Early Initiatives for Children at Risk: Prevention and Treatment of Callous-Unemotional Traits

Introduction:Early Initiatives for Children at Risk (Norwegian acronym; TIBIR) was developed to scale up the use of evidence-based interventions for the prevention and treatment of child conduct problems. The program consists of 5 interventions (3 parent training interventions, 1 teacher intervention, and 1 child intervention). Previously, the parent training interventions in TIBIR have been found effective in reducing child conduct problems. Scholars have in recent years become more aware of the importance of reducing callous-unemotional (CU) traits (i.e., lack of empathy and guilt, and deficient or shallow emotions and callousness towards others), as these traits seem to be associated with severe and stable antisocial behavior. Therefore, with the use of three randomized controlled trials, we examined whether three interventions in TIBIR produced positive outcomes on CU traits.

Method:In total, 551 families were included in the present study. Data were derived from participants enrolled for three randomized effectiveness trials: 1) The Parent Management Training, Oregon model (PMTO) trial consisted of 137 families randomized to PMTO or regular services. 2) The Brief Parent Training (BPT) trial consisted of 216 families randomized to BPT or regular services. 3) The Individual Social Skills Training (ISST) trial consisted of 198 children randomized to ISST or practice as usual. We conducted confirmatory factor analyses to examine the psychometrical robustness of the CU trait construct. Finally, we examined the immediate and long-term (6 months after termination) effectiveness of the interventions.

Results:Overall, the trials showed that the parent training interventions (i.e. PMTO and BPT) in TIBIR had significant and positive effects on CU traits, with moderate effect sizes. PMTO produced larger effect sizes than BPT both immediately after and 6 months after intervention termination. Findings from the ISST trial showed no positive effects.

Conclusions: Findings suggest that parent training can produce positive outcomes on CU traits in real-world settings, both when delivered as full-scale treatment (PMTO) and as short-term intervention (BPT). Child social skills training did not produce the same positive outcomes. The findings implicate that parent training could be the intervention of choice when delivering intervention to children with CU traits. Future research should examine whether the effectiveness of parent training can be strengthened when combined with child social skills training.