Early starting, aggressive, and/or callous-unemotional? Examining the overlap and predictive utility of antisocial behavior subtypes

Abstract

Antisocial behavior (AB) in adolescence predicts problematic outcomes in adulthood. However, researchers have noted marked heterogeneity within the broad group of youth engaging in these destructive behaviors and have attempted to identify those with distinct etiologies and different trajectories of symptoms. In the present study, we evaluate 3 prominent AB subtyping approaches: age of onset, presence of callous-unemotional (CU) traits, and aggressive versus rule-breaking symptoms. We examined the overlap of these subtypes and their predictive validity in a diverse sample of 268 low-income young men followed prospectively from adolescence into emerging adulthood. We found that those with early starting AB were uniquely high on aggressive symptoms but not on CU traits. Early starting AB and both aggression and rule breaking measured during adolescence predicted most subsequent psychiatric and AB outcomes in early adulthood in univariate models, whereas CU traits were only predictive of adolescent arrests, later substance dependence diagnosis, and later CU traits. Finally, after accounting for shared variance among predictor variables, we found that aggressive symptoms explained the most unique variance in predicting several later outcomes (e.g., antisocial personality disorder) over and above other subtyping approaches. Results are discussed in relation to of the use of existing subtyping approaches to AB, noting that aggression and age of onset but not CU traits appear to be the best at predicting later negative outcome.