Behavioral Treatment for Children With Conduct Problems and Callous-Unemotional Traits

Florida International University48 enrolled

Overview

The purpose of this study is to modify behavior therapy so that it is optimized for children with conduct problems and callous-unemotional traits by emphasizing reward components and de-emphasizing punishment components.

Several studies have demonstrated that standard behavioral treatments do not appear to be sufficient for children with conduct problems (CP) and callous-unemotional (CU) traits. Other research suggests that children with CPCU are less responsive to punishments as evaluated using controlled laboratory tasks. Based on these two sets of findings, it was hypothesized that behavioral treatment modified to emphasize reward and de-emphasize punishments would be advantageous when used to treat children with CPCU. This hypothesis was tested in a treatment development study that had three phases. During phase 1, which occurred in 2010, the intervention was planned and treatment procedures and manuals were developed. During phase 2, which occurred in 2011, a pilot study was conducted in which the intervention was tested in an iterative manner in a group of 12 children with conduct problems and callous-unemotional traits. In phase 3, a larger trial was conducted using a cross over design, with one-half of participants getting standard behavioral treatment for four weeks followed by modified behavioral treatment for four weeks and remaining participants receiving treatments in the reverse order.Treatments were evaluated using parent ratings, counselor ratings, and frequency counts of behavior during treatments.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Conduct Disorder Oppositional Defiant Disorder

Interventions

Reward-Emphasized TreatmentBEHAVIORAL

Intensive behavioral treatment delivered in a summer camp setting, with reward components emphasized and punishment components de-emphasized

Standard TreatmentBEHAVIORAL

Intensive behavioral treatment delivered in a summer camp setting, with rewards and punishment equally emphasized.

Eligibility

Sex: ALLMin age: 7 YearsMax age: 12 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Clinical diagnosis of oppositional defiant disorder or conduct disorder * Ages 7 to 12 years old * t-score of 65 or above on CU scale of Antisocial Process Screening Device as rated by parents or teacher * at least parent/caregiver fluent in English * able to participate in vigorous outdoor activities * parent/caregiver agreement to keep psychoactive medication treatment constant throughout the study Exclusion Criteria: * Full scale intelligence quotient (IQ) of less than 75 * medical conditions that contra-indicate participation in treatment * current or past clinical diagnosis of pervasive developmental disorder, schizophrenia or other psychotic disorders, sexual disorder, organic mental disorder, or eating disorder * lack of functional impairment * current or past seizures or other neurological disorders

Locations (1)

Florida International University

Miami, Florida, United States

Outcomes

Primary Outcomes

Conduct Problems

Counselors recorded each instance of conduct problems, defined as lying, stealing, intentional destruction of property, and intentional aggression. The average number per day was computed for each week of treatment.

Time frame: Weekly

Negative Verbalizations

Counselors recorded each instance of negative verbalizations, defined as verbal abuse to staff, teasing peers, and swearing. The average number per day was computed for each week of treatment.

Time frame: Weekly

Complaining

Counselors recorded each instance of complaining. The average number per day was computed for each week of treatment.

Time frame: Weekly

Interruption

Counselors recorded each instance of interrupting. The average number per day was computed for each week of treatment.

Time frame: Weekly

Noncompliance

Counselors recorded each instance of noncompliance. The average number per day was computed for each week of treatment.

Time frame: Weekly

Rule Violations

Counselors recorded each instance of rule violations. The average number per day was computed for each week of treatment.

Time frame: Weekly

Positive Peer Behavior

Counselors recorded each instance of positive behavior with peers, defined as helping, sharing and ignoring teasing. The average number per day was computed for each week of treatment.

Time frame: Weekly

Minutes in Time Out

Data from ClinicalTrials.gov

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Secondary Outcomes

IOWA Inattentive/Overactive Scale - Counselor

At the end of each treatment week counselors rated each child's overall inattentive-overactive-impulsive behavior during the week. Rating were completed using Likert scales that ranged from 0 ("not at all") to 3 ("very much"). Items were summed to compute a scale score with a theoretical range of 0 to 15.

