As described below, three neurocognitive dysfunctions have been linked to clinical aspects of conduct disorder, thereby bridging brain-systems and clinical data. This work has involved a range of clinical entities, which often overlap in patterns depicted in Figure 1. As discussed below, these dysfunctions are more clearly associated with callous–unemotional traits than the other entities shown in Figure 1. Thus, the first dysfunction, deficient empathy, occurs relatively selectively in youth with these traits, whereas the second dysfunction, heightened threat sensitivity, does not occur in this group. Rather, heightened threat sensitivity occurs in patients who have conduct disorder without callous–unemotional traits and in patients with anxiety disorders. The third dysfunction, deficient decision making, is expressed similarly in youth with conduct disorder who have callous–unemotional traits and those without such traits. Moreover, deficient decision making may represent the lowest common denominator for conduct problems — that is, the dysfunction is shared by multiple syndromes involving conduct problems. Few studies have examined correlations among these three neural dysfunctions, and none have directly compared patterns of dysfunction in children with the different clinical presentations depicted in Figure 1. Hence, it remains unclear how these dysfunctions interact to shape clinical profiles for individual children.
