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Abstract

Children with conduct problems and callous-unemotional traits (i.e., lack of empathy, guilt, and lack of caring behaviors)(CP + CU) show poor response to empirically supported interventions for treating disruptive behaviors. Children with CP + CU are specifically less responsive to discipline components of parent training, although they respond well to reward-based behavioral strategies. This case study presents the treatment of a 5-year-old boy with severe disruptive behavior (CP, attention-deficit/hyperactivity disorder) and pronounced CU traits using Parent–Child Interaction Therapy, followed by the delivery of an adjunctive token economy system. Interventions that treat children with CP + CU are critically needed and have the potential for significant societal impact given the stability of their traits and severe behavioral outcomes. Findings from this case report (a) document an improvement in CP that was maintained to follow-up and (b) provide preliminary support for adapting parent-training interventions to modify severe CP in young children with CU traits.

Keywords

callous-unemotional traits conduct problems parent training Parent–Child Interaction Therapy attention-deficit/hyperactivity disorder

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Bagner

D. M.

Eyberg

S. M.

(2007). Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 36, 418-429.

Bagner

D. M.

Sheinkopf

S. J.

Vohr

B. V.

Lester

B. M.

(2010). Parenting intervention for externalizing behavior problems in children born premature: An initial examination. Developmental and Behavioral Pediatrics, 31, 209-216.

Barkley

R. A.

(1997). Defiant children: A clinician’s manual for assessment and parent training. New York, NY: Guilford.

Blair

R. J. R.

(1995). A cognitive developmental approach to morality: Investigating the psychopath. Cognition, 57, 1-29.

Blair

R. J. R.

Peschardt

K. S.

Budhani

Mitchell

D. G. V.

Pine

D. S.

(2006). The development of psychopathy. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47, 262-275.

Broidy

L. M.

Nagin

D. S.

Tremblay

R. E.

Bates

J. E.

Brame

Dodge

K. A.

(2003). Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: A six-site, cross-national study. Developmental Psychology, 39, 222-245.

Caldwell

Skeem

Salekin

Van Rybroek

(2006). Treatment response of adolescent offenders with psychopathy features: A 2-year follow-up. Criminal Justice and Behavior, 33, 571-596.

Caputo

A. A.

Frick

P. J.

Brodsky

S. L.

(1999). Family violence and juvenile sex offending: Potential mediating roles of psychopathic traits and negative attitudes toward women. Criminal Justice and Behavior, 26, 338-356. doi:10.1177/009385489902600300410.1177/0093854899026003004

10.

Chaffin

Funderburk

Bard

Vale

L. A.

Gurwitch

(2010). A combined motivation and Parent-Child Interaction Therapy package reduces child welfare recidivism in a randomized dismantling field trial. Journal of Consulting and Clinical Psychology, 79, 84-95. doi:10.1037/a002122710.1037/a0021227

11.

Chaffin

Silovsky

J. F.

Funderburk

Valle

L. A.

Brestan

E. V.

Balachova

. . . Bonner

B. L.

(2004). Parent-Child Interaction Therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500-510. doi:10.1037/0022-006X.72.3.50010.1037/0022-006X.72.3.500

12.

Christian

R. E.

Frick

P. J.

Hill

N. L.

Tyler

Frazer

D. R.

(1997). Psychopathy and conduct problems in children: II. Implications for subtyping children with conduct problems. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 233-241.

13.

Dadds

M. R.

Hawes

D. J.

(2006). Integrated family intervention for child conduct problems: A behaviour-attachment-systems intervention for parents. Bowen Hills, QLD Australia: Australian Academic Press.

14.

Dadds

M. R.

Perry

Hawes

D. J.

Merz

Riddell

A. C.

Haines

D. J.

. . . Abeygunawardane

A. I.

(2006). Attention to the eyes and fear-recognition deficits in child psychopathy. British Journal of Psychiatry, 189, 280-281.

15.

Dadds

M. R.

Salmon

(2003). Punishment insensitivity and parenting: Temperament and learning as interacting risks for antisocial behavior. Clinical Child and Family Psychology Review, 6, 69-86.

16.

Dodge

K. A.

Pettit

G. S.

(2003). A biopsychosocial model of the development of chronic conduct problems in adolescence. Developmental Psychology, 39, 349-371.

17.

Dodge

K. A.

Price

J. M.

Bachorowski

Newman

J. M.

(1990). Hostile attributional biases in severely aggressive adolescents. Journal of Abnormal Psychology, 99, 385-392.

18.

