Vol.:(0123456789)
Clinical Child and Family Psychology Re iew (2024) 27:165–219
h ps://doi.o g/10.1007/s10567-023-00466-z
Emo ion Recogni ion De ici s inChild en andAdolescen s
wi hPsychopa hic T ai s: ASys ema ic Re iew
Bea izDíaz‑Vázquez1 · Lau aLópez‑Rome o1 · Es ellaRome o1
Accep ed: 3 Decembe 2023 / Published online: 19 Janua y 2024
© The Au ho (s) 2024
Abs ac
Child en and adolescen s wi h psychopa hic ai s show de ici s in emo ion ecogni ion, bu he e is no consensus as o he
ex en o hei gene alizabili y o abou he a iables ha may be mode a ing he p ocess. The p esen Sys ema ic Re iew
b ings oge he he exis ing scien i ic co pus on he subjec and a emp s o answe hese ques ions h ough an exhaus i e
e iew o he exis ing li e a u e acco ding o PRISMA 2020 s a emen . Resul s con i med he exis ence o pe asi e de ici s
in emo ion ecogni ion and, mo e speci ically, on dis ess emo ions (e.g., ea ), a de ici ha anscends all modali ies o
emo ion p esen a ion and all emo ional s imuli used. Mo eo e , hey suppo ed he key ole o a en ion o ele an a eas
ha p o ide emo ional cues (e.g., eye- egion) and poin ou di e ences acco ding o he p esence o dis up i e beha io
and based on he psychopa hy dimension examined. This e idence could ad ance he cu en knowledge on de elopmen al
models o psychopa hic ai s. Ye , homogeniza ion o he condi ions o esea ch in his a ea should be p io i ized o be able
o d aw mo e obus and gene alizable conclusions.
Keywo ds Emo ion ecogni ion· Psychopa hic ai s· Childhood· Adolescence· A en ion bias
In oduc ion
Psychopa hic pe sonali y, de ined as a cons ella ion o
in e pe sonal (e.g., supe icial cha m, g andiosi y), a ec-
i e (lack o emo se, callousness) beha io al/li es yle (e.g.,
i esponsibili y, impulsi i y) and a guably an isocial ai s
(e.g., poo beha io al con ol, ea ly beha io al p oblems)
(Ha e & Neumann, 2008), cons i u e one he bes p edic o s
o se e e, ch onic and di icul - o- ea an isocial beha io ,
wi h an impo an economic and social bu den (Reidy e al.,
2015). In an e o o gain deepe insigh s in o he eme -
gence o he mos se ious, agg essi e and pe sis en pa e n
o child and you h conduc p oblems (CP), he s udy o psy-
chopa hic pe sonali y has been downwa d ex ended o ea ly
de elopmen al s ages. This line o esea ch has allowed o
collec ex ensi e e idence on use ulness and iabili y o psy-
chopa hic ai s ac oss ea ly childhood (i.e., p eschool yea s;
e.g., Walle & Hyde, 2018), middle childhood (i.e., elemen-
a y school yea s; e.g., Go in e al., 2019) and adolescence
(e.g., Lynam e al., 2009). P e ious esea ch conduc ed in
young samples was mainly ocused on he a ec i e dimen-
sions o psychopa hic ai s (i.e., CU ai s), la gely exam-
ined as a pu a i e p ecu so o adul psychopa hy (Hyde &
Do e e , 2022). In his ega d, an ex ensi e line o esea ch
has suppo ed CU ai s as a po en ial iden i ie o an e io-
logical and clinically dis inc i e subg oup o p oblema ic
child en1 (see F ick e al., 2014). As a esul , a new speci ie ,
la gely based on he CU concep ualiza ion, has been added
o CD in he la es edi ion o he Diagnos ic and S a is ical
Manual o Men al Diso de s (DSM-5; Ame ican Psychia -
ic Associa ion—APA, 2013; i.e., “wi h limi ed p osocial
emo ions”), and he In e na ional Classi ica ion o Diseases
(ICD-11; Wo ld Heal h O ganiza ion—WHO, 2019; i.e.,
“limi ed s. p osocial emo ions”).
* Lau a López-Rome o
[email p o ec ed]
Bea iz Díaz-Vázquez
[email p o ec ed]
Es ella Rome o
es ella. ome [email p o ec ed]
1 Depa men o Clinical Psychology andPsychobiology,
Facul ade de Psicoloxía, Uni e sidade de San iago de
Compos ela, Campus Vida, San iagodeCompos ela, Spain
1 When no o he cla i ica ion is made, he e ms “child en” o “child-
hood” o e all e e o bo h ea ly (i.e., p eschool) and middle child-
hood (i.e., elemen a y school), including child en up o age 12.
166 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Rega dless he ad ances achie ed om he CU concep u-
aliza ion, he s udy o psychopa hic pe sonali y in childhood
and adolescence has been en iched om a mul idimensional
pe spec i e, in ol ing a cons ella ion o in e pe sonal [g an-
diose-manipula i e (GM)], a ec i e (CU) and beha io al
ai s [impulsi e-need o s imula ion (INS)]. So a , compel-
ling e idence on ea ly iden i ica ion, ela i e s abili y and
p edic i e alue o he psychopa hic cons ella ion has been
consis en ly p o ided (Salekin e al., 2018). Beyond old and
cu en deba es abou which dimension(s) should be con-
side ed in de elopmen al models o CP (see F ick, 2022;
Salekin, 2022), addi ional suppo o conside ing in e pe -
sonal (GM) and beha io al ai s (INS)2 when de ining and
s udying psychopa hic pe sonali y has been inc easingly
collec ed (see Salekin, 2017, 2022). Hence, some ecen
s udies ha e ein o ced psychopa hic ai s, concep ualized
as a mul idimensional cons uc , as a ele an p edic o in
he de elopmen o se ious CP and o he o ms o child and
adolescen maladjus men (e.g., Be gs øm & Fa ing on,
2022; Bu ke e al., 2022; Colins e al., 2022; Fan i e al.,
2018; López-Rome o e al., 2021, 2022). A c i ical ques ion
in he ield is, he e o e, whe he including o he dimensions
o psychopa hy may inc ease ou knowledge abou he con-
s uc , pa icula ly cla i ying how all a ec i e, in e pe sonal,
and beha io al dimensions de elop, and which e iological
p ocesses migh be unde lying. I psychopa hic pe sonali y
indeed iden i ies a subg oup o child en and adolescen s wi h
mo e se ious and pe sis en CP, disen angling i s po en ial
dis inc i e e iological pa hways will en ich de elopmen al
models o bo h psychopa hic ai s and dis up i e beha io .
Un a eling heDe elopmen al Basis
o Psychopa hic T ai s: The Role o Emo ion
Recogni ion
P obably due o he p ominence o he a ec i e ai s in he
concep ualiza ion and mani es a ion o psychopa hic pe son-
ali y, a ec i e impai men s ha e been la gely esea ched in
ela ion o psychopa hic ai s a he neu obiological, cogni-
i e, emo ional and beha io al le els (Blai , 2013). De el-
opmen al models o psychopa hy ha e commonly poin ed
o an amygdala dys unc ion (e.g., Blai , 2003a), which is
in ol ed in emo ion ecogni ion (Phelps & LeDoux, 2005),
a p ocess ha also seems o be a ec ed in indi iduals high
on psychopa hic ai s (Dawel e al., 2012). Emo ion ec-
ogni ion e e s o he abili y o a ibu e emo ional s a es in
o he s, based on he iden i ica ion o emo ional cues ele an
o socializa ion. Accu a ely p ocessing emo ional exp es-
sions, pa icula ly acial exp essions, is c i ical o e e yday
unc ioning as i acili a es app op ia e in e pe sonal com-
munica ion (Ma sh & Blai , 2008), p omo es sha ed a ec-
i e expe ience (Hinnan & O’B ien, 2007), and mo i a es
p osocial beha io (Ma shall & Ma shall, 2011). Con e sely,
de ici s in emo ion ecogni ion may lead o dys unc ional
in e pe sonal ela ionships and social adjus men (Ky a-
nides e al., 2020), pa icula ly when de ici s in ecogni ion
a ec dis ess emo ions (e.g., ea , sadness). Hence, ailing
o ecognize o he s’ dis ess may hinde he de elopmen o
empa hic conce n h ough a p ocess ha would imply he
absence o discom o ha ypically ollows w ong beha -
io s (e.g., guil ). This, in u n, would es ain he inhibi ion
o hose beha io s ha may cause dis ess in o he s (e.g.,
Kochanska e al., 2010). Acco dingly, de ici s in emo ion
ecogni ion ha e been sugges ed as a po en ial link be ween
psychopa hic ai s and di e en o ms o beha io al malad-
jus men (e.g., CP, an isocial beha io ) commonly obse ed
in high psychopa hic indi iduals (F ick e al., 2014; Salekin,
2017).
Whe he emo ion ecogni ion de ici s a e speci ic o dis-
ess emo ions o e lec a mo e pe asi e emo ional impai -
men has been a ques ion o e deba e. F om one pe spec-
i e, Blai (1995, 2006) sugges ed ha psychopa hy would
be ma ked by speci ic de ici s in he ecogni ion o bo h
ea and sadness. This would esul in he no-expe ience o
a e sion a e a beha io ha may cause dis ess in o he s,
allowing indi iduals wi h psychopa hic ai s o beha e in a
sel -g a i ying and goal-di ec ed manne , wi hou he nega-
i e consequence o eeling guil y and bad. O e all, hese
de ici s would pa ially explain he callous, un emo se ul
and decei ul beha io in psychopa hic pe sonali y. F om an
al e na i e app oach, Dadds e al. (e.g., Dadds e al., 2006,
2008) ha e p oposed a dys unc ion on a en ional mecha-
nisms ha would unde lie emo ion ecogni ion de ici s.
Mo e speci ically, a en ional de ici s o socially ele an
cues (i.e., he eyes, wi h some new e idence also o he
mou h; Deme iou & Fan i, 2022), would se e as he basis
o he emo ion ecogni ion de ici s obse ed in high psy-
chopa hic indi iduals (Dadds e al., 2011, 2014). F om his
pe spec i e, impai men s in emo ion ecogni ion would be
mo e pe asi e a he han speci ic and would de i e a mo e
gene alized de ici in socio-emo ional unc ioning (Dawel
e al., 2012).
Bo h heo e ical app oaches ound suppo in p e ious
me a-analy ic s udies, which mainly examined esul s om
adul popula ions. The i s documen ed me a-analysis on he
opic p o ided suppo o a speci ic de ici in ecognizing
ea and, o a lesse ex en , sadness om acial exp essions
2 These dimensions, pa icula ly he in e pe sonal and beha io al,
ha e been di e en ly labelled in p e ious li e a u e as i is he case o
“g andiose-decei ul” o he in e pe sonal (Ande shed, e al., 2002;
Colins e al., 2014) o “da ing-impulsi e” (Salekin & Ha e, 2016),
“impulsi e-i esponsible” (Ande shed e al., 2002) o he beha io al
dimensions. To be consis en ac oss he s udy, we ha e assumed GM,
CU and INS ac onyms, as de ined in he main ex , o e e o in e -
pe sonal, a ec i e and beha io al psychopa hic ai s espec i ely.
167Clinical Child and Family Psychology Re iew (2024) 27:165–219
in an isocial indi iduals, wi h no mode a ion o psycho-
pa hic ai s (Ma sh & Blai , 2008). La e s udies epo ed
a mo e pe asi e de ici , wi h impai men s in he ecogni-
ion o mul iple emo ions (Wilson e al., 2011), also when
mo e han acial cues (i.e., ocal, pos u al) we e examined
(Dawel e al., 2012). F om hese me a-analy ic s udies, only
Dawel e al. (2012) dis inguished be ween adul and young
samples—including bo h middle-school child en and ado-
lescen s, who showed de ici s o all emo ions, and pa icu-
la ly ange , ea and sadness, wi h g ea e e ec s o ea .
Ye , mos analyses we e conduc ed o he o al sample, wi h
mos adul s om he o ensic se ing, and mos child en/ado-
lescen s om communi y o clinical se ings. No addi ional
dis inc ion was made be ween child and adolescen samples,
and no o he ele an mode a o s (e.g., gende , age, sample
ype, he p esence -o no - o concu en dis up i e beha io )
we e examined.
Emo ion Recogni ion andPsychopa hic T ai s
inChildhood andAdolescence
The mul iple s udies published so a in child and adolescen
samples ha e yielded, o da e, mixed esul s, p obably due
o a a ie y o designs, sampling p ocedu es and me hods
ha makes i di icul o ex ac i m conclusions (No ham
& Dadds, 2020). Mi o ing esul s om adul samples (e.g.,
B islin & Pa ick, 2019; Deme io e al., 2017; Ky anides
e al., 2020), some s udies p o ided addi ional e idence o
he speci ic de ici in he ecogni ion o ea (e.g., Fai child
e al., 2009), and o he dis ess emo ions, including ange
o sadness (e.g., Muñoz, 2009; Powell e al., 2023). O he s,
in con as , ha e ound mo e pe asi e de ici s ac oss di -
e en emo ions including disgus o happiness (e.g., Kahn
e al., 2017). The e is also opposi e e idence, wi h some
s udies showing inc eased ecogni ion o dis ess emo ions
(e.g., Schwenck e al., 2014), o e en no associa ion be ween
psychopa hic ai s and emo ion ecogni ion (e.g., Ma in-
Key e al., 2020). Unde s anding he di e si y o esul s,
and hei po en ial causes and explana ions, is o u e mos
impo ance o cla i y how psychopa hic ai s de elop,
and which mechanisms may boos o es ain hei nega-
i e consequences. In his ega d, applied implica ions om
his knowledge may di e depending on whe he emo ion
ecogni ion de ici s indeed exis , whe he hey a e speci ic
o one o wo emo ions (e.g., ea o sadness), o whe he
hey e lec a mo e pe asi e impai men in socioemo ional
unc ioning and he in e p e a ion o o he s emo ional s a es.
Rela ed wi h his las hypo hesis, s udies examining a en ion
de ici s ela ed o emo ion ecogni ion also yielded mixed
esul s, pa icula ly when using eye- acke me hodologies
(Deme iou & Fan i, 2022). Thus, e en hough he e was
e idence o educed a en ion o o he ’s eyes in child en
and adolescen s high on CU ai s (e.g., Dadds e al., 2006,
2008; Ma in-Key e al., 2018), some s udies also e ealed
no associa ion be ween CU ai s and a en ion o he eyes
(e.g., Bed o d e al., 2017; Muñoz e al., 2021). In addi ion,
he inclusion o o he ele an ace a eas, such as he mou h,
has made hese esul s e en mo e complex, wi h some s ud-
ies sugges ing ha he de ici s a e mo e speci ic o he eye-
egion (e.g., Deme iou & Fan i, 2022) whils o he s sug-
ges ha emo ions linked o eye- egion de ici s (i.e., ea and
ange ) could di e om hose obse ed in he mou h- egion
(i.e., sadness) (Ha mann & Schwenck, 2020).
