Multilevel meta-analyses of emotional processing deficits associated with callous-unemotional (CU) traits: Do they differ by age and sex?

Callous-unemotional (CU) traits, defined by deficient empathy and remorse, characterize a distinct subgroup of antisocial individuals with more severe behavioral problems and unique affective profiles. Two processes implicated in the development of CU traits are hyporeactivity to and inaccurate recognition of others’ emotions. Although many studies link CU traits to emotional processing deficits, findings have been inconsistent across age and sex. We conducted multilevel meta-analyses of emotional reactivity and recognition, accounting for age and sex as moderators, to clarify these discrepancies. A four-level meta-analysis indicated CU traits were negatively associated with emotional reactivity to both broad emotional stimuli (r = -.23, p < .0001; k = 106, n = 402) and distress-specific stimuli (r = -.22, p < .0001; k = 83, n = 234), with no moderation by age or sex. Similarly, a three-level meta-analysis showed CU traits were negatively associated with recognition accuracy for both broad facial emotions (r = -.09, p < .0001; k = 97, n = 437) and distress (e.g., fear, sadness; r = -.10, p < .0001; k = 60, n = 140). Sample age moderated broad (r = .003, p = .01) and distress (r = .004, p = .04) recognition deficits, such that effects diminished with sample age. These results have important implications for causal theories of CU traits and support emotional hyporreactivity as a core deficit that may cause delays in the development of emotion recognition abilities. Such developmental changes have implications for improving treatments for individuals with elevated CU traits.