Callous–unemotional traits and antisocial behaviour Children with conduct disorder and callous–unemotional traits

Children with conduct disorder and callous–unemotional traits present with persistent and violent patterns of antisocial behaviour. Callous–unemotional traits, such as limited empathy, guilt and shallow affect, are currently being considered as a subtyping index for conduct disorder in DSM-5, and may have independent diagnostic value, even in the absence of conduct disorder. Much attention has been paid to antisocial behaviour combined with the core affective personality features of psychopathy (callous–unemotional traits). It is natural that children and adults with a combination of antisocial behaviour and callous–unemotional traits should attract research, clinical and popular interest. These individuals commit more than their fair share of antisocial acts and appear to respond differently to typical socialisation efforts and at least some clinical interventions. However, it is worth recalling that Cleckley’s original conceptualisation of psychopathy highlighted that the core psychopathy traits (comparable with callous–unemotional traits) can be present in individuals who do not show antisocial behaviour. Although Cleckley’s work on psychopathy is of seminal importance, we need to keep in mind that he described clinical case studies and as such could not address questions about the prevalence of core psychopathic features in the absence of antisocial behaviour. We now know that antisocial behaviour and callous– unemotional traits have an asymmetrical relationship for both children and adults: high levels of antisocial behaviour often occur in the absence of callous–unemotional traits, whereas high levels of callous–unemotional traits often occur in the presence of antisocial behaviour (see for example Hart & Hare, Fontaine et al ). However, several longitudinal studies now suggest that callous–unemotional traits can also occur in the absence of clinical levels of antisocial behaviour (for example Barker et al, Frick et al, Rowe et al, Fontaine et al). It is noteworthy that in these large community samples, ‘callous–unemotional traits only’ was associated with subclinical levels of antisocial behaviour or later developing antisocial behaviour. In addition, and perhaps more interestingly, individuals with ‘callous–unemotional traits only’ commonly showed elevated levels of other types of impairment including poor peer relationships, low prosociality and increased hyperactivity. Callous–unemotional traits may therefore have the potential to serve as a useful clinical indicator for psychiatric vulnerability and psychosocial maladjustment, in addition to their potential utility in subtyping children with conduct disorder.