Conduct disorder with limited prosocial emotions: a multimethod study in criminal justice-involved boys

More than 10 years after its introduction in DSM-5, support for the 'limited prosocial emotions' specifier (LPE) for the diagnosis of conduct disorder (CD) remains scarce, possibly because studies failed to comprehensively assess the specifier and to include important characteristics. This study was designed to tackle both major limitations.

In a sample of 323 criminal justice-involved male adolescents (ages 16-17 years), diagnostic interviews were used to differentiate between males who meet criteria for both CD and the DSM-5 specifier (CD + LPE) and males who only meet criteria for CD (CD Only). Individual and environmental characteristics were measured by means of questionnaires and computerized tasks.

The CD + LPE (vs. CD Only) group exhibited higher levels of aggression, delay discounting, and boldness, was more likely to be expelled from school, and had significantly more delinquent friends. Levels of treatment engagement and empathy also were lower in the CD + LPE group. The DSM-5 LPE specifier significantly added to the prediction of various of these characteristics beyond indices of CD severity (i.e., total number of CD symptoms and childhood-onset CD) and features of attention-deficit/hyperactivity disorder. However, no significant group differences emerged for other characteristics (e.g., emotion recognition accuracy, anxiety, sensation seeking, response inhibition, and warm parenting).

Findings provide important and novel evidence to support the utility of the DSM-5 LPE specifier for CD. Some findings were unexpected, though, underscoring the need to replicate and extend the current results when testing the viability of this specifier.