Editorial: Testing the Validity of the Limited Prosocial Emotions Specifier

Colins et al.¹ address a timely and important topic. Specifically, both the DSM-5 and the International Classification of Diseases, 11th edition (ICD-11) for the first time introduced a specifier (ie, with limited prosocial emotions) for the diagnosis of conduct disorder (DSM-5) or for the diagnoses of conduct-dissocial and oppositional defiant disorders (ICD-11) to designate those persons with these disorders who also show elevated levels of callous-unemotional (CU) traits. This change was based on research showing that children and adolescents with significant conduct problems who also show elevated levels of CU traits seem to be an etiologically and clinically important subgroup of persons with these disorders.^2,3 The DSM-5 chose not to conduct field trials to test the validity of new diagnoses (only reliability) and, instead, considers research on new diagnoses as the field trials for future revisions of the manual.⁴ Thus, the work by Colins et al.¹ is critical for this validation process. The study by Colins et al. has a number of methodological features that make their results particularly informative.¹ The most notable feature was the use of a large nonreferred sample that was followed from 3 to 5 years of age to 11 to 13 years of age with a high retention rate. The authors also provide a nice summary of past attempts to validate the LPE specifier, which has provided mixed support at best. However, they also note that most of these studies did not use the full criteria for the LPE specifier and that this is an important limitation that Colins et al. overcome, especially given that the criteria include only 4 symptoms. Thus, the authors' findings that children with the LPE specifier and serious conduct problems exhibited more conduct disorder (CD) symptoms and comorbid problems (ie, fearlessness, symptoms of oppositional defiant disorder, and attention-deficit/hyperactivity disorder [ADHD]) and were at higher risk for future CD symptoms 3 years later are critical advances.