The P esen S udy
The pa e n o mixed esul s ob ained in p e ious esea ch
aises he need o sys ema ically o ganize he cu en knowl-
edge, p o iding compelling e idence abou well-es ablished
indings, and iden i ying he gaps and inconsis encies ha
should be add essed in u u e esea ch. This sys ema ic
e iew is de o ed o accu a ely examining he associa ion
be ween psychopa hic ai s, add essing all i s dimensions,
and emo ion ecogni ion de ici s in young samples, including
ea ly childhood, middle-childhood, and adolescence (mean
age up o 18yea s old). As i migh be expec ed, CU ai s
ha e de i ed mos o he esea ch aimed a unde s anding
he a o emen ioned impai men s in emo ion ecogni ion
and p ocessing (see No ham & Dadds, 2020). Howe e , as
e idence has been collec ed on he mul idimensionali y o
he cons uc (Salekin, 2017, 2022) s udies add essing o he
psychopa hy dimensions would be also conside ed. This may
shed new ligh on he na u e o emo ion ecogni ion de ici s
in psychopa hic pe sonali y, leading o disen angle some o
i s mechanis ic ends. I would also help o cla i y whe he
p e ious indings on CU ai s can be ex apola ed o o he
psychopa hy dimensions, whe he he e migh be speci ic
de ici s o speci ic dimensions o whe he a combina ion
o high in e pe sonal, a ec i e, and beha io al psychopa hic
ai s may iden i y a dis inc i e e iological subg oup.
All s udies published o da e ha e been aken in o accoun ,
wi h no ime es ic ions imposed. E en hough he e a e
some p e ious me a-analyses on his opic, hey ha e been
published mo e han 10yea s ago, wo o hem conside ed
oge he young and adul samples (Ma sh & Blai , 2008;
Wilson e al., 2011), and one dis inguished be ween mid-
child/adolescen s and adul samples (Dawel e al., 2012).
Howe e , he s udy om Dawel e al. (2012) did no co e
any s udy in p eschool samples, did no dis inguish be ween
child en and adolescen s, and did no accoun o any o he
po en ial a iables ele an o unde s and he associa ion
be ween emo ion ecogni ion and psychopa hic ai s in
youngs e s, such as he sample ype o he co-occu ence o
CP (Dawel e al., 2012). The e o e, all s udies published up
o 2022 we e examined, and se e al me hodological a i-
ables and sample cha ac e is ics o s udies we e compa ed in
168 Clinical Child and Family Psychology Re iew (2024) 27:165–219
an a emp o accoun o he disc epancies obse ed in p e-
ious esea ch. Due o he impo ance ha a en ion de ici s
may ha e in he emo ion ecogni ion impai men s obse ed
in indi iduals high on psychopa hic ai s (Dadds e al.,
2006), and wi h he aim o p o ide addi ional cla i ica ion
in he a o emen ioned heo e ical app oaches, s udies exam-
ining a en ion biases in he con ex o emo ion ecogni ion
and psychopa hic pe sonali y we e also included.
Mo e speci ically, he p esen sys ema ic e iew aims o
espond o he ollowing ques ions:
1. A e he e emo ion ecogni ion de ici s in child en and
adolescen s wi h di e en le els o psychopa hic ai s?
2. A e emo ion ecogni ion de ici s ela ed o speci ic emo-
ions (e.g., ea , sadness) o do hey espond o a mo e
pe asi e emo ional impai men ?
3. A e he e speci ic de ici s associa ed o di e en psy-
chopa hy dimensions?
4. A e emo ion ecogni ion de ici s speci ically ela ed wi h
a en ion biases o ele an a eas showing emo ional and/
o dis ess cues? (e.g., eye egion, mou h egion)
5. A e he e speci ic di e ences acco ding o age (i.e.,
childhood e sus adolescence), gende (i.e., boys, gi ls),
sample ype (i.e., communi y-based, o ensic, clinical-
e e ed) and he co-occu ence o di e en o ms o dis-
up i e beha io including CP, conduc diso de (CD)
and opposi ional de ian diso de (ODD)?
In acco dance wi h p e ious li e a u e, we an icipa e (a)
an associa ion be ween emo ion ecogni ion and psycho-
pa hic ai s; (b) he p esence o mo e pe asi e a he han
speci ic de ici s; (c) he in luence o he di e en dimen-
sions o psychopa hy, (d) a ele an ole o a en ion biases
in emo ion ecogni ion de ici s; and (e) he mode a ing ole
o socio-demog aphic a iables, including sex and age, as
well as he exis ence o clinical diagnoses (CD, ODD) o
subclinical symp oms (CP).
In sum, his e iew is aimed o o ganize he a ailable
e idence in his ield, by p o iding a comp ehensi e guide
o s udies and by add essing mul iple sou ces o a iabil-
i y. Ul ima ely, his e iew is expec ed o iden i y sha ed
conclusions ac oss s udies, and o delinea e some guide-
lines o homogenize u u e p o ocols and a o addi ional
eplica ion.
Me hod
Sys ema ic Sea ch S a egy
The p esen e iew was pe o med acco ding o he ac u-
alized P e e ed Repo ing I ems o Sys ema ic Re iews
and Me a-Analyses (PRISMA) guidelines (Page e al.,
2021). The PRISMA Checklis is p o ided in TableS1,
a ailable online. A p o ocol o his s udy was de eloped
and egis e ed on PROSPERO (Regis a ion numbe :
CRD42021276769).
A sea ch s a egy (a ailable on P ospe o and Supple-
men X) was de eloped o co e he key elemen s o his
sys ema ic e iew, including (1) psychopa hic ai s (cal-
lous* unemo ion* o CU o psychopa hy o psychopa hic),
(2) emo ion ecogni ion (emo ion* ecogni ion o emo ion*
p ocess* o emo ion* iden i ica ion o eye gaze o eye ack*
o eye ix* o acial emo ion* o emo ion* a en *), and (3)
he de elopmen al pe iod (child* o adolesc*). No e ha
emo ion p ocessing was also included in he sea ch s a egy
since some s udies used indis inc i ely emo ion ecogni ion
and p ocessing o examine speci ic de ici s in he ecogni-
ion o basic emo ions. The sea ch o iden i y ele an li e a-
u e was conduc ed on Sep embe 22nd, 2021 on PsycIn o,
Scopus, PubMed and Web o Science (WOS) da abases. An
upda e o he sys ema ic sea ch was conduc ed on Decem-
be 23, 2022 in o de o include all published s udies up o
2022. The same sea ch e ms we e applied ac oss all da a-
bases wi h adjus men s made o accommoda e he speci ic
equi emen s o he sea ch si es (see Table1). We did no
impose a s a da a as mos s udies in his a ea ha e been
published in he pas 20yea s, and i was ou in en ion o
p o ide a comple e pic u e o he s a e o he a . Publica-
ions we e es ic ed o pee e iew jou nal a icles o ensu e
a minimum h eshold o quali y. In addi ion o he elec onic
sea ch, he e e ence lis s o he included s udies we e also
checked o iden i y o he po en ially eligible s udies.
Eligibili y C i e ia
This e iew aimed o include all published s udies, in Eng-
lish o Spanish, ha examined he ela ionship be ween
psychopa hic ai s and emo ion ecogni ion in child en and
adolescen s (mean age up o 18). S udies including pa ici-
pan s aged ≥ 18 we e included as long as hey we e based
on a well-es ablished adolescen sample (e.g., high-school
s uden s; o ensic ju enile samples ha in some con ex s
may in ol e pa icipan s up o age 21). The e iew included
c oss-sec ional and longi udinal s udies, wi h bo h co e-
la ional and/o be ween-g oups designs. Speci ic inclusion
c i e ia o s udies in his e iew we e:
1. S udies should include a alida ed measu e o psycho-
pa hic ai s, as well as a alid ecogni ion measu e (lab
ask), wi h no med o alida ed s imuli (i.e., acial,
ocal, pos u al exp ession) o a leas one o mo e basic
emo ions (e.g., ange , disgus , ea , happiness, sadness
and su p ise; Ekman, 1992).
2. Samples migh be communi y, a isk, o ensic o clini-
cal, o any combina ion he eo . Fo ensic samples a e
169Clinical Child and Family Psychology Re iew (2024) 27:165–219
de ined as popula ions ha ha e been in con ac wi h he
ju enile jus ice sys em; clinical samples include pa ici-
pan s ha ha e been diagnosed wi h some men al dis-
o de , pa icula ly CD o ODD; a isk samples include
pa icipan s om disad an aged en i onmen s, as well
as hose wi h high le els o CP ha ha e no ye been
in con ac wi h ju enile jus ice sys ems no ei he ha e
ecei ed a men al diso de diagnosis, and communi y
samples include pa icipan s who do no mee c i e ia
o o ensic, clinical o a isk samples.
3. S udies de ining psychopa hic ai s as a dicho omous
a iable (e.g., high CU ai s), should also include a con-
ol g oup. The con ol g oup may be a communi y o a
ma ched o ensic, a isk o clinical sample wi h dis inc-
i e le els o psychopa hic ai s (e.g., low CU ai s).
4. S udies mus be ull- ex pape s published in pee -
e iewed jou nals in bo h Spanish and English.
S udies we e excluded i hey we e based on adul sam-
ples (mean age < 18), o whe he hey explici ly included
pa icipan s wi h known cogni i e impai men s ha a e
likely o in luence emo ion ecogni ion, including b ain
inju ies, neu ode elopmen al diso de s (e.g., au ism spec-
um diso de ; ASD) o cu en subs ance abuse. S udies
including be ween-g oups designs wi h pa icipan s mee ing
c i e ia o one o mo e o he a o emen ioned impai men s
we e e ained as long as i was possible o ex ac speci ic
da a o pa icipan s wi h psychopa hic ai s who do no
mee c i e ia o hose impai men s. S udies exclusi ely
based on popula ions wi h an a en ion de ici hype ac i i y
diso de (ADHD) diagnosis we e also excluded. Ye , consid-
e ing he high co-occu ence a es be ween CP and ADHD
(Hudec & Mikami, 2017), s udies we e e ained i hey we e
based on popula ions wi h CP, who may also mee c i e ia
o CD o ODD, e en hough hey epo ed he inclusion o
pa icipan s wi h como bid ADHD (k = 17). To gain cla i y
abou he po en ial in luence o ADHD symp oms in emo-
ion ecogni ion de ici s ela ed o psychopa hic ai s, he
pe cen age o pa icipan s wi h ADHD will be ex ac ed,
and in o ma ion abou con ol analysis (o he absence o )
will be explici ly p o ided.
S udy Iden i ica ion andSelec ion
Ti le and abs ac we e sc eened by wo esea che s, and
excluded i hey did no mee he inclusion c i e ia. Bo h
esea che s we e blinded o each o he ’s decisions and he
i s s udy selec ion was pu in common once he s udy selec-
ion phase was inished. Re Wo ks was independen ly used
by bo h esea che s as a e e ence manage ool. O he 3215
abs ac s sc eened, 74 we e included o ull- ex e iew,
which was also pe o med by wo esea che s who wo ked
independen ly. I s udies me he inclusion c i e ia, hey we e
inally included in he e iew. I hey iola ed some o he
eligibili y assump ions, hey we e classi ied based on he
eason o exclusion (e.g., adul samples, emo ion p ocessing
ins ead o emo ion ecogni ion, no measu es o psychopa hic
ai s, no lab ask o emo ion ecogni ion, pa icipan s wi h
neu ode elopmen al disabili ies). A he ull- ex le el,
a icles we e excluded i hey: Included pa icipan s wi h a
mean age ha exceed he 18yea s o age (k = 3), measu ed
emo ion ecogni ion h ough ques ionnai es o scena ios
wi h addi ional con ex ual cues ha equi e emo ional in e -
ences (k = 3), examined complex ins ead o basic emo ions
(k = 1), emo ion ecogni ion was compu ed as a unc ion o
a global measu e (e.g., mo al easoning, emo ional unde -
s anding) (k = 5), o i was es ic ed o in o m abou owns’
emo ional s a e in esponse o emo ional con en (e.g., emo-
ional esponsi eness) (k = 2), emo ion ecogni ion de ici s
we e no (exclusi ely) linked o psychopa hic ai s (k = 4),
assessed emo ional p ocessing ins ead o emo ion ecog-
ni ion (k = 4), and he e was e idence o subs ance abuse
Table 1 Sys ema ic sea ch s a egy
a #= AND
b Resul s based on he upda ed sys ema ic sea ch, conduc ed on Decembe 23, 2022
Da abase PsycIn o Scopus Pubmed WOS
Keywo ds L1. (callous* unemo ion* o CU o psychopa hy o psychopa hic) #a
L2. (emo ion* ecogni ion o emo ion* p ocess* o emo ion* iden i ica ion o eye gaze o eye ack* o eye ix* o
acial emo ion* o emo ion* a en *) #
L3. (child* o adolesc*)
Fields Any ield (ALL) TITLE-ABS-KEY All ields All ields
Resul sb939 321 1044 1273
Fil e s 1. Language: English, Spanish
2. Age: 0–18
3. Pee Re iew
4. Humans (male, emale, inpa ien ,
ou pa ien )
1. Language: English 1. Language: English,
Spanish
2. Humans
3. Age: 0–18
1. Language:
English,
Spanish

170 Clinical Child and Family Psychology Re iew (2024) 27:165–219
(k = 2). I he s udies me he inclusion c i e ia bu su icien
da a was no a ailable o ex ac he main esul s, da a we e
di ec ly eques ed om he au ho s by email.
A all s ages o he e iew p ocess, disag eemen s we e
sol ed by discussion and consensus and, when needed, a
hi d esea che se led he un esol ed disag eemen s. The
in e - a e ag eemen Cohen’s kappa was used o compa e
ag eemen be ween he esea che s ega ding he decision
o include o exclude he eligible s udies, and in e p e ed
as ≤ 0, no ag eemen , 0.01–0.20, none o sligh , 0.21–0.40
ai , 0.41–0.60 mode a e, 0.61–0.80 subs an ial, 0.81—1.00
almos pe ec ag eemen (McHugh, 2012).
