New therapy for children with treatment-resistant behavior problems has lasting results August 24

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A study has shown that children with ruthless and emotionless traits can be made more prosocial.

Children who display aggressive, destructive and non-conforming behavior appear to respond positively to a new behavioral therapy aimed at both parents and children, a study by psychologists at the Parent Child Research Clinic at UNSW Sydney reveals.

And the research could give new hope to exhausted parents after it was shown that the improvements in disruptive and prosocial behavior children learned were more likely to last long after the treatment program stopped, compared to standard treatment. .

In a recent article published in the journal Behavior Therapy, researchers described how 43 families of children with “emotionless” (CU) traits and their parents participated in a randomized controlled trial that measured the effectiveness of two programs. different therapies on children’s behavior. .

The children, ages three to seven, were randomly placed into either an existing behavioral treatment program – Parent-Child Interaction Therapy (PCIT) – or a version of that same therapy that was modified by the researchers to target the different needs. children with insensitive-emotionless traits (PCIT-CU).

They found that both of these programs had a positive effect on the disruptive behavior problems and callous and unemotional traits of the children in each group throughout the duration of the training. This meant less aggression and fewer violent outbursts, more compliant behavior, and a better ability to show and feel empathy for others.

But when the researchers contacted the families 12 weeks after the training ended, there was a clear and noticeable difference between the two groups in what they had learned from the treatment course.

“For children who received the new treatment we developed, we saw lasting improvement,” said Dr Georgie Fleming, lead author of the study at the UNSW School of Psychology.

“And at the same time, we saw a pattern of deterioration in children who received the standard treatment.”

New treatment vs old

Dr. Fleming said this suggests that the modifications made to the PCIT in the enhanced version appear to have resulted in more lasting and positive behavioral changes, which past treatment strategies have struggled to maintain until now.

She said Enhanced Treatment (PCIT-CU) differed from Standard Treatment (PCIT) in three main areas designed to focus more on the needs of children with insensitive and unemotional traits.

First, they taught parents to use parenting behaviors aimed at strengthening the relationship and attachment between parent and child by expressing warmth and affection.

“We explicitly trained parents to be more warm and loving when interacting with their children,” Dr. Fleming said.

“Things like sitting closer to their child during play, putting the ‘smile’ in their voice when they praise the child, and doing things that are specifically meant to make the child laugh.”

The second change concerned the field of discipline. Dr. Fleming said that in standard treatment, the emphasis is on providing consistent discipline strategies. But in the case of children with CU traits, this could be counterproductive.

“There is evidence that children with insensitive and emotionless traits learn typical consequences less well than children with conduct problems or children in general.”

So, to avoid potentially aggravating bad behavior, the researchers incorporated what they called a “structured and individualized token economy system” into the disciplinary portion of the training.

“Basically, we identify the behaviors that we want these kids to do more of. So things like “listen to your parents when they ask you to do something, use gentle hands with your siblings and friends.”

“And for any instances where children exhibit what we would call ‘prosocial behaviors’, they receive a token – a kind of small reward – which they accumulate over time and can redeem for a whole menu of different rewards.”

The final modification to the enhanced PCIT-CU treatment was to actively train the children in their emotional skills.

“There’s really strong evidence that kids with insensitive, emotionless traits are underdeveloped at recognizing particular facial expressions, they’re not as good at picking up when someone is feeling scared or sad. And so we We’ve trained in the micro-expressions that we universally show as humans, and then we’ve developed those skills to get them to a place where they see someone who’s in distress, and they’re able to respond in a prosocial way.

years of preparation

The PCIT treatment modifications were based on previous research by lead author Professor Eva Kimonis from her pioneering work on the treatment of insensitive and unemotional traits and aggressive behavior in young children. Therapy is delivered in a unique environment where parent and child are observed behind a one-way mirror.

“The way it works is you have a two-way mirror, and your parent and child play together, while the parent uses the skills we taught them with the child,” Professor Kimonis said. said.

“And then you have a therapist like Georgie [Fleming] behind the one-way mirror, using a microphone to give real-time feedback to the parent via a wireless earpiece that the parent wears.

Professor Kimonis said it was important to treat children in this subgroup early, as callous and emotionless traits can develop into psychopathy later in life for some children.

“Emotionless insensitive traits are the precursor to childhood psychopathy, but that doesn’t mean that every child who shows emotionless insensitive traits will become a psychopath,” Professor Kimonis said.

“There’s this long-standing perspective that the trajectory of insensitive traits to psychopathy is really hard to get kids out of, and once you’re on the path to psychopathy, you’re not susceptible to treatment,” said Professor Kimonis.

“But I think what this treatment does is offer hope that we can actually adjust that trajectory, and those traits are potentially susceptible to intervention when we do it quite young. So we don’t think biology is necessarily fate.

After years of research on this subgroup of children, Professor Kimonis is excited about the latest research findings and what it could mean for improving the lives of parents and children in families where these early behavioral problems cause such sorrow.

“This is really new research, it’s the first study where we’ve only recruited this subgroup of children with insensitive traits and found that targeted treatment works better than treatment. It’s the first try that takes this group of kids and says, “We can make things better for them and get them out of that way on the track.”

Give access to children

Professor Kimonis said the latest research is the first step in a multi-pronged plan to enable access to these types of specialist treatment for children who might not otherwise get it.

“The first step is to figure out how we can best get this to the kids who need it.

“Georgia [Dr Fleming] is already leading a project based on this research at Ingleburn Public School that ensures that children who exhibit these characteristics – as well as their parents and teachers – have access to this program in communities where they are less likely to have access to this kind of help.

“A real novelty in the way we deliver the program in school is to involve the teacher to work with the parent to use consistent strategies. This means that the gains from treatment are more likely to extend to home and school.

The researchers said they are also considering other schools and there are plans to build a clinic at Condell Park Public School as a second site, with both schools serving a network of schools around them.

“The next step is to promote this program in the community of practitioners who do this type of treatment, so that we can then extend the learnings,” said Professor Kimonis.

Dr. Fleming said beauty treatment is not a one-size-fits-all approach, but rather tailored to each family and each child based on their needs.

“There’s so much room to individualize how we administer treatment, and we certainly understand what the barriers are for each individual family that keeps them stuck in this cycle of chronic non-compliance and chronic outbursts of anger.”

At its core, therapy is a parenting program, but with a difference.

“They don’t come to us to learn how to parent in the same way that they don’t come to us to learn how to drive a car – they already know how to drive the car,” Professor Kimonis said. “It’s like they come to us to learn how to be like a Formula 1 driver, because raising these kind of kids requires a different skill set and almost a super parenting approach.”

Dr Fleming said: ‘I have so much empathy for the parents when they walk into the room. And if we could work with the parent, using our scientific expertise and their expertise on their family and child, we have almost everything we need in the room to tweak a few things to make life a little easier. for all family members, that’s the goal.

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