PCIT for children with callous-unemotional traits

The risk factors for childhood conduct problems vary considerably across individuals, and effective intervention requires individualizing treatment to the unique needs of children on etiologically distinct developmental pathways. The importance of this causal heterogeneity is recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which includes for the first time a specifier for the diagnosis of callous-unemotional (CU)-type conduct disorder (i.e., CD with limited prosocial emotions). This change was informed by decades of research supporting that CU traits designate a distinct subgroup of children with early starting, severe, and aggressive conduct problems that are not only associated with significantly increased risk of negative outcomes as adolescents and adults but are also less responsive to traditional interventions. This attenuated treatment response has been attributed to the failure of traditional interventions to adequately target the distinct risk factors involved in the development of CU-type conduct problems. Accordingly, an adaptation of parent–child interaction therapy (PCIT) was developed that addresses these unique risk factors. PCIT-CU, as it is known, differs from standard PCIT in three key ways: it (a) trains parents to engage in warm, emotionally responsive parenting to improve conscience development among temperamentally fearless children, (b) systematically supplements punishment-based parenting strategies with reward-based techniques, and (c) delivers emotional skill-building to target the distinct core emotional deficits of these children. Given there are currently few guidelines regarding best practice for the 20–50% of children with conduct problems that show elevated CU traits, this line of research is critical to improving their outcomes.