Research suggests that children with conduct problems and callous-unemotional traits (CP/CU) display frequent and serious antisocial behavior in childhood and continue to do so in adolescence and adulthood (Frick &White, 2008). Research also suggests that these same children may show a less positive response to standard behavior therapy than other children with conduct problems (Hawes &Dadds, 2005;Waschbusch, Carrey, Willoughby, King, &Andrade, 2007). One possible reason for this finding is that children with CP/CU may have distinct learning styles in that they over-focus on rewards and are less likely to learn from punishment (e.g., Blair, Mitchell, Budhani, Peschardt, &Newman, 2004;O'Brien &Frick, 1996). This suggests that reward-emphasized behavior therapy approaches may be more effective for children with CP/CU as compared to standard behavior therapy which relies on both reward and punishment.
The aims of the proposed research are (1) To modify an intensive behavior treatment (BT) that has been empirically supported for children with disruptive behavior disorders so that it emphasizes rewards relative to punishment and therefore matches the unique learning styles of CP/CU children;(2) to conduct an initial trial of the modified treatment make refinements based on these data;and (3) to test the feasibility of implementing and evaluating the modified treatment. Following these aims, the study will proceed in three steps. First, treatment modifications and supporting materials will be developed by the principal investigator in consultation with experts in CP/CU and in consultation with experts in behavioral treatment for conduct problems. Second, a number of case studies will be conducted to provide an initial evaluation of the modified behavioral treatment and to make changes based on the results. Third, the feasibility of the final modified treatment will be evaluated in a small clinical trial of 40 children with CP/CU in which 20 children with CP/CU will be randomly assigned to receive the modified behavioral treatment that emphasizes reward-based interventions and the remaining 20 children with CP/CU will receive standard behavior therapy which emphasized both reward and punishment based interventions. The penultimate goal of the proposed research is to conduct an R01 grant to definitively test whether a modified form of behavior therapy, which is tailored to the unique learning styles of children with CP/CU by emphasizing reward-based interventions, results in more effective treatment of CP/CU than the current gold standard of traditional behavior therapy.
The results of the proposed studies are intended to develop a novel approach for implementing behavioral intervention for children with serious conduct problems. This research will inform future studies examining interventions for children with frequent and severe antisocial behaviors.
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