Eisenstadt

T. H.

McElreath

L. S.

Eyberg

S. M.

McNeil

C. B.

(1994). Interparent agreement on the Eyberg Child Behavior Inventory. Child and Family Behavior Therapy, 16, 21-28. doi:10.1300/J019v16n01_0210.1300/J019v16n01_02

19.

Essau

C. A.

Sasagawa

Frick

P. J.

(2006). Callous-unemotional traits in community sample of adolescents. Assessment, 13, 454-469.

20.

Eyberg

S.M.

Bessmer

Newcomb

Edwards

Robinson

(1994). Dyadic parent-child interaction coding system II: A manual. (Social and behavioral sciences documents, Ms. No. 2897). San Rafael, CA: Select Press.

21.

Eyberg

S. M.

Nelson

M. M.

Boggs

S. R.

(2008). Evidence-based psychosocial treatments for child and adolescent with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37, 215-237.

22.

Eyberg

S. M.

Pincus

(1999). Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory–Revised: Professional Manual. Odessa, FL: Psychological Assessment Resources.

23.

Fanti

K. A.

Frick

P. J.

Georgiou

(2009). Linking callous-unemotional traits to instrumental and non-instrumental forms of aggression. Journal of Psychopathology and Behavioral Assessment, 31, 285-298.

24.

Farrington

D. P.

(1991). Childhood aggression and adult violence: Early precursors and later-life outcomes. In Pepler

D. J.

Rubin

K. H.

(Eds.), The development and treatment of childhood aggression (pp. 5-29). Hillsdale, NJ: Lawrence Erlbaum.

25.

Frick

P. J.

(2004). The Inventory of Callous-Unemotional Traits. Unpublished rating scale

26.

Frick

P. J.

(2006). Developmental pathways to conduct disorder. Child Psychiatric Clinics of North America, 15, 311-332.

27.

Frick

P. J.

(2009). Extending the construct of psychopathy to youth: Implications for understanding, diagnosing, and treating antisocial children and adolescents. Canadian Journal of Psychiatry, 54, 803-812.

28.

Frick

P. J.

Bodin

S. D.

Barry

C. T.

(2000). Psychopathic traits and conduct problems in community and clinic-referred samples of children: Further development of the Psychopathy Screening Device. Psychological Assessment, 12, 382-393.

29.

Frick

P. J.

Cornell

A. H.

Bodin

S. D.

Dane

H. A.

Barry

C. T.

Loney

B. R.

(2003). Callous-unemotional traits and developmental pathways to severe conduct problems. Developmental Psychology, 39, 246-260.

30.

Frick

P. J.

Dickens

(2006). Current perspectives on conduct disorder. Current Psychiatry Reports, 8, 59-72.

31.

Frick

P. J.

Hare

R. D.

(2001). The antisocial process screening device. Toronto, ON: Multi-Health Systems.

32.

Frick

P. J.

Kimonis

E. R.

Dandreaux

D. M.

Farell

J. M.

(2003). The 4 year stability of psychopathic traits in non-referred youth. Behavioral Sciences & the Law, 21, 713-736.

33.

Frick

P. J.

Loney

B. R.

(1999). Outcomes of children and adolescents with conduct disorder and oppositional defiant disorder. In Quay

H. C.

Hogan

(Eds.), Handbook of disruptive behavior disorders (pp. 507-524). New York, NY: Plenum.

34.

Frick

P. J.

Marsee

M. A.

(2006). Psychopathy and developmental pathways to antisocial behavior in youth. In Patrick

C. J.

(Ed.), Handbook of psychopathy (pp. 355-374). New York, NY: Guilford.

35.

Frick

P. J.

Moffitt

T. E.

(2010). A proposal to the DSM-V childhood disorders and the ADHD and disruptive behavior disorders work groups to include a specifier to the diagnosis of conduct disorder based on the presence of callous-unemotional traits. Washington, DC: American Psychiatric Association.

36.

Frick

P. J.

Morris

A. S.

(2004). Temperament and developmental pathways to conduct problems. Journal of Clinical Child & Adolescent Psychology, 33, 54-68.

37.

Frick

P. J.

Silverthorn

(2001). Psychopathology in children. In Sutker

P. B.

Adams

H. E.

(Eds.), Comprehensive handbook of psychopathology (3rd ed., pp. 881-920). New York, NY: Kluwer.

38.

Frick

P. J.

White

S. F.

(2008). Research review: The importance of callous-unemotional traits for developmental models of aggressive and antisocial behavior. Journal of Child Psychology and Psychiatry, 49, 359-375.

39.

