A systematic review of callous-unemotional traits and attachment in children and adolescents.

METHODS: The systematic review and meta-analysis included 17 research articles from 1994 to 2022. Results were summarized by developmental periods. RESULTS: Attachment insecurity was associated with CU traits across development (r = .17). This association was marginally stronger for high-risk samples (e.g., clinical, justice) and for continuous attachment measures versus coding schemes. From early to middle childhood, attachment disorganization was associated with CU traits (r = .17). IMPLICATIONS: Research on attachment and CU traits in childhood is still in its infancy. Changes in attachment measures from childhood to adolescence make developmental comparisons difficult. Results suggest attachment as a potential developmental mechanism for youth with CU traits, however, the area requires more research.

Supporting adoptive and foster parents of adolescents through the trauma-informed e-Connect parent group: a preliminary descriptive study.

Introduction: Adolescents in adoption and foster care are likely to show internalizing and externalizing problems and affective dysregulation, leading to a lower quality of parent-adolescent attachment relationships and high levels of strain for parents. This study describes the results of the first application of the trauma-informed attachment-based Connect Parent Group in an online form (e-Connect) with Italian adoptive and foster parents. In this study, we describe (1) trends in the aforementioned variables between pre- (T1) and post- (T2) intervention and (2) parents' feedback and suggestions about the intervention. Method: Participants were 10 adoptive and 10 foster parents (53% females, Mage = 53.48; SDage = 4.93) who attended e-Connect, an attachment-focused and trauma-informed 10-session online group intervention. This intervention aims at increasing caregiver awareness of attachment and trauma concerning adolescents' problem behaviors and sensitive responsiveness, thereby leading to improvements in parent-adolescent relationship quality, decreases in adolescents' problems, and reductions in caregiver strain. One e-Connect group was offered for adoptive parents and one for foster parents. Parents completed questionnaires 1 week before (T1) and after (T2) the intervention and responded to a feedback interview following program completion. Results: Only at the descriptive level, scores of adolescents' internalizing and externalizing problems, affective dysregulation, and caregivers' strain show decreasing trends. Parents reported high satisfaction with the program, declaring changes in parent-adolescent relationships both currently (94.7%) and anticipated in the future (100%). All parents indicated that they would recommend e-Connect to other parents. Discussion: Given promising parents' feedback, the feasibility of e-Connect supporting adoptive and foster parents of adolescents can be further empirically investigated.

Parent-Youth Attachment Insecurity and Informant Discrepancies of Intrafamilial Aggression.

This study investigated how youth attachment anxiety and avoidance are associated with informant discrepancies of intrafamilial aggression within families where youth have clinically significant mental health challenges (N = 510 youth-parent dyads). Using polynomial regressions, we tested whether youth attachment avoidance and anxiety moderated the absolute magnitude of the association between youth- and parent-reports of aggression toward each other. Furthermore, difference scores were computed to test whether youth attachment was associated with the direction of youths' reports of the frequency of aggression relative to parents (i.e., did youth under- or over-report). Dyads' reports of youth-to-parent aggression were more strongly related at high than low levels of attachment anxiety. Results also revealed that youth attachment anxiety was associated with youth over-reporting of youth-to-parent and parent-to-youth aggression (relative to parents), whereas attachment avoidance was associated with youth over-reporting parent-to-youth aggression (relative to parents). These findings highlight the importance of understanding the source of informant discrepancies in social-emotional development and family functioning.

"It opened a new door for me": A qualitative study of forcibly displaced parents' experiences of an attachment-based parenting program.

The aim of the study was to explore forcibly displaced parents' experiences of how an online attachment-based parenting program (eConnect) impacted their relationships with their teens. Data was collected from four focus group discussions with 28 parents who participated in the eConnect program. Data was analyzed using network thematic analysis. A global theme emerged from the analysis: Strengthened Parent-Teen Relationships. Four underpinning organizing themes described the process through which the parent-teen relationship was strengthened: Knowledge Served as the Foundation for Change, Increased Parental Self-Efficacy, Improved Emotional Attunement Facilitates Dyadic Affect Regulation, and Shifted Power Dynamics and Emerging Mutual Parent-Teen Partnership. Findings suggest that eConnect is promising intervention for strengthening parent-teen relationships and supporting forcibly displaced families.

Attachment and trauma-informed programme to support forcibly displaced parents of youth in Sweden: feasibility and preliminary outcomes of the eConnect Online programme.

