Abstract: Conduct problems (CP) are a common psychiatric condition among children and adolescents. It is well known that severe and persistent conduct problems in youth may lead to adult psychopathy. Though not all children and adolescents with CP will develop further adult psychopathy, the aim of modern treatment is to avoid this outcome. Adult psychopathy is associated with poor physical health, low education, criminality, unemployment, drug use and unfortunate family relations with insufficient parenting and child neglect and abuse. In the past decades, scientists have described a phenomena called callous-unemotional traits, which seem to be an important precursor for adult psychopathy in youths with CP. Callous-unemotional traits are seen in children and adolescents with a more severe and persistent conduct problem including lack of empathy and fear. They commit violent crimes at a younger age, have a preference for novel and dangerous activities and display resistance to common intervention. Several studies suggest that there is a neurobiological deficit in these children, which may explain parts of the complexity in treating and preventing further psychopathy. There are studies documenting a functional abnormality in several brain regions, most importantly the limbic –prefrontal circuit. There is less documentation about a possible structural abnormality in these children, who may explain the functional outcomes. Method: In this literature study I did a search in the database PubMed, to find studies about structural MRI and adolescents with callous-unemotional traits. Results: Several studies showed different anatomy in brain regions as insula, amygdala, anterior cingulate cortex and orbitofrontal cortex in children with callous-unemotional traits compared to normal developed controls. Conclusion: A possible structural neurobiological cause cannot be excluded in explaining the stereotype pattern of behavior in children and adolescents with callous-unemotional traits.