Written by Mary B. Ritchie and the Research Committee
Youth who display callous-unemotional (CU) traits are characterized by a shallow and deficient emotion, lack of remorse or guilt, lack of empathy, and a lack of concern about performance in important activities. CU traits have been associated with early, severe, and persistent aggressive behavior, as well as an increased risk of developing adult psychopathy. Unfortunately, those with CU traits tend to benefit less than other children from established evidence-based interventions aimed at reducing conduct problems among youth. The poor treatment response to existing interventions among those with CU traits has been attributed to distinct familial, cognitive, emotional, and biological factors. For example, youth with CU traits are less responsive to cues of punishment and more responsive to rewards than those without CU traits. Further, youth with CU traits show a distinct temperament style characterized by a lack of fearful inhibitions and display deficits in emotional processing. CU traits have also been associated with a low warmth and responsivity parenting style.
With evidence of poorer treatment response to existing interventions, Kimonis and her colleagues (2019) sought to test the efficacy of adapting (or modifying) a therapeutic approach to increase its effectiveness. Parent-Child Interaction Therapy (PCIT) is one intervention that has shown positive effects among youth who display conduct problems but not among those with CU traits. Traditionally, PCIT is a treatment aimed at strengthening the parent-child relationship by encouraging positive parenting strategies. The current study aimed to enhance traditional PCIT by addressing three factors distinct to CU traits. Specifically, Kimonis and colleagues (2019) adapted PCIT to enhance parental warmth and responsivity, shift the focus away from punishment towards rewards, and target emotional deficits by coaching and rewarding emotional skills.
A total of 23 families with 3-6 year old children (87% boys) displaying elevated CU traits participated in this study. Each family received the PCIT-CU intervention for 21-weekly 1-hour sessions and were followed for three months after treatment ended. In the first stage of the intervention, parents were coached to increase their use of verbal and physical expressions of warmth in the context of play. In the second phase, parents were coached to integrate into their parenting a reward-based behaviour modification system, in which positive behaviours were reinforced. In the final phase, parents sought to address their childrens’ insensitivity to distress cues by enhancing attention to critical facial cues, improving emotional understanding, modeling empathic behaviour, and increasing frustration tolerance.
Treatment retention was high (74% of families remained in treatment) and parents reported high satisfaction with the program. The PCIT-CU intervention produced decreases in conduct problems and CU traits, as well as increases in empathy. These effects were maintained over the 3-month follow-up period. Overall, these results provide preliminary evidence for the value of using PCIT-CU to treat young children with CU traits.
Reference: Kimonis, E. R., Fleming, G., Biggs, N., Brouwer-French, L., Frick, P. J., Hawes, D. J., Bagner, D. M., Thomas, R., & Dadds, M. (2019). Parent-Child Interaction Therapy adapted for preschoolers with callous-unemotional traits: An open trial pilot study. Journal of Clinical Child and Adolescent Psychology, 48, 347-361.
