A commentary on Perlstein et al. (2023): the past and future of treating youth with limited prosocial emotions.

Perlstein, Fair, Hong, and Waller (Journal of Child Psychology and Psychiatry, 2023) meta-analysis provides a critically important summary of the research on the treatment of children and adolescents with elevated callous-unemotional (CU) traits, 10 years after they were added to diagnostic criteria in the "with Limited Prosocial Emotions" specifier for conduct disorder. Their meta-analysis provides clear and convincing evidence that many treatments that reduce conduct problems in youth are also effective for children with elevated CU traits. However, their findings also indicate that CU traits are a severity indicator, in that youth high on these traits start treatment with more severe behavior problems and, despite improving with treatment, often leave treatment with more severe behavior problems. Such findings provide a clear focus for future research to adapt existing treatments to be more effective for youth with elevated CU traits. Further, the findings from the meta-analysis suggested that while treatments overall were not effective in reducing callous-unemotional traits, high-quality parenting interventions show promise for improving this outcome.