Quali y Assessmen
Two independen e iewe s assessed he quali y o included
s udies using he App aisal Tool o C oss-Sec ional S udies
(AXIS) (Downes e al., 2016), which con ains 20 ques ions
ega ding in oduc ion, me hods, esul s and discussion o
each s udy. Each ques ion could be answe ed wi h “yes” (1
poin ) o “no”/“don’ know” (0 poin s). Longi udinal s ud-
ies we e assessed ia he C i ical App aisal Skills P og am
(CASP), a 12-ques ion checklis ha add esses di e en
aspec s conce ning he objec i es, sample ec ui men ,
measu emen , a i ion, esul s and implica ions. Disa-
g eemen s on s udies’ quali y assessmen we e sol ed by
consensus.
Da a Ex ac ion andSyn hesis
Rele an da a o each included a icle we e added o an
ex ac ion shee de eloped o his e iew and e ined when
necessa y. Da a ex ac ion included pa icipan s cha ac e -
is ics (N [ emales], sample ype and age ange [mean age]),
psychopa hic and/o CU ai s measu e and in o man , emo-
ion ecogni ion ask speci ici ies (i.e., ype o s imuli, emo-
ions assessed and measu emen ou come), and main esul s
speci ically ela ed wi h he objec i es o his e iew. Fo
co ela ional s udies we ex ac ed esul s ocused on he ela-
ionship be ween psychopa hic ai s and emo ion ecogni-
ion, whils in be ween-g oup designs we ocused on esul s
ob ained in compa isons be ween he high psychopa hic
and he compa ison g oups. Be ween-g oup designs whe e
psychopa hic ai s we e examined as po en ial co a ia es
we e also conside ed as long as i was possible o ex ac
speci ic da a on he e ec o psychopa hic ai s on emo ion
ecogni ion. Fo s udies assessing a en ion biases, in o ma-
ion abou he A eas o in e es (AOI) and he measu emen
ou come was also ex ac ed. S udies we e o ganized by hei
ocus on speci ic CU ai s (k = 26) (Table2) o mul idimen-
sional psychopa hic ai s (Table3), and he inclusion o
a en ion biases measu emen (Table4). Addi ional in o -
ma ion abou main s udy cha ac e is ics was also collec ed,
including: he main pu pose o he s udy, he s udy design,
sample de ini ion, pe cen age (%) o males, loca ion and
e hnici y, psychopa hy dimension, emo ion ecogni ion
ask speci ici ies (i.e., s imuli, exposu e du a ion, numbe
o blocks and ials, and esponse o ma ), and he inclusion
(o no ) o a en ion biases analyses including, when a ail-
able, he ype o measu e and/o he measu emen de ice
(TableS3).
A na a i e app oach was used o syn hesize he indings
o each s udy, ob ained by compiling he in o ma ion om
he ex ac ion shee o m. A minimum o i e s udies epo -
ing simila esul s was used as a c i e ion o ex ac i m
conclusions. Ne e heless, inconsis en indings o desc ip-
i e esul s based on a smalle numbe o s udies we e also
epo ed as hey may p o ide ele an in o ma ion o es ab-
lish new ways o discussion and analysis in u u e esea ch.
Resul s
S udy Selec ion
The sys ema ic sea ch was conduc ed in wo di e en ime
poin s; he i s one p o ided 1631 i les om he elec onic
da abase sea ch, and wo addi ional e e ences loca ed ia
e e ence-lis sea ches. The second one (upda e) p o ided
3577 i les. A e excluding duplica es, 4679 s udies we e
sc eened based on i les and abs ac s. A o al o 76 a icles
we e selec ed o ull- ex assessmen o eligibili y, and he
emaining a icles we e excluded o being o - opic and
because hey ailed o mee he minimum inclusion c i e ia
o his sys ema ic e iew. A e he ull ex assessmen , 50
a icles we e inally included in he e iew. The excluded
a icles and he easons o hei exclusion a e a ailable in
Supplemen a y Ma e ial (TableS5). The en i e selec ion
p ocess is ep esen ed in he lowcha o Fig.1.
The in e - a e ag eemen Cohen’s Kappa e ealed an
almos pe ec ag eemen (K = 0.89) be ween he esea ch-
e s ega ding he decisions o include o exclude he eligible
s udies.
S udy Cha ac e is ics
TableS3, a ailable online, p o ides a summa y o he main
cha ac e is ics o each included s udy. The 50 included
s udies we e published be ween 2000 and 2022 and p o-
ide da a om 12,139 child en and adolescen s (40.84%
emales [N = 4958]; M age = 12.27) belonging o clinical
(k = 10), o ensic (k = 6), communi y (k = 9), a - isk (k = 9)
and combined (k = 16) samples. Depending on age, we can
dis inguish be ween samples o child en (i.e., up o 12yea s
old; k = 13), samples o adolescen s (i.e., om 12yea s old;
k = 16), and mixed samples o child en and adolescen s
171Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 S udies examining emo ion ecogni ion in ela ion o CU ai s
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Aghajani e al.
(2021)
n = 81 (–)
CD/LPE+ = 19
CD/LPE- = 31
*22% como bid
ADHD
CG = 31
Fo ensic Com-
muni y
15–19
(M CD/
LPE ± = 16.84
M HC = 17.02)
LPE p oxy om
he Remo seless,
Callousness and
Unemo ionali y
subscales o he
YPI (SR)
CD/LPE+ = wo o
mo e i ems > 5
Facial Fea
Sad
RT and accu acy
(% o co ec
a ibu ion)
Con olling o age and IQ,
bu no ADHD:
1. The e we e no signi ican
di e ences ac oss g oups in
ER as measu ed by RT and
% o co ec a ibu ion o
o he ’s emo ions
Benne and Ke ig
(2014)
n = 417 (111)
P ima y CU
(1) = 55
Seconda y CU
(2) = 76
Low CU (3) = 279
Fo ensic 12–18 (16.5)
(M1 = 15.85
M2 = 16.06
M3 = 16.26)
ICU To al sco e
(SR)
CU > 26
CG < 26
Facial Fea
Ange
Sad
Shame
Disgus
Accu acy (%
o co ec
esponses)
1. The acqui ed (seconda y)
CU g oup we e mo e accu-
a e in ecognizing o he s
disgus
2. Membe ship in he p ima y
CU g oup was less han he
acqui ed g oup as accu acy
inc eased o ecogni ion o
disgus , bu was mo e likely
as accu acy inc eased o
shame
3. In ela ion o he Low CU
g oup, he p ima y CU
we e mo e accu a e in he
ecogni ion o ange . The e
we e no di e ences wi h he
acqui ed CU g oup
172 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Dadds e al. (2018)n = 364 (102)
*53% ODD/CD;
35.6% ADHD
Clinical 3–16 (8.93) APSD/SDQ CU
de i ed measu e
(Combined PR,
TR, SR)
Facial Happy
Sad
Ange
Fea
Disgus
Neu al
Accu acy (To al
sco e)
Con olling o he e ec s o
ADHD medica ion:
1. Low CU ai s we e ela ed
wi h mo e accu a e ER
2. The ela ionship be ween
CU ai s and ER di e ed
acco ding o mal ea men
his o y; CU ai s we e
associa ed wi h poo e
ecogni ion o hose wi h
ze o o negligible his o y o
mal ea men
3. Pa e ns o mode a ion
e ec s o mal ea men
we e inconsis en ac oss
subg oups. Fo he g oup
who sel - epo ed mal ea -
men , CU ai s we e ela ed
wi h poo ER in hose wi h
lowe anxie y
4. Bo h di ec and mode a ed
e ec s o CU on ER we e
no limi ed o ea o sad-
ness. Nega i e co ela ions
we e o some ex en e iden
o all he analyzed emo-
ions, excep happiness
De Ridde e al.
(2016)
n = 55 (10) Fo ensic NR (14.8) YPI CU subscale
(SR)
Ecological Ange
Dis ess
Accu acy (To al
sco e)
1. High CU adolescen s we e
as accu a e as low CU ado-
lescen s in in e ing dis ess
and ange in s a membe s
2. High CU adolescen s
no ably o e es ima ed he
gene al in ensi y o bo h
ange and dis ess
3. High CU adolescen s pe -
cei ed mo e ange in s a
membe s when hey we e
misbeha ing, pa icula ly
b eaking he ules
173Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Ezpele a e al.
(2017)
n = 320 (155)
CU+ /ODD+ = 51
CU+/ODD− = 24
CU−/ODD+ = 38
CU−/ODD− = 207
*8.7% como bid
ADHD
(CG) = 207
Communi y 8 (–) ICU To al sco e
(TR)
Emo icons Happy
Sad
Ange
Fea
Neu al
Accu acy
RT
Con olling o sex, SES and
como bidi ies:
1. Child en wi hin he CU−/
ODD+ and he CU+/
ODD+ we e less accu a e
han he CG in p ocessing
he in o ma ion, speci ically
when he s imuli exp essed
happiness, ea o neu al
2. Child en high on CU ai s
bu low on ODD pe o med
simila ly o he CG wi h
espec o bo h accu acy
and RT wi h one excep ion:
child en high on CU ai s
esponded as e o ea
3. Child en wi hin he CU+/
ODD+ g oup di e ed in
accu acy bu no in RT in
ela ion o he CG
Kahn e al. (2017) 112 (–) Fo ensic 12–20 (15.5) ICU To al sco e
(SR)
Facial Happy
Sad
Ange
Disgus
Fea
Neu al
Accu acy 1. The e we e no signi ican
main e ec s o CU ai s o
in e ac ions wi h anxie y in
p edic ing o e all accu acy
in he a ec i e acial ecog-
ni ion ask
When p edic ing accu acy o
independen ly iden i y he 6
analyzed emo ions:
2. CU ai s we e posi i ely
associa ed wi h ea ec-
ogni ion accu acy a lowe
le els o anxie y
3. CU ai s we e ela ed
wi h poo e esul s in he
ecogni ion o disgus , wi h
a end sugges ing ha his
ela ionship end o occu a
high le els o anxie y
180 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Pe icle c e al.
(2019)
n = 1005 (–)
(504 win pai s,
209 MZ, 295 DZ)
Communi y 6–7 Fou i ems ad hoc
1. “he/she didn’
seem o eel
guil y a e mis-
beha ing”
2.” he/she has been
insensi i e o o h-
e s' eelings”
3.” his/he emo-
ions appea
supe icial”
4.” has no kep his/
he p omises”
Facial Happy
Sad
Ange
Fea
Accu acy Con olling o o he p ob-
lems (physical agg ession,
ADHD and dep essi e
symp oms), and o he ec-
ogni ion o o he emo ions:
1.The e was a ela ionship
be ween CU ai s, meas-
u ed in kinde ga en and
i s g ade, and poo emo-
ional ecogni ion o ea ,
measu ed in i s g ade
2. The ela ionship be ween
CU ai s and de ici s in ea
ecogni ion was gene ically
in luenced
3. The ela ionship be ween
CU ai s and de ici s in
he ecogni ion o sadness
did no hold a e con ol-
ling o o he p oblems and
he ecogni ion o o he
emo ions. No gene ic in lu-
ence was e lec ed in his
ela ionship, al hough e i-
dence was p o ided o he
in luence o he non-sha ed
en i onmen

181Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Rehde e al. (2017)n = 761 (657)
EA = 446
CP+ CU = 20
CG = 442
AA = 315
CP+ CU = 16
CG = 291
Communi y a isk 6–7 ICU Empa hic-
p osocial and
callous subscales
(PR)
Facial Ange
Sad
Happy
Fea
Accu acy (o e -
all and speci ic
emo ions)
Con olling o p ima y ca -
egi e s’ yea s o educa ion
and child en’s age:
1.Di e ences among ypical
child en (CG), child en
wi h CP-only and chil-
d en wi h CP + CU we e
mode a ed by child ace and
amily income o o e all
emo ion ecogni ion, and by
child ace o speci ic emo-
ion ecogni ion
2. Only among EA child en,
and child en wi hin amilies
wi h highe income- o-
needs a io (i.e., no ex eme
po e y), CG showed
be e accu acy o o e all
emo ion ecogni ion han
child en in he CP only and
CP + CU g oups
3. Only among EA child en,
CG showed be e ecogni-
ion o happy aces han
child en in he CP only and
CP + CU g oup
4. Child en in he CP only
and CP + CU g oups o en
did no pe o m di e en ly
on emo ion ecogni ion
accu acy
Schwenck e al.
(2011)
n = 192 (–)
ASD = 55
CD = 70
(CD/CU+ = 36
CD/CU− = 34)
*44.8% como bid
ADHD
CG = 67
Clinical 6–17 (12.3) ICU To al sco e
(PR)
CD/CU+ ≥ 32
(median spli )
CD/CU− < 32
Facial mo phed Ange
Happy
Sad
Fea
Disgus
Accu acy
RT
1. The e we e no signi ican
di e ences be ween CD
g oups (CU+/CU−) in
emo ion ecogni ion based
on RT and he numbe o
co ec ly iden i ied emo-
ions
2. Remo ing ADHD child en
ecei ing medical ea men
did no change he pa e n
o esul s
182 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Schwenck e al.
