Pilot RCT integrating PMT and emotion coaching for children with callous-unemotional traits

Abstract

Children with conduct problems and elevated callous-unemotional (CU) traits whose parents participate in parent management training (PMT) start and end treatment with higher levels of conduct problems than those with conduct problems alone and face a higher risk of negative outcomes. Because these children have deficits in emotion recognition and empathy, incorporating an emotion-focused intervention into PMT may enhance child outcomes. This study describes the development and evaluation of a brief parent-focused emotion-coaching (EC) intervention combined with an evidence-based PMT program, Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), for use with clinic-referred children (3–7 years) with conduct problems and elevated CU traits (N = 43; M age = 6.08 years, SD = 1.39, 83.7% male). We employed a treatment deployment (i.e., effectiveness) model to inform the EC content and integrate it with HNC. HNC-EC is one of a growing number of interventions targeting known developmental mechanisms related to child CU traits. We examined parent and child outcomes from a pilot randomized controlled trial comparing HNC-EC and HNC. Parent-report, direct observation, and laboratory measures were employed at baseline, mid-treatment, and post-treatment. Intention-to-treat and completer analyses demonstrated that both HNC and HNC-EC led to significant improvements in children's conduct problems and CU traits. There were relatively few differences between the two groups; however, those differences favored HNC-EC in the domains of conduct problems, emotion recognition, parenting, and parent adjustment. Findings support the effectiveness of both HNC and HNC-EC in addressing the needs of this high-risk population, and suggest the added benefit of incorporating EC into PMT.