Is Parent-Child Interaction Therapy Adapted for Preschoolers with Callous-Unemotional Traits Superior to Standard Treatment?

• In Event: Callous-Unemotional And Psychopathic Traits: Looking Back at the Early Years to Inform Prevention and Intervention

Abstract

The risk factors for childhood conduct problems vary considerably across individuals. The importance of this causal heterogeneity is recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which includes for the first time a specifier for the diagnosis of callous-unemotional (CU) type conduct disorder (i.e., CD with limited prosocial emotions). The presence of CU traits designates a distinct subgroup of children with early starting, severe, and aggressive conduct problems that are not only associated with significantly increased risk of negative psychosocial outcomes as adolescents and adults, but are also less responsive to current gold-standard interventions for conduct problems, relative to their peers low on CU traits. Effective intervention thus requires individualizing treatment to the unique needs of children on etiologically distinct developmental pathways. The attenuated treatment response for CU-type conduct problems has been attributed to the failure of traditional interventions to adequately target the distinct risk factors involved in their development. While the field has developed a better understanding of the unique deficits and needs of children with CU traits, the translation of this knowledge into targeted interventions is relatively new. This presentation presents the final results of a randomized controlled trial to test whether an adaptation of Parent-Child Interaction Therapy (PCIT) to target three distinct risk factors associated with CU-type conduct problems—low parental warmth and responsivity; insensitivity to punishment; and emotional processing and empathic deficits—is superior to standard PCIT in improving conduct problem symptoms in 3-7 year old clinic-referred children with CU-type conduct problems (N=43). This trial builds on promising findings from an open trial pilot study of this targeted intervention, called PCIT-CU, which found that it produced statistically and clinically significant improvements in parent-rated and observed child conduct problems and parent-rated child CU traits and empathy. Families were randomized to receive either 21 weekly sessions of PCIT-CU (n=22) or 14 sessions of Standard PCIT followed by 7 weekly telephone check-in consultations to control for dosage (n=21). All families were invited to complete five comprehensive assessments, measuring child conduct problems, CU traits, and empathy levels, and parents’ treatment satisfaction. Assessments occurred at baseline, after the first Child Directed Interaction (CDI) phase, after the second Parent Directed Interaction (PDI) phase, after the third Coaching and Rewarding Emotional Skills (CARES) phase (PCIT-CU condition only), and three months after treatment completion. Results of latent growth curve models will be presented, testing whether families in the PCIT-CU condition show greater improvement in post-treatment outcomes than those assigned to standard PCIT (treatment efficacy); and whether parents report greater satisfaction and show better intervention completion rates for PCIT-CU than standard PCIT (acceptability). Preliminary results indicated that both conditions showed a decrease in conduct problem intensity over the treatment period, but that 3-month follow-up outcomes were superior for the PCIT-CU condition with moderate effect sizes. There are currently few guidelines regarding best practices for treating children with conduct problems and limited prosocial emotions, whose relative treatment resistance highlights the importance of testing novel targeted and comprehensive interventions.

Authors

• Georgette E. Fleming, University of New South Wales
  Presenting Author

• Eva R Kimonis, University of New South Wales
  Non-Presenting Author

• Bryan Neo, University of New South Wales
  Non-Presenting Author

• Nancy Briggs, University of New South Wales
  Non-Presenting Author