Clinical utility of diagnosing limited prosocial emotions in young children using the Clinical Assessment of Prosocial Emotions (CAPE).

Abstract

This study evaluated the interrater reliability, convergent and divergent validity, incremental validity, and clinical prognostic utility of the Clinical Assessment of Prosocial Emotions (CAPE; Frick, 2013) for assessing limited prosocial emotions (LPE). Participants were 232 young children (Mage = 3.94 years, SD = 1.46, range = 2–8; 74.6% boys) clinic-referred for conduct problems. We scored the CAPE using binary and dimensional scoring approaches and measured outcomes using parent-report and child laboratory measures. CAPE LPE symptom ratings had good interrater reliability. Children diagnosed with pretreatment LPE had more severe externalizing problems and lower empathy than children without LPE but did not differ in emotion recognition accuracy or anxiety. Dimensional CAPE symptom sum scores were associated with criterion variable scores in expected ways and offered incremental validity beyond scores on the parent-report Inventory of Callous-Unemotional Traits for predicting conduct problem severity, aggression, empathy deficits, and global emotion recognition accuracy. Among children who completed parent management training (n = 44), those diagnosed with LPE ended treatment with more severe aggressive behavior than those without LPE. Overall, children diagnosed with CAPE LPE have severe externalizing problems and achieve reduced benefits from standard parent management training, supporting the need for tailored and intensive interventions to maximize treatment outcomes.

The Clinical Assessment of Prosocial Emotions (CAPE): Initial tests of reliability and validity in a clinic-referred sample of children and adolescents.

“…In the present study, we showed that scores from the CAPE were also substantially correlated with ratings of CU traits on the ICU. Also, consistent with past research (Hawes et al, 2020; Molinuevo et al, 2020; Neo et al, 2023), we found that scores from the CAPE were correlated with measures of conduct problems and aggression. Of note, we also demonstrated the CAPE scores were associated with aggression, even when controlling for CD symptoms.…”

“…In summary, the current results, along with past findings (Hawes et al, 2020; Molinuevo et al, 2020; Neo et al, 2023) support cautious use of the CAPE in clinical assessments and the continued development and testing of its psychometric properties. Of most importance, the current findings suggest that CAPE scores predicted clinically important constructs, even after controlling for the level of CU traits obtained on behavior ratings.…”

“…It also prevented us from testing whether the reliability and validity of the CAPE was consistent across the wide age range used in our study (i.e., 6–17 years of age). The CAPE was designed to allow clinicians to tailor their follow-up questions to the developmental level of the child, and the results from Neo et al (2023) suggested that this can be done in a reliable and valid manner for children ages 2–8. However, more research is needed on how best collect information and weigh information from different informants across different developmental levels.…”

“…While this is an important test of validity of the CAPE and the LPE diagnoses, elevated CU traits have also been shown to designate subgroups of youth with conduct problems who show very different emotional (e.g., differences in emotional reactivity to distress in others) and cognitive (e.g., differences in their responses to punishment) characteristics, as well as differences in their response to treatment (see Frick, 2022 for a review). While these outcomes were tested by Neo et al (2023) in young children, future studies need to continue to test the CAPE’s validity in designating an important subgroup of youth with serious conduct problems, using other indicators of potential etiological and clinical utility.…”

“…Finally, a study by Neo et al (2023) further tested the psychometric properties of the CAPE using a sample of 232 clinic-referred children aged 2-8 years. The authors reported that the CAPE LPE symptom scores had good interrater reliability and internal consistency and, as in the Hawes et al (2020) study, they predicted conduct problem severity and aggression over and above a parent rating of CU traits.…”