The Inventory of Callous-Unemotional traits (ICU) is a widely used measure of the affective aspects of psychopathy in children and adolescents. Although a 3-bifactor model of the ICU has often been supported, method-variance effects and mixed results for the Unemotional subscale raise concerns. This study applied a multi-informant design to investigate the structural and concurrent validity of the self-, parent-and teacher-versions of the ICU in a Norwegian at-risk adolescent sample (N = 160, female = 46.3%, mean age = 14.73 years, SD = 1.47). Confirmatory Factor Analysis demonstrated method-variance effects of the standard-and reverse-scored items. The best fitting model was the 12-item 2-factor ICU, comprising a Callousness and an Uncaring factor. The scale reliabilities were acceptable with Cronbach alphas ranging from .810 to .906 across respondent groups. Cross-rater reliability was poor, with Intra Class Correlations ranging from .170 to .226. The concurrent validity of the ICU12 was supported by within-rater associations to externalizing problems, aggression, and problematic alcohol use. Crossrater associations of ICU12-scores to self-reported delinquency and lower levels of anxiety, provided additional support for the concurrent validity. The unidimensional ICU12 total score was associated both to delinquency and rule-breaking behavior as observed for the Callousness factor and to lack of anxiety and reduced fear sensitivity as observed for the Uncaring factor. The ICU items aimed at capturing lack of prosocial emotions, seem to need revision. Future research should assess the predictive validity and clinical relevance of unidimensional versus factor models of the ICU.

Callous-unemotional (CU) traits have been linked to more severe and sustained behavior problems among adolescents. The aims of this study were to examine the treatment impact and malleability of CU traits among adolescents and explore potential moderation effects of treatment condition and CU sub-typology. A sample of 159 adolescents (45.9% girls; M age = 14.7 years, SD = 1.47) and their parents participated in a randomized controlled trial of Functional Family Therapy with three assessments (baseline, 6-months and 18-months) of behavior problems, CU traits, prosocial skills and the parent-youth relationship. Latent growth curve model (LGCM) analyses revealed that children with higher CU traits had greater reductions in aggressive and rule-breaking behavior and greater improvements in social skills (|standardized coefficients| = 0.27–0.32). Similarly, higher CU traits were linked to larger increases in parent-ratings of family cohesion and youth-ratings of maternal support (standardized coefficients = 0.26–0.27). Reliable Change Index summaries showed that CU traits remained unchanged for the majority of participants (73.6% and 72.6% had no reliable short- and long-term change, respectively). Baseline anxiety linked to CU sub-typology moderated some of the study results. Findings show that adolescents with co-occurring behavior problems and elevated CU traits can obtain improvement in behavioral and relational outcomes in out-patient treatment. Strikingly, such improvements can occur notwithstanding a limited reduction in CU traits. Future work should investigate whether the treatment gains would be more substantial and stable if treatment adjuncts modifying the CU traits themselves were concurrently deployed.

Despite the availability of evidence-based treatment models for adolescent behavior problems, little is known about the effectiveness of these programs for adolescents with callous-unemotional (CU) traits. Defined by lack of empathy, lack of guilt, flattened affect and lack of caring, CU traits have been linked to long-term anti-social behavior and unfavorable treatment outcomes and might be negatively related to outcomes in evidence-based programs such as Functional Family Therapy (FFT). This study used a single-group pre-post evaluation design with a sample of 407 adolescents (49.1% female, mean age = 14.4 years, SD = 1.9) receiving FFT to investigate whether outcomes in FFT are predicted by CU traits and to what extent reliable changes in CU traits can be observed. The results showed that although CU traits are related to increased problem severity at baseline, they predicted neither treatment dropout nor post-treatment externalizing behavior and family functioning. CU traits were related to diminished improvement ratings, in particular with respect to parental supervision. Reductions in CU traits were observed across the time of treatment, and these were most profound among adolescents with elevated levels of CU traits at baseline. Further research should investigate whether certain evidence-based treatment components are more suited for adolescents with CU, and if the addition of specific intervention elements for reducing CU-traits could further improve outcomes for this high-risk population.