Parent Training Adapted to the Needs of Children with Callous-Unemotional Traits: A Randomized Controlled Trial

Abstract

Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether Parent-Child Interaction Therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to Standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive Standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed effects models showed treatment gains in conduct problems deteriorated for children in Standard PCIT relative to those in PCIT-CU during the three-month follow-up period (ds = 0.4–0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.

The Nature and Nurture of Callous-Unemotional Traits

“…Several treatments that focus specifically on youths with behavior problems and CU traits are now emerging. Consistent with Nature × Nurture research, these treatments focus on increasing positive parenting (e.g., Fleming et al, 2022). Based on additional neurocognitive research on CU traits, emerging treatments are also targeting the development of empathy (by supporting attention to and understanding of emotions in other people) and increased frustration tolerance, among other needs specific to individuals with CU traits (Dadds et al, 2012; Fleming et al, 2022).…”

“…Consistent with Nature × Nurture research, these treatments focus on increasing positive parenting (e.g., Fleming et al, 2022). Based on additional neurocognitive research on CU traits, emerging treatments are also targeting the development of empathy (by supporting attention to and understanding of emotions in other people) and increased frustration tolerance, among other needs specific to individuals with CU traits (Dadds et al, 2012; Fleming et al, 2022). The hope is that by targeting the deficits of these youths more directly, treatment can promote behavior in the normative range even among those with relatively highly heritable behavior problems.…”