Callous-Unemotional Traits as an Intervention Target and Moderator of Parent–Child Interaction Therapy—Emotion Development Treatment for Preschool Depression and Conduct Problems

Objective: Callous-unemotional (CU) traits—characterized by low empathy, prosociality, and guilt—predict severe and persistent conduct problems. Although some interventions for conduct problems have been less effective in children with high levels of CU traits, studies have not examined whether CU traits interfere with treatment for other childhood disorders. Moreover, few treatments have demonstrated efficacy in decreasing CU traits themselves in early childhood. This study examined whether Parent–Child Interaction Therapy—Emotion Development (PCIT-ED), a novel PCIT adaptation that promotes emotional competence with demonstrated efficacy in treating preschool-onset major depressive disorder and oppositional defiant disorder, was also effective in treating these disorders in children displaying higher levels of CU traits. The study also examined whether PCIT-ED treatment produced significant and sustained decreases in CU traits. Method: This study examined 3- to 5-year-olds (N = 114) with preschool-onset major depressive disorder who completed the PCIT-ED trial. Children were randomly assigned to either immediate PCIT-ED treatment (n = 64) or a waitlist control condition (n = 50) in which they received the active treatment after 18 weeks. Psychiatric diagnoses and severity and CU traits in children were assessed at baseline, immediately after treatment, and 18 weeks after treatment completion. Results: Compared with the waitlist, PCIT-ED effectively reduced major depressive disorder and oppositional defiant disorder in preschoolers, regardless of initial levels of CU traits. Moreover, CU traits decreased from before to after treatment, and this treatment effect was sustained 18 weeks after treatment. Conclusion: Results support that novel interventions that enhance emotional development display significant promise in treating CU traits—behaviors that left untreated predict severe conduct problems, criminality, and substance use. Clinical trial registration information: A Randomized Controlled Trial of PCIT-ED for Preschool Depression; https://clinicaltrials.gov; NCT02076425.