The association between callous-unemotional traits and substance use in childhood and adolescence: A systematic review and meta-analysis

Callous-unemotional (CU) traits are characterized by a lack of guilt and empathy, restricted affect, and low concern about performance, and are increasingly recognized as co-occurring with substance use in youth. However, there is mixed evidence concerning whether they make a unique contribution to substance use. This systematic review and meta-analysis sought to quantify the association between CU traits and substance use in childhood, accounting for potential moderators including sample characteristics (age, gender, community versus clinical/forensic samples), CU traits measure and informant, and study design (cross-sectional or longitudinal). Separate meta-analyses were conducted for alcohol, cannabis, and a substance use composite. Small, significant associations were found between CU traits and alcohol (θ = 0.17), cannabis (θ = 0.17) and the substance use composite (θ = 0.15), which were present in both community and clinical/forensic samples. Findings suggest that CU traits co-occur with a range of substance use problems, and that CU traits should be considered in assessments of youth presenting with substance use problems regardless of the nature of the setting.