目的:最近为改善有行为问题和冷酷无情(CU)特征的幼儿的结局所做的努力涉及调整治疗以满足该亚组的独特需求。然而,这些努力忽略了CU亚组内不同的主要和次要变异的积累证据.现有的治疗适应统一针对与主要CU特征相关的危险因素,并且没有研究调查有CU型行为问题的幼儿对治疗适应的反应性的变异特异性模式。
方法:参与者是45个家庭,有一个3至7岁的诊所转诊儿童(M=4.84岁,SD=1.08,84%的男孩)有品行问题和CU特征。主要和次要CU变异是基于基线父母评定的焦虑评分来定义的。所有家庭都在城市大学的研究诊所接受了针对CU特征的亲子互动疗法(PCIT-CU)。家庭完成了五项评估,以衡量儿童的行为问题和情感结果。
结果:线性混合效应模型表明,行为问题随时间变化的速率和形状在变体之间有所不同,这样具有继发性CU特征的儿童从治疗后到随访表现出反抗和失调的行为恶化,而主要CU性状与维持收益相关。CU性状的改善率没有差异。任何一种变体的情感移情都没有改善。通过对具有次要CU特征的儿童的随访,内化问题得到了有意义的改善。
结论:研究结果表明,PCIT-CU对有行为问题和主要CU特征的儿童是一种有希望的干预措施,但可能需要为具有次要CU特征的儿童进一步个性化。该试验在澳大利亚新西兰临床试验注册中心(ACTRN12616000280404)注册。
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.
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.
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.
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).