Louisiana State University, Baton Rouge, Louisiana.
J Am Acad Child Adolesc Psychiatry. 2021 Aug;60(8):952-954. doi: 10.1016/j.jaac.2020.12.020. Epub 2020 Dec 21.
Colins et al. address a timely and important topic. Specifically, both the DSM-5 and the International Classification of Diseases, 11th edition (ICD-11) for the first time introduced a specifier (ie, with limited prosocial emotions) for the diagnosis of conduct disorder (DSM-5) or for the diagnoses of conduct-dissocial and oppositional defiant disorders (ICD-11) to designate those persons with these disorders who also show elevated levels of callous-unemotional (CU) traits. This change was based on research showing that children and adolescents with significant conduct problems who also show elevated levels of CU traits seem to be an etiologically and clinically important subgroup of persons with these disorders. The DSM-5 chose not to conduct field trials to test the validity of new diagnoses (only reliability) and, instead, considers research on new diagnoses as the field trials for future revisions of the manual. Thus, the work by Colins et al. is critical for this validation process. The study by Colins et al. has a number of methodological features that make their results particularly informative. The most notable feature was the use of a large nonreferred sample that was followed from 3 to 5 years of age to 11 to 13 years of age with a high retention rate. The authors also provide a nice summary of past attempts to validate the LPE specifier, which has provided mixed support at best. However, they also note that most of these studies did not use the full criteria for the LPE specifier and that this is an important limitation that Colins et al. overcome, especially given that the criteria include only 4 symptoms. Thus, the authors' findings that children with the LPE specifier and serious conduct problems exhibited more conduct disorder (CD) symptoms and comorbid problems (ie, fearlessness, symptoms of oppositional defiant disorder, and attention-deficit/hyperactivity disorder [ADHD]) and were at higher risk for future CD symptoms 3 years later are critical advances.
科林斯等人探讨了一个及时且重要的话题。具体而言，《精神疾病诊断与统计手册》第五版（DSM-5）和《国际疾病分类》第 11 版（ICD-11）首次引入了一个特定项目（即有限的亲社会情感），用于诊断品行障碍（DSM-5）或品行障碍-对立违抗性障碍和对立违抗性障碍的诊断（ICD-11），以指定那些具有这些障碍且表现出较高冷酷无情（CU）特征的人。这一变化基于研究表明，具有明显行为问题且表现出较高 CU 特征的儿童和青少年似乎是这些障碍患者中具有重要病因学和临床意义的亚组。DSM-5 选择不进行现场试验来测试新诊断的有效性（仅测试可靠性），而是将新诊断的研究视为手册未来修订的现场试验。因此，科林斯等人的研究对于这一验证过程至关重要。科林斯等人的研究具有许多方法学特征，使他们的研究结果特别有意义。最显著的特征是使用了一个大型的非转介样本，该样本从 3 岁到 5 岁被跟踪到 11 岁到 13 岁，保留率很高。作者还对过去验证 LPE 特定项目的尝试进行了很好的总结，这些尝试最多只能提供混合支持。然而，他们也指出，这些研究大多没有使用 LPE 特定项目的完整标准，这是一个重要的限制，科林斯等人克服了这一限制，尤其是考虑到标准只包括 4 个症状。因此，作者的发现是，具有 LPE 特定项目和严重行为问题的儿童表现出更多的品行障碍（CD）症状和共病问题（即无畏、对立违抗性障碍症状和注意力缺陷/多动障碍[ADHD]），并且在 3 年后发生 CD 症状的风险更高，这是重要的进展。
