Callous-unemotional traits are associated with clinical severity in referred boys with conduct problems

Clinical practice with the heterogeneous group of children that present with conduct problems may benefit from improved formats for diagnostic subtyping. We investigated whether high levels of callous-unemotional traits (i.e. lack of empathy, remorselessness and shallow affects) would differentiate clinic-referred conduct-problem boys from those low on such traits. A consecutive series of 41 boys with conduct problems (6-13 years, mean age=9.60 years) referred to public child psychiatric units in Sweden were studied with data elicited from caregivers. Conduct-problem boys with many callous-unemotional traits had significantly more pervasive, varied and aggressive disruptive behavioural problems than boys low on these traits had. Higher levels of conduct problems in subjects with callous-unemotional traits were not explained by confounding presence of DSM-IV attention-deficit hyperactivity disorder and oppositional defiant disorder/conduct disorder symptoms. Boys with callous-unemotional traits also experienced poorer household circumstances and lived in families under high stress. Interestingly, they less often received help in school from special teachers but were more often diagnosed with dysthymia than boys low on callous-unemotional traits. We conclude that callous-unemotional traits might designate a subgroup of boys with different aetiology to their conduct problems and possibly with specific treatment needs. However, the findings need to be replicated with larger samples.