Exploring the clinical utility of the DSM-5 conduct disorder specifier of ‘with limited prosocial emotions’ in an adolescent inpatient sample

Abstract

BackgroundWith the recent addition of a callous-unemotional (CU) specifier to the diagnosis of conduct disorder (CD) in the DSM-5, studies are needed to evaluate the clinical utility of this specifier and the best ways to identify youth meeting criteria for this specifier in clinical samples. MethodsTo this end, the current study examined cross-sectional correlates and treatment response across four groups of inpatient adolescents (N=382, ages 12–17): those with CD without the specifier, with CD and the CU specifier, CU alone, and a group of psychiatric controls. We used two different measures to identify adolescents with high levels of CU traits: the Antisocial Process Screening Device (APSD) [1] and the Inventory of Callous-Unemotional Traits (ICU) [2]. Questionnaires and structured interviews were used to evaluate a range of outcomes including presence of baseline levels and treatment outcomes of both externalizing and internalizing problems. FindingsResults indicated that the ICU, but not the APSD differentiated between conduct disordered youth with and without the specifier on externalizing behaviors in both cross-sectional relations and treatment response. ConclusionsThe results of the current study caution the use of the most frequently used measure to identify the CU specifier, and make suggestions about alternatives.