Sarah M. Haas

Treatment response in CP/ADHD children with callous/unemotional traits.

The current study examines the role of callous/unemotional (CU) traits in response to treatment among children with conduct problems (CP) and attention-deficit/hyperactivity disorder (ADHD). Fifty-four children with CP/ADHD and 16 controls (age = 9.48, SD = 1.58) took part in a summer treatment and research program. Simple correlations showed that CU and CP were associated with a number of treatment outcome measures. When examined together in regression analyses, CU and CP were uniquely associated with three treatment outcomes each (CU—improvement in social skills and problem solving, negative behaviors in time-out; CP—time-outs per day, peer ratings, peer dislike). The implications for these findings with regard to treatment response in children with CP/ADHD with and without CU traits are explored.

Behavior Therapy and Callous-Unemotional Traits: Effects of a Pilot Study Examining Modified Behavioral Contingencies on Child Behavior

The conduct problems of children with callous-unemotional (CU) traits (i.e., lack of empathy, lack of guilt/lack of caring behaviors) are particularly resistant to current behavioral interventions, and it is possible that differential sensitivities to punishment and reward may underlie this resistance. Children with conduct problems and CU (CPCU) are less responsive to behavioral punishment techniques (e.g., time-out), whereas reward techniques (e.g., earning points for prizes or activities) are effective for reducing conduct problems. This study examined the efficacy of modified behavioral interventions, which de-emphasized punishment (Condition B) and emphasized reward techniques (Condition C), compared with a standard behavioral intervention (Condition A). Interventions were delivered through a summer treatment program over 7 weeks with an A-B-A-C-A-BC-A design to a group of 11 children (7-11 years; 91% male). All children were diagnosed with either oppositional defiant disorder or conduct disorder, in addition to attention-deficit hyperactivity disorder. Results revealed the best treatment response occurred during the low-punishment condition, with rates of negative behavior (e.g., aggression, teasing, stealing) increasing over the 7 weeks. However, there was substantial individual variability in treatment response, and several children demonstrated improvement during the modified intervention conditions. Future research is necessary to disentangle treatment effects from order effects, and implications of group treatment of CPCU children (i.e., deviancy training) are discussed.

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous-unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, Mage = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.

A Case Study Examining Fixed Versus Randomized Criteria for Treating a Child With Conduct Problems and Callous-Unemotional Traits

ABSTRACT Children with conduct problems and callous unemotional traits (CPCU) seem to show a decreased response to behavioral treatment. It was hypothesized that children with CPCU may respond differently to behavior therapy when the target behavior criteria are fixed a priori versus when they are randomly determined post hoc. A single-case study experiment was conducted as an initial step toward investigating this hypothesis. The study was conducted using a daily report card implemented in the context of an intensive behavioral summer treatment program. Results indicated that rates of negative behaviors were higher when rewards were delivered using randomly determined levels of target behaviors as compared to using fixed levels of target behaviors. Results suggest the importance of providing children with CPCU specific and predictable treatment goals when using contingency management procedures. Additional research that examines how children with CPCU react to components of behavioral treatment may help improve their response to behavior therapy.

Callous-Unemotional Traits are Uniquely Associated with Poorer Peer Functioning in School-Aged Children

This study examines externalizing symptoms (attention-deficit/hyperactivity disorder [ADHD], conduct problems, and callous-unemotional [CU] traits) in relation to domains of peer functioning (social competence, loneliness, and close friendship quality), with a specific focus on the role of CU traits. One hundred twenty-four elementary students (grades 3–6; 45% boys) completed multiple measures of peer functioning, and teachers completed measures of externalizing symptoms and social competence. After controlling for demographic variables and other externalizing symptoms, CU traits were significantly associated with poorer peer functioning across all variables except for demands of exclusivity in close friendships. ADHD symptoms were also uniquely associated with poorer social functioning across a number of variables. In contrast, conduct problems were at times associated with better social functioning after controlling for the effects of other externalizing problems. These findings bolster the importance of developing and evaluating social skills interventions for children displaying elevated CU traits.