Time frame: Weekly

IOWA Inattentive/Overactive Scale - Parent

At the end of each treatment week parents rated each child's overall inattentive-overactive-impulsive behavior during the week. Rating were completed using Likert scales that ranged from 0 ("not at all") to 3 ("very much"). Items were summed to compute a scale score with a theoretical range of 0 to 15.

Time frame: Weekly

IOWA Oppositional-defiant Scale - Counselor

At the end of each treatment week counselors rated each child's overall oppositional-defiant behavior during the week. Rating were completed using Likert scales that ranged from 0 ("not at all") to 3 ("very much"). Items were summed to compute a scale score with a theoretical range of 0 to 15.

Time frame: Weekly

IOWA Oppositional-defiant Scale - Parent

At the end of each treatment week parents rated each child's overall oppositional-defiant behavior during the week. Rating were completed using Likert scales that ranged from 0 ("not at all") to 3 ("very much"). Items were summed to compute a scale score with a theoretical range of 0 to 15.

Time frame: Weekly

WPRF Serious Conduct Problems Scale - Counselor

At the end of each treatment week counselors rated each child's serious conduct problems during the week. Rating were completed on the Weekly Problem Rating Form (Haas et al, 2011) using Likert scales that ranged from 1 ("no problem") to 7 ("serious problem"). Items were averaged to compute a scale score with a theoretical range of 1 to 7, with high scores indicating more serious problems.

Time frame: Weekly

WPRF Serious Conduct Problems Scale - Parent

At the end of each treatment week parents rated each child's serious conduct problems during the week. Rating were completed on the Weekly Problem Rating Form (Haas et al, 2011) using Likert scales that ranged from 1 ("no problem") to 7 ("serious problem"). Items were averaged to compute a scale score with a theoretical range of 1 to 7, with high scores indicating more serious problems.

Time frame: Weekly

WPRF Rule Following Problems - Counselor

At the end of each treatment week counselors rated each child's rule following problems during the week. Rating were completed on the Weekly Problem Rating Form (Haas et al, 2011) using Likert scales that ranged from 1 ("no problem") to 7 ("serious problem"). Items were averaged to compute a scale score with a theoretical range of 1 to 7, with high scores indicating more serious problems.

Time frame: Weekly

WPRF Rule Following Problems - Parent

At the end of each treatment week parents rated each child's rule following problems during the week. Rating were completed on the Weekly Problem Rating Form (Haas et al, 2011) using Likert scales that ranged from 1 ("no problem") to 7 ("serious problem"). Items were averaged to compute a scale score with a theoretical range of 1 to 7, with high scores indicating more serious problems.

Time frame: Weekly

WPRF Overall Problems - Counselor

At the end of each treatment week counselors rated each child's overall problems during the week. Rating were completed on the Weekly Problem Rating Form (Haas et al, 2011) using Likert scales that ranged from 1 ("no problem") to 7 ("serious problem"). Items were averaged to compute a scale score with a theoretical range of 1 to 7, with high scores indicating more serious problems.

Time frame: Weekly

WPRF Overall Problems - Parent

At the end of each treatment week parents rated each child's overall problems during the week. Rating were completed on the Weekly Problem Rating Form (Haas et al, 2011) using Likert scales that ranged from 1 ("no problem") to 7 ("serious problem"). Items were averaged to compute a scale score with a theoretical range of 1 to 7, with high scores indicating more serious problems.

Time frame: Weekly

How Much Did Your Child Benefit From Treatment?

At the end of each treatment block parents rated their overall satisfaction with the treatment provided to their child. This item was phrased as follows: "How much did your child benefit from this treatment?". This item was rated using a Likert scale that ranged from 0 ("not at all") to 3 ("very much").