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Children whose presentations meet DSM-5 criteria for the “with limited prosocial emotions” specifier for conduct disorder (CD) present with two or more of the following characteristics over at least 12 months and in multiple relationships or settings: lack of remorse or guilt, callousness–lack of empathy, lack of concern about performance in important activities, and shallow or deficient affect (American Psychiatric Association 2013; see Chapter 42, “Conduct Disorder”). Decades of research have been devoted to understanding how these so-called callous-unemotional (CU) traits develop among youths, but knowledge is limited on how to best treat this population. Findings are mixed regarding whether treatment improves conduct problems among youths with CU traits; however, there is converging evidence to suggest that CU traits can be treated with psychosocial interventions. Children with conduct problems and CU traits (hereafter referred to as CP + CU) tend to exhibit a reduced sensitivity to punishment when they have already learned that a behavior is reinforcing and tend to have problems processing others’ emotions, which may complicate treatment efforts (see Frick et al. 2014).
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