Callous-unemotional Traits as an Intervention Target and Moderator of Parent-Child Interaction Therapy-Emotion Development Treatment for Preschool Depression and Conduct Problems.

OBJECTIVE Callous-unemotional (CU) traits-characterized by low empathy, prosociality, and guilt-predict severe and persistent conduct problems. Although some interventions for conduct problems have been less effective in children with high levels of CU traits, studies have not examined whether CU traits interfere with treatment for other childhood disorders. Moreover, few treatments have demonstrated efficacy in decreasing CU traits themselves in early childhood. This study examined whether Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), a novel PCIT adaptation that promotes emotional competence with demonstrated efficacy in treating preschool-onset Major Depressive Disorder (PO-MDD) and Oppositional Defiant Disorder (ODD), was also effective in treating these disorders in children displaying higher levels of CU traits. The study also examined whether PCIT-ED treatment produced significant and sustained decreases in CU traits. METHOD This study examined 3-to 5-year-olds (N=114) with PO-MDD who completed the PCIT-ED trial. Children were randomized to either immediate PCIT-ED treatment (n=64) or a wait list (WL) control condition (n=50) in which they received the active treatment after 18 weeks. Children's psychiatric diagnoses and severity and CU traits were assessed at baseline, immediately after treatment, and 18 weeks after treatment completion. RESULTS Compared to the WL, PCIT-ED effectively reduced MDD and ODD in preschoolers, regardless of initial levels of CU traits. Moreover, CU traits decreased from pre- to post-treatment, and this treatment effect was sustained 18 weeks post-treatment. CONCLUSION Results support that novel interventions that enhance emotional development display significant promise in treating CU traits-behaviors that left untreated predict severe conduct problems, criminality and substance use.