(2014)
n = (64)
CP = 32
(CP/CU+ = 16;
CP/CU− = 16)
*62.6% como bid
ADHD
CG = 32
Clinical 8–16 (13.23) ICU To al sco e
(PR)
CP/CU+ > 35.5
(median spli )
CP/CU− < 35.5
Facial mo phed Ange
Happy
Sad
Fea
Disgus
Accu acy
RT
The e we e no signi ican
di e ences in he analyzed
a iables be ween child en
wi h and wi hou como bid
ADHD
Rega ding RT:
1. Gi ls wi h CP/CU− eac ed
mo e slowly han CG o
aces de eloping happy,
sad, and ea ul exp essions
2. Gi ls wi h CP/CU+ did no
di e om CP/CU− and
CG
Rega ding accu acy:
3. Gi ls wi h CP/CU+ ecog-
nized ea ul exp essions
be e han he o he wo
g oups
4. Gi ls wi h CP/CU− ecog-
nized sad exp essions less
o en han CG
5. Gi ls wi h CP/CU+ mis-
ook sad aces mo e
commonly as disgus ed
aces han CG; whils gi ls
wi h CP/CU− iden i ied
ea ul aces as disgus ed
mo e o en han he CP/
CU+ g oup
183Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Whi e e al. (2016)n = 337 (185)
(High LC = 107;
Low LC- = 230;
High PI = 96;
Low PI = 241)
A - isk 3–7 (4.82) MAP-DB
Low Conce n,
Punishmen
Insensi i i y
(PR)
High/Low
g oups ≥ /≤ 80 h
pe cen ile
Facial Fea
Happy
Ange
Neu al
Accu acy
La ency (mean
RT)
Con olling o age, sex,
empe loss, agg ession,
impulsi i y, and he con ol
block
In e ms o Accu acy:
1. The High LC g oup was
less accu a e in iden i y-
ing ea ul aces han he
low LC; he accu acy a es
did no di e o ang y o
happy aces
2. The e we e no di e ences
be ween High and Low PI
g oups
3. Female we e mo e accu-
a ely o emo ional acial
exp essions han males
In e ms o La ency:
3. No signi ican di e ences
we e obse ed be ween
High/Low LC and PI
g oups
Wol and Muñoz
(2014)
n = 50 (–) A - isk 11–16 (14.3) YPI CU subscale
ICU To al sco e
(SR)
Facial and
Body pos u es
Dynamic
Fea
Ange
Happy
Disgus
Sad
Pain
Accu acy Con olling o age and io-
len delinquency:
1. Fea ul acial and bodily
exp essions we e un ela ed
wi h CU ai s
2. Fo he YPI-CU, he e
we e de ici s in he ecogni-
ion o pain in aces, o en
misiden i ied as sadness and
disgus , and ange in pos-
u es, o en misiden i ied as
happiness and disgus
3. Fo he ICU, esul s
showed a signi ican
enhancemen in he ecog-
ni ion o ange in aces and
disgus in pos u es
184 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 2 (con inued)
S udy Pa icipan s CU measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o
emo ion ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Woodwo h and
Waschbusch
(2007)
n = 73 (14)
CP = 32
CP/CU = 24
CG = 18
*84.9% como bid
ADHD
Clinical
Communi y
7–12.78 (9.81) APSD CU
(Combined PR,
TR)
CU+ ≥ 67
(median spli )
CU− ≤ 63
Facial Ange
Disgus
Fea
Happy
Sad
Su p ise
Accu acy Con olling age, sex, IQ and
ADHD
1. Child en wi h highe CU
sco es we e less accu a e
in labelling sad a ec han
child en wi h lowe CU
sco es
2. Child en wi h highe CU
sco es we e mo e accu-
a e in labelling ea han
child en wi h lowe CU
sco es, bu his main e ec
was quali ied by he CP-CU
in e ac ion end
3. Child en wi h high CP
bu low CU ai s we e less
accu a e han o he child en
in in e p e ing ea ul acial
emo ions
AA A ican Ame ican, ADHD a en ion de ici hype ac i i y diso de , APSD an isocial p ocess sc eening de ice, ASD au ism spec um diso de , CD conduc diso de , CG compa ison g oup,
CP conduc p oblems, CU callous-unemo ional, DZ dizygo ic, EA Eu opean Ame ican, ER emo ion ecogni ion, GM g andiose-manipula i e, HC heal hy con ol, ICU in en o y o callous-
unemo ional ai s, INS impulsi e-need o s imula ion, IQ in elligence quo ien , LC low conce n, LPE limi ed p osocial emo ions, M media, MAP-DB mul idimensional assessmen p o ile o
dis up i e beha io , MZ monozygo ic, NR no epo ed, ODD opposi ional de ian diso de , PI punishmen insensi i i y, PR pa en - epo ed, RT eac ion ime, SES socioeconomic s a us, SDQ
s eng hs and di icul ies ques ionnai e, SR sel - epo ed, TR eache - epo ed, UBHR unbiased hi a e, UNSW Uni e si y o New Sou h Wales, YPI you h psychopa hic ai s in en o y
185Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 3 S udies examining emo ion ecogni ion in ela ion o o e all psychopa hic ai s
S udy Pa icipan s Psychopa hy measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Blai and Coles
(2000)
n = 55 (24)
PSD = 11
CG = 10
Communi y 11–14 (12.4) PSD To al sco e
(TR)
Facial Happy
Su p ise
Fea
Sad
Disgus
Ange
Accu acy
(To al co ec
answe s)
1. Highe sco es in psychopa hic
ai s we e ela ed wi h lowe
emo ional ecogni ion, as well as
wi h an inc eased impai men in
he ecogni ion o ange , sadness
and ea ul exp essions
2. A he dimensional le el, Fac o 1
(GM/CU) was in e sely co e-
la ed wi h he abili y o ecognize
sadness and ea . Fac o 2 (INS)
was in e sely co ela ed wi h he
abili y o ecognize ea ul exp es-
sions
3. When compa ing child en high
and low in psychopa hic ai s,
esul s e ealed a poo e ecogni-
ion o sadness in he high g oup,
con olling o men al age and sex
Blai e al. (2001)n = 51 (-)
PP = 20
CG = 31
A - isk 9–17
(MPP = 12.93)
(MCG = 12.84)
PSD To al sco e
(TR)
PP > 28
CG < 20
Facial (mo phed) Happy
Sad
Su p ise
Fea
Disgus
Ange
Sensi i i y
(nº o s ages
needed o co -
ec ly iden i y
he exp ession)
Accu acy
(% o e o s)
1.Child en wi h psychopa hic en-
dencies needed signi ican ly mo e
s ages be o e hey could success-
ully ecognize sad exp essions
2.Child en wi h psychopa hic en-
dencies made mo e e o s when
p ocessing ea ul exp essions,
being mo e likely o misclassi y
ea as one o he o he i e basic
emo ions
3. The e we e no g oup di e ences
o he ecogni ion o happy,
ange , disgus and su p ise

186 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 3 (con inued)
S udy Pa icipan s Psychopa hy measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Blai e al. (2005)n = 43 (–)
PP = 22
CG = 21
A - isk 11.8–15.5
(MPP = 13.5)
(MCG = 12.87)
APSD To al sco e
(TR)
PP > 25
CG < 25
Vocal Happy
Disgus
Ange
Sad
Fea
Accu acy
(% e o s)
1. Boys wi hin he PP g oup o e all
made mo e e o s han he CG
2. Boys wi h PP p esen ed a selec-
i e impai men o he ecogni-
ion o ea ul ocal a ec
3. Boys PP g oup did no show
signi ican impai men in he
ecogni ion o sad ocal a ec
4. When making e o s on ang y o
disgus ed exp essions, child en
wi hin he PP g oup we e mo e
likely o mis ake hese exp essions
o ea ul exp ession
5. Wi hin he PP g oup, he co a i-
a e age had a signi ican posi i e
e ec in he ecogni ion o ea ul
a ec , and he IQ had a signi ican
e ec in he ecogni ion o ea ul
and disgus ed ocal a ec s
6. A he dimensional le el, he e
we e a posi i e co ela ion
be ween CU ai s and he numbe
o ea ul and happy ocal a ec
ecogni ion e o s, and be ween
GM ai s and he numbe o
ea ul ecogni ion e o s. The e
we e no signi ican co ela ions
wi h INS
Bowen e al. (2014)n = 100 (–)
O ende s = 63
CG = 37
Fo ensic
Communi y
13–17
(Mo = 15.79)
(MCG = 15.41)
YPI To al sco e and
CU subscale
(SR)
High > 2.5
Low < 2.5
Facial
(mo phed)
Happy
Sad
Fea
Ange
Disgus
Su p ise
Accu acy
(% co ec ecog-
ni ion sco es a
each in ensi y)
1.Young o ende s wi h high psy-
chopa hic ai s we e signi ican ly
wo se a de ec ing 50% and 75%
in ensi y o disgus ed aces
2. Ha ing high le els o psycho-
pa hic ai s explained enhanced,
a he han diminished, ecogni-
ion o sad exp essions
3. The e was a posi i e co ela ion
be ween CU ai s and 25% and
100% ange ecogni ion
187Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 3 (con inued)
S udy Pa icipan s Psychopa hy measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Dadds e al. (2006)S udy 1 = 33
(–)
S udy 2 = 65
(–)
Communi y S udy 1 = 8–15
(12.07)
S udy 2 = 9–17 (13.2)
APSD/SDQ CU and
AB (GM/INS)
subscales
(Combined PR-SR)
Facial Happy
Sad
Ange
Disgus
Fea
Neu al
Accu acy 1. AB (GM-INS) and CU ai s
we e associa ed wi h di e en ER
p oblems in young males
2. AB was uniquely associa ed wi h
a endency o o e -in e p e hos il-
i y in neu al aces
3. CU ai s we e uniquely ela ed o
poo ecogni ion o ea ul exp es-
sions, which a e in pa owing o
isual neglec o he eye egion o
o he people’s eyes
4. This de ici imp o ed in he eye
gaze condi ion, bu e u ned in he
mou h gaze condi ion
Fai child e al. (2009)n = 121 (–)
EO-CD = 42
AO-CD = 39
*21% como -
bid ADHD
CG = 40
Communi y
A - isk
14–18
(EO-CD = 15.8)
(AO-CD = 15.5)
(CG = 15.8)
YPI To al sco e
(SR)
High > 2.5
Facial (mo phed) Ange
Disgus
Fea
Happy
Sad
Su p ise
Accu acy
(To al sco e)
1. Rela i e o CG, ecogni ion o
ange , ea , disgus , and happiness
was impai ed in pa icipan s wi h
EO-CD. Also, ecogni ion o ea
was impai ed in pa icipan s wi h
AO-CD. These esul s we e epli-
ca ed when emo ing pa icipan s
wi h ADHD
2. Pa icipan s wi h CD who we e
high on psychopa hic ai s
showed impai ed ea , sadness and
su p ise ecogni ion, as compa ed
o hose low in psychopa hic ai s
Fai child e al. (2010)n = (55)
CD = 25
*20% como -
bid ADHD
CG = 30
Communi y
A - isk
14–18 YPI To al sco e and
CU
(SR)
High > 2.5 in To al
sco e
Facial (mo phed) Ange
Disgus
Fea
Happy
Sad
Su p ise
Accu acy
(To al sco e)
1. Gi ls wi h CD showed impai ed
ecogni ion o ange and disgus .
These esul s we e eplica ed
when emo ing pa icipan s wi h
ADHD
2. Pa icipan s wi h CD and high
on psychopa hic ai s showed
impai ed ecogni ion o sadness,
as compa ed o hose lowe in
psychopa hic ai s
188 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 3 (con inued)
S udy Pa icipan s Psychopa hy measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Gillen e al. (2018)n = 144 (49) Fo ensic 11–18 (15.24) PCL: YV subscales Facial
Vocal one
Happy
Sad
Ange
Fea
Accu acy
(To al sco e)
1. The PCL: YV To al sco e was
ela ed o lowe accu acy o happy
and sad aces
2. In e pe sonal (GM) ai s we e
posi i ely ela ed o ea ul and
ang y acial emo ion ecogni ion
accu acy, when con olling o he
o he wo psychopa hic ac o s
3. A ec i e (CU) ai s we e
associa ed wi h poo e accu acy in
iden i ying happy aces and sad,
ang y and ea ul oices
4. Beha io al (INS) ai s we e no
ela ed o accu acy in ecognizing
emo ional acial o ocal ones
Kahn e al. (2016)n = 141 (23) Fo ensic 14–18 (17.03) PCL: YV
ICU SR
APSD SR
CPS SR
YPI SR
All subscales
Facial Happy
Fea
Su p ise
Disgus
Exci emen
Accu acy 1. Con olling o IQ, he e is no
e idence o signi ican associa-
ions be ween psychopa hic ai s,
measu ed by he PCL: YV, and
Expe ien ial EI
2. Fo sel - epo ed measu es,
he e was a nega i e associa ion
be ween he Callous-Disinhibi ed
scale om he CPS and he
expe ien ial a ea, bu i did no
hold when con olling o mul iple
compa isons. The associa ion was
nega i e wi h he GM ac o
Lemos Vasconcellos
e al. (2014)
n = 41 (–)
(High PP = 20
Low PP = 21)
Fo ensic 13–19
(M High PP = 16.3; M
Low PP = 16.7)
PCL-YV To al sco e
High PP ≥ 30
Low PP ≤ 20
Facial Fea
Sad
Happy
Disgus
Su p ise
Ange
Accu acy 1. The High PP g oup was sig-
ni ican ly poo e han he Low PP
g oup in he ecogni ion o ea in
aces p esen ed o 200ms
2. No o he di e ences be ween
g oups eached s a is ical signi i-
cance; ye , e ec sizes also dem-
ons a ed a mode a e di e ence
o ea ecogni ion a 500ms and
1s, wi h wo se pe o mance o
he High PP g oup, and small- o-
mode a e di e ence o sadness
and su p ise a 500ms, wi h wo se
pe o mance o he Low PP g oup
189Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 3 (con inued)
S udy Pa icipan s Psychopa hy measu e
(in o man )
Emo ion ecogni ion Main ou come speci ic o emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ions Measu emen
Sha p e al. (2014)n = 417 (187) Communi y 10–12 (11.33) YPI subscales
(SR)
Facial (eye egion) Happy
Sad
Ange
Fea
Disgus
Su p ise
Accu acy 1. GM, CU and INS signi ican ly
(and in e sely) co ela ed wi h
emo ion ecogni ion
2. When he h ee dimensions we e
modeled oge he in a eg es-
sion amewo k, only CU ai s
signi ican ly p edic ed emo ion
ecogni ion, bu only in ela ion o
complex emo ions
3. No psychopa hy dimension
we e p edic i e o basic emo ion
ecogni ion
S e ens e al. (2001)n = 18 (–)
(PSD+ = 9;
PSD− = 9)
A - isk 9–15 (11.7) PSD To al sco e
(TR)
PSD+ > 25
PSD− < 20
Facial
Audi o y
Happy
Sad
Ange
Fea
Accu acy 1. The PSD+ g oup was less likely
o name he acial o ocal a ec
co ec ly han he PSD- g oup
2. Bo h g oups we e signi ican ly
mo e likely o name he acial
exp essions han he ocal a ec s
3. The PSD+ g oup showed selec-
i e impai men s in he ecogni-