OBJECTIVES: To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents. DESIGN: The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments. SETTING: Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden. PARTICIPANTS: Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8-17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect). INTERVENTION: eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent-child attachment insecurity. RESULTS: The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (η 2=0.29) and family functioning significantly improved (η 2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (η 2=0.16). CONCLUSIONS: The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment.

eConnect: implementation and preliminary evaluation of a virtually delivered attachment-based parenting intervention during COVID-19.

Connect, an attachment-based and trauma-informed parenting group intervention, has been demonstrated to improve adolescent mental health, parental wellbeing, and family functioning. We report on the online adaptation and delivery of Connect (eConnect) and pre-post treatment changes in parent, family and youth functioning in a clinical sample (N= 190) of parents of youth with serious mental health challenges. Consistent with research evaluating in-person Connect, parents reported significant reductions in youth internalizing and externalizing problems, attachment anxiety and avoidance, and aggression toward parents. Parents also reported significant reductions in caregiver strain and aggression toward their child. Unlike prior research, parent depressed mood did not decline, perhaps due to pandemic stressors. Program completion was remarkably high (84.7%), and parents reported high program satisfaction. Uptake by eConnect program facilitators and host agencies was extremely positive, suggesting good potential for sustainability and broadened program accessibility. Randomized clinical trials and implementation within diverse populations are needed.

eCONNECT Parent Group: An Online Attachment-Based Intervention to Reduce Attachment Insecurity, Behavioral Problems, and Emotional Dysregulation in Adolescence.

During adolescence, a secure parent-adolescent relationship promotes youths' adjustment and psychological well-being. In this scenario, several studies have demonstrated the effectiveness of the CONNECT program, a 10-session, attachment-based parenting intervention that helps parents understand and reframe their parent-adolescent interactions, reducing adolescents' insecure attachment and behavioral problems. Furthermore, recent years have witnessed a significant increase in the implementation of effective online versions of psychological interventions, emphasizing the opportunity for more agile and easier dissemination of evidence-based protocols. Therefore, this study aims to identify changes in adolescents' attachment insecurity, behavioral problems, and parent-child affect regulation strategies, providing preliminary findings on an online, 10-session, attachment-based parenting intervention (eCONNECT). A total of 24 parents (20 mothers, 4 fathers; Mage = 49.33, SD = 5.32) of adolescents (Mage = 13.83 years, SD = 1.76, 45.8% girls) were assessed on their adolescents' attachment insecurity (avoidance and anxiety) and behavioral problems (externalizing and internalizing), and on their affect regulation strategies in the parent-child interaction (adaptive reflection, suppression, and affect dysregulation) at three time points: before intervention (t0), after intervention (t1), and at a 2-month follow-up (t2). Mixed-effects regression models highlighted a reduction in adolescents' internalizing problems (d = 0.11), externalizing problems (d = 0.29), and attachment avoidance (d = 0.26) after the intervention. Moreover, the reduction in externalizing problems and attachment avoidance remained stable at follow-up. Additionally, our findings highlighted a reduction in parent-child affect dysregulation. Results add preliminary evidence on the implementation suitability of an online attachment-based parenting intervention to change at-risk adolescents' developmental trajectories by reducing attachment insecurity, behavioral problems, and parent-child affect regulation.

Psychometric Evaluation of the Affect Regulation Checklist: Clinical and Community Samples, Parent-Reports and Youth Self-Reports.

The Affect Regulation Checklist (ARC) was designed to capture affect dysregulation, suppression, and reflection. Importantly, affect dysregulation has been established as a transdiagnostic mechanism underpinning many forms of psychopathology. We tested the ARC psychometric properties across clinical and community samples and through both parent-report and youth self-report information. Clinical sample: Participants included parents (n = 814; Mage = 43.86) and their child (n = 608; Mage = 13.98). Community sample: Participants included independent samples of parents (n = 578; Mage = 45.12) and youth (n = 809; Mage = 15.67). Exploratory structural equation modeling supported a three-factor structure across samples and informants. Dysregulation was positively associated with all forms of psychopathology. In general, suppression was positively associated with many forms of psychopathology, and reflection was negatively associated with externalizing problems and positively associated with internalizing problems.

Parent Emotion Regulation, Mindful Parenting, and Youth Attachment: Direct and Indirect Associations with Internalizing and Externalizing Problems.

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health.

Patterns and Predictors of Different Youth Responses to Attachment-Based Parent Intervention.

