The Empathy Hierarchy: Unique Associations of Childhood Callous Unemotional Traits and Autism Spectrum Disorder Symptoms.

Child conduct problems commonly co-occur with callous-unemotional (CU) traits and autism spectrum disorder (ASD), which are both associated with empathy deficits; however, their unique associations are poorly understood because few studies consider the high overlap between CU traits and ASD. This study addressed this knowledge gap by investigating the unique associations between CU traits and ASD symptoms, and components of empathy (attention to others' distress, emotion recognition, understanding emotional states, empathic responding), and differences between children classified into clinical groups (conduct problems with and without CU traits and ASD) and typically developing children. Parents reported on their child's psychopathology symptoms and empathy, and children completed laboratory tasks measuring empathy components. Results indicated that ASD symptoms, but not CU traits, were uniquely associated with emotion recognition deficits. Meanwhile, CU traits were uniquely associated with reduced empathic responding, and this relationship was exacerbated with ASD symptoms. Theoretical and clinical implications are discussed.