The research, led by Lily Chen and Eva Kimonis of the University of New South Wales together with colleagues at Macquarie University, is the first to disentangle the unique contributions of ASD symptoms and CU traits to different components of empathy in clinic-referred children as young as one to eight years old. The distinction matters enormously for treatment. Children with conduct problems, which include the symptoms of oppositional defiant disorder and conduct disorder, are among the most common referrals to psychological services, and an estimated 20 to 50 percent of them also show CU traits, a pattern marked by lacking guilt, remorse, and concern for others. Meanwhile, between 22 and 51 percent of young people with ASD also display elevated CU traits, creating a diagnostic tangle that has long frustrated clinicians trying to decide which intervention a child actually needs.

The theoretical backbone of the study is a hierarchical model of empathy proposed by Nuske and colleagues, which treats empathic responding as the final product of an assembly line. First, a child must attend to another person’s emotional cues. Next, the child must recognise which emotion those cues express and understand the underlying emotional state, a capacity related to theory of mind. Only then can the child produce a behavioural empathic response, such as comforting or helping. According to the model, empathy can fail at any link in this chain, and crucially, different disorders may break different links. Prior meta-analyses suggested that CU traits blunt affective resonance, the emotional arousal that motivates prosocial action, whereas ASD primarily disrupts cognitive empathy, including emotion recognition and perspective taking. But almost no previous study had tested both conditions simultaneously in the same young clinical sample.

The researchers recruited 317 children referred to a university-based or community-based clinic in metropolitan Sydney for assessment and treatment of conduct problems, plus 91 typically developing children from the same communities. Parents completed well-validated questionnaires: the Eyberg Child Behaviour Inventory for conduct problems, the Social Communication Questionnaire for ASD symptoms, and the preschool version of the Inventory of Callous-Unemotional Traits. Children themselves then completed a battery of laboratory tasks. A preschool dot-probe task measured how quickly children orient their attention toward images of distress. A dynamic emotion recognition task presented 40 one-second video clips of adults expressing anger, fear, happiness, sadness, or pain, and asked children to identify the emotion. Understanding of emotional states was probed with an ingenious task built around four emotional scenes from the animated film The Lion King, in which children were asked how Simba felt and why. Prosocial responding was captured through parent-report measures of empathic behaviour.

The statistical strategy was deliberately layered. Hierarchical regressions tested whether ASD symptoms or CU traits were uniquely associated with each empathy component, over and above the severity of conduct problems and the influence of components lower in the hierarchy. The results drew a strikingly clean dividing line. ASD symptoms, but not CU traits, were uniquely associated with poorer emotion recognition, a small-to-moderate effect. When the researchers examined specific emotions, higher ASD symptoms predicted deficits in recognising anger, fear, and pain, though not happiness or sadness in this sample. In contrast, CU traits, but not ASD symptoms, were uniquely and negatively associated with empathic responding, and this association was small to moderate in size. Neither condition showed a unique association with attention to distress cues or with understanding of emotional states once the lower components of the hierarchy were accounted for.

The person-centred analyses told the same story from a different angle. Children were classified into clinical groups: conduct problems alone, conduct problems plus CU traits, conduct problems plus ASD, and conduct problems with both. The two groups containing ASD, CP+ASD and CP+CU+ASD, showed significantly poorer emotion recognition than the CP+CU group, whose accuracy did not differ from typically developing children. The pattern reversed for empathic responding. Here the CP+CU+ASD group showed the lowest prosocial behaviour of all, significantly below the CP+CU group, which in turn fell significantly below the CP-only group. Children with conduct problems alone did not differ from typically developing children. In other words, ASD erodes the cognitive front end of the empathy chain, while CU traits erode the affective back end, and when both are present the damage compounds.

One of the most consequential implications of the findings is that emotion recognition deficits long attributed to psychopathy and CU traits may actually have been driven by undetected, co-occurring ASD symptoms. Earlier meta-analyses had reported that children with CU or psychopathic traits struggle to recognise anger, fear, and sadness. But those analyses never controlled for ASD. The current results, consistent with a 2021 study of seven-year-old community children, suggest that once ASD symptoms are accounted for, the link between CU traits and emotion recognition largely evaporates. This reframing matters because it redirects clinical attention: a child with conduct problems and poor emotion reading may need support with social perception, not the interventions designed for shallow affect.

Equally intriguing is what the study found about children with ASD whose empathic responding remains intact. Despite measurable emotion recognition deficits, these children engaged in prosocial behaviour at levels comparable to typically developing peers. Emerging research suggests that some autistic individuals experience differences rather than deficits in emotional processing, including hypersensitivity to others’ emotions that can heighten emotional resonance in some situations, even when recognising facial expressions is harder. This challenges the popular but inaccurate stereotype that autism is defined by an absence of empathy, and it aligns with systematic reviews showing that autistic children comfort, help, and share to the same degree as their neurotypical peers.

The study is not without limitations, which the authors acknowledge candidly. Some laboratory tasks, particularly the dot-probe measure of attention and the Lion King task of emotional understanding, may have been too demanding for children as young as one to four years old, since the attention task is validated only from age three and the understanding task from age five. Low accuracy rates and high variance on these measures may explain why no unique associations emerged for those components, contradicting some earlier work with older children and adolescents. Laboratory data were also not available for every participant, leaving some analyses underpowered, and the sample contained no children with ASD without comorbid conduct problems, so the findings cannot yet be generalised to that population. The authors suggest that mobile eye tracking, which requires no active response from the child, could provide a more developmentally appropriate window onto attentional processes in future research.

The clinical payoff is concrete. For children with conduct problems and co-occurring ASD, the hierarchical model implies that adding an emotion recognition module to treatment could produce flow-on benefits to emotional understanding and empathic behaviour. For children with CU traits, whose recognition and understanding appear relatively preserved, the evidence points toward directly training empathic responding itself. One promising example is the Coaching and Rewarding Emotional Skills module adapted for Parent-Child Interaction Therapy for children with CU traits, which uses parent modelling and an intensive reward-based token economy to reinforce prosocial behaviour and has been shown to significantly improve child empathy. Given that CU traits predict earlier-onset, more severe, and more treatment-resistant antisocial behaviour, identifying which children need which kind of support, and doing so before school age, could change developmental trajectories that are otherwise difficult to redirect. The authors call for replication in larger samples and in populations beyond clinic-referred children, but the central message is already clear: empathy fails in different places for different children, and treatment should target the exact link that is broken.

Subject of Research: Differential associations of childhood callous-unemotional traits and autism spectrum disorder symptoms with components of empathy in children with conduct problems

Article Title: The Empathy Hierarchy: Unique Associations of Childhood Callous Unemotional Traits and Autism Spectrum Disorder Symptoms

Article References: The Empathy Hierarchy: Unique Associations of Childhood Callous Unemotional Traits and Autism Spectrum Disorder Symptoms. (n.d.). https://doi.org/10.1007/s10578-026-02104-5

Image Credits: AI Generated

DOI: 10.1007/s10578-026-02104-5

Keywords: autism spectrum disorder, callous-unemotional traits, empathy, emotion recognition, conduct problems, prosocial behaviour, theory of mind, child psychopathology, hierarchical model of empathy, clinical assessment, developmental psychology, Parent-Child Interaction Therapy