ion o bo h sad and ea ul acial
exp essions and sad ocal one
4. The wo g oups did no di e
in hei ecogni ion o happy o
ang y acial exp essions, and ea -
ul, happy and ang y ocal ones
196 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 4 (con inued)
S udy Pa icipan s CU/psychopa-
hy
measu e
(in o man )
Emo ion Recogni ion A en ion biases Main ou come speci ic o
a en ion biases and emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ion Measu emen AOI Measu emen
Le an ini e al.,
(2022a)
n = 116 (–)
ODD = 94
CD = 22
*48.28%
como bid
ADHD
Clinical 7 –12 (9.0) APSD
subscales (Com-
bined PR, TR)
Facial Happy
Sadness
Ange
Disgus
Fea
Neu al
Accu acy Face
Eyes
Mou h
Numbe o
ixa ions
(FC), A e -
age leng h
o each ixa-
ion (FD),
Leng h o
i s ixa ion
(FFD)
Con olling o age, IQ,
ex e nalizing p oblems and
SES:
1. CU ai s we e sig-
ni ican ly and nega i ely
associa ed wi h sadness
ecogni ion and na cissism
was nega i ely associa ed
wi h disgus ecogni ion
2.Rega ding gaze pa e n,
CU ai s we e nega i ely
associa ed wi h leng h o
i s ixa ion o he mou h
o ang y aces, numbe
o ixa ions o he eyes o
sad aces and leng h o
i s ixa ion o he eyes o
disgus ed aces
3. Impulsi i y (INS) was
posi i ely associa ed wi h
he numbe o ixa ions
and a e age leng h o each
ixa ion o he eyes o
ang y aces and numbe
o ixa ions o he eyes o
ea ul aces
4. Na cissism (GM) was
nega i ely associa ed wi h
he numbe o ixa ions o
he eyes o ang y aces, and
posi i ely associa ed wi h
he numbe o ixa ions o
he mou h o ang y aces

197Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 4 (con inued)
S udy Pa icipan s CU/psychopa-
hy
measu e
(in o man )
Emo ion Recogni ion A en ion biases Main ou come speci ic o
a en ion biases and emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ion Measu emen AOI Measu emen
Ma in-Key
e al. (2018)
n = 101 (49)
CD = 50 (24)
*34% como bid
ADHD
CG = 51 (25)
Fo ensic
Communi y
13–18
MCD-
male = 15.94)
MCD-
emale = 16.21)
MCG-
male = 16.22)
MCG-
emale = 16.40)
ICU To al sco e
(SR)
Facial s a ic and
dynamic
Ange
Sad
Fea
Happy
Su p ise
Disgus
Neu al
Accu acy Eyes
Mou h
Ini ial eye
p e e ence
To al eye
p e e ence
Con olling o subjec ,
como bidi y and age:
1. Highe le els o CU
ai s we e associa ed wi h
poo e ea ecogni ion
ac oss he whole sample
2. Wi hin he CD g oup,
hose high on CU ai s
showed be e ea ecogni-
ion, and educed a en ion
o he eyes o su p ise
aces
3. CU and emo ional in en-
si y in e ac ed o p edic
ini ial eye p e e ence o
su p ise, which inc eased
wi h emo ional in ensi y
and was la ge o high CU
pa icipan s
4.Wi h excep ion o disgus ,
emales showed g ea e
o al eye p e e ences han
male o all emo ions
198 Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 4 (con inued)
S udy Pa icipan s CU/psychopa-
hy
measu e
(in o man )
Emo ion Recogni ion A en ion biases Main ou come speci ic o
a en ion biases and emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ion Measu emen AOI Measu emen
Ma in-Key
e al. (2021)
n = 96 (48)
CD = 45 (23)
*20% como bid
ADHD
CG = 51 (25)
Fo ensic
Communi y
13–18
MCD-
male = 15.80)
MCD-
emale = 16.36)
MCG-
male = 16.22)
MCG-
emale = 16.40)
ICU To al sco e
(SR)
Body pos u es
(dynamic and
s a ic)
Ange
Fea
Neu al
Accu acy A ms A m p e e -
ence sco e
(% o ime
ixa ion)
Con olling o subjec , age
and psychia ic como bid-
i y:
1. The e we e no e ec s o
CU ai s on body pos u e
ecogni ion
2. The e ec s o CU ai s
a ied acco ding o CD
s a us and sex, wi h CD
males wi h lowe le els o
CU ai s showing he mos
a ypical ixa ion beha io
Mo e speci ically:
3. Highe le els o CU ai s
p edic ed highe a m
p e e ence sco e ac oss
he en i e sample, ye ,
CU ai s we e nega i ely
associa ed wi h a m p e e -
ence sco es in emales, bu
posi i ely associa ed in
males
4. Fo ea ul and neu al
body pos u es, CU ai s
we e ela ed wi h a m
p e e ence sco es in he CD
g oup. These associa ion
we e nega i e o emales,
bu posi i e o males (in
he o al sample)
5. This a ypical ixa ion
beha io did no explain
he body pos u e ecogni-
ion de ici s obse ed in
CD
199Clinical Child and Family Psychology Re iew (2024) 27:165–219
Table 4 (con inued)
S udy Pa icipan s CU/psychopa-
hy
measu e
(in o man )
Emo ion Recogni ion A en ion biases Main ou come speci ic o
a en ion biases and emo ion
ecogni ion
N ( emale) Sample ype Age ange (M) Type o s imuli Emo ion Measu emen AOI Measu emen
Muñoz e al.
(2021)
n = 73 (12)
*52%
ADHD
Clinical 11–16 (14.0) ICU To al sco e
and subscales
APSD I/CP
sco e
(SR)
Facial Fea
Ange
Happy
Neu al
Accu acy Eyes
Mou h
Re lexi e
a en ional
o ien ing
(numbe ,
di ec ion
and eloci y
o saccades)
1.Child en high on CU ai s
did no show a signi ican
de ici in e lexi e gaze o
he eye egion o ea ul
aces
2. Simila non-signi ican
e ec s we e obse ed o
he o he emo ions
3. Child en high on CU ai s
pe o med mo e poo ly
in labelling ea ul aces
accu a ely, only when he
mou h egion and no he
eye egion o he ace was
p imed. Ye , he e we e
no signi ican di e ences
ega ding he associa ion
be ween ICU sco es and
ea ecogni ion ac oss he
mou h- ixa ion and he eye-
ixa ion condi ion
4. You hs high on I/CP who
a e also high on CU ai s
shi ed hei gaze less
owa d ea ul eyes when
ini ially ocused on he
mou h. Only he Callous-
ness ace was signi ican ly
associa ed wi h dec eased
gaze shi
AB an isocial beha io , ADHD a en ion de ici hype ac i i y diso de , AOI a ea o in e es , APSD an isocial p ocess sc eening de ice, ASD au ism spec um diso de , CD conduc diso de , CG
compa ison g oup, CP conduc p oblem, CU callous-unemo ional, CPTI child p oblema ic ai s in en o y, DBD dis up i e beha io diso de , ER emo ion ecogni ion, FC ixa ion coun , FD
ixa ion du a ions, FFD i s ixa ion du a ion, GM g andiose-manipula i e, HC heal hy con ol, I/CP impulsi i y/conduc p oblems, ICU in en o y o callous-unemo ional ai s, INS impulsi e-
need o s imula ion, NR no epo ed, M media, ODD opposi ional de ian diso de , PR pa en - epo ed, RT eac ion ime, SD s a is ic de ia ion, SDQ s eng hs and di icul ies ques ionnai e, SR
sel - epo ed, TR eache s- epo ed
200 Clinical Child and Family Psychology Re iew (2024) 27:165–219
(k = 20). Wi hin child en’s samples, he majo i y o he
analyzed a icles ha e ocused on middle childhood (k = 9).
A ew a icles included combined samples om ea ly and
middle childhood (k = 3). Only one s udy examined emo-
ion ecogni ion de ici s in p eschoole s (Kimonis e al.,
2016). Mos o he popula ion analyzed came om Eu o-
pean samples (k = 26; 11 UK; 3 Ge many; 3 Ne he lands;
2 Cyp us; 2 I aly; 1 Spain; 1 Swi ze land and i e wi h no
egion speci ied). The nex mos equen loca ion was USA
(k = 9), Aus alia (k = 4), Canada (k = 2) and B azil (only 1
s udy). E hnici y was epo ed in 27 s udies being Whi e/
Caucasian (k = 19) and A ican Ame ican (k = 7) he mos
analyzed e hnic g oups.
The mos common diagnosis no i ied was CD (k = 16),
ollowed by ODD (k = 7) and CP (k = 3). In some cases, he
clinical sample was classi ied acco ding o he le el o CU
ai s (Benne & Ke ig, 2014; Deme iu & Fan i, 2022), he
speci ie wi h Limi ed P osocial Emo ions (LPE), unde he
label “o ende s” (Bowen e al., 2014), based on le els o
Low conce n (LC) and punishmen insensi i i y (PI) (Whi e
e al., 2016), o based on he p esence/absence o “psycho-
pa hic pe sonali y” (Blai e al., 2001, 2005; Lemos Vascon-
cellos e al., 2014).
Rega ding he clinical samples (i.e., child en and ado-
lescen s wi h (sub)clinical le els o CP, ODD and CD)
(n = 2724; 22.44% o o al sample), some a icles epo ed
he numbe o como bid ADHD (n = 2724; 24.63% o
clinical samples). Also, despi e no being conside ed in
his e iew, in h ee cases ASD was no i ied (Bou s e al.,
2018; Klapwijk e al., 2016; Schwenck e al., 2011). All his
in o ma ion was added o he desc ip i e sample sec ion, in
all esul s ables (see Tables2, 3, 4).
The p esence and in ensi y o psychopa hic ai s ha e
been assessed wi h a ious ins umen s, including he You h
Psychopa hic T ai s In en o y (YPI; Ande shed e al., 2002)
(k = 9), he In en o y o Callous Unemo ional T ai s (ICU;
F ick, 2004) (k = 24; 48%), he An isocial P ocess Sc eening
De ice (APSD; F ick y Ha e, 2002) (k = 12), he Psychopa-
hy Sc eening De ice (PSD; F ick e al., 1994) (k = 3), he
S eng hs and Di icul ies Ques ionnai e (SDQ; Goodman,
1997) (k = 4), he Child P oblema ic T ai s In en o y (CPTI;
Colins e al., 2014) (k = 1), he Psychopa hy Checklis :
You h Ve sion (PCL: YV; Fo h e al., 2003) (k = 3), I ems
ad hoc (k = 1) and he Mul idimensional Assessmen P o ile
o Dis up i e Beha iou (MAP-DB; Wakschlag e al., 2012)
(k = 1). Some imes cu -o poin s we e used o de e mine
he p esence o absence o psychopa hic ai s (especially
CU ai s), which ha e been a bi a ily chosen acco ding o
di e en s udies. Rega ding CU ai s, some imes he sub-
di ision in h ee dimensions (i.e., callouness, unca ing, and
unemo ional) was also conside ed.
The a ec i e ac o o psychopa hy (i.e., CU ai s) has
been he mos e alua ed psychopa hy dimension (k = 33;
66%). S udies ha jus ocused on CU ai s a e desc ibed
in Table2. These ai s can be ound in di e en deg ees
o in ensi y (high/low) o can be concep ualized dicho o-
mously (p esence/absence). Also, 17 s udies conside ed
psychopa hic ai s as a mul idimensional cons uc . Mos
o hem (k = 9) conside ed psychopa hic pe sonali y as a
composi e o al sco e, wi h 3 also p o iding da a on speci ic
CU ai s (Bou s e al., 2018; Bowen e al., 2014; Fai child
Reco ds iden i ied
om Da abases (n=
1631):
PsycIn o (n = 436)
Scopus (n = 152)
Pubmed (n = 465)
WOS (n = 578)
Reco ds emo ed be o e
sc eening:
Duplica e eco ds emo ed
by Re wo ks (n = 529)
Reco ds sc eened
(n = 1102)
Reco ds excluded based on i le
and abs ac :
(
n = 1039
)
Repo s assessed o
eligibili y
(
n = 63
)
Repo s excluded (n = 17)
See Reasons in Appendix X
Reco ds iden i ied om:
Ci a ion sea ching (n = 2)
S udies included in
i s sea ch (n = 46)
Iden i ica ion o s udies ia da abases and e
g
is e s
(
i s sea ch
)
Iden i ica ion o s udies ia
o he me hods
Iden i ica ion
Sc eenin
g
Included
New s udies
(
u
p
da e
)
Reco ds iden i ied
om Da abases (n=
3577):
PsycIn o (n = 939)
Scopus (n = 321)
Pubmed (n = 1044)
WOS (n = 1273)
Reco ds emo ed be o e
sc eening:
Duplica e eco ds
emo ed (n = 12)
Duplica e eco ds
emo ed by Re wo ks
(n = 1432)
Reco ds sc eened
(n = 2113)
Reco ds excluded based on
i le and abs ac :
(
n = 2104
)
Repo s assessed o
eligibili y
(
n = 9
)
Repo s excluded (n =
7)
See he easons o he
a icles indica ed wi h
(*) in Appendix X
S udies included in
upda e
(n = 2)
To al s udies included
in e iew (n = 50)
Fig. 1 Flowcha o sys ema ic e iew p ocess. Adap ed om he low diag am o PRISMA (Page e al., 2021)
201Clinical Child and Family Psychology Re iew (2024) 27:165–219
e al., 2010). The emaining s udies ocused on di e en sub-
dimensions (i.e., GM, CU, INS) (k = 5), o used al e na i e
combina ions (e.g., GM-INS, CU) (Dadds e al., 2006, 2008,
2011). A icles assessing psychopa hic ai s om a mul idi-
mensional pe spec i e a e epo ed in Table3.
Conside ing design, 24 s udies compa ed pe o mance
in emo ion ecogni ion ac oss he whole sample using a
co ela ional design. In he emaining (k = 26), a be ween-
g oup design was used. To de e mine membe ship o he
compa ison g oup, one o he ollowing c i e ia was con-
side ed: CU le els (high s. low), cu -o poin s based on
psychopa hy assessmen ins umen s, no clinical diso de s
and no being an o ende . Mos s udies we e c oss-sec ional
(k = 45; 90%), whils jus i e s udies p o ided longi udinal
esul s (Bed o d e al., 2017; De Ridde e al., 2016; Pe icle c
e al., 2019; Rehde e al., 2017).
All s udies included in he p esen e iew employed an
emo ional ecogni ion ask. Mos o he a icles examined
he ecogni ion o basic emo ions (Ekman, 1992). Howe e ,
he mos epea ed emo ions we e dis ess emo ions ( ea and
sadness). Fea was analyzed in all a icles excep 1 (98%)
(Milone e al., 2019), whils sadness was conside ed in 44
a icles (88%). Some a icles assessed mo e emo ions han
he basic ones (i.e., exci emen , shame, pain, mad, sca ed)
(Bed o d e al., 2017; Benne & Ke ig, 2014; Kimonis e al.,
2016), bu hese esul s we e no conside ed o he pu pose
o he cu en e iew.
