Callous–unemotional traits as a cross-disorders construct

Callous–unemotional (CU) traits are currently viewed as the defining signs and symptoms of juvenile psychopathy. It is unclear,
however, whether CU traits have validity only in the context of conduct disorder (CD) as proposed by Frick and Moffitt (A
proposal to the DSM-V childhood disorders and the ADHD and disruptive behavior disorders work groups to include a specifier
to the diagnosis of conduct disorder based on the presence of callous–unemotional traits, American Psychiatric Association,
Washington, DC, 2010), or also outside CD, either in combination with other forms of psychopathology or as a stand-alone construct.

The current review systematically studied the existent literature on CU traits in juveniles to examine their validity inside
and outside CD according to the framework regarding the validity of a psychiatric diagnosis provided by Robins and Guze (Am
J Psychiatry 126:983–987, 1970).

Inside youth with conduct problems, and CD specifically, it seems that CU traits meet the Robins and Guze criteria. As many
of the reviewed studies included youth with ODD and ADHD as well, there are indications the same might be true for ODD and
ADHD, although probably to a lesser extent. In other disorders, CU traits may be present as well, but their role is not firmly
established. As stand-alone construct, data are lacking or are scarce on all of the above-mentioned criteria.

CU traits are a useful specifier in CD, and possibly also in disruptive behaviour disorders (DBDs) more generally. High CU
traits outside DBDs exist but it is as yet unknown if there is a clinical need for defining CU traits as a stand-alone construct.