OBJECTIVE: Few studies have evaluated attachment-based parent interventions for pre-teens and teens, and in particular, differential adolescent trajectories of response. This study examined distinct patterns, and multi-level predictors, of intervention response among youth with serious behavioral and mental health problems whose parents participated in Connect, an attachment- and trauma-informed parent program. METHOD: Participants included 682 parents (Mage = 42.83, 86% mothers) and 487 youth (Mage = 13.95, 53% female, 28.1% ethnic minority) enrolled in a community-based evaluation of Connect. Parents and youth reported on youth externalizing and internalizing problems (EXT and INT) at six time points from baseline through 18-months post-intervention. Demographic and youth and family level predictors were assessed at baseline. RESULTS: Growth mixture modeling revealed three distinct trajectory classes in both the parent and youth models based on different patterns of co-occurring EXT and INT and degree of improvement over time. Youth with severe EXT showed the largest and fastest improvement, and, interestingly, were characterized by higher callous-unemotional traits and risk-taking at program entry. Youth with comorbid EXT/INT demonstrated a partial or moderate response to intervention in the parent and youth model, respectively, and were characterized by more attachment anxiety at baseline. Most youth showed relatively moderate/low levels of EXT/INT at baseline which gradually improved. Caregiver strain also predicted trajectory classes. CONCLUSIONS: These results have significance for tailoring and personalizing interventions for high-risk youth and provide new understanding regarding the profiles of subgroups of youth who show different responses to an attachment-based parent intervention.

Reflections of parents of children with 22q11.2 Deletion Syndrome on the experience of receiving psychiatric genetic counseling: 'Awareness to Act'.

Individuals with 22q11.2 deletion syndrome (22qDS) have a 25%-41% risk for a psychotic disorder. Although early intervention for psychiatric conditions leads to the best long-term outcomes, healthcare providers often provide inadequate information about these issues and psychiatric services are underused by this population. We conducted semi-structured interviews with parents of children with 22qDS a month after they received psychiatric genetic counseling (pGC), to evaluate outcomes and perceived value of pGC with respect to parents' needs. Using grounded theory, we generated a theoretical framework of the process of building parental awareness of psychiatric risks associated with 22qDS and protective and management strategies for mental health (MH). Parents described how after their child's diagnosis with 22qDS, a variety of barriers stalled their building awareness of psychiatric risk and protective/management strategies: dealing with the immediate symptoms of 22qDS; child's young age; parental fear and stigma; and missing MH guidance. These barriers led them to carry the burden of worrying over missing emerging psychiatric symptoms and the stress over advocating for their child's MH. Parents indicated pGC was beneficial in that led them to achieve an 'awareness to act,' feeling confident in being alert and equipped to protect and/or manage their child's MH.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

Effect of a parenting intervention on decreasing adolescents' behavioral problems via reduction in attachment insecurity: A longitudinal, multicenter, randomized controlled trial.

INTRODUCTION: Secure attachment in adolescence, related to caregiving quality, is a robust predictor of positive behavioral adjustment in early adulthood and beyond. Nevertheless, few attempts have been made to develop treatments to promote parent-adolescent attachment security. METHODS: Using a longitudinal, multicenter, randomized controlled trial design, two questionnaire-based studies were run in Italy (Study 1: n = 100 mothers of adolescents, 60% boys, Mage = 14.89, SD = 1.58; Study 2: n = 40 mothers and 40 adolescents, 60% boys, Mage = 14.90, SD = 1.91) to test the effectiveness of an attachment-based parenting intervention (i.e., Connect) in reducing adolescents' behavioral problems and attachment insecurity 2 weeks post-intervention (t2) and at a 4-month follow-up (t3). It was further investigated whether a decrease in avoidant and anxious attachment at t2 would account for changes in externalizing and internalizing problems, respectively, at t3. All adolescents belonged to two-parent intact families. RESULTS: Mothers who completed Connect reported significantly fewer adolescent behavioral problems and lower adolescent attachment insecurity, compared to mothers in the waitlist group, at both t2 and t3 (Study 1). These findings were confirmed in a second subsample (Study 2), considering both mothers' and adolescents' reports. Controlling for pre-intervention behavioral problems, reductions in internalizing and externalizing problems were observed in both studies at t3 via a decrease in anxious and avoidant attachment, respectively, at t2. CONCLUSIONS: The findings point to the malleability of attachment security in adolescence and highlight the importance of targeting parenting quality to promote adolescent behavioral adjustment.

Transforming Connections: A Trauma-Informed and Attachment-Based Program to Promote Sensitive Parenting of Trans and Gender Non-conforming Youth.

