Severe traumatic brain injury in childhood as a factor associated with the emergence of callous-unemotional traits: a case report
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1529Keywords:
Traumatic Brain Injury, Callous-Unemotional Traits, Antisocial BehaviorAbstract
Introduction: Severe traumatic brain injury (TBI) in childhood is a potentially devastating condition that can lead to long-term neurological and behavioral consequences. Recent studies have suggested a possible association between early brain injury and the emergence of callous-unemotional (CU) personality traits, characterized by lack of empathy, affective coldness, and antisocial behavior. Objective: To report the case of a child who developed behavioral changes compatible with CU traits after severe TBI, discussing the possible relationship between brain injury and the emergence of such personality patterns. Method: Observational and descriptive case report based on medical record analysis, family interviews, and review of recent scientific literature. Clinical, neurological, and behavioral variables were assessed from the traumatic event through psychological evolution. Informed Consent Form signed by the responsible party. Research Ethics Committee (CEP) of UNIDAVI, under opinion number 7.787.715. Results: After the TBI, the patient exhibited marked behavioral alterations, including impulsivity, emotional indifference, and decreased sensitivity to punishment. Temporal and clinical analysis suggests a causal relationship between brain injury and the appearance of CU traits, supporting literature findings that highlight the involvement of prefrontal and limbic regions in such behavioral profiles. Conclusion: This case supports the hypothesis that severe childhood TBI may act as a risk factor for the development of callous-unemotional traits, emphasizing the importance of early neuropsychological and multidisciplinary follow-up in pediatric patients with significant brain injuries.
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1. Li L, Liu J. The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review. Dev Med Child Neurol. 2012;55(1):37–44. https://doi.org/10.1111/j.1469-8749.2012.04414.x PMid:22998525
2. Koenigs M, Young L, Adolphs R, Tranel D, Cushman F, Hauser M, et al. Damage to the prefrontal cortex increases utilitarian moral judgements. Nature. 2007;446(7138):908–11. https://doi.org/10.1038/nature05631 PMid:17392781
3. Breeden AL, Cardinale EM, Lozier LM, VanMeter JW, Marsh AA. Callous-unemotional traits drive reduced white-matter integrity in youths with conduct problems. Psychol Med. 2015;45(14):3033–46. https://doi.org/10.1017/S0033291715000987 PMid:26087816
4. Dotterer HL, Waller R, Shaw DS, Plass JL, Brang D, Forbes EE, Hyde LW. Antisocial behavior with callous-unemotional traits is associated with widespread disruptions to white matter structural connectivity among low-income, urban males. Neuroimage Clin. 2019;23:101836. https://doi.org/10.1016/j.nicl.2019.101836 PMid:31077985
5. Waller R, Hawes SW, Byrd AL, Dick AS, Sutherland MT, Riedel MC, Tobia MJ, Bottenhorn KL, Laird AR, Gonzalez R. Disruptive behavior problems, callous-unemotional traits, and regional gray matter volume in the adolescent brain and cognitive development study. Biol Psychiatry Cogn Neurosci Neuroimaging. 2020;5(5):481-89. https://doi.org/10.1016/j.bpsc.2020.01.002 PMid:32144045
6. Khalaf HKS, Martin AF, De Brito SA, Barker ED. The underlying mechanisms in the association between traumatic brain injury in childhood and conduct disorder symptoms in late adolescence. Res Child Adolesc Psychopathol. 2023;51(5):709–25. https://doi.org/10.1007/s10802-022-01015-y PMid:36637701
7. Squillaci MM, Cacioppa G, Squillaci A, et al. Callous-unemotional traits and environmental and neurobiological influences: A review. Int J Environ Res Public Health. 2021;18(9):4712. https://doi.org/10.3390/ijerph18094712 PMid:34067392
8. Sharp DJ, Scott G, Leech R. Network dysfunction after traumatic brain injury. Nat Rev Neurol. 2014;10(3):156-66. https://doi.org/10.1038/nrneurol.2014.15 PMid:24569683
9. Anderson V, Spencer-Smith M, Wood A. Do children really recover better? Neurobehavioural plasticity after early brain insult. Brain. 2011;134(Pt 8):2197-221. https://doi.org/10.1093/brain/awr103 PMid:21616969
10. Anderson SW, Bechara A, Damasio H, Tranel D, Damasio AR. Impairment of social and moral behavior related to early damage in human prefrontal cortex. Nat Neurosci. 1999;2(11):1032–7. https://doi.org/10.1038/14833 PMid:10526345
11. Viding E, Blair RJR, Moffitt TE, Plomin R. Evidence for substantial genetic risk for psychopathy in 7-year-olds. J Child Psychol Psychiatry. 2005;46(6):592–7. https://doi.org/10.1111/j.1469-7610.2004.00393.x PMid:15877766
12. Max JE, Wilde EA, Bigler ED, Thompson WK, MacLeod M, Vasquez AC, Merkley T, Hunter JV, Chu ZD, Yallampalli R, Hotz G, Chapman SB, Yang TT,Levin HS. Neuroimaging correlates of novel psychiatric disorders after pediatric traumatic brain injury. J Am Acad Child Adolesc Psychiatry. 2012;51(11):1208–17. https://doi.org/10.1016/j.jaac.2012.08.026 PMid:23101744
13. Blair RJR, Cipolotti L. Impaired social response reversal: a case of acquired sociopathy. Brain. 2000;123(Pt 6):1122–41. https://doi.org/10.1093/brain/123.6.1122 PMid:10825356
14. Adolphs R, Tranel D, Damasio H, Damasio AR. Impaired recognition of emotion in facial expressions following bilateral damage to the human amygdala. Nature. 1994;372(6507):669–72. https://doi.org/10.1038/372669a0 PMid:7990957
15. Catroppa C, Anderson V, Morse S, Haritou F, Rosenfeld J. Outcome and predictors of functional recovery 5 years following pediatric traumatic brain injury. J Pediatr Psychol. 2008;33(7):707-18. https://doi.org/10.1093/jpepsy/jsn006 PMid:18287103
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