The mos equen emo ion ecogni ion asks used we e
UNSW Facial Emo ion Task (k = 6), The Emo ion Hexa-
gon Task (k = 5), NimS im Se o Facial Exp essions (k = 4),
Facial Emo ion Recogni ion Task (k = 3), RaFD (k = 3),
DANVA-II (k = 2) y CET (k = 2). Bo h accu acy and eac ion
ime we e he mos used measu es o emo ion ecogni ion.
The emo ion ecogni ion ask was some imes complemen ed
by ano he ask o assess a en ional bias (k = 11). The cha -
ac e is ics o he a en ional asks, wi h hei speci ic esul s,
a e p esen ed in Table4. Only wo o hese a icles examined
a en ional bias by assessing gaze di ec ion be ween mo h-
e s and child en (Bed o d e al., 2017; Dadds e al., 2011).
In he o he s, eye acke de ices we e used. To assess he
a en ional pa e n, AOI we e es ablished: eyes and mou h
(k = 8), only he ace (Bed o d e al., 2017), eyes (Dadds
e al., 2011) o a ms (Ma in-Key e al., 2021). The analysis
o he esponse conside ed accu acy, eac ion ime (RT),
numbe and du a ion o ixa ions.
The mos analyzed s imulus ype was acial and human
(k = 43; 86%). Bodily s imuli (Ma in-Key e al., 2021;
Muñoz, 2009; Wol & Muñoz, 2014) and ocal ones we e
also examined (Blai e al., 2005; Gillen e al., 2018; S e-
ens e al., 2001), as well as non-human s imuli, including
doll aces (O’Kea ney e al., 2017, 2020) and emo icons
(Ezpele a e al., 2017).
S imuli p esen a ion ime anged om 200ms (Lemos
Vasconcellos e al., 2014) o 6s o s a ic images (Bou s
e al., 2018), and om 1s (Kimonis e al., 2016; Ma in-Key
e al., 2018) o 9s (Schwenck e al., 2011, 2014) o dynamic
emo ional s imuli. In he case o ideo clips, he p esen a-
ion anged be ween 3s (Ma in-Key e al., 2021) and 144s
(Ma in-Key e al., 2017, 2020).
Risk o Bias inS udies
The e alua ion made om AXIS and CASP sugges s o e all
a low o mode a e le el o bias among he eligible s udies
(see TablesS4, S5, a ailable online). Mos o he included
s udies p o ided good indica o s o quali y, sugges ing a low
isk o bias. Excep ionally, some a icles ha did no p o ide
su icien in o ma ion o eplicabili y (Milone e al., 2019)
o used subjec i e measu es ha may in oduce conside able
bias in o he s udy (De Ridde e al., 2016).
Resul s o Indi idual S udies
The main esul s ob ained in he a icles included in his
sys ema ic e iew a e epo ed in Tables2, 3 and 4. The i s
wo analyze hose s udies ha conside CU ai s (Table2)
and all psychopa hic ai s (Table3) espec i ely. The hi d
one (Table4), g oups oge he all hose a icles ha e alu-
a ed a en ional bias in addi ion o emo ion ecogni ion.
Emo ion Recogni ion andPsychopa hic T ai s
CU T ai s CU ai s was he mos s udied dimension (k = 33).
E idence was ound on he ela ionship be ween high le -
els o CU ai s and a de ici in gene al emo ion ecogni-
ion (Bed o d e al., 2017; Deme iou & Fan i, 2022; Ha -
mann & Schwenck, 2020; Lui e al., 2016). In addi ion, his
impai men also a ec ed he ecogni ion o some speci ic
emo ions. Hence, Woodwo h and Waschbusch (2007) ound
ha child en high on CU ai s we e less accu a e in label-
ling sadness. Fea ecogni ion has also been a ec ed bo h
in isola ion (Dadds e al., 2008; Ma in-Key e al., 2018;
Muñoz, 2009; Pe icle c e  al., 2019; Whi e e  al., 2016)
and in combina ion wi h o he dis ess emo ions, including
ange (Muñoz, 2009), disgus (Syl e s e al., 2011) and sad-
ness (Billeci e al., 2019).
I seems ha emo ional complexi y may play a ole
in emo ion ecogni ion, as pos ula ed by some au ho s
(Adolphs & T anel, 2004). In his sense, Sha p e al. (2014)
ound ha CU ai s migh imply a di icul y in he ecogni-
ion o complex emo ions as opposed o simple emo ions.
Mo eo e , his de ici seems o a ec all modali ies: bodily
(Muñoz, 2009), ocal ( ea and happy; Blai e al., 2005;
sad, ang y and ea ; Gillen e al., 2018) and acial (all o he
s udies e iewed in his sec ion). E idence was also ound

202 Clinical Child and Family Psychology Re iew (2024) 27:165–219
in ega ds emo ional p ocessing, measu ed as eac ion
ime, wi h child en high on CU ai s ecognizing he emo-
ions o ange , sadness and ea mo e slowly (Ha mann &
Schwenck, 2020).
In some cases, no signi ican di e ences acco ding o
he le el o CU ai s we e ound in he accu acy o ec-
ognizing dis ess emo ions, including ang y, sad and ea -
ul aces (Ha mann & Schwenck, 2020), also in ecological
en i onmen s (De Ridde e al., 2016). In his ecological
assessmen , conduc ed in a o ensic sample, CU pa icipan s
seemed o o e es ima e he in ensi y o dis ess and ange
in s a membe s, pa icula ly when hey we e misbeha ing
(De Ridde e al., 2016). In egula ask condi ions, he lack
o ela ionship be ween CU ai s and ecogni ion o ea ul
aces and body pos u es a ied depending on he assessmen
ins umen used (Wol & Muñoz, 2014). A simila esul was
also ound in Bowen e al. (2014), wi h a posi i e co ela-
ion be ween CU ai s and 25% and 100% ange in ensi y
ecogni ion.
In sum, he e was a b oad end o ela e CU ai s wi h
mode a e pe asi e emo ion ecogni ion (Lui e al., 2016)
as well as a speci ic de ici o ea , wi h e ec sizes anging
om mode a e (Ma in-Key e al., 2017) o la ge (De Rid-
de e al., 2016; Woodwo h & Waschbusch, 2007). Mod-
e a e (Ma in-Key e al., 2017) and la ge e ec s we e also
ound o sadness (De Ridde e al., 2016). These de ici s
anscended modali y and ype o s imulus p esen ed. Emo-
ion p ocessing was also s ongly impai ed, wi h longe ime
equi ed o emo ional ecogni ion in child en and adoles-
cen s high on CU ai s.
CU Subdimensions Two s udies conside ed he ole o sub-
dimensions o CU ai s, wi h some mixed esul s e en in
e ec sizes, which ha e consis en ly been small o he di -
e en subdimensions (Kimonis e al., 2016; Moo e e al.,
2019) and ha e anged om small (Moo e e al., 2019) o
mode a e o he o al ICU sco e (Kimonis e al., 2016). On
he one hand, Kimonis e al. (2016) ound ha sco ing high
on he ICU o al sco e was associa ed wi h lowe accu acy
in ecognizing ea , ange , happiness and sadness. Rega d-
ing subdimensions, callousness was only associa ed wi h
poo ea and sadness ecogni ion bu no a e con olling
o unca ing. Mo eo e , unca ing emained signi ican ly
associa ed wi h ange , happy and sad ecogni ion a e con-
olling o callousness. On he o he hand, Moo e e  al.
(2019) ound ha he ICU o al sco e was signi ican ly asso-
cia ed wi h impai ed sadness ecogni ion. Fu he mo e, he
unca ing/callousness subdimension was signi ican ly asso-
cia ed wi h impai ed ecogni ion o happiness, sadness, ea ,
su p ise and disgus . Fo all hese emo ions, he ela ion-
ship be ween unca ing/callousness and he ecogni ion o
dis ess emo ions was en i ely accoun ed by sha ed gene ic
in luences. An opposi e pa e n o esul s was obse ed o
he unemo ional subdimension, which was signi ican ly
associa ed wi h imp o ed ecogni ion o su p ise and dis-
gus .
CU Va ian s Some schola s poin ed o he exis ence o wo
CU a ian s. P ima y callousness a ises as a unc ion o a
gene ically based de ici in emo ion p ocessing mainly cha -
ac e ized by a lack o emo ional dis ess and anxie y (Blai
e al., 2006). In con as , acqui ed callousness p oposes ha
CU migh a ise ough he esul o en i onmen al ac o s,
wi h anxie y playing a cen al ole in he de ini ion o he
seconda y a ian (Ke ig & Becke , 2010). Following hese
p emises, Benne and Ke ig (2014) in es iga ed he impo -
ance o hese wo a ian s in emo ion ecogni ion, inding
di e ences depending on he ype o CU a ian . Thus, he
acqui ed o seconda y g oup we e mo e accu a e in ecog-
nizing o he s disgus whils p ima y CU we e mo e accu-
a e in he ecogni ion o ange compa ed wi h he low CU
g oup. Fo bo h p ima y and seconda y a ian s, he ela-
ions wi h emo ion ecogni ion we e s ong. In addi ion, he
abili y o ecognize ce ain emo ions de e mined he classi-
ica ion o he adolescen s in o he p ima y (mo e accu acy
o shame) o seconda y g oup (mo e accu acy o disgus ).
Psychopa hic T ai s (GM, CU, INS) Highe sco es in psycho-
pa hic ai s, measu ed as a mul idimensional cons uc ,
we e ela ed wi h lowe acial emo ional ecogni ion (Blai
& Coles, 2000; Dadds e al., 2006; Sha p e al., 2014; S e-
ens e al., 2001), as well as wi h an inc eased impai men
in he ecogni ion o happy (Gillen e al., 2018) ange (Blai
& Coles, 2000), sadness (Blai & Coles, 2000; Gillen e al.,
2018; S e ens e al., 2001) and ea ul exp essions (Blai
& Coles, 2000; Lemos Vasconcellos e al., 2014; S e ens
e al., 2001). Mo eo e , when compa ing g oups wi h high
and low le els o psychopa hic ai s, esul s e ealed a
poo e ecogni ion o sadness in he high psychopa hic ai s
(PP) g oup.
P ocessing (RT) and ecogni ion (accu acy) we e also
impai ed o dis ess emo ions (i.e., sadness and ea ), wi h
child en wi h psychopa hic ai s, who need mo e s ages
(i.e., emo ional complexi y) o ecognize disgus (Bowen
e al., 2014) and sad exp essions (Blai e al., 2001). Also,
hey made mo e e o s wi h ea exp essions, being mo e
likely o misclassi y ea as one o he o he i e basic emo-
ions (Blai e al., 2001), and mo e speci ically wi h ang y
exp essions (Blai e al., 2005).
These de ici s we e seen in he same di ec ion when ocal
s imuli we e conside ed (Blai e al., 2005; S e ens e al.,
2001). In his sense, boys wi h psychopa hic ai s p esen ed
a selec i e impai men o he ecogni ion o ea ul ocal
a ec (Blai e al., 2005) o we e less accu a e o co ec ly
iden i y he sad ocal a ec (S e ens e al., 2001). One o
he included s udies examined emo ion ecogni ion as pa
203Clinical Child and Family Psychology Re iew (2024) 27:165–219
o emo ional in elligence and ound no ela ionship be ween
expe ien ial emo ional in elligence, measu ed as a p oxy o
emo ion ecogni ion h ough acial emo ion assessmen , and
he combina ion o he h ee psychopa hy dimensions (Kahn
e al., 2016).
O e all, as was obse ed o CU ai s, he p esence o
psychopa hic ai s en ailed a lowe acial and ocal emo ion
ecogni ion ocused on dis ess emo ions ( ea and sadness),
wi h e ec sizes anging om mode a e (Gillen e al., 2018;
Lemos Vasconcellos e al., 2014) o la ge (Blai & Coles,
2000) o bo h emo ions and modali ies. Mo eo e , p ocess-
ing was also signi ican ly impai ed, needing mo e ime o
eac o mo e s ages o each mo phed emo ion o each an
accu a e iden i ica ion.
O he Combina ions o Psychopa hic T ai s A he dimen-
sional le el, GM/CU ai s, ep esen ing he Fac o 1 o
psychopa hic pe sonali y, we e mode a ely in e sely co e-
la ed wi h he abili y o ecognize sadness and ea (Blai &
Coles, 2000). Ye , in Blai e al. (2005) no signi ican co -
ela ion was ound. GM- INS we e associa ed wi h di e en
emo ion ecogni ion p oblems (Dadds e al., 2006). Con-
side ing psychopa hic ai s sepa a ely, INS was in e sely
co ela ed wi h he abili y o ecognize ea ul exp essions
(Blai & Coles, 2000) o no ela ed o accu acy in ecogniz-
ing emo ional acial o ocal ones (Gillen e al., 2018). In
o he s udies, INS in e ac ed wi h CU ai s in p edic ing
p ea en i e ea - ecogni ion de ici s (Syl e s e al., 2011).
In he case o GM, his psychopa hic dimension a ec s he
numbe o ea ul ecogni ion e o s (Blai e al., 2005; Gil-
len e al., 2018) and he accu acy o iden i y ang y acial
emo ions (Gillen e al., 2018).
Measu emen o Psychopa hic T ai s
Se e al di e en assessmen ins umen s ha e been used o
he measu emen o psychopa hic ai s (see “S udy Cha -
ac e is ics” sec ion). Pa icula ly no iceable is he a iabil-
i y when conside ing he in o man [pa en - epo (PR),
eache - epo (TR) and sel - epo (SR)], he ocus on di -
e en subscales (e.g., o al sco es, CU ai s), he dimen-
sional e sus ca ego ical concep ualiza ion o he a iables,
and he cu -o poin s employed o de ine high/low sco es
on he in ended measu es, e en when using he same ins u-
men . This he e ogenei y can be obse ed in Tables2, 3, 4,
included in he ex .
