.0 International License, which permits use, sharing, Introducing MASC: A movie for the assessment of social cognition. adaptation, distribution and reproduction in any medium or format, as Journal of Autism and Developmental Disorders, 36(5), 623–636. long as you give appropriate credit to the original author(s) and the https://doi.org/10.1007/s10803-006-0107-0. source, provide a link to the Creative Commons licence, and indicate if Essau, C. A., Sasagawa, S., & Frick, P. J. (2006). Callous-unemotional changes were made. The images or other third party material in this article traits in a community sample of adolescents. Assessment, 13(4), are included in the article's Creative Commons licence, unless indicated 454–469. https://doi.org/10.1177/1073191106287354. otherwise in a credit line to the material. 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Developmental risk for psychopathy Publisher’sNote Springer Nature remains neutral with regard to juris- introduction: Characteristics and diagnosis of psychopathy. In A. dictional claims in published maps and institutional affiliations. Thapar, D. Pine, J. Leckman, S. Scott, M. Snowling, & E. Taylor (Eds.), Rutter’s child and adolescent psychiatry (Sixth ed., pp. 966–

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