Fricker-Elhai

A. E.

Ruggiero

K. J.

Smith

D. W.

(2005). Parent-Child Interaction Therapy with two maltreated siblings in foster care. Clinical Case Studies, 4, 13-39. doi:10.1177/153465010325967110.1177/1534650103259671

40.

Funderburk

B. W.

Eyberg

S. M.

Rich

B. A.

Behar

(2003). Further psychometric evaluation of the Eyberg and Behar rating scales for parents and teachers of preschoolers. Early Educational Development, 14, 67-81.

41.

Gioia

G.A.

Isquith

P.K.

Guy

S.C.

Kenworthy

(2000). Behavior Rating of Executive Function. Lutz, FL: Psychological Assessment Resources.

42.

Haas

S. M.

Waschbusch

D. A.

Pelham

W. E.

King

Andrade

B. F.

Carrey

N. J.

(2011). Treatment response in CP/ADHD children with callous/unemotional traits. Journal of Abnormal Child Psychology, 39, 541-552.

43.

Hawes

D. J.

Dadds

M. R.

(2005). The treatment of conduct problems in children with callous-unemotional traits. Journal of Consulting and Clinical Psychology, 73, 737-741.

44.

Hawes

D. J.

Dadds

M. R.

(2007). Stability and malleability of callous-unemotional traits during treatment for childhood conduct problems. Journal of Clinical Child & Adolescent Psychology, 36, 347-355.

45.

Hawes

D. J.

Dadds

M. R.

Frost

Hasking

P.A.

(2011). Do childhood callous-unemotional traits drive change in parenting practices? Journal of Clinical Child & Adolescent Psychology, 40(4), 507-518. doi:10.1080/15374416.2011.58162410.1080/15374416.2011.581624

46.

Herman-Smith

Pearson

Cordiano

Aguirre-McLaughlin

(2008). Addressing individual client needs in manualized treatment: Case comparisons. Clinical Case Studies, 7, 377-396. doi:10.1177/153465010831586710.1177/1534650108315867

47.

Hinshaw

S. P.

(1991). Stimulant medication and the treatment of aggression in children with attention deficits. Journal of Clinical Child Psychology, 20, 301-312.

48.

Hipwell

A. E.

Pardini

D. A.

Loeber

Sembower

Keenan

Stouthamer-Loeber

(2007). Callous-unemotional behaviors in young girls: Shared and unique effects relative to conduct problems. Journal of Clinical Child & Adolescent Psychology, 36, 293-304.

49.

Hoffman

M. L.

(1994). Discipline and internalization. Developmental Psychology, 30, 26-28.

50.

Kazdin

A. E.

(2005a). Parent management training. New York, NY: Oxford University Press.

51.

Kazdin

A. E.

(2005b). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. New York, NY: Oxford University Press.

52.

Kazdin

A. E.

Whitley

M. K.

(2003). Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior. Journal of Consulting and Clinical Psychology, 71, 504-515.

53.

Keenan

Loeber

Zhang

Stouthamer-Loeber

Van Kammen

W. B.

(1995). The influence of deviant peers on the development of boys’ disruptive and delinquent behavior: A temporal analysis. Development and Psychopathology, 7, 715-726.

54.

Kimonis

E. R.

Frick

P. J.

Boris

N. W.

Smyke

A. T.

Cornell

A. H.

Farrell

J. M.

Zeanah

C. H.

(2006). Callous-unemotional features, behavioral inhibition, and parenting: Independent predictors of aggression in a high-risk preschool sample. Journal of Child and Family Studies, 15, 745-756.

55.

Kimonis

E. R.

Frick

P. J.

Fazekas

Loney

B. R.

(2006). Psychopathy, aggression, and the processing of emotional stimuli in non-referred girls and boys . Behavioral Sciences & the Law. Special Issue: Gender and Psychopathy Volume 2, 24, 21-37.

56.

Kimonis

E. R.

Frick

P. J.

Skeem

J. L.

Marsee

M. A.

Cruise

Munoz

L. C.

. . . Morris

A. S.

(2008). Assessing callous-unemotional traits in adolescent offenders: Validation of the inventory of callous-unemotional traits. Journal of the International Association of Psychiatry and Law, 31, 241-251.

57.

Kochanska

Murray

K. T.

(2000). Mother-child mutually responsive orientation and conscience development: From toddler to early school age. Child Development, 71, 417-431.

58.

Kochanska

Thompson

R. A.

(1997). The emergence and development of conscience in toddlerhood and early childhood. In Grusec

J. E.

Kuczynski

(Eds.), Parenting and children’s internalization of values: A handbook of contemporary theory (pp. 53-77). New York, NY: Wiley.

59.

