Callous-Unemotional Traits Do Not Predict Functional Family Therapy Outcomes for Adolescents With Behavior Problems

Abstract

Despite the availability of evidence-based treatment models for adolescent behavior problems, little is known about the effectiveness of these programs for adolescents with callous-unemotional (CU) traits. Defined by lack of empathy, lack of guilt, flattened affect and lack of caring, CU traits have been linked to long-term anti-social behavior and unfavorable treatment outcomes and might be negatively related to outcomes in evidence-based programs such as Functional Family Therapy (FFT). This study used a single-group pre-post evaluation design with a sample of 407 adolescents (49.1% female, mean age = 14.4 years, SD = 1.9) receiving FFT to investigate whether outcomes in FFT are predicted by CU traits and to what extent reliable changes in CU traits can be observed. The results showed that although CU traits are related to increased problem severity at baseline, they predicted neither treatment dropout nor post-treatment externalizing behavior and family functioning. CU traits were related to diminished improvement ratings, in particular with respect to parental supervision. Reductions in CU traits were observed across the time of treatment, and these were most profound among adolescents with elevated levels of CU traits at baseline. Further research should investigate whether certain evidence-based treatment components are more suited for adolescents with CU, and if the addition of specific intervention elements for reducing CU-traits could further improve outcomes for this high-risk population.

Behavioral Improvements but Limited Change in Callous-Unemotional Traits in Adolescents Treated for Conduct Problems

“…The clinical meaningfulness of such statistically significant findings needs to be assessed, as the observed average reduction in our study of a couple of scale points can occur by a minimal 1-scale-point change on merely two or three questions on the ICU12. Furthermore, it seems that baseline levels of CU traits might be a moderator of CU change, as our results, and those of a previous study, observed more pronounced reductions in CU traits for adolescents with elevated baseline levels of CU traits (Thøgersen et al, 2021). Importantly, the growth curve analysis indicate that these reductions might be temporary, and the observed short-term effects could be driven by regression to the mean effects.…”

“…This implies that FFT provided neither better nor worse outcomes for adolescents with CU traits when compared to the alternative treatments available in Norway. Although there might be plausible theoretical advantages of using the FFT approach to work with youth with CU traits (Thøgersen et al, 2021;White et al, 2013), these were not empirically observed in the current study when FFT was compared to other high-quality treatment options. This might be due to the fact that some of the treatments provided in the control condition (e.g., MST and parent management training) have treatment foci and interventions similar to that of FFT.…”

“…There is evidence to suggest that CU traits are malleable for younger children, in particular when the parents are involved in treatments that specifically target CU-specific risk factors (Dadds et al, 2019;Kimonis et al, 2019;Kjøbli et al, 2018;Waller et al, 2013). While some treatment studies in adolescent samples have also reported reductions in CU traits (e.g., Lui et al, 2019;Salekin et al, 2012;Thøgersen et al, 2021), others show more mixed results (Butler, 2011;Fonagy et al, 2018) or no change (Manders et al, 2013;Reddy et al, 2013). The fact that reductions in CU traits are mostly observed in studies without a control group or across treatment conditions, makes it difficult to ascertain that CU traits respond to treatment rather than being a result of time, maturation, or measurement effects.…”

Possible Interventions for Preventing the Development of Psychopathic Traits among Children and Adolescents?

“…The results of a Danish pre-post treatment study showed that even though CU traits were associated with more rule-breaking behaviour and hyperactivity at the start of treatment, this did not increase the risk of adolescents interrupting or gaining less benefit from FFT [ 67 ]. On the other hand, CU traits were related to the level of improvement as rated by parents, adolescents, and the therapist at the end of treatment.…”