The In en o y o Callous Unemo ional T ai s (ICU;
F ick, 2004) (k = 24; 48%) was he mos widely used. When
he in o man was he child/ adolescen (i.e., SR) and he
o al sco e o he ins umen was conside ed, mos o he
e iewed s udies did no ind de ici s associa ed wi h CU
ai s and emo ion ecogni ion (Klapwijk e al., 2016)
o a en ion biases (Bou s e al., 2018; Ma in-Key e al.,
2021; Muñoz e al., 2021), e en when CU ai s we e ea ed
dimensionally (Ma in-Key e al., 2017, 2020). When de i-
ci s in emo ion ecogni ion we e epo ed, hey ended o be
mo e pe asi e (e.g., Pauli e al., 2021) a he han speci ic
(e.g., ea ; Muñoz, 2009), and pa icula ly in a isk samples
(Lui e al., 2016). These de ici s we e ypically associa ed
wi h o he a iables examined in he s udy, including CU
a ian s o anxie y (Benne & Ke ig, 2014; Kahn e al.,
2017), o we e linked o sample cha ac e is ics (e.g., clini-
cal g oups; Ma in-Key e al., 2018). I we conside ex e nal
in o man s (i.e. pa en s and eache s), he a iabili y o he
esul s con inues o be main ained, wi h a ce ain endency
owa ds an app ecia ion o de ici s in he ecogni ion o
sadness (Ha mann & Schwenck, 2020; Moo e e al., 2019;
Schwenck e al., 2014), mixed emo ions (O’Kea ney e al.,
2020), and happy, ea ul, neu al and ang y acial exp es-
sion (Ezpele a e al., 2017; Ha mann & Schwenck, 2020).
Also, a ela ion be ween poo e emo ion ecogni ion and
high CU was ound (Bed o d e al., 2017). Only wo s udies
ound no ela ionship be ween CU ai s and emo ional pe -
cep ion (O’Kea ney e al., 2017) o ecogni ion (Schwenck
e al., 2011), when using pa en ’s o eache ’s epo s. When
mul iple subscales we e used (i.e., Callousness, Unca ing,
Unemo ional), bo h impai ed and enhanced emo ion ecog-
ni ion we e ound (Kimonis e al., 2016; Moo e e al., 2019;
Rehde e al., 2017). As is he case o he sel - epo ed meas-
u es, he ou comes some imes depended on he mode a o
a iables, including sex (Schwenck e al., 2014) and e hnic-
i y (Rehde e al., 2017).
When using he An isocial P ocess Sc eening De ice
(APSD; F ick y Ha e, 2002) (k = 12) all bu one s udy
(Muñoz e al., 2021), showed de ici s in emo ion ecogni-
ion, especially o ea (Woodwo h & Waschbusch, 2007)
and sadness (Dadds e al., 2006, 2008), as well as an abe -
an pa e n in a en ion, especially o he eyes (Billeci e al.,
2019; Dadds e al., 2008, 2011). I is impo an o no e ha
de ici s in emo ion ecogni ion we e mos ly obse ed wi h
he APSD o al sco e, conside ing all he psychopa hy
dimensions, i espec i ely o he in o man (Blai & Coles,
2000; Blai e al., 2001, 2005; Dadds e al., 2006, 2008;
Le an ini e al., 2022a; Syl e s e al., 2011).
Fo The You h Psychopa hic T ai s In en o y (YPI;
Ande shed e al., 2002) (k = 9), which is a sel - epo ed
measu e, all s udies ound de ici s in mul iple emo ions, i.e.,
disgus (Bowen e al., 2014), sadness (Fai child e al., 2009,
2010) and complex emo ions (Sha p e al., 2014), ac oss
all psychopa hy dimensions. Again, esul s di e ed in ela-
ion o po en ial mode a o s, as sample ype (e.g., o ende s;
Bowen e al., 2014) o he use o speci ic subscales (e.g.,
YPI CU; De Ridde e al., 2016).
In some cases, a ious ins umen s we e simul aneously
used o measu e psychopa hic ai s. Sepa a e esul s o
he measu emen s employed we e some imes no p o ided
204 Clinical Child and Family Psychology Re iew (2024) 27:165–219
(Bou s e al., 2018; Dadds e al., 2008, 2011, 2018; Kahn
e al., 2016; Kohls e al., 2020a). In o he cases, s udies
epo ed di e en esul s acco ding o he ins umen (Kahn
e al., 2016; Wol & Muñoz, 2014). As an example, Wol
and Muñoz (2014) showed ha CU ai s measu ed h ough
he ICU we e ela ed wi h a signi ican enhancemen in he
ecogni ion o ange aces and disgus ed body pos u es, a
esul ha did no eplica e when using he CU measu e o
he YPI. Finally, some s udies showed di e ences ac oss
ins umen s ha seemed mo e ela ed wi h he dimension
assessed (e.g., ICU o al e sus callousness) a he han he
ins umen i sel (Kimonis e al., 2016; Muñoz e al., 2021).
In sum, as p e iously obse ed, a iabili y in he esul s
is he dominan end o bo h accu acy and a en ion. Ne e -
heless, we can iden i y ce ain pa e ns. Po en ial mode a o
a iables examined in he e iew (e.g., age, gende , sample
ype) seemed o play a signi ican ole in de e mining de ici s
in emo ion ecogni ion. In he case o CU ai s measu ed
wi h he ICU, mo e speci ic de ici s we e obse ed when
da a was epo ed by pa en s and/o eache s a he han
sel - epo s. Finally, he use o di e en subscales, combin-
ing a ious assessmen ins umen s, and employing di e -
en cu -o poin s could ha e a ec ed he esul s, inc easing
hei a iabili y.
(Sub)Clinical G oups: The Role o Dis up i e Beha io
Expec edly, highe le els o psychopa hic ai s we e
epo ed wi hin he g oups o child en and adolescen s wi h
CP, o wi h he clinical g oups (CD/ODD) (Kohls e al.,
2020a; Ma in-Key e al., 2018, 2020). CD was he clinical
condi ion mos s udied (k = 13). Wi hin his g oup, when we
conside high le els o psychopa hic ai s, esul s showed
de ici s in ea , sadness and su p ise emo ions (Fai child
e al., 2009), as well as a unique de ici in ecognizing sad-
ness (Fai child e al., 2010) in bo h male and emale samples
espec i ely. Howe e , esul s a y when we only analyze
CU ai s. Thus, e en hough one s udy showed ha ele-
a ed CU ai s wi hin he CD g oup we e associa ed wi h
o e all emo ion ecogni ion impai men s, a he han de i-
ci s in pa icula emo ions (Kohls e al., 2020a), in mos o
he examined s udies no signi ican di e ences we e ound,
ega dless o he ype o s imulus used, as a unc ion o CU
ai s (Aghajani e al., 2021; Kohls e al., 2020a; Kohls e al.,
2020b; Klapwijk e al., 2016; Ma in-Key e al., 2017, 2020,
2021; Milone e al., 2019; Schwenck e al., 2011). Indeed,
in all o he a o emen ioned s udies bu wo (Aghajani e al.,
2021; Ma in-Key e al., 2020) de ici s in emo ion ecog-
ni ion we e uniquely ela ed wi h he p esence o CD. In
addi ion o his inding, some au ho s poin ed ou ha his
g oup (CD/CU+) would no bene i om inc easing he
emo ional in ensi y o he s imuli o enhance ecogni ion
(Pauli e al., 2021). Rega ding p ocessing, highe le els o
CU ai s indica ed as e p ocessing speed, equi ing less
ime o ecognize emo ions in gene al (Klapwijk e al., 2016)
and ea in pa icula (Ma in-Key e al., 2018).
This pa e n o mixed esul s was also eplica ed i we
analyze he clinical condi ion cons i u ed by ODD (k = 3).
In his ega d, i was ound ha (a) high o low le els o CU
ai s did no a ec emo ional ecogni ion (Ezpele a e al.,
2017; O’Kea ney e al., 2017), (b) only a ec ed he ecog-
ni ion o mixed emo ions (O’Kea ney e al., 2020), o (c)
e en highe le els o CU ai s we e associa ed wi h be e
ecogni ion o ea (Ezpele a e al., 2017).
Wi hin he g oup o CP (k = 2), esul s con i med ha
highe le els o CU ai s in ol ed a be e ecogni ion o
ea (Schwenck e al., 2014; Woodwo h & Waschbusch,
2007). Also, CU le els did no a ec emo ional p ocess-
ing (Schwenck e al., 2014), and lowe le els o CU ai s
implied lowe ecogni ion o sadness as compa ed o heal hy
con ols (Schwenck e al., 2014). Mo eo e , i was he in en-
si y o CP and no he in ensi y o CU ai s wha seemed o
de e mine poo e ea ecogni ion (Woodwo h & Wasch-
busch, 2007).
O he combina ions yielded simila esul s. In g oups wi h
CD/ODD, emo ional a ec was gi en by high o low le els
o ODD, so ha a high le els o CU in bo h condi ions,
he e was poo e ecogni ion o ea in he ODD− g oup
and wo se ecogni ion o ange in ODD+ (Ha mann &
Schwenck, 2020). In o he cases, i was he p esence o se -
e al dimensions o psychopa hy ha was associa ed wi h he
obse ed de ici s; in his ega d, CU ai s de e mined wo se
ecogni ion o sadness and high GM implied wo se ecogni-
ion o disgus (Le an ini e al., 2022a).
Despi e he ew s udies ha looked a psychopa hic pe -
sonali y as a whole, i seems o be his combina ion (e.g.,
CP + PP), and no exclusi ely CU ai s, which seems o
show mo e de ici s in emo ional ecogni ion wi hin clinical
g oups. In ac , when looking only a CU ai s, i seems ha
he in ensi y o dis up i e beha io al diso de s could make
he di e ence in emo ion ecogni ion, a he han he p es-
ence o CU ai s. Thus, CU ai s would be mo e associa ed
wi hin he (sub)clinical g oups wi h be e and as e ea
ecogni ion, wi h e ec s anging om mode a e (Ezpele a
e al., 2017) o la ge (Ma in-Key e al., 2018).
Como bid ADHD Co-occu ence a es be ween CP and
ADHD a e pa icula ly high (Hudec & Mikami, 2017).
Tha is he eason why da a conce ning como bidi y o
ADHD we e epo ed when a ailable o some clinical
g oups (k = 20). Two s udies did no epo any es o con-
ol analysis o como bid ADHD (Ma in-Key e al., 2020;
O’Kea ney e al., 2017), and some o he s did no con ol
o como bid ADHD (Aghajani e al., 2021; Klapwijk e al.,
2016; Le an ini e al., 2022a; Muñoz e al., 2021). Ye , in
mos o he included s udies ha epo ed como bid le -
205Clinical Child and Family Psychology Re iew (2024) 27:165–219
els o ADHD, i s po en ial e ec was es ed o con olled
o (Ezpele a e al., 2017; Ha mann & Schwenck, 2020;
Kohls e al., 2020a; Ma in-Key e al., 2017, 2018, 2021;
Pe icle c e al., 2019; Schwenck e al., 2014; Woodwo h
& Waschbusch, 2007), as i was he e ec o ADHD medi-
ca ion (Bou s e al., 2018; Dadds e al., 2018; Schwenck
e al., 2011). When ADHD was conside ed, he e we e no
signi ican di e ences in he analyzed a iables be ween
child en wi h and wi hou como bid ADHD, o esul s we e
eplica ed in he same di ec ion when ADHD o hype ac-
i i y was emo ed o con olled o (Dadds e al., 2011;
Fai child e al., 2009, 2010; Schwenck e al., 2011), e en in
communi y samples (Pe icle c e al., 2019). Addi ional s ud-
ies also epo ed ha ADHD medica ion did no in luence
he obse ed esul s (Bou s e al., 2018; Dadds e al., 2018;
Schwenck e al., 2011).
Emo ional S imuli P esen ed
Type o S imulus P esen ed (Facial, Vocal o Bodily) Mos
o he s udies included in his e iew add essed emo ional
ecogni ion and/o p ocessing using human acial s imuli
(k = 46). O hese, only 7 ha e ound no de ici s associa ed
wi h he p esence o psychopa hic ai s, ei he concep ual-
ized as speci ic dimensions o as a whole (Aghajani e al.,
2021; Kahn e al., 2016; Kohls e al., 2020b; Ma in-Key
e al., 2020; Milone e al., 2019; O’Kea ney e al., 2017;
Schwenck e  al., 2011). Milone e  al. (2019) and Sha p
e al. (2014) ocused he analysis on a speci ic acial egion,
i.e., he eyes, inding mixed esul s (agains and suppo ing
espec i ely), ega ding he impai men o emo ional ecog-
ni ion in he p esence o psychopa hic ai s.
Emo ional ecogni ion o human bodily pos u es was also
explo ed (Muñoz, 2009; Ma in-Key e al., 2021; Wol &
Muñoz, 2014). Excep Ma in-Key e al. (2021), which only
ound an a ypical ixa ion beha io (i.e., a m p e e ence)
in high CD males, he emaining s udies ound de ici s in
emo ion ecogni ion in he p esence o psychopa hic ai s.
De ici s we e also eplica ed o ocal s imuli. De ici s in he
ocal ecogni ion o sadness we e he mos common (Gillen
e al., 2018; S e ens e al., 2001), bu he e we e also de i-
ci s in he ecogni ion o he ocal a ec o ange and ea
in ela ion o CU ai s (Gillen e al., 2018), and ea in he
p esence o psychopa hic ai s (Blai e al., 2005).
De Ridde e al. (2016) dese es special men ion o
loca ing he assessmen o emo ional ecogni ion in a alid
ecological en i onmen . Resul s showed he same accu-
acy le els o dis ess emo ions be ween low and high CU
g oups, bu esul s e ealed di e ences in o e es ima ing
in ensi y o ange and dis ess emo ions in he s a , espe-
cially when pa icipan s we e misbeha ing. Finally, i should
be no ed he use o non-human s imuli in some s udies.
Emo icons we e used in Ezpele a e al. (2017) and dolls wi h
de achable aces in O’Kea ney e al. (2017, 2020). Excep
o O’Kea ney e al. (2017), de ici s we e ound in accu acy
and eac ion ime o mixed (e.g., happy-sad) and simple
emo ions in clinical ODD g oups.
By syn hesizing, he ela ionship be ween he p esence o
psychopa hic ai s and de ici s in emo ional ecogni ion was
ound in all ypes o emo ional s imuli s udied.
In ensi y andDu a ion o S imuli Rega ding in ensi y, he e
was no ag eemen in he esul s ound ac oss he analyzed
s udies. Hence, in non-clinical g oups, some au ho s ound
ha highe le els o psychopa hic ai s equi e a clea e
emo ional s imulus o be ecognized (Blai e  al., 2001).
Howe e , Bowen e al. (2014) ound ha he p esence o
psychopa hic ai s de e mined a wo se ecogni ion o dis-
gus a medium o high in ensi ies. Fu he mo e, when con-
side ing only CU ai s, pa icipan s ecognized ange a ed
wi h e y low and e y high in ensi y be e .
