Children with disruptive behavior disorders (DBDs) with callous-unemotional (CU) traits can improve with specialized treatment modules and parenting programs, according to results of a systematic review and meta-analysis published in The Journal of Child Psychology and Psychiatry.
Researchers from the University of Pennsylvania searched publication databases through May 2022 for studies focusing on child- or parent-focused interventions for DBD. A total of 60 studies were included in the final analysis.
The pooled study population comprised 9405 children with a mean age of 10.04 (SD, 3.89) years, of whom 74.91% were boys and 44.19% were racial or ethnic minorities.
The study interventions were child-focused (66.7%), parenting-focused (55%), pharmacotherapy (23.3%), family-focused (10%), or had multiple components (43%). The study designs were randomized controlled trials (50%), open trials (42%), nonrandomized controlled trials (5%), or retrospective studies (3%).
In the analysis that compared outcomes between children with DBD with those who had DBD plus CU, symptoms of DBD improved overall with treatment (standardized mean difference [SMD], 1.04; 95% CI, 0.42-1.67; P <.01). Stratified by the presence of CU, DBD symptoms improved among children with DBD plus CU (SMD, 1.08; 95% CI, 0.45-1.72; P <.001) and DBD alone (SMD, 1.01; 95% CI, 0.38-1.64; P <.01). There was no evidence of changes to CU symptoms with treatment (SMD, β, -0.07; 95% CI, -0.28 to 0.13; P =.48). These comparisons included significant heterogeneity (93.30%).
Notably, the DBD plus CU cohort had more severe DBD symptoms at baseline (SMD, 1.18; P <.001) and at the end of treatment (SMD, 0.73; P <.001).
In the analysis that evaluated DBD treatments on CU trait outcomes, no effect was observed overall (SMD, 0.09; 95% CI, -0.02 to 0.20; P =.10). This comparison had significant heterogeneity (72.23%), but the outcome was robust to the removal of outliers.
Treatment effects on CU traits were significantly related with racial and ethnic diversity (β, -0.01; P <.001), in which effects were significant in less ethnically diverse groups (SMD, 0.15; 95% CI, 0.002-0.30; P <.05) and outcomes were related with type of treatment (β, 0.22; P <.05), in which parenting-focused interventions were associated with improved CU trait symptoms (SMD, 0.22; 95% CI, 0.06-0.38; P <.05).
The study characteristics that significantly affected CU trait outcomes included informant (β, 0.16; P <.05), study quality (β, 0.15; P <.05), use of the Antisocial Process Screening Device (APSD; β, -0.21; P <.05), and location (β, -0.24; P <.05).
The major limitation of this analysis was the high amount of heterogeneity.
Study authors conclude, “[W]hile DBD+CU children are responsive to treatment, CU traits are associated with greater posttreatment symptom severity. In addition, programs with a parenting component appeared effective in directly reducing CU traits. In the next generation of treatments for DBD, we urgently need prevention and treatment efforts that begin early in life when behavior problems emerge and the development of empathy and prosociality can go awry.”
Perlstein S, Fair M, Hong E, Waller R. Treatment of childhood disruptive behavior disorders and callous-unemotional traits: a systematic review and two multilevel meta-analyses. J Child Psychol Psychiatry. Published online March 1, 2023. doi:10.1111/jcpp.13774