Kolko

D. J.

Dorn

L. D.

Bukstein

O. G.

Pardini

Holden

E. A.

Hart

(2009). Community vs. clinic-based modular treatment of children with early-onset ODD or CD: A clinical trial with 3-year follow-up. Journal of Abnormal Child Psychology, 37, 591-609.

60.

Lahey

B. B.

Loeber

(1997). Attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and adult antisocial behavior: A life span perspective. In Stoff

D. M.

Breiling

Maser

J. D.

(Eds.), Handbook of antisocial behavior (pp. 51-59). Hoboken, NJ: Wiley.

61.

Loney

B. R.

Butler

M. A.

Lima

E. N.

Counts

C. A.

Eckel

L. A.

(2006). The relation between salivary cortisol, callous-unemotional traits, and conduct problems in an adolescent non-referred sample. Journal of Child Psychology and Psychiatry, 47, 30-36.

62.

Lynam

D. R.

Caspi

Moffitt

T. E.

Loeber

Stouthamer-Loeber

(2007). Longitudinal evidence that psychopathy scores in early adolescence predict adult psychopathy. Journal of Abnormal Psychology, 116, 155-165.

63.

Marshall

Cooke

D. J.

(1996). The role of childhood experiences in the aetiology of psychopathy. In Cooke

D. J.

Forth

A. E.

Newman

J. P.

Hare

R. D.

(Eds.), Issues in criminological and legal psychology: No. 24, International perspectives on psychopathy (pp. 107-108). Leicester, UK: British Psychological Society.

64.

Matos

Torres

Santiago

Jurado

Rodriguez

(2006). Adaptation of Parent-Child Interaction Therapy for Puerto Rican families: A preliminary study. Family Process, 45, 205-222.

65.

McCabe

K. M.

Yeh

Lau

Bertely Argote

(2011). Parent-Child Interaction Therapy for Mexican Americans: Results of a pilot randomized clinical trial at follow-up. Behavior Therapy. Advance online publication.

66.

McCord

(1964). The psychopath: An essay on the criminal mind. Princeton, NJ: Van Nostrand.

67.

McDonald

Dodson

M. C.

Rosenfeld

Jouriles

E. N.

(2011). Effects of a parenting intervention on features of psychopathy in children. Journal of Abnormal Child Psychology, 39, 1013-1023.

68.

McGoey

K. E.

DuPaul

G. J.

(2000). Token reinforcement and response cost procedures: Reducing the disruptive behavior of preschool children with attention-deficit/hyperactivity disorder. School Psychology Quarterly, 15, 330-343.

69.

McMahon

R. J.

(1994). Diagnosis, assessment, and treatment of externalizing problems in children: The role of longitudinal data. Journal of Consulting and Clinical Psychology, 62, 901-917.

70.

McMahon

R. J.

Frick

P. J.

(2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 34, 477-505.

71.

Moffitt

T. E.

(2003). Life-course persistent and adolescence-limited antisocial behavior: A 10-year research review and research agenda. In Lahey

B. B.

Moffitt

T. E.

Caspi

(Eds.), Causes of conduct disorder and juvenile delinquency (pp. 49-75). New York, NY: Guilford.

72.

Moffitt

T. E.

(2006). Life-course-persistent versus adolescence-limited antisocial behavior. In Cicchetti

Cohen

D. J.

(Eds.), Developmental psychopathology, Vol. 3: Risk, disorder, and adaptation (2nd ed., pp. 570-598). Hoboken, NJ: Wiley.

73.

Moffitt

T. E.

Caspi

(2001). Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Development and Psychopathology, 13, 355-375.

74.

Nixon

R. D. V.

Sweeney

Erickson

D. B.

Touyz

S. W.

(2003). Parent-Child Interaction Therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71, 251-260.

75.

Obradovic

Pardini

Long

Loeber

(2007). Measuring interpersonal callousness in boys from childhood to adolescence. An examination of longitudinal invariance and temporal stability. Journal of Clinical Child & Adolescent Psychiatry, 36, 276-292.

76.

O’Brien

B. S.

Frick

P. J.

(1996). Reward dominance: Associations with anxiety, conduct problems and psychopathy in children. Journal of Abnormal Child Psychology, 24, 223-240.

77.

O’Leary

M. M.

Loney

B. R.

Eckel

L. A.

(2007). Gender differences in the association between psychopathic personality traits and cortisol response to induced stress. Psychoneuroendocrinology, 32, 183-191.

78.

Pardini

D. A.

Lochman

J. E.

Frick

P. J.

(2003). Callous/unemotional traits and social-cognitive processes in adjudicated youths. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 364-371.

79.

