The Clinical Assessment of Prosocial Emotions (CAPE 1.1): A multi-informant validation study.

Abstract

Support for the clinical importance of callous and unemotional (CU) traits has grown considerably in recent years, yet tools for the assessment of CU traits in clinical settings have largely been limited to questionnaires. This study examined the validity of the Clinical Assessment of Prosocial Emotions (CAPE 1.1), a newly developed clinician-rating measure of CU traits in children and adolescents. Participants were children aged 3 to 15 years (N ϭ 82; 75% male) who were referred for treatment of conduct problems. Diagnoses of conduct disorder and oppositional defiant disorder were formulated based on semistructured diagnostic interviews prior to treatment. The CAPE 1.1 was scored based on structured interviews administered jointly to mothers and fathers and was validated with questionnaire measures of CU traits and other correlates of CU traits from multiple informants. Evidence of criterion validity was found in significant associations between CAPE 1.1 scores and questionnaire measures of CU traits completed by mothers, fathers, and teachers. Evidence of construct validity was found in significant associations between CAPE 1.1 scores and established correlates of CU traits, including severity of oppositional defiant disorder/conduct disorder symptoms indexed via diagnostic interview with parents, teacher ratings of proactive aggression, and reports of affective empathy by mothers and fathers. These findings provide support for the clinical utility of the CAPE 1.1 and its inclusion as part of a comprehensive assessment of children and adolescents with conduct problems. Public Significance StatementThis study provides empirical support for a new interview-based method for assessing limited prosocial emotions (e.g., a lack of guilt and empathy) in children with conduct problems (e.g., aggressive and disruptive behavior). This is important because existing clinical tools for assessing limited prosocial emotions have been limited to questionnaires alone despite the important role of clinical interview data in the formulation of psychiatric diagnoses.

The DSM-5 with Limited Prosocial Emotions Specifier for Conduct Disorder: a Systematic Literature Review

“…Nevertheless, it is relevant to note that this study did not consider CD diagnosis and reported findings that contrast common expectations surrounding the DSM-5 LPE specifier. 5 A second study that explored the psychometric properties of the CAPE, reported group comparisons between children and adolescents with ODD or CD who met DSM-5 criteria for the DSM-5 specifier (ODD/ CD + LPE; n = 20) and who did not (n = 34) (Hawes et al 2019). 6 Both groups did not significantly differ in antisocial behavior and proactive aggression, though the ODD/CD + LPE group displayed significantly lower levels of affective empathy (d = .70).…”

“…Yet, both studies would not have been included because of our inclusion criteria. TheCentifanti et al (2019) study did not consider a CD diagnosis, whilst theHawes et al (2019) study did not differentiate between an ODD and CD diagnosis when testing the LPE specifier. J Psychopathol Behav Assess (2020) 42:248-258…”

Psychometric Properties of a Semistructured Interview to Assess Limited Prosocial Emotions

“…The CAPE 1.1 has been subjected to recent psychometric evaluation and shown promising reliability and validity of symptom counts and diagnostic cutoffs in international samples of high-risk (Centifanti et al, 2020) and detained youth (Molinuevo et al, 2019). Hawes et al (2020) found evidence to support the reliability and validity of the CAPE 1.1 in a clinic-referred sample of children and adolescents (3 to 15 years) with conduct problems. CAPE 1.1 scores were associated with established correlates of CU traits (i.e., ODD and CD symptom severity, proactive aggression, and affective empathy).…”

“…While the CAPE 1.1 is a promising clinical tool to assess CU traits as defined by the LPE specifier (Hawes et al, 2020; Molinuevo et al, 2019), it requires extensive training in the assessment of psychopathology, extensive training in the CAPE specifically, and a fair amount of time in asking follow-up questions specifically about LPE. Such a clinician rating system may not be feasible in many clinical or research settings where the child needs to be assessed comprehensively for psychopathology by a semi-structured interview and without a clinician with extensive training.…”

Longitudinal Associations between Callous-unemotional (CU) Traits and School-based Affiliative Relationships among South Korean Children

“…These 9 items tapped into the presence of callousness and a lack of guilt (e.g., I am helpful if someone is hurt, upset or feeling ill', "I feel bad or guilty when I do something wrong"), with each item rated on a 3-point scale from 0 (not true) to 2 (certainly true). The original UNSW CU traits index has been shown to exhibit high reliability and construct validity (Hawes et al, 2019) and has been used to validate other measures of CU traits (Hawes et al, 2020). In the current sample, the psychometric properties and construct validity of a revised 9-item CU traits scale were established in a prior study using confirmatory factor analysis (see Hwang et al, 2020Hwang et al, , 2021; T1, α = .78; T2, α = .81; T3, α = .81).…”