In he case o clinical g oups, he esul s o e all indi-
ca ed ha ecogni ion accu acy was be e o high in en-
si y s imuli a bo h high and low CU le els. Howe e , CD/
CU+ g oups bene i ed less om he inc eased in ensi y o
emo ional exp essions (Pauli e al., 2021). In some cases,
CU and emo ional in ensi y in e ac ed o p edic ini ial eye
p e e ence o su p ise, which inc eased wi h emo ional
in ensi y and was la ge o high CU pa icipan s (Ma in-
Key e al., 2018).
The e ec s o du a ion we e only analyzed in Lemos Vas-
concellos e al. (2014), who ound ha he du a ion o he
s imuli p esen a ion a ec ed ea ecogni ion in hose g oups
ha sco ed high on psychopa hic ai s, wi h mode a e e ec
sizes. Fea ecogni ion was wo se in he sho es expe imen-
al condi ion (200ms) compa ed o he o he condi ions.
No o he di e ences be ween g oups eached s a is ical
signi icance; ye e ec sizes also demons a ed a mode a e
di e ence o ea ecogni ion a 500ms and 1s, wi h wo se
pe o mance o he High PP g oup, and small- o-mode a e
di e ence o sadness and su p ise a 500ms, wi h wo se
pe o mance o he Low PP g oup.
The Role o A en ion
The pa e n o a en ion and eye ixa ion o egions o he
ace o body as a media ing ac o o emo ional ecogni-
ion has been a ac o s udied in some a icles o he p e-
sen e iew (k = 11). Wi hin he non-clinical g oups, esul s
end o indica e ha a highe le els o CU ai s, an abe -
an a en ional pa e n owa ds he eye egion is obse ed
in he numbe o ixa ions (Dadds e al., 2008; Deme iou
& Fan i, 2022), and in he du a ion o eye in e ac ions and
on he i s a en ional ocus o he eye egion (Dadds e al.,
2008), which could de e mine a de ici in he ecogni ion
o ea (Dadds e al., 2008) o o all emo ions in gene al
212 Clinical Child and Family Psychology Re iew (2024) 27:165–219
be assessed in he ligh o some impo an limi a ions. The
mos ema kable conce ns he high he e ogenei y ound in
he di e en s udies. I is ha d o iden i y a unique sou ce
o his a iabili y, bu he e a e some possible ac o s ha
migh be o in luence. Mul iple emo ions we e p esen ed,
bu no he same ac oss all s udies. Mos o hem conside ed
he basic emo ions (Ekman, 1992), bu a imes, he emo-
ions chosen we e in esponse o he esea che 's objec i es
(e.g., dis ess emo ions, complex emo ions). In ensi y a
p esen a ion, complexi y and exposu e imes we e a iable
oo, bo h being cha ac e is ics ele an o emo ion ecogni-
ion. Also, occasionally, emo ional s imuli we e p esen ed
se e al imes, so he lea ning e ec canno be dismissed.
The en i onmen al condi ions (e.g., ligh , noise, spaces)
o he expe imen al se up and he way in o ma ion is col-
lec ed (e.g., sel - egis a ion, hi d pa collec ion) can lead
o di e ences in he esul s. The wide ange o di e en
ins umen s used o assess psychopa hic ai s, wi h di e -
en in o man s (i.e., eache s, pa en s, sel - epo ), he con-
side a ion o psychopa hic ai s om a dimensional e sus
a ca ego ical pe spec i e, o he a bi a y cu -o poin used
o de e mine he p esence/absence o psychopa hic ai s,
may also lead o inconsis encies in he esul s. As a esul
o his a iabili y, a imes, he sho age o s udies made
i challenging o ex ac obus esul s and d aw gene aliz-
able conclusions. In addi ion, some s udies did no p o ide
enough in o ma ion o eplica ion. In his ega d, while ce -
ain ecogni ion de ici s we e eplica ed ac oss s imuli and
p esen a ion modali ies, which is ele an o gene aliza ion,
u u e esea ch would bene i om homogenizing expe i-
men al condi ions and p omo ing eplica ion s udies ac oss
di e se samples, con ex s, and se ings.
O he ac o s ha a ec he a iabili y in esul s include
he limi ed sample size in some o he included s udies and
he non-di e en ia ion o he sample wi h espec o sex. A
be e unde s anding o his phenomenon ine i ably equi es
he es ablishmen o di e en ia ed samples be ween boys
and gi ls and he ec ui men o a su icien sample size
o be able o d aw eliable conclusions, pa icula ly when
be ween-g oups designs a e conside ed. Also impo an is
o con inue examining he longi udinal associa ion be ween
emo ion ecogni ion and psychopa hic ai s, as mos o he
s udies included in his e iew we e c oss-sec ional and hin-
de ed he possibili y o in e p e he di ec ionali y o he
e ec s. New longi udinal esea ch will help o disen angle
he po en ial causal mechanisms, add essing linked de i-
ci s in o he ele an b ain s uc u es and unc ional a eas.
Hence, complemen a y measu es o emo ional p ocessing,
including psychophysiological eco dings (i.e., hea a e,
skin conduc ance), a e pa icula ly needed o p o ide u he
e idence on unde lying mechanisms ha migh be in luenc-
ing he ela ionship be ween psychopa hic ai s and emo ion
ecogni ion. Fu u e esea ch would also bene i om includ-
ing p eschool samples, as he a ailable esul s a e sca ce
in his de elopmen al pe iod. This would help o elucida e
whe he de ici s in emo ion ecogni ion in ea ly childhood
could be somehow explained by he p esence o psycho-
pa hic ai s beyond age- ela ed easons (i.e., inc eased abil-
i y o ecognize di e en emo ions as child en g ow up).
Finally, addi ional sugges ions o u u e esea ch would
include s imuli wi h di e en emo ional in ensi ies. Limi ing
he ecogni ion me hodology only o images o high emo-
ional in ensi y may no p o ide a clea pic u e o emo ional
ecogni ion di icul ies, whils con empla ion o a ious
emo ional in ensi ies may be bes sui ed o e eal sensi i -
i y and mo e sub le di e ences in ecogni ion (Adolphs &
T anel, 2004). Mo e a en ion should be also paid o o he
modali ies such as ocal a ec , as hey ep esen a g ea
complemen o acial and bodily s imuli in socializa ion
p ocesses. Las ly, p omo ion o c oss-na ional and c oss-
cul u al s udies wi h he aim o ou lining cul u al di e ences
in emo ional ecogni ion should be also encou aged.
Some o he limi a ions conce ning his s udy should also
be ou lined. I co e s a wide pe iod o ime (i.e., mo e han
20yea s), and wo dis inc i e de elopmen al pe iods (i.e.,
childhood and adolescence), which esul s in an app eci-
able numbe o s udies, wi h mul iple esul s o be ex ac ed.
This ac , along wi h he inclusion o mixed samples, makes
complex o p o ide a ine -g ained ex ac ion, wi h s udies
speci ically examined by age, sex o sample ype. Rela edly,
o add ess all he in ended objec i es, an ex ensi e sea ch
equa ion was used, p o iding a g ea numbe o esul s o be
sc eened. The g ea numbe o eligible s udies equi ed an
o ganized ex ac ion. Fo he cu en s udy, and based on ou
objec i es, esul s we e o ganized based on he psychopa hy
dimension analyzed, and he assessmen o a en ion de ici s,
bu o he o ms o o ganiza ion could be possible, includ-
ing he sample ype, o he de elopmen al pe iod. Howe e ,
because some s udies included mixed samples, hese al e -
na i e o ms o o ganiza ion we e inally disca ded. The
inclusion o adolescen samples led o include some pa ici-
pan s olde han 18, esul ing in a wide age ange. Ye , hei
inclusion was jus i iable as hey we e pa o well-de ined
adolescen samples (e.g., high school, samples wi hin ju e-
nile o ensic sys ems ha include pa icipan s up o 21yea s
old). Finally, es ic ing he sea ch o published s udies (i.e.,
excluding g ey li e a u e) may aise he likelihood o publi-
ca ion biases due o he ile d awe e ec . The inclusion o
mul iple esul s, in di e en di ec ions, could ha e a enu-
a ed his e ec bu he po en ial in luence o his kind o
biases canno be diminished when in e p e ing he esul s.

213Clinical Child and Family Psychology Re iew (2024) 27:165–219
Theo e ical andP ac ical Implica ions
Emo ion ecogni ion o acial exp essions ep esen s a c u-
cial componen o human social in e ac ion, allowing he
obse e o in e ano he 's emo ional s a e and adjus hei
beha io (Blai , 2003b). This e iew p o ides impo an
clinical, social and scien i ic implica ions. On a clinical and
scien i ic le el, i aises he need o a end o his p oblem
a an ea ly age, as we al eady know ha psychopa hic ai s
can be eliable iden i ied ea ly in de elopmen (Colins e al.,
2014; López-Rome o e al., 2019) and, wha is e en mo e
impo an , ha hese ai s could be mo e malleable a child-
hood when beha io al pa e ns a e no i mly es ablished.
Disen angling he mechanisms unde lying he de elopmen
o psychopa hic ai s will p o ide addi ional insigh abou
a cons uc ha has p o ed i s alue o child and you h CP.
This, in u n, will help o imp o e he de elopmen o mo e
ailo ed p e en i e and in e en ion app oaches, aimed a
es aining high- isk pa e ns o beha io al maladjus men ,
wi h ela ed bene i s in he policy and social ields. Howe e ,
mo e esea ch is needed o cla i y how p e en i e in e en-
ions could be imp o ed om esea ch in emo ion ecogni-
ion, pa icula ly in ea ly childhood.
In (sub)clinical samples, pa en aining seems o be he
op ion ha wo ks bes o educe conduc p oblems (Rome o
e al., 2023). Recen ly, a emp s ha e been made o imp o e
beha io al pa en aining in e en ions o inc ease e icacy
o child en wi h CP + CU (Dadds e al., 2019; Kimonis
e al., 2019; Waschbusch e al., 2019) wi h some p omising
esul s o high CU child en e idenced in a ecen me a-
analysis (Pe ls ein e al., 2023). Based on p e ious esea ch
on he associa ion be ween pa en ing p ac ices and psy-
chopa hic ai s (e.g., Walle e al., 2018), hese ailo ed
p og ams emphasized he impo ance o imp o ing he
quali y o pa en –child ela ionships by inc easing sensi-
i e and ecep i e pa en ing in e ac ions (Kimonis e al.,
2019). Aligning wi h p io ecommenda ions o ansla ing
emo ion- ela ed e idence o p e en ion (e.g., Iza d, 2002),
some ecen in e en ions ha e also inco po a ed an elemen
o dis ess cue and emo ion ecogni ion aining, wi h he
goal o inc easing socioemo ional skills (e.g., empa hy) in
child en wi h high CU ai s. In e es ingly, p omising esul s
ha e been epo ed in his ega d (Fleming e al., 2022),
e en when conside ing a en ion de ici s as he a ge o he
in e en ion (Muñoz e al., 2021). Because p e ious esea ch
has sugges ed ha pa en ing p ac ices could be mode a -
ing he associa ion be ween psychopa hic ai s and emo-
ion ecogni ion de ici s (Le an ini e al., 2022b), addi ional
knowledge on hese in e ac ions would se e o con inue
e ining pa en ing p og ams wi h socioemo ional compo-
nen s speci ically ailo ed o child en and adolescen s wi h
psychopa hic ai s.
Ye , hese p omising implica ions a he p ac ical le el
should also be in e p e ed wi h cau ion. Hence, some s udies
included in his e iew showed no de ici s (e.g., Ma in-Key
e al., 2020), o e en be e ecogni ion (e.g., Ezpele a e al.,
2017) in ela ion o psychopa hic ai s. This is pa icula ly
impo an wi hin he (sub)clinical g oups, wi h psychopa hic
ai s, and no jus CU, being linked wi h impai men s in
emo ion ecogni ion. Howe e , high CU indi iduals end o
be he a ge o he cu en in e en ions in ended o educe
child CP (Pe ls ein e al., 2023), whils o he psychopa hic
dimensions ha e been o e looked in in e en ion. Also, i
psychopa hic indi iduals show enhanced abili ies o emo-
ion ecogni ion, as e ealed bu some s udies in his e iew
(e.g., Ezpele a e al., 2017; Klapwijk e al., 2016; Ma in-
Key e al., 2018), his kind o in e en ions may come wi h
some ia ogenic esul s. Imp o ing he cu en knowledge on
emo ion ecogni ion in ela ion o psychopa hic pe sonali y,
accoun ing o all i s dimensions and po en ial mode a o s,
would be decisi e o keep mo ing o wa d a he p ac i-
cal le el, wi h e inemen s in e idence-based p og ams ha
eally accoun o de ici s in his popula ion.
Homogenizing esea ch condi ions and a o ing eplica-
ion s udies could help in his pu pose, allowing he es ab-
lishmen o mo e obus and clea e conclusions on he asso-
cia ion be ween emo ion ecogni ion and psychopa hic ai s
and, in u n, on he ans e o hose esul s o he applied
con ex .
Conclusions
This is he i s sys ema ic e iew speci ically ocused on he
associa ion be ween psychopa hic ai s, accoun ing o all i s
dimensions, and emo ion ecogni ion de ici s in child en and
adolescen s. Resul s o e all showed impai men s in emo ion
ecogni ion in ela ion o psychopa hic ai s. These esul s
e ealed pe asi e de ici s ac oss emo ions, al hough hey
we e mo e ma ked o dis ess emo ions, including ea o
sadness, wi h de ici s being eplica ed ac oss all modali ies
o emo ion p esen a ion and all s imuli used. Impo an ly,
when dis up i e beha io is p esen , o e all psychopa hic
ai s, beyond CU, seem o accoun o emo ion ecogni ion
de ici s. A en ional pa e ns seemed biased in child en and
adolescen s high on psychopa hic ai s and in ol e di e en
pa e ns ega ding he a eas o in e es analyzed, including
he eyes o he mou h. No wi hs anding hese esul s, he
p esen e iew is cha ac e ized by a g ea he e ogenei y in
s udy designs and ask condi ions, hampe ing he es ablish-
men o i m conclusions. Conside ing he impo ance o his
esea ch o de elopmen al models o psychopa hic ai s,
eplica ion s udies, based on mo e s anda dized s udy cha -
ac e is ics, a e pa icula ly encou aged.
214 Clinical Child and Family Psychology Re iew (2024) 27:165–219
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