Callous-Unemotional Traits Improve With Parent-Child Intervention Therapy

A Muslim Mother sits with her daughter as she teaches her from the comfort of their own home. The young girl is seated on a sofa while the mother sits across from her on a chair with a clipboard in her hands. She is testing the young girls memory and recording her answers.
Researchers investigated whether parent-child interaction therapy targeting callous-unemotional traits may be effective at improving conduct problems among young children.

Parent-Child Interaction Therapy (PCIT) targeting callous-unemotional (CU) traits may be effective at improving conduct problems among young children, according to results of a study published in Behavior Therapy.

Families (N=43) with a child aged 3 to 7 years that were referred to a clinic due to conduct problems and CU traits were recruited between 2016 and 2019 at the University of New South Wales in Australia. Participants were randomized to receive PCIT (n=21) or PCIT-CU (n=22). The interventions were delivered weekly over 14 (PCIT) or 21 (PCIT-CU) weeks in person.

The PCIT group received weekly telephone consultations for an additional 7 weeks to balance intervention durations. Intervention efficacy was evaluated using the Eyberg Child Behavior Inventory (ECBI), the Child Behavior Checklist (CBCL), and the Diagnostic Interview Schedule for Children, Adolescents, and Parents (DISCAP)

Overall, the children were aged mean 4.84 (SD, 1.12) years, fathers were aged 42.56 (SD, 6.38) years, and mothers were aged 38.30 (SD, 5.35) years, 83.7% of the children were boys, 74.4% of the parents were married, and 48.8% of annual household income was ≤$160,000.

Compared with baseline, diagnostic status did not change significantly post intervention (χ2, 1.90; P =.75) or at 3 months (χ2, 1.76; P =.78).

At the 3-month follow-up, a clinically significant change in ECBI intensity was observed among 50% and 53%, ECBI problems among 56% and 73%, CBCL aggressive behavior among 71% and 56%, CBCL externalizing among 50% and 50%, CBCL oppositional defiant problems among 64% and 69%, DISCAP oppositional defiant disorder among 69% and 69%, and DISCAP conduct disorder among 85% and 100% among the PCIT-CU and PCIT cohorts, respectively. At 3 months, the PCIT-CU intervention was associated with higher percentages of reliable changes for all measures except CBCL oppositional defiant problems.

Treatment was stopped prematurely among 19% of families in the PCIT and 23% of families in the PCIT-CU interventions. The families that participated reported high levels of satisfaction with the process and outcome of therapy.

The findings of this study may not be generalizable as participants were recruited from an affluent area and more than half of families earned >$160,000 annually.

The study authors concluded, “Findings indicated that both Standard PCIT and its adaptation for CU traits produced significant improvements in child conduct problem symptoms and CU traits. In partial support of hypotheses, children assigned to PCIT-CU showed sustained improvement in conduct problems to 3-month follow-up, whereas Standard PCIT participants showed some deterioration in outcomes.”


Fleming GE, Neo B, Briggs NE, Kaouar S, Frick PJ, Kimonis ER. Parent training adapted to the needs of children with callous-unemotional traits: a randomized controlled trial. Behav Ther. Published online July 16, 2022. doi:10.1016/j.beth.2022.07.001