Abstract
Growing evidence supports the existence of two variants of youth with high callous–unemotional (CU) traits who present with markedly different risk profiles and outcomes, with potential implications for risk assessment and treatment formulation. So far, studies have identified variants of CU youth mainly using data-driven cluster approaches based on levels of CU traits and co-occurring anxiety. Yet, the extent to which this knowledge may be translated into clinical practice is unclear. To this end, the present study employed a severity-based, cut-off approach to systematically characterise CU groups across a range of clinically informative domains, including trauma history, psychiatric symptomatology, affective functioning, attachment style and behavioural risk. Analyses were based on multi-rated data from a community sample of high-risk youths (n = 155, M = 18 years). Consistent with previous studies, we found that, whereas variants show comparable levels of antisocial behaviour, those who present with both high CU and high anxiety report more severe childhood maltreatment, psychological distress, ADHD symptomatology and behavioural risk—including substance use, suicidal ideation and unsafe sex. In addition, these youth show greater attachment insecurity and affective dysregulation, as indexed by levels of irritability and alexithymia. Together, findings indicate that (1) trauma history is a key factor that differentiates variants of CU youth high vs. low on anxiety, and (2) differences in individual functioning across variants point to the need for tailored clinical assessment tools and intervention strategies. Importantly, the present findings indicate that variants of CU youth can be meaningfully differentiated using cut-off based approaches that parallel methods used in clinical assessments.
Highlights
In the DSM-5, callous–unemotional (CU) traits—referred to as ‘Limited Prosocial Emotions’—feature as a new diagnostic specifier for conduct disorder, to enable the identification of a severe subgroup of youth at increased risk for early-onset and persistent antisocial behaviour [1]
We refer to our sample as ‘youth’, as it is (1) in line with the term used by international organisations (e.g. UN) to describe individuals aged 15–24; and (2) consistent with the extant literature on variants of CU youth, which is primarily focused on youth populations (e.g. [17,18,19,20, 24, 25])
The CU and high anxiety (CU+Anx) group did not differ from the Anxious group on either measure of affective functioning
Summary
In the DSM-5, callous–unemotional (CU) traits—referred to as ‘Limited Prosocial Emotions’—feature as a new diagnostic specifier for conduct disorder, to enable the identification of a severe subgroup of youth at increased risk for early-onset and persistent antisocial behaviour [1]. Compared to other antisocial youth, those with high CU traits show marked differences in neurocognitive, emotional and behavioural functioning, including difficulties in social-information processing [3], under-arousal to empathy-inducing stimuli [4], disruptions in affective theory of mind [5], lower sensitivity to punishment [1] as well as alterations in brain regions involved in emotion and learning (e.g. amygdala, PFC; [2]). Together, these features are thought to contribute to the more violent, chronic and recidivistic pattern of antisocial behaviour displayed by youth with high CU traits, and represent an important target for intervention.
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