Callous unemotional traits, autism spectrum disorder symptoms and empathy in boys with oppositional defiant disorder or conduct disorder
Introduction
Lack of empathy is a core feature of callous unemotional (CU) traits. CU traits are closely related to the interpersonal-affective dimension of adult psychopathy, and identify a particular severe and violent subgroup of individuals with oppositional defiant disorder (ODD) and conduct disorder (CD; for a review see Frick et al. (2013)). Research suggests that ODD/CD individuals with CU traits are impaired in affective empathy (sharing others’ emotions) rather than cognitive empathy (understanding others’ emotions; Blair, 2013, Blair et al., 2014). This impairment has been linked to amygdala dysfunction, potentially reducing emotional responsiveness (Blair, 2013) and/or attention (White et al., 2012) to another person's distress.
Lack of empathy is also a defining feature of autism spectrum disorders (ASD; Baron-Cohen et al., 1985). Individuals with ASD show persistent deficits in social interactions and communication together with rigid and repetitive behavior (APA, 2013). Empathy problems in ASD seem to be related to aspects of cognitive empathy rather than affective empathy (Blair, 2005). The social deficits that characterize ASD have been explained by deficits in Theory of Mind (ToM; Baron-Cohen et al., 1985). ToM is conceptually linked to cognitive empathy (Baron-Cohen and Wheelwright, 2004), and involves the ability to understand that people have mental states, such as thoughts, believes and desires that are different to one's own (Baron-Cohen et al., 1985). Multiple studies have demonstrated that individuals with ASD indeed have deficits in aspects of cognitive empathy (for reviews see Boucher, 2012, Hill and Frith, 2003).
Some behavioral overlap exists between CU traits and ASD, as both are linked to disruptive behaviors (Frick et al., 2013, Kaat and Lecavalier, 2013) and reduced empathic responsiveness (APA, 2013). Accordingly, it seems important to account for both conditions while studying associated empathy deficits. Until now, only four studies have done this in clinical samples. Two studies have compared empathic profiles in boys with severe conduct problems and CU traits, ASD, and controls, revealing distinct profiles: boys with CU traits showed less affective empathy, whereas boys with ASD showed less cognitive empathy (Jones et al., 2010, Schwenck et al., 2012). One study compared profiles of aggressive ASD male adolescents with high or low CU traits (Rogers et al., 2006). Both groups showed impaired cognitive empathy, those with CU traits also showed impairments in aspects of affective empathy. The fourth study examined additive and interactive effects of CU traits and ASD symptoms in relation to empathy in ODD/CD boys and girls between 3 and 9 years of age (Pasalich et al., 2014). Findings revealed negative associations between CU traits and affective empathy and negative associations between ASD symptoms and cognitive empathy. Rather unexpected, higher CU traits were also related to lower levels of cognitive empathy, and a ‘double hit’ of high CU traits and high ASD symptoms tended to predict the lowest levels of affective empathy. Starting from the work of Rogers and colleagues (2006), Pasalich and colleagues (2014) took these results to suggest that high levels of both CU traits and ASD symptoms may be associated with serious conduct problems and therefore also with low levels of affective empathy. Yet, based on studies suggesting that ASD individuals are actually quite sensitive (Schwenck et al., 2012), perhaps even overly sensitive to another person's distress (Smith, 2008), ASD symptoms might as well be expected to confound the “true” relationship between CU traits and affective empathy. If so, antisocial individuals with high levels of CU traits may show particularly low levels of affective empathy at low rather than high levels of ASD symptoms. By lack of empirical evidence we can only speculate about the role of ASD symptoms in the relationship between CU traits and affective empathy.
The aim of this study is to investigate additive and interactive effects of CU traits and ASD symptoms in relation to trait empathy in a clinical sample of ODD/CD boys. To the best of our knowledge this study tests the effects for the first time in boys with ODD/CD between 7 and 12 years of age. To examine the unique relationship between CU traits and empathic sadness, the current study includes a measure of empathic sadness in addition to broader measures of affective and cognitive empathy. Starting from the hypothesis that children with CU traits are selectively less emotionally responsive to distress cues (fear and sadness; Blair, 2013), we expect to find inverse relationships between CU traits and affective empathy, in particular with empathic sadness. Based on the hypothesis that children with ASD are poor in ToM (Baron-Cohen et al., 1985), we expect to find an inverse association between ASD symptoms and cognitive empathy. By lack of evidence we cannot formulate strong hypotheses about interaction effects. The work of Pasalich and colleagues (2014) suggests that the lowest levels of affective empathy could be expected in boys who have high levels of CU traits and ASD symptoms. By contrast, there is reason to expect lowest levels of affective empathy in ODD/CD boys high on CU traits but particularly low on ASD symptoms because ASD symptoms may confound the “true” association between CU traits and affective empathy.
Section snippets
Method
This study was approved by the Medical Ethical Committee of Leiden University Medical Centre (LUMC), and parents gave written consent prior to participation according to the declaration of Helsinki.
Results
Table 1 includes the means and standard deviations for all variables. Table 2 includes the bivariate correlations between the main study variables.
Discussion
This study investigated additive and interactive effects of CU traits and ASD symptoms in relation to trait empathy in ODD/CD boys between 7 and 12 years of age. In line with predictions, we found an inverse association between CU traits and empathic sadness. The negative association between CU traits and the broader measure of affective empathy was not significant, however. The finding is consistent with theory and research (Blair, 2013, Blair et al., 2014) demonstrating that ODD/CD children
Conflict of interests
None.
Acknowledgments
This study was supported by grant 056–21-010 funded by the Netherlands Organization for Scientific Research (NWO) awarded to Hanna Swaab, Minet de Wied and Stephanie van Goozen. We thank all participants for participating in the study.
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