Gender non-conforming and trans youth experience high rates of bullying and victimization, placing them at risk for serious mental health challenges. Parent support is one of the most significant protective factors in this population, and yet few programs are specifically developed to promote parenting sensitivity, understanding, and acceptance. Connect, a trauma-informed and attachment-based group program for caregivers of at-risk adolescents, has been shown to reduce parent stress and depressed mood, increase parents' sense of efficacy and satisfaction, and reduce parent-teen conflict. Teens benefit from increased attachment security and improved mental health and well-being. Treatment effects have been documented to continue for up to 2 years post-treatment. This paper describes the adaptation of the Connect program to create a new program, Transforming Connections, for caregivers of transgender and gender non-conforming youth. Participants in the first three groups were 20 parents of 16 gender non-conforming youth (ages 12-18). Common themes in group discussions related to gender included: coming out, connecting with peers, affirming pronouns/names, medical transition, parental reactions (e.g., confusion, isolation, grief, acceptance), and concerns about safety and mental health. All parents completed the full program, attending on average 9 of 10 sessions. Caregivers reported feeling respected, safe, and welcomed in the program and indicated that learning about attachment enhanced their understanding of their teen and their gender journey as well as themselves as a parent. Additionally, all parents reported applying the ideas discussed in the group frequently (60%) or somewhat frequently (40%). The majority indicated that their relationship with their teen had improved somewhat (65%) or a great deal (20%). Findings provide positive preliminary evidence of the fit and value of Transforming Connections for these families.

Pilot randomized controlled trial of an attachment- and trauma-focused intervention for kinship caregivers.

BACKGROUND: Kinship care placements are increasing in many Western countries, however families in kinship care are underserved partly due to the lack of evidence-based interventions addressing their unique needs. OBJECTIVE: We conducted a pilot randomized controlled trial (RCT) to examine research feasibility and the acceptability, fidelity, and preliminary outcomes of an attachment- and trauma-focused intervention for kinship caregivers in Australia. PARTICIPANTS AND SETTING: Participants included 26 kinship caregivers (Mage = 55.00 years; 54% grandparents) with youth (Mage = 10.58 years; 38% female), and 19 practitioners from child protection, out-of-home care and other services. METHOD: Kinship caregivers were randomized to Connect for Kinship Parents (Connect-KP) or care-as-usual (CAU), and completed assessments at baseline, post-intervention, and 6-month follow-up. Placement changes were evaluated at 6-month follow-up. A subset of practitioners received both training and supervision in implementing Connect-KP, and their videorecorded sessions were coded for fidelity. RESULTS: Practitioners rated the training highly and demonstrated excellent fidelity to program content and process. Results supported the research feasibility and all kinship caregivers reported high levels of program satisfaction and had very high attendance and completion rates. Direction of effects favored Connect-KP vs. CAU for all nine caregiver and youth outcomes, with the largest effects observed for significant reductions in caregiver strain, caregiver psychological aggression, and youth affect suppression following intervention. At 6-month follow-up, more youth from CAU (15%) vs. Connect-KP (0%) experienced an unplanned placement change. CONCLUSIONS: Our findings show promise of Connect-KP as a potentially effective intervention that can be successfully implemented in child welfare services, and provide impetus for a larger-scale RCT.

Network Structure of Callous-Unemotional Traits and Conduct Disorder Symptoms Among At-Risk Youth: Multi-Informant Reports and Gender Differences.

Network analytic techniques examine how items used to measure underlying constructs are related to one another and identify core characteristics. While many studies have examined the covariance of callous-unemotional (CU) traits or features and conduct disorder (CD) symptoms, the inter-item relations of these constructs and the core characteristics of the CU construct are unclear. The present study aimed to examine the network connectivity of, and between, CU features and CD symptoms. We also examined both parent-reports and youth self-reports and gender differences. CU features and CD symptoms were rated by parents (n = 814; 74% mothers; age 23-73, M age = 43.86, SD = 8.13) and their child (n = 608; 57% female; age 7-19, M age = 13.98, SD = 2.36). Network plots depicted greater connectivity (i.e., density and weights) for CU features relative to CD symptoms across both informants. However, youth-reported CU features and CD symptoms were less densely connected than parent-reports. Items commonly comprising the callousness subscale were more central and linked the two constructs together, relative to uncaring items, across informant and gender. Gender related effects indicated lower centrality for male versus female youth, and this finding was particularly evident in youth-reports. Our findings highlight relations between CU features and CD symptoms, and point to the importance of callousness items in conceptualizations of CU features among high-risk youth from both the perspective of the parent and child. We also inform understanding of gender differences in CU features for which the literature is currently limited.

The Mediational Effect of Affect Dysregulation on the Association Between Attachment to Parents and Oppositional Defiant Disorder Symptoms in Adolescents.

