Dimensions of Warm Parenting Attributions Differentiate Conduct Problem Subtypes in Young Children.

Understanding the developmental psychopathology of child conduct problems (CP) has been advanced by differentiating subtypes based on levels of internalizing problems (INT) and/or callous-unemotional (CU) traits (i.e., low empathy/guilt, poor motivation, shallow/deficient affect). The current study sought to elucidate prior inconsistencies in the role of warm/positive and harsh/negative parenting subcomponents in CP by differentiating subtypes on the basis of INT and CU traits. Parents of 135 young children (M age = 4.21 years, SD = 1.29) referred to specialty clinics for the treatment of CP completed pre-treatment measures of parenting and rated their child's levels of CP, INT, and CU traits. Results of planned comparisons revealed that mothers of children classified as secondary CU variants (high CU/ high INT) reported fewer overall warm attributions toward their child, compared with CP-only (low CU) children. They also reported a more negative dyadic relationship characterized by feelings of anger/hostility, active avoidance and/or a desire to do harm to their child relative to primary CU variants (high CU/ low INT). Mothers of primary CU variants attributed fewer good and altruistic intentions towards others in their child, relative to CP-only children. Subtypes were undifferentiated on observed positive and negative parenting behaviors, indicative of a disconnect between parenting behaviors and cognitions for mothers of children high on CU traits. Findings are discussed in relation to their theoretical and practice implications, and in guiding future research.

Clinical utility of diagnosing limited prosocial emotions in young children using the Clinical Assessment of Prosocial Emotions (CAPE).

This study evaluated the interrater reliability, convergent and divergent validity, incremental validity, and clinical prognostic utility of the Clinical Assessment of Prosocial Emotions (CAPE; Frick, 2013) for assessing limited prosocial emotions (LPE). Participants were 232 young children (Mage = 3.94 years, SD = 1.46, range = 2-8; 74.6% boys) clinic-referred for conduct problems. We scored the CAPE using binary and dimensional scoring approaches and measured outcomes using parent-report and child laboratory measures. CAPE LPE symptom ratings had good interrater reliability. Children diagnosed with pretreatment LPE had more severe externalizing problems and lower empathy than children without LPE but did not differ in emotion recognition accuracy or anxiety. Dimensional CAPE symptom sum scores were associated with criterion variable scores in expected ways and offered incremental validity beyond scores on the parent-report Inventory of Callous-Unemotional Traits for predicting conduct problem severity, aggression, empathy deficits, and global emotion recognition accuracy. Among children who completed parent management training (n = 44), those diagnosed with LPE ended treatment with more severe aggressive behavior than those without LPE. Overall, children diagnosed with CAPE LPE have severe externalizing problems and achieve reduced benefits from standard parent management training, supporting the need for tailored and intensive interventions to maximize treatment outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits.

OBJECTIVE: Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems. METHOD: Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes. RESULTS: Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits. CONCLUSIONS: Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).

The measure of empathy in early childhood: Testing the reliability, validity, and clinical utility of scores in early childhood.

Empathy is a critical socioemotional skill that motivates prosocial behavior and supports the ability to respond to the emotions of others. Although accurate measurement of empathy in young children is critical for identifying and remediating empathy deficits, currently available parent-report measures of childhood empathy have several psychometric limitations. The present study tested the reliability, validity, and clinical utility of scores on the Measure of Empathy in Early Childhood (MEEC), a new multidimensional, parent-report empathy scale, in 4- to 7-year-old children. The psychometric properties of MEEC scores were assessed by examining their associations with criterion, construct, discriminant, and clinical validity measures. A sample of 129 parents of community and clinic-referred children (Mage = 5.62 years, SD = 1.01, 65.9% boys) completed the MEEC and other relevant parent-report questionnaires. Internal consistencies (α = .79-.93) of MEEC scores were good. Correlations between MEEC scores and parent-report measures, sex, and age robustly supported their validity in 4- to 7-year-old children. Logistic regression analyses demonstrated that MEEC scores significantly predicted membership into clinical subgroups characterized by empathy deficits. Linear regression analyses indicated that prosocial behavior and sympathy MEEC subscales, but not affective empathy, statistically predicted parent-reported callous-unemotional traits. Theoretical and clinical implications of these findings for developmental models of empathy and empathy-related disorders are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Conception and Development of the Warmth/Affection Coding System (WACS): A Novel Hybrid Behavioral Observational Tool for Assessing Parent-to-Child Warmth.

A vast body of research and theory underscores the importance of parental warmth/affection (hereby 'warmth' and 'warmth/affection' are used interchangeably) as a distinct relational process that is fundamental to core developmental processes including parent-child attachment, socialization, emotion recognition and responsivity, and empathic development. The increasing focus on parental warmth as a viable transdiagnostic and specific treatment target for Callous-Unemotional (CU) traits highlights the critical need for a reliable and valid tool for measuring this construct within clinical contexts. However, existing assessment methods have limitations in their ecological validity, clinical utility, and the comprehensiveness of their coverage of core warmth subcomponents. In response to this clinical and research need, the observational Warmth/Affection Coding System (WACS) was developed to comprehensively measure parent-to-child warmth/affection. This paper chronicles the conception and development of the WACS, which adopts a hybrid approach of utilizing both microsocial and macro-observational coding methods to capture key verbal and non-verbal subcomponents of warmth that are currently underrepresented or poorly captured by existing assessment tools. Recommendations for implementation and future directions are also discussed.

Parent Training Adapted to the Needs of Children With Callous-Unemotional Traits: A Randomized Controlled Trial.

Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.