Pardini

D. A.

Lochman

J. E.

Powell

(2007). The development of callous-unemotional traits and antisocial behavior in children: Are there shared and/or unique predictors? Journal of Clinical Child & Adolescent Psychology, 36, 319-333.

80.

Pearl

E. S.

(2008). Parent-child interaction therapy with an immigrant family exposed to domestic violence. Clinical Case Studies, 7, 25-41. doi:10.1177/153465010730093910.1177/1534650107300939

81.

Piacentini

J. C.

Cohen

(1992). Combining discrepant diagnostic information from multiple sources: Are complex algorithms better than simple ones? Journal of Abnormal Child Psychology, 20, 51-63.

82.

Rae

Zimmer-Gembeck

M. J.

(2007). Behavioral outcomes of Parent-Child Interaction Therapy and Triple P-Positive Parenting Program: A review and meta-analysis. Journal of Abnormal Child Psychology, 35, 475-495.

83.

Reynolds

C. R.

Kamphaus

R. W.

(2006). Behavior Assessment System for Children, 2nd Edition. NY: Pearson.

84.

Rote

J. A.

Dunstan

D. A.

(2011). The assessment and treatment of long-standing disruptive behavior problems in a 10-year-old boy. Clinical Case Studies, 10, 263-277. doi:10.1177/153465011141022810.1177/1534650111410228

85.

Rubin

K. H.

Bukowski

Parker

J. G.

(1998). Peer interactions, relationships, and groups. In Damon

(Ed.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (pp. 619-700). New York, NY: Wiley.

86.

Salekin

R. T.

(2002). Psychopathy and therapeutic pessimism: Clinical lore of clinical reality? Clinical Psychology Review, 22, 79-112.

87.

Schuhmann

E. M.

Foote

R. C.

Eyberg

S. M.

Boggs

S. R.

Algina

(1998). Efficacy of Parent-Child Interaction Therapy: Interim report of a randomized trial with short-term maintenance. Journal of Consulting and Clinical Psychology, 27, 34-45.

88.

Silverthorn

Frick

P. J.

Reynolds

(2001). Timing of onset and correlates of severe conduct problems in adjudicated girls and boys. Journal of Psychopathology and Behavioral Assessment, 23, 171-181.

89.

Smyth

R.M.D

Kirkham

J.J.

Jacoby

Altman

D.G.

Gamble

Williamson

P.R.

(2011). Frequency and reasons for outcome reporting bias in clinical trials: interviews with trialists. British Medical Journal, 342, c7153.

90.

Stingaris

Goodman

(2009). Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 404-412.

91.

Thomas

Zimmer-Gembeck

M. J.

(2011). Accumulating evidence of Parent-Child Interaction Therapy in the prevention of child maltreatment. Child Development. Advance online publication. doi:10.1111/j.1467-8624.2010.01548.x10.1111/j.1467-8624.2010.01548.x

92.

Tynan

W.D.

Schuman

Lampert

(1999). Concurrent parent and child therapy groups for externalizing disorders: From the laboratory to the world of managed care. Cognitive & Behavioral Practice, 6, 3-9.

93.

Viding

Blair

R. J. R.

Moffitt

T. E.

Plomin

(2005). Evidence for a substantial genetic risk for psychopathic traits in 7-year-olds. Journal of Child Psychology and Psychiatry, 46, 592-597.

94.

Viding

Jones

A. P.

Frick

P. J.

Moffitt

T. E.

Plomin

(2008). Heritability of antisocial behaviour at 9: Do callous-unemotional traits matter? Developmental Science, 11, 17-22.

95.

Waschbusch

D. A.

(2002). A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychological Bulletin, 128, 118-150.

96.

Waschbusch

D. A.

Carrey

N. J.

Willoughby

M. T.

King

Andrade

B. F.

(2007). Effects of methylphenidate and behavior modification on the social and academic behavior of children with disruptive behavior disorders: The moderating role of callous/unemotional traits. Journal of Clinical Child & Adolescent Psychology, 36, 629-644.

97.

Williams

Armstrong

Bradley-Klug

Curtiss

(in press). HOT DOCS: A parenting intervention to prevent and address challenging behavior in young children. Journal of Early Childhood and Infant Psychology.

98.

Wootton

J. M.

Frick

P. J.

Shelton

K. K.

Silverthorn

(1997). Ineffective parenting and childhood conduct problems: The moderating role of callous-unemotional traits. Journal of Consulting and Clinical Psychology, 65, 301-308.

Adapting Parent–Child Interaction Therapy to Treat Severe Conduct Problems With Callous-Unemotional Traits

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