The Importance of Early Nurturance for Social Development.

he lack of ability for empathy and related callous and unemotional (CU) traits is perhaps among the most T destructive of human characteristics. Such traits could be at the root of much violent crime and the initiation and prolongation of harmful social conflicts. These traits, known to be precursors of psychopathy, are evident in childhood, with recent work suggesting they can be detectable as early as the preschool period of development. Despite the unusually clear clinical manifestations of these traits and broad consensus on how to identify them, mental health clinicians and those in social welfare have been at a loss on how to effectively treat this condition. Conduct disorder with CU traits and psychopathy have been widely regarded as untreatable for most patients. In this context, Humphreys et al.’s findings from the Bucharest Early Intervention Project provide exciting new promise for early intervention in this elusive domain. This unique randomized controlled trial, which has allowed a comparison between the outcomes of children reared in institutional settings and those randomized early in childhood out of the institution and into therapeutic foster homes, has provided an unprecedented window into the effects of relative emotional neglect on child emotional, behavioral, and neurobiological outcomes. Although many findings from this study have focused on attachment-related outcomes, the study also has informed the effects of early deprivation and neglect on risk for other forms of psychopathology. In this vein, the investigators compared CU traits at adolescent outcomes in those randomized to foster care with those who remained in the institution. An intent-to-treat analysis displayed a markedly decreased prevalence of this characteristic in boys randomized to foster care compared with those who remained in institutions. Specifically, the caregiver’s ability to respond to child distress, distinct from caregiver support, which was a nonsignificant factor, served as a mediator of the decreased rate of CU traits in adolescent boys. These findings provide some of the most compelling empirical evidence to date for the importance of the early caregiving relationship in the development of empathic capacities. This study falls short of providing definitive evidence that early caregiver responsiveness is the essential ingredient toward the prevention of CU traits in adolescence. To test this hypothesis, a study design that randomizes participants based on this characteristic and measures this trait before and after intervention is needed to confirm and