Oppositional defiant disorder (ODD) is a childhood disorder, commonly occurring in early school aged children with some symptoms becoming normative in adolescence (e.g., irritability, disagreeing). Affect dysregulation is a risk factor in the development of ODD. Affect regulation is nurtured within parent-child relationships, thus disruptions to attachment may derail children's capacity to develop adaptive affect regulation, increasing the risk for ODD. Using a high-risk sample of adolescents, we investigated the association between attachment anxiety and attachment avoidance with ODD through affect dysregulation. Attachment anxiety, but not avoidance, was associated with affect dysregulation and ODD. Affect dysregulation was found to fully mediate the relationship between attachment anxiety and ODD concurrently and prospectively. Similar findings have been demonstrated among children; results show that attachment anxiety, and its effects on affect dysregulation, are associated with ODD symptoms well into adolescence.

Attachment insecurity accounts for the relationship between maternal and paternal maltreatment and adolescent health.

OBJECTIVES: Maltreatment is linked with poor health outcomes. Attachment and affect regulation may mitigate the long-term impact of these adverse experiences on health outcomes. Little is known about the relative impact of maternal versus paternal maltreatment and interparental violence (IPV) on general health status of female and male youth. METHOD: The present study examined the impact of exposure to maternal and paternal emotional and physical maltreatment, neglect, IPV, and cumulative maltreatment exposure in adolescence on general physical health problems reported five years later. High-risk youth (N = 179; Mage = 15.34, SD = 1.53; 46.4% female) self-reported maltreatment experiences, attachment insecurity, and affect dysregulation at Time 1; and affect dysregulation and physical health five years later at Time 2. RESULTS: Attachment insecurity accounted for the effect of maternal and paternal emotional maltreatment, and maternal and paternal cumulative maltreatment exposure, on physical health. Additionally, attachment insecurity accounted for the effect of paternal neglect on physical health. Further sex differences were found with regard to maltreatment type and are discussed. CONCLUSION: Both maternal and paternal maltreatment in adolescence predicted poor general health five years later via attachment insecurity. Youth who lack a secure attachment with their parents are most vulnerable to these impacts.

Addressing parental stress and adolescents' behavioral problems through an attachment-based program: an intervention study

The primary concern of this study is to address parenting stress and adolescents' behavioral and emotional problems through an attachment based parenting intervention (Connect parents group) for parents of adolescents, in particular to test whether this intervention led to reduced levels of parenting stress, and adolescents' emotional and behavioral problems. 44 parents (33 mothers and 11 fathers; M= 50.4, SD= 4.9) of adolescents (M= 15 years, SD= 1.4) were randomly assigned to one of two groups: An attachment based intervention group (Connect), or a wait-list control group. They were assessed before and immediately after the ten-week intervention. Outcome measures were self-reported parenting stress, and multi-informant assessments of adolescents' emotional and behavioral problems. Compared to the control group, parents completing the Connect program reported significant reductions in their adolescents' externalizing behavior problems at treatment completion. Mediation model showed that, among parents completing the Connect program reductions in parental stress were mediated through decreases in adolescents' externalizing behavior problems. Decrease in adolescents' externalizing behavioral problems affected parental stress experienced in caring. These preliminary results underscore the importance of helping parents of adolescents to reduce levels of parenting stress through effective interventions able to curtail adolescents' emotional and behavioral problems. Furthermore, they provide additional evidence for the effectiveness of the Connect program and offer insights into the potential mechanisms that underlie change

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Profiles of primary and secondary callous-unemotional features in youth: The role of emotion regulation.

There is increasing evidence for multiple pathways in the development of callous-unemotional (CU) features, including primary and secondary profiles. Understanding affect regulation strategies among variants may provide further insight to the development and treatment of CU features. This study evaluated whether profiles of CU features could be identified within a clinical sample of youth using measures of affect dysregulation, affect suppression, anxiety, and maltreatment. We also examined whether these profiles were consistent across gender. Participants (N = 418; 56.7% female) ranged in age from 12 to 19 years (M = 15.04, SD = 1.85) and were drawn from a clinical sample. Latent profile analysis (LPA) was conducted using five indicators, including affect regulation, suppression, anxiety, CU features, and maltreatment. The best fitting model, a four-profile solution, included a low (low CU/dysregulation), anxious (low CU/high dysregulation), primary CU (high CU/low dysregulation), and secondary CU profile (high CU/dysregulation/maltreatment). LPAs found the same four-profile model when conducted separately for males and females. This is the first study to examine gender and include affect regulation strategies in the examination of primary and secondary profiles of CU.