Help for children with severe conduct problems shows promise in open trial

August 7, 2018 by Isabelle Dubach, University of New South Wales
Help for children with severe conduct problems shows promise in open trial
The researchers adapted parent-child interaction therapy (PCIT), where parents are coached using a wireless headset from behind a one-way mirror by a therapist. Credit: University of New South Wales

A targeted intervention could successfully decrease severe conduct problems and callous traits in young children and help correct their developmental trajectory, a new UNSW study has shown. The work has been published in the Journal of Clinical Child & Adolescent Psychology.

Children who display so-called callous-unemotional traits have early-starting, persistent and aggressive conduct problems, and are at risk for future criminal behaviour, violence, and psychopathy.

"This is the first test of an intervention designed specifically for this population, with promising effects on children's behavioural problems and empathy levels," says lead author and Associate Professor Eva Kimonis from the School of Psychology at UNSW Science.

In the trial, 23 Australian families with a three- to six-year-old child with clinically significant conduct problems and callous-unemotional traits participated in the 21-week intervention and five assessments at a university-based research clinic. Seventeen of the 23 families finished the program.

"In our intervention, we adapted an existing gold-standard program – Parent-Child Interaction Therapy – to target the specific needs of children who don't just display conduct problems, but also callous-unemotional traits. For these children who show poorly developed levels of empathy and remorse, existing interventions don't typically work well," Associate Professor Kimonis says.

Standard parent-child interaction therapy (PCIT) has two phases delivered via coaching of parents using a wireless headset from behind a one-way mirror by a therapist.

The researchers adapted PCIT to coach parents to increase their use of verbal and physical expressions of warmth, and they integrated a reward-based system to motivate and reinforce positive child behaviours (i.e., compliance with commands and rules).

"It has been shown that children with callous traits who receive warm, sensitive, and responsive parenting have fewer conduct problems in later development, so that was a key part of the intervention," Associate Professor Kimonis says.

"Children with callous-unemotional traits also fail to learn from punishment, and we know using reward-based systems is more effective for them."

Families also received an additional coaching module designed to address the child's insensitivity to other people's distress cues – for example, difficulty recognising expressions associated with sadness and fear in others that is common amongst children with callous traits.

"As a result of the intervention, child conduct problems and callous-unemotional traits decreased, and empathy increased," Associate Professor Kimonis says.

By three months post-treatment, 75% of children who had completed the treatment no longer showed clinically significant , and parents reported a high level of satisfaction with the program.

"We followed families up for three months, and treatment effects were retained over this time. We have plans for further follow-up," says Associate Professor Kimonis.

The team is also in the process of conducting a randomised controlled trial in which they are comparing the novel intervention to standard treatment.

"So far, our pilot results are promising – they show that children who receive the novel targeted treatment have better outcomes than children receiving standard treatment."

In 2016, Associate Professor Kimonis' team showed that indications of callous traits can be reliably observed in children as young as three, allowing children at risk to undergo earlier identification and treatment.

Families interested in intervention services may contact the UNSW Parent-Child Research Clinic (Ph: (02) 9385 0376, email:, Web:

Explore further: High-quality foster care reduces chance of callous-emotional trait development for abandoned children early in life

Related Stories

High-quality foster care reduces chance of callous-emotional trait development for abandoned children early in life

December 1, 2015
A study to be published in the December 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) reports that high-quality foster care can mitigate the development of callous-unemotional ...

Callous and unemotional traits show in brain structure of boys only

December 27, 2017
Callous-unemotional traits are linked to differences in brain structure in boys, but not girls. This reports a European research team led by the University of Basel and University of Basel Psychiatric Hospital in a study ...

New hope for society's most challenging kids

July 23, 2012
(Medical Xpress) -- Parents of young children who show extreme behaviour problems and a lack of empathy or remorse may find new hope from research at the University of Sydney.

Babies' interest in human faces linked to callous and unemotional traits

October 16, 2014
Scientists at King's College London, the University of Manchester, and the University of Liverpool have found that an infant's preference for a person's face, rather than an object, is associated with lower levels of callous ...

Adopted preschoolers show more empathy when parents are affectionate

October 1, 2015
Young children whose parents regularly provide warmth and positive reinforcement show more empathy for others and care about following rules, according to a new University of Michigan study examining adoptive families.

Parent-child interactive intervention cuts depression

August 4, 2018
(HealthDay)—An intervention targeting depression in very young children can be effective in community settings, according to a study published online June 20 in The American Journal of Psychiatry.

Recommended for you

Suicide risk in abused teen girls linked to mother-daughter conflict

October 18, 2018
Teenage girls who were maltreated as children are more likely to entertain suicidal thoughts if the relationship with their mother is poor and the degree of conflict between the two of them high.

Study shows how bias can influence people estimating the ages of other people

October 17, 2018
A trio of researchers from the University of New South Wales and Western Sydney University has discovered some of the factors involved when people make errors in estimating the ages of other people. In their paper published ...

Infants are more likely to learn when with a peer

October 16, 2018
Infants are more likely to learn from on-screen instruction when paired with another infant as opposed to viewing the lesson alone, according to a new study.

Researchers use brain cells in a dish to study genetic origins of schizophrenia

October 16, 2018
A study in Biological Psychiatry has established a new analytical method for investigating the complex genetic origins of mental illnesses using brain cells that are grown in a dish from human embryonic stem cells. Researchers ...

Income and wealth affect the mental health of Australians, study shows

October 16, 2018
Australians who have higher incomes and greater wealth are more likely to experience better mental health throughout their lives, new research led by the Bankwest Curtin Economics Centre has found.

Study suggests biological basis for depression, anxiety, sleep disturbances in older adults

October 15, 2018
UC San Francisco researchers, in collaboration with the unique Brazilian Biobank for Aging Studies (BBAS) at the University of São Paulo, have shown that the earliest stages of the brain degeneration associated with Alzheimer's ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.