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How large is this group?
For children with disruptive behaviour
disorders, we’re talking about 5 per cent
of the population worldwide. When we’re
talking about the callous and unemotional
type of conduct problems, it’s around
2 per cent of children.
What are the short and long-term effects
of these behaviours if they go untreated?
We know that children who have
callous‑unemotional type conduct
problems begin showing their behavioural
problems a lot earlier in life. And their
behavioural problems are much more
severe than other children, so they’re
more likely to be aggressive. They also
show problems across settings, so they
may show problems both at school and
at home, and with caregivers other than
parents, as well as with parents.
These children are at risk for a lot of
problems later in life. They’re more likely
to engage in delinquent types of activities
and violent delinquency, and to become
involved in criminal activities later on in
life. And they’re particularly at risk for
showing antisocial personality traits as
young adults and older adults.
Are these behaviours genetic?
Like many mental health problems, they
seem to be a combination of genetic
susceptibility and having the right
environmental circumstances to allow
these behaviours to come to fruition.
Can you describe the intervention in
detail, including how it differs from
current treatments?
We’ve adapted a gold standard
intervention called Parent-Child Interaction
Therapy. The way it works is you have a
parent who interacts with their child in
play, and they’ve been taught a number of
skills to interact with their child to improve
their parenting.
It’s multiphase treatment where at
first they’re being guided by a coach
who’s behind a one-way mirror in vivo
using a bug-in-ear device to improve the
quality of the parent-child relationship.
In the second phase, we’re working on
teaching parents skills to better manage
the child’s behaviour using effective
disciplinary strategies.
Then, what we’ve done in our
adaptations for children with callous and
unemotional traits is identify three specific
needs for this population. And we’ve
adapted the treatment to address the three
needs. So, the first is low levels of parent
wants and responsiveness. We’re coaching
the parents in vivo to increase these
displays of wants and affection.
The second component is that
these children are less responsive to
punishment, but at the same time
responsive to reward. So we are giving
parents certain skills to manage the
behaviour with these unique factors
in mind.
And then the third component is that
we are working with the parent and the
child to increase the level of the child’s
response to emotional stimuli. We’re
helping the children to better recognise
when people are in distress, like when
they’re hurt, in pain, afraid or sad. This
is particularly impaired in children with
callous and unemotional traits. And we’re
trying to improve how the child then
responds to these types of emotions in
other people.
So, it’s really this three-pronged
approach to better match the intervention
to the specific needs of children with
callous and unemotional traits.
Can you describe the evidence for the
effectiveness of this so far?
We’ve done what’s called an open trial,
where we’ve identified children who
have these significant levels of disruptive
behavioural problems plus callous and
unemotional traits.
And we specifically focus on this
group of children and families, where
we’ve delivered our novel and targeted
intervention to these families.
An open trial means we didn’t compare
this intervention to something else. What
we’ve found are large reductions in the
children’s behavioural problems – the
disruptive behaviours like aggression, non-
compliance and defiance.
We also see reductions in the children’s
levels of callous and unemotional traits.
And we see moderate increases in
children’s empathy levels.
When we watched the parent and
child interacting from behind a one-way
mirror, we also saw that the children
were much more compliant from pre- to
post-treatment.
Parents were telling us they found the
intervention to be acceptable. They were
satisfied with the treatment. And we had
relatively low dropout rates compared
to other parent training programs.
For example, when we looked at our
treatment completers versus dropouts,
by three months after treatment was
finished, we saw that, for the completers,
75 per cent showed reduction in
behavioural problems that were in a
normative range. The child was no longer
showing clinically significant problems,
and that compared with only 25 per cent
of the dropout families showing that
level of improvement. These are really
promising initial results.
Now what we’re doing is comparing
our novel targeted treatment against the
gold standard treatment. We’re doing
that in a randomised controlled trial. So,
families have been randomised to either
receive the novel targeted treatment
or the standard treatment. So far, what
we’re seeing are pretty good reductions
or better reductions in the behavioural
problems in our targeted treatment, which
is quite promising.
Once that part of the study has been
finished, and if your method proves
effective, could it be rolled out widely?
At the moment, we’re trying to work
with some schools in southwest Sydney
to be able to use this matching system,
where we have this very comprehensive
assessment of a child with disruptive
behavioural problems.
Then, that comprehensive assessment
is used to decide whether the child
receives the standard treatment, because
we know they’ll benefit from the standard
treatment, or whether they show callous-
unemotional traits, in which case they
could benefit more from this enhanced
targeted treatment.
That’s what we’re currently doing to
improve how we treat children with
behaviour problems. ■
* The trial results have been published
in the Journal of Clinical Child &
Adolescent Psychology.
Kimonis and her team are conducting
a trial that compares the novel
intervention to the standard treatment.
Families interested in participating are
invited to contact the clinic on (02) 9385
0376, preschoolparenting@gmail.com,
or by visiting www.conductproblems.
com/contact/.
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