Cortisol, callous-unemotional traits, and pathways to antisocial behavior

Two decades of research has implicated the hypothalamic-pituitary-adrenal (HPA) axis in the development of antisocial behavior in children. However, findings regarding the association between cortisol and antisocial behavior have been largely inconsistent, and the role of the HPA axis in relation to broader etiological processes remains unclear. We examine evidence that the role of the HPA axis in the development of antisocial behavior may differ across subgroups of children.

A meta-analysis has supported the prediction that low levels of cortisol are associated with risk for childhood antisocial behavior, but the relationship is weaker than previously assumed. Recent studies suggest the association between cortisol levels and antisocial behavior may vary depending on type of antisocial behavior, patterns of internalizing comorbidity, and early environmental adversity. The findings are consistent with evidence that two early-onset pathways to antisocial behavior can be distinguished based on the presence or absence of callous-unemotional traits.

We speculate that early adversity is important to the development of chronic antisocial behavior in children with low levels of callous-unemotional traits and HPA-axis hyperactivity, but that high levels of callous-unemotional traits and HPA-axis hypoactivity characterize a particularly severe subgroup, for whom antisocial behavior develops somewhat independently of adversity.