Commentary: Optimism and guidance for improving treatment effects among children with callous-unemotional traits - reflections on Perlstein et al. (2023).

Callous-unemotional (CU) traits have increasingly received attention as a potential predictor and outcome of treatment for children with conduct problems. The results of Perlstein et al. (2023) offer the first meta-analytic evidence against the long-held belief that CU traits confer treatment resistance. The results also suggest that children with conduct problems and CU traits require something more or different to achieve treatment outcomes commensurate with their conduct problems-only peers. In this commentary, I reflect on how treatment adaptations for children with conduct problems and CU traits have attempted to achieve this goal, emphasizing that more work is needed to maximize improvement in putative mechanisms and mediators of treatment-related change. In this way, I argue that Perlstein et al. (2023) offer both optimism and guidance for improving treatment effects among children with conduct problems and CU traits.