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Effects of Behavioral Treatment Modified to Fit Children with Conduct Problems and Callous-Unemotional (CU) Traits.

ABSTRACT: Research suggests that children with conduct problems (CP) and callous-unemotional (CU) traits show a diminished response to behavior therapy, perhaps due to a reward-oriented, punishment insensitive learning style. Children with CP and CU may benefit from personalizing behavioral treatment for them by emphasizing rewards and de-emphasizing punishments. This hypothesis was tested in a sample of 46 children (78.3% boys), ages 7.0 to 12.6 years (M = 9.3, SD = 1.4). All participants met criteria for ODD and ADHD and 63% also met criteria for CD. Participants were oversampled for high CU, but CU scores ranged from average to high. Children received four weeks of modified behavior therapy that emphasized rewards and de-emphasized punishments and four weeks of treatment as usual, which was standard behavior therapy that balanced rewards and punishments. Treatments were implemented in a summer treatment program and compared using a within-subjects design, with order of treatment counterbalanced. Disruptive behavior was equal or slightly higher in modified behavior therapy than in standard behavior therapy on point system measures, but lower on parent weekly ratings. End of treatment ratings showed both treatments produced significant improvements compared to pre-treatment ratings but did not differ from each other. Personalizing behavior therapy for children with CP and CU produced inconsistent findings relative to standard behavior therapy. Behavior therapy is likely to be a necessary part of treatment for children with CP and CU, but treatment personalization efforts may provide some benefit by addressing other deficits shown by these children.

SUBMITTER: Waschbusch DA

PROVIDER: S-EPMC6893108 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:Children who are frequently aggressive or lack empathy show various deficits in their social information processing. Several findings suggest that children with conduct problems (CP) show a tendency to interpret ambiguous situations as hostile (hostile attribution bias) and have difficulties to disengage from negative stimuli (attentional bias). The role that additional callous-unemotional traits (CU-traits) play in these biases is yet unclear. Investigating both attentional and attributional aspects of social information processing in children can help us to understand where anomalies in the processing pathway occur and whether the biases are associated with CP and CU-traits separately or in an interactive manner. Methods:We compared three groups of children: (a) 25 children with CP and low levels of CU-traits (b) 25 children with CP and elevated levels of CU-traits (c) 50 gender (68% male), age (8-17 years) and intelligence score-matched typically developing children, on a pictorial emotional stroop task and a hostile attribution bias task. Results:In contrast to our predictions, there were no significant group differences regarding attentional biases or hostile attribution biases. Boys with CP and high levels of CU-traits showed a significantly higher hostile attribution bias compared to girls with CP and high levels of CU-traits. The attention bias to angry stimuli significantly correlated with the hostile attribution bias. Compared to the control group the CP group with low levels of CU-traits showed a significantly stronger association between the attention bias to angry stimuli and the hostile attribution bias. Conclusions:The current study provides evidence that boys with CP and high levels of CU-traits interpret ambiguous situations as more hostile than girls do. Our results further provide indications that the interaction of attentional and attributional biases in children with CP might contribute to their increased aggressive behavior.

Project description:Among youths with conduct problems, callous-unemotional (CU) traits are known to be an important determinant of symptom severity, prognosis, and treatment responsiveness. But positive correlations between conduct problems and CU traits result in suppressor effects that may mask important neurobiological distinctions among subgroups of children with conduct problems.To assess the unique neurobiological covariates of CU traits and externalizing behaviors in youths with conduct problems and determine whether neural dysfunction linked to CU traits mediates the link between callousness and proactive aggression.This cross-sectional case-control study involved behavioral testing and neuroimaging that were conducted at a university research institution. Neuroimaging was conducted using a 3-T Siemens magnetic resonance imaging scanner. It included 46 community-recruited male and female juveniles aged 10 to 17 years, including 16 healthy control participants and 30 youths with conduct problems with both low and high levels of CU traits.Blood oxygenation level-dependent signal as measured via functional magnetic resonance imaging during an implicit face-emotion processing task and analyzed using whole-brain and region of interest-based analysis of variance and multiple-regression analyses.Analysis of variance revealed no group differences in the amygdala. By contrast, consistent with the existence of suppressor effects, multiple-regression analysis found amygdala responses to fearful expressions to be negatively associated with CU traits (x = 26, y = 0, z =?-12; k = 1) and positively associated with externalizing behavior (x = 24, y = 0, z =?-14; k = 8) when both variables were modeled simultaneously. Reduced amygdala responses mediated the relationship between CU traits and proactive aggression.The results linked proactive aggression in youths with CU traits to hypoactive amygdala responses to emotional distress cues, consistent with theories that externalizing behaviors, particularly proactive aggression, in youths with these traits stem from deficient empathic responses to distress. Amygdala hypoactivity may represent an intermediate phenotype, offering new insights into effective treatment strategies for conduct problems.

Project description:The ability to empathise relies in part on using one's own affective experience to simulate the affective experience of others. This process is supported by a number of brain areas including the anterior insula (AI), anterior cingulate cortex (ACC), medial prefrontal cortex (mPFC), and the amygdala. Children with conduct problems (CP), and in particular those with high levels of callous-unemotional traits (CP/HCU) present with less empathy than their peers. They also show reduced neural response in areas supporting empathic processing when viewing other people in distress. The current study focused on identifying brain areas co-activated during affective introspection of: i) One's own emotions ('Own emotion'); ii) Others' emotions ('Other emotion'); and iii) One's feelings about others' emotions ('Feel for other') during fearful vs neutral scenarios in typically developing boys (TD; n = 31), boys with CP/HCU (n = 31), and boys with CP and low levels of CU (CP/LCU; n = 33). The conjunction analysis across conditions within the TD group revealed significant clusters of activation in the AI, ACC/mPFC, and occipital cortex. Conjunction analyses across conditions in the CP/HCU and CP/LCU groups did not identify these areas as significantly activated. However, follow-up analyses were not able to confirm statistically significant differences between groups across the whole network, and Bayes-factor analyses did not provide substantial support for either the null or alternate hypotheses. Post-hoc comparisons indicated that the lack of conjunction effects in the CP/HCU group may reflect reduced affective introspection in the 'Other emotion' and 'Feel for other' conditions, and by reduced affective introspection in the 'Own emotion' condition in the CP/LCU group. These findings provide limited and ultimately equivocal evidence for altered affective introspection regarding others in CP/HCU, and altered affective introspection for own emotions in CP/LCU, and highlight the need for further research to systematically investigate the precise nature of empathy deficits in children with CP.

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Effects of Behavioral Treatment Modified to Fit Children with Conduct Problems and Callous-Unemotional (CU) Traits.

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