Poster #92 - Impact of an 8-week intervention on coercive parent-child interactions among children with disruptive behavior disorders

• In Event: Poster Session 14

Abstract

Disruptive behavior disorders (DBDs; i.e., ADHD, Conduct Disorder, Oppositional Defiant Disorder) are the most common child referral concern to mental health professionals in the U.S. (Danielson et al., 2018). Caregivers of these children report increased strain in the caregiver-child relationship that may maintain coercive, unhealthy interactions over time (DuPaul et al., 2001). Further, the presence of elevated callous-unemotional traits (e.g., low levels of guilt following wrongdoing, shallow emotional affect, callous lack of empathy) put children at risk for even more severe aggression and conduct problems (Kimonis et al., 2008) and are at risk for more severe coercive caregiver-child interactions (Pasalich et al., 2011). Unfortunately, children with elevated callous-unemotional traits are less responsive to standard behavioral interventions and thus they represent a treatment challenge. The coercive process (Patterson, 1992; Reid et al., 2002), the most commonly cited behavioral model of caregiver-child conflict, is the primary explanatory mechanism implicated in the maintenance of DBDs. Despite the coercive process being the foundation of understanding maladaptive caregiver-child interactions and is thought to contribute to the development of DBDs, until recently no caregiver-report assessment tools existed to directly measure this dyadic process. The purpose of the current pilot study is twofold. First, we aimed to assess whether the Summer Treatment Program (STP), an established 8-week intensive behavioral intervention for children with DBDs, reduced coercive caregiver-child interactions using a new parent-report measure of coercive interactions. We then sought to assess whether the child’s level of callous-unemotional traits moderated this effect. One hundred and eight caregivers and their children who had been diagnosed with DBDs participated in the STP, a well-established intensive, 8-week behavioral intervention for children with DBDs which involves the children receiving behavior modification for 9 hours per day and caregivers attending a weekly parent management training group. Children were on average 8.37 years old (SD = 1.79, range 6-12), 75% male, 72% Hispanic, and caregivers reported an average income of $66,241. A subsample of 33 families participated in our pilot study assessing whether the STP reduced parent report of coercive interactions and whether the child’s callous-unemotional traits moderated this effect. Coercive parent-child interactions were measured using the recently developed Parent-Child Coercive Process Scale (Mitnick et al., 2021) and child callous-unemotional traits was measured using the Inventory of Callous-Unemotional Traits (Kimonis et al., 2008). A repeated measures ANOVA revealed, even after accounting for child age, sex, ethnicity, and caregiver education and income, a significant main effect of time on the coercive caregivers-child interactions such that there was significant improvement in caregiver-child interactions from pre- to post-treatment (F=6.65, p<.01). However, callous-unemotional traits moderated this effect such that we only saw improvement in caregiver-child interactions among children with low/normative levels of callous-unemotional traits (F=6.60, p<.01). That is, among children with elevated callous-unemotional traits, there was no change in the coercive caregiver-child interactions pre- to post-treatment. Results have significant policy implications suggesting that standard behavioral interventions for DBDs are not sufficient to improve family functioning among children with elevated callous-unemotional traits.

Authors

• Emily L Robertson, Florida International University
  Presenting Author

• Jennifer Piscitello, Florida International University

• Maya Renaud, Florida International University

• Diandra Leon, Florida International University

• William E Pelham, Florida International University