Abstract
BackgroundChildren with early onset of Callous-Unemotional (CU) traits are at a higher risk for long-term, persistent psychosocial problems. The current study aimed to explore the characteristics of CU in preschool children with Attention Deficit Hyperactivity Disorder (ADHD) and the diagnostic significance of CU traits in ADHD.MethodsA total of 176 preschool children (89 with ADHD and 87 Typically Developing Children [TDC]) aged 4–5 years old were recruited to the study. The participants were assessed for CU traits, emotional and behavioral problems, and how their executive functioning was associated with ADHD using multiple assessment scales. Multiple linear regression analysis was performed to assess the incremental validity of the Inventory of Callous-Unemotional Traits (ICU), adjusting for possible covariates by child’s sex, conduct problems, and oppositional defiant symptoms.ResultsThe results showed that there was a significant difference of ICU scores between the ADHD and TDC groups (F = 30.12, P < 0.001). In terms of callousness, ADHD + Oppositional Defiant Disorder (ODD) group showed a significant high score, and the ADHD only group scored significantly higher than the TDC group (F = 20.42, P < 0.001). The ICU was negatively associated with the prosocial behaviour subscale (γ = − 0.57, P < 0.01) and showed low to moderate positive correlations with emotional and behavioural problems, as well as executive function (γ = 0.24–0.67, P < 0.05). The ICU scores explained 6% of the incremental validity in ADHD symptoms. The diagnostic value of the ICU for ADHD was medium and acceptable.ConclusionsThe current study indicated that early identification of CU traits may help clinicians better understand symptoms and behavioural problems in children with ADHD. CU traits therefore could be considered as a useful assessment tool for ADHD.
Highlights
Callous can be defined as lacking empathy and having a shallow affect [1], which is emphasised within Conduct Disorder (CD)
Oppositional Defiant Disorder (ODD) and CD frequently occur in comorbidity with Attention Deficit Hyperactivity Disorder (ADHD) [5], with the prevelance estimated to be between 20%, and slightly more than 40% among preschool children [2]
The demographic and clinical characteristics of the ADHD group and typically developing children (TDC) group are presented in Appendix 1
Summary
Callous can be defined as lacking empathy and having a shallow affect [1], which is emphasised within Conduct Disorder (CD). Based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnosis of CD specifies there is limited prosocial emotions displayed for at least two of the four characteristics, which are lack of remorse or guilt, Zhang et al Child Adolesc Psychiatry Ment Health (2021) 15:35 callous-lack of empathy, unconcerned about performance, and shallow or deficient affect [2]. These four charactersistics are closely combined in children to reflect different personality traits of a person including prosocial emotions. The current study aimed to explore the characteristics of CU in preschool children with Attention Deficit Hyperactivity Disorder (ADHD) and the diagnostic significance of CU traits in ADHD
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