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The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder.

ABSTRACT: BACKGROUND:'With Significant Callous-Unemotional Traits' has been proposed as a specifier for conduct disorder (CD) in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The impact of this specifier on children diagnosed with CD should be considered. METHODS:A multi-site cross-sectional design with volunteers (n = 1136) in the third-seventh grades and 566 consecutive referrals (ages 5-18) to a community mental health center were used to estimate the prevalence rates of CD with and without the proposed specifier. In addition, the degree of emotional and behavioral (especially physical aggression) disturbance and level of impairment in youth with and without CD and with and without the specifier was evaluated. RESULTS:In the community sample, 10%-32% of those with CD and 2%-7% of those without CD met the callous-unemotional (CU) specifier threshold depending on informant. In the clinic-referred sample, 21%-50% of those with CD and 14%-32% without CD met the CU specifier threshold depending on informant. Those with CD and the specifier showed higher rates of aggression in both samples and higher rates of cruelty in the clinic-referred sample. CONCLUSIONS:Results indicate between 10% and 50% of youth with CD would be designated with the proposed CU specifier. Those with CD and the specifier appear to be more severe on a number of indices, including aggression and cruelty.

SUBMITTER: Kahn RE

PROVIDER: S-EPMC3248960 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder.

Kahn Rachel E RE Frick Paul J PJ Youngstrom Eric E Findling Robert L RL Youngstrom Jennifer Kogos JK

Journal of child psychology and psychiatry, and allied disciplines 20110926 3

<h4>Background</h4>'With Significant Callous-Unemotional Traits' has been proposed as a specifier for conduct disorder (CD) in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The impact of this specifier on children diagnosed with CD should be considered.<h4>Methods</h4>A multi-site cross-sectional design with volunteers (n = 1136) in the third-seventh grades and 566 consecutive referrals (ages 5-18) to a community mental health center were used to est ...[more]

PMID: 21950481

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Project description:Previous studies have reported changes in gray matter volume in youths with conduct disorder (CD), although these differences are difficult to interpret as they may have been driven by alterations in cortical thickness, surface area (SA), or folding. The objective of this study was to use surface-based morphometry (SBM) methods to compare male youths with CD and age and sex-matched healthy controls (HCs) in cortical thickness, SA, and folding. We also tested for structural differences between the childhood-onset and adolescence-onset subtypes of CD and performed regression analyses to assess for relationships between CD symptoms and callous-unemotional (CU) traits and SBM-derived measures.We acquired structural neuroimaging data from 20 HCs and 36 CD participants (18 with childhood-onset CD and 18 with adolescence-onset CD) and analyzed the data using FreeSurfer.Relative to HCs, youths with CD showed reduced cortical thickness in the superior temporal gyrus, reduced SA in the orbitofrontal cortex (OFC), and increased cortical folding in the insula. There were no significant differences between the childhood-onset and adolescence-onset CD subgroups in cortical thickness or SA, but several frontal and temporal regions showed increased cortical folding in childhood-onset relative to adolescence-onset CD participants. Both CD subgroups also showed increased cortical folding relative to HCs. CD symptoms were negatively correlated with OFC SA whereas CU traits were positively correlated with insula folding.Cortical thinning in the superior temporal gyrus may contribute to the social cognitive impairments displayed by youths with CD, whereas reduced OFC SA may lead to impairments in emotion regulation and reward processing in youths with CD. The increased cortical folding observed in the insula may reflect a maturational delay in this region and could mediate the link between CU traits and empathy deficits. Altered cortical folding was observed in childhood-onset and adolescence-onset forms of CD.

Dataset Information

The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder.

Publications

The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder.

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