Behavioral Treatment for Children With Conduct Problems and Callous-Unemotional Traits

Designing a Novel Behavioral Treatment Protocol for Children Characterized by Conduct Problems and Callous-unemotional Traits

The purpose of this study is to modify behavior therapy so that it is optimized for children with conduct problems and callous-unemotional traits by emphasizing reward components and de-emphasizing punishment components.

Several studies have demonstrated that standard behavioral treatments do not appear to be sufficient for children with conduct problems (CP) and callous-unemotional (CU) traits. Other research suggests that children with CPCU are less responsive to punishments as evaluated using controlled laboratory tasks. Based on these two sets of findings, it was hypothesized that behavioral treatment modified to emphasize reward and de-emphasize punishments would be advantageous when used to treat children with CPCU. This hypothesis was tested in a treatment development study that had three phases. During phase 1, which occurred in 2010, the intervention was planned and treatment procedures and manuals were developed. During phase 2, which occurred in 2011, a pilot study was conducted in which the intervention was tested in an iterative manner in a group of 12 children with conduct problems and callous-unemotional traits. In phase 3, a larger trial was conducted using a cross over design, with one-half of participants getting standard behavioral treatment for four weeks followed by modified behavioral treatment for four weeks and remaining participants receiving treatments in the reverse order.Treatments were evaluated using parent ratings, counselor ratings, and frequency counts of behavior during treatments.

Inclusion Criteria:

• Clinical diagnosis of oppositional defiant disorder or conduct disorder
• Ages 7 to 12 years old
• t-score of 65 or above on CU scale of Antisocial Process Screening Device as rated by parents or teacher
• at least parent/caregiver fluent in English
• able to participate in vigorous outdoor activities
• parent/caregiver agreement to keep psychoactive medication treatment constant throughout the study

Exclusion Criteria:

• Full scale intelligence quotient (IQ) of less than 75
• medical conditions that contra-indicate participation in treatment
• current or past clinical diagnosis of pervasive developmental disorder, schizophrenia or other psychotic disorders, sexual disorder, organic mental disorder, or eating disorder
• lack of functional impairment
• current or past seizures or other neurological disorders