CAPE for measuring callous-unemotional traits in disadvantaged families: a cross-sectional validation study

Background: Callous-unemotional (CU) traits are important for designating a distinct subgroup of children and adolescents with behaviour problems.  As a result, CU traits are now used to form the specifier "with Limited Prosocial Emotions" that is part of the diagnostic criteria for the Conduct Disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 ^th Edition (DSM-5) and International Classification of Diseases 11 ^th Revision (ICD-11).  Given this inclusion in major classification systems, it is important to develop and test methods for assessing these traits that can be used in clinical settings.  The present study aimed to validate a clinician rating of CU traits, the Clinical Assessment of Prosocial Emotions, Version 1.1 (CAPE 1.1), in a sample of hard-to-reach families referred to a government program designed to prevent the development of behaviour problems in high risk families. Methods: Clinical ratings of children were obtained from 34 families of children ages 5 to 18 (M=13.5; SD=3.2). The ratings on the CAPE 1.1 were based on interviews with both parent and child. Results: Of the sample, 21% (100% male) met the diagnostic cut-off for the specifier according to the CAPE 1.1, and CAPE 1.1 scores were associated with parent ratings of CU traits, psychopathic traits, and externalising behaviours. CAPE 1.1 ratings were also associated with risk for violence obtained from case files.  Conclusions: These findings provide preliminary evidence for the validity of the CAPE 1.1 as clinician rated measure of CU traits.