2.2. Clinical Assessment

Patients’ clinical profiles were also assessed by means of several questionnaires, either through self or parental reports. Particularly, the Italian versions of the following measures were used: the Behavior Rating Inventory of Executive Functions–Second version (BRIEF-2) [51] administered to parents of all included children for the assessment of EF profiles; the Antisocial Process Screening Device (APSD) [62] administered to parents of all included children for the evaluation of CU traits; the Basic Empathy Scale (BES) [12], administered to parents of all children aged 11 years old or less, and the Interpersonal Reactivity Index (IRI) [25], administered in its self-report version to adolescents aged 12 years old or more, for the assessment of empathic competences.

The Behavior Rating Inventory of Executive Function–Second version (BRIEF-2) [51] is the updated version of the BRIEF questionnaire which provides a structured assessment of executive function behaviors in everyday life environments, allowing the identification of helpful clinical manifestations in different contexts, i.e., home and school. In its parent-report version that was used in the present study, this tool has been validated for 5- to 18-year-old children and adolescents. BRIEF-2 is a multi-dimensional measure and items are nearly equally distributed across nine factors, each referring to specific executive functions: Inhibit, Self-Monitor, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Task Monitor, Organization of Materials. Three composite scales are also identifiable, each including at least two factors: Behavioral Regulation Index (BRI) (including Inhibit and Self-Monitor), Emotional Regulation Index (ERI) (Shift and Emotional Control) and Cognitive Regulation Index (CRI) (Initiate, Working Memory, Plan/Organize, Task Monitor, Organization of Materials). A Global Executive Composite (GEC) score is also computed as sum of the three aforementioned composite indexes.

The Antisocial Process Screening Device (APSD) [62] is a 20-item clinician-administered rating scale normed on a community sample of pre-adolescent children. The available version of the APSD was designed to be completed by parents and teachers; the former was used in the present study. Items are rated on a three-point Likert scale and the scale consists of three main dimensions, based on factor analysis: Narcissism, Impulsivity and Callous-Unemotional. There is substantial support for the validity of the APSD for distinguishing sub-groups of antisocial youths with more severe and aggressive behavior, with characteristics similar to adults with psychopathy [63] (Cronbach’s α = 0.86).

The Basic Empathy Scale (BES) [12] is a self- or parent-reported questionnaire, the latter being used in this study, for children and/or adolescents composed of 20 items distributed across two subscales, respectively, referring to the affective and cognitive components of empathy. Both exploratory and confirmatory analyses of the original validation established good internal consistency for each subscale with Cronbach’s α ranging from 0.79 to 0.85. The Interpersonal Reactivity Index (IRI) was originally developed by Davis, 1980 [25], as a self-reported questionnaire for adults and subsequently adapted for adolescents by Litvack-Miller and colleagues [64]; it is composed of 28 items distributed across four subscales, respectively referring to Fantasy and Perspective-Taking (combined into the Cognitive Empathy subscale), Empathic Concern and Personal Distress (combined into the Affective Empathy subscale).