Bad Boys and Mean Girls: Children with callous unemotional traits

A study by psychologists at UNSW Sydney’s Parent Child Research Clinic reveals that children who display aggressive, destructive and non-compliant behaviour appear to respond positively to a new behavioural therapy aimed at both parents and children,

The research could give worn-out parents new hope after it was shown the improvements in disruptive and prosocial behaviour learned by the children were more likely to stick well after the treatment program ceased, compared with standard treatment.

Forty three families of children aged between three and seven were placed randomly in either an existing behavioural treatment program – Parent-Child Interaction Therapy (PCIT) – or a version of this same therapy that was modified by the researchers to target the different needs of children with callous-unemotional traits (PCIT-CU).

They found that both of these programs had a positive effect on the disruptive behaviour problems and callous unemotional traits of the children in each group for the duration of the training.

But when the researchers checked in with the families 12 weeks after the training had ended, there was a stark and noticeable difference between the two groups in how much they retained from the treatment course.

“For the kids who got the new treatment that we developed, we saw a sustained improvement,” said Dr Georgie Fleming, study lead author from UNSW’s School of Psychology.

“And at the same time, we saw a pattern of deterioration of the children who got the standard treatment.”

New treatment vs old

Dr Fleming said this suggests that the modifications to the PCIT in the enhanced version seems to have brought about more long-lasting and positive changes in behaviour, something that past therapeutic strategies have struggled to maintain up until now.

She said the enhanced treatment (PCIT-CU) differed from the standard treatment (PCIT) in three main areas which were designed to focus more strongly on the needs of children with callous-unemotional traits.

First, they coached parents to use parenting behaviours that aimed to strengthen the relationship and attachment between parent and child by expressing warmth and affection.

“We explicitly coached parents to be warmer and more affectionate when interacting with their kids

“Things like sitting closer to their child during play, putting the ‘smile’ into their voice when they praise the child, and doing things that are specifically intended to make the child laugh,” Dr Fleming said.

The second modification was in the area of discipline. Dr Fleming said in standard treatment, there is an emphasis on delivering consistent discipline strategies. But in the case of children with CU traits, this could be counterproductive.

So to guard against making bad behaviour potentially worse, the researchers integrated a small reward system into the disciplinary part of the training.

“Basically we identify behaviours that we want these children to do more of. So, things like ‘listen to your parents when they ask you to do something, use gentle hands with your siblings and your friends’.

“And for all the instances where kids are showing what we would call ‘prosocial behaviours’, they get a token – some sort of small reward – which they accrue over time and are able to trade in for a whole menu of different rewards.”

“There is really robust evidence kids with callous-unemotional traits are underdeveloped in being able to recognise particular facial expressions, they’re not as good at picking up when someone is feeling scared or sad.

Years in the making

The modifications of the PCIT treatment were based on previous research led by senior author, Professor Eva Kimonis, from her pioneering work on the treatment of callous-unemotional traits and aggressive behaviour in young children.

Prof. Kimonis said it’s important to treat children in this subgroup early, as callous unemotional traits can develop into psychopathy later in life for some children.

“But I think what this treatment does is offer hope that actually we can adjust this trajectory, and these traits are responsive potentially to intervention when we do it young enough. So we don’t believe biology is necessarily destiny.”

Giving children access

Prof. Kimonis said the latest research is the first step in a multi-pronged plan to enable access to these sorts of specialised treatments for children who otherwise may not get it.

“Step one is working out how we can best get this to the children that need it.

“Georgie [Dr Fleming] is already leading a project based on this research at Ingleburn Public School which ensures kids that have these traits – and their parents and teachers – get access to this program in communities where they are less likely to have access to this sort of help.

“The next step is to promote this program in the community of practitioners who do this type of treatment, so we can then expand the learnings out,” Prof. Kimonis said.

The researchers said they are also looking at other schools and that there are plans to build a clinic at Condell Park Public School as a second site, with both schools serving a network of schools around them.

At its heart, the therapy is a parenting program, but with a difference.

Dr Fleming said: “I have so much empathy for parents when they enter the room. And if we could work together with the parent, using our expertise from the science, and their expertise on their family and their kid, we almost have everything we need in the room to tweak a couple of things so that life becomes a little bit easier for everyone in the family – that’s the goal.”