New Research
Predictive Value of Callous-Unemotional Traits in a Large Community Sample

https://doi.org/10.1097/CHI.0b013e3181b766abGet rights and content

Abstract

Objective

Callous-unemotional (CU) traits in children and adolescents are increasingly recognized as a distinctive dimension of prognostic importance in clinical samples. Nevertheless, comparatively little is known about the longitudinal effects of these personality traits on the mental health of young people from the general population. Using a large representative sample of children and adolescents living in Great Britain, we set out to examine the effects of CU traits on a range of mental health outcomes measured 3 years after the initial assessment.

Method

Parents were interviewed to determine the presence of CU traits in a representative sample of 7,636 children and adolescents. The parents also completed the Strengths and Difficulties Questionnaire, a broad measure of childhood psychopathology. Three years later, parents repeated the Strengths and Difficulties Questionnaire.

Results

At 3-year follow-up, CU traits were associated with conduct, hyperactivity, emotional, and total symptom scores. After adjusting for the effects of all covariates, including baseline symptom score, CU traits remained robustly associated with the overall levels of conduct problems and emotional problems and with total psychiatric difficulties at 3-year follow-up.

Conclusions

Callous-unemotional traits are independently associated with future psychiatric difficulties in children and adolescents. An assessment of CU traits adds small but significant improvements to the prediction of future psychopathology. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(11):1079–1084.

Section snippets

Sample

In 2004, a sample of British children aged 5 to 16 years was identified using the child benefit register.15 In Great Britain, “child benefit” is a universal state benefit payable for each child in the family, and it has an extremely high uptake. For this reason, the British Child and Adolescent Mental Health Survey 2004 used the child benefit register to develop a sampling frame of postal sectors from England, Wales, and Scotland. Families whose record was under revision or who had no recorded

Results

At the baseline assessment, CU trait ratings were obtained from the parents of 7,636 children (96% of respondents). Of these children, 88% had no definite CU traits, 8% had one definite trait, 2% had two definite traits, and 2% had three or more definite traits. The CU traits were significantly correlated (p < .001 for all correlations) with the five SDQ symptom scores: conduct symptoms (r = 0.46), emotional symptoms (r = 0.24), hyperactivity symptoms (r = 0.33), peer problems (r = 0.30), and

Discussion

In this large study of a representative sample of children and adolescents, after controlling for the effects of potential confounders, CU traits were longitudinally associated with the overall level of psychiatric problems (SDQ total difficulties score) and specifically with conduct and emotional problems, although not with hyperactivity problems. As in our previous follow-up of the same cohort,14 the strongest predictor of future psychiatric symptoms was the baseline symptom score, and by

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    The British Child and Adolescent Mental Health Surveys of 1999 and 2004 and their longitudinal extensions were funded by the Department of Health and the Scottish Executive and performed by the Office for National Statistics.

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