The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5

Abstract

In DSM 5, conduct disorder (CD) has been expanded with a new specifier 'with Limited Prosocial Emotions' (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe antisocial subgroup of CD. However, research in clinical practice has been scarce. Therefore, the current study will examine differences in clinical symptoms between subtypes of CD, based on both subtyping schemes. Subsequently, it will investigate whether the LPE specifier explains unique variance in aggression, added to the AoO subtyping. A sample of 145 adolescents with CD (51 % male, mean age 15.0) from a closed treatment institution participated in this study. CD diagnoses and AoO subtype were assessed using a structured diagnostic interview. The LPE specifier was assessed using the callous-unemotional dimension of the Youth Psychopathy Traits Inventory (YPI). Self-reported proactive and reactive aggression, rule-breaking behavior and internalizing problems within the subtypes were compared. Youth with childhood-onset CD and LPE showed significantly more aggression than adolescent-onset CD without LPE (proactive aggression: F = 3.1, p < 0.05, reactive aggression: F = 3.7, p < 0.05). Hierarchical regression revealed that the LPE specifier uniquely explained 7 % of the variance in reactive aggression, additionally to the AoO subtyping. For proactive aggression, the interaction between AoO and the LPE added 4.5 % to the explained variance. Although the LPE specifier may help to identify a more aggressive subtype of CD in adolescents, the incremental utility seems to be limited. Therefore, clinical relevance of the LPE specifier in high-risk adolescent samples still needs to be investigated thoroughly.

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

“…Second, we included studies that tested the categorically defined DSM-5 LPE specifier criteria via measures that allow assessing the four DSM-LPE symptoms. Thus, studies that could not assess all symptoms (e.g., Colins 2016;Jambroes et al 2016) or used CU measures that cannot straightforwardly be linked to the four LPE symptoms, for example, because CU measures also tapped interpersonal traits (Rowe et al 2010), were not included for review purposes. The first and second inclusion criteria were used to be 1 Because the main diagnostic criteria of CD remained unchanged in the DSM-5, studies that assessed DSM-IV CD are equally valid to assess DSM-5 CD.…”

“…1 PRISMA Flow Diagram * Papers were predominantly excluded for review purposes because CU measures were not used to assess the DSM-5 specifier symptoms. Other reasons were, for example, the use of CU measures that only enable to assess three of the four LPE specifier criteria (Colins 2016;Colins and Vermeiren 2013;Jambroes et al 2016), the lack of formal comparison of CD + LPE with CD Only youth (McMahon et al 2010), or lack of information about the assessment procedure followed to determine a CD diagnosis (Pechorro et al 2015); ** Two papers were identified after checking the references Sakai et al 2017), whilst three papers were identified by advance online publication explorations (Byrd et al 2018;Sethi et al 2018;Oldenhof et al 2018); *** Three of the five aforementioned potentially relevant papers were not included for review purposes because no measures of CD were used (Byrd et al 2018), and because youth who did not met criteria for CD also enrolled in the study whilst analyses were not run separately for youth with a CD diagnosis (Oldenhof et al 2018;Sakai et al 2017); **** Two papers used largely overlapping samples (Colins et al 2017;Van Damme et al 2016), but focused on a different research question, and therefore added significant incremental information to the review. Consequently, both papers were included for review purposes but will be treated as one and the same study magnitude of the significant group differences.…”

Conduct disorders and psychopathy in children and adolescents: aetiology, clinical presentation and treatment strategies of callous-unemotional traits

“…This category, although necessary for a diagnosis, cannot capture the complexity of the clinical manifestations of CD, which are highly heterogeneous in terms of clinical presentation (high or low level of socialized behaviours, early or late onset, with impulsive or proactive aggression, high or low rate of comorbid affective disorders), outcome (remission or chronicity) and response to treatments (good or poor response to psychoterapy or pharmachotherapy) [ 3 ]. The fifth edition of Diagnostic and Statistical Manual of Mental Health [ 2 ] (DSM-5) has defined a new specifier for the CD diagnosis named “with limited prosocial emotions” (LPE); this update should help clinicians and researchers in reducing this heterogeneity, to improve their diagnostic and prognostic abilities [ 4 , 5 ].…”

Taxometric analyses and predictive accuracy of callous-unemotional traits regarding quality of life and behavior problems in non-conduct disorder diagnoses

“…However, recent studies find limited usefulness of the cut-off score for the criteria of the LPE specifier in detained youths (Colins and Vermeiren, 2013;Colins, 2016;Colins et al, 2017), in former refugees (Latzman et al, 2016), and in conduct-disordered youths with substance abuse (Sakai et al, 2016). Only 4.5-7% of the variance in aggression was explained by the LPE specifier (Jambroes et al, 2016). In addition, research comparing the parent-reported versus selfreported LPE criteria yields inconclusive results (Van Damme et al, 2016;Colins et al, 2017).…”