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). Preliminary 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-only 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 test the feasibility of the modified BT and make refinements based on these data;and (3) to conduct a preliminary investigation of the efficacy and feasibility of 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 series of single-subject research studies will be conducted to evaluate the feasibility of the modified behavioral treatment and to make changes based on the results. Third, a preliminary evaluation of the feasibility and efficacy of the final modified treatment will be evaluated in a small clinical trial of 40 children with CP/CU. The preliminary clinical trial will use a within subjects design such that 20 children with CP/CU will receive the modified behavioral treatment for four weeks followed by standard behavioral treatment for four weeks, whereas the remaining 20 children with CP/CU will receive the two treatments in the reverse order, with order of treatment assigned randomly. The results of this work will ultimately be used in an R01 grant to definitively test whether a modified form of behavior therapy, which is tailored to the unique learning and information processing style (deficits) of CP/CU youth, results in more effective treatment of CP/CU than the current gold standard of traditional behavior therapy. Although children with CP/CU may need adjunctive treatments that focus on the affective, cognitive, and inter-personal components of CU, it is our premise that control of antisocial behavior through effective behavior therapy must first be accomplished before clinicians and researchers consider adjunctive treatments.
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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