Can reciprocated parent-child eye gaze and emotional engagement enhance treatment for children with conduct problems and callous-unemotional traits: a proof-of-concept trial.

Abstract

High levels of callous-unemotional (CU) traits are associated with reduced effectiveness of parenting programmes for children with conduct problems. This may be due to low levels of emotional engagement (EE) by these children with their parents. We evaluate a theoretically driven strategy for improving emotional engagement in high CU traits children undergoing a parenting intervention (parent management training; PMT) for child conduct problems. N=40, 3- to 8-year-old children referred for conduct problems and showing stable, high levels of CU traits, were randomised to receive PMT+Emotional Engagement (EE), or the control condition PMT+Child Centred Play (CCP). A benchmarking sample of N=70 children who received PMT only was also included. Observational coding of the parent-child interactions targeted by EE and CCP respectively was repeated throughout treatment and follow-up. Emotional engagement produced unique improvements in parent-child emotional engagement (shared eye gaze); however, these reverted to baseline levels after treatment. CCP produced unique improvements in parents' child centeredness and child positive play, but by post-treatment, all children had improved on these factors. Both interventions produced similar improvements in general parental warmth. Reductions in severity of conduct problems at post-treatment and follow-up were large in size and did not differ between conditions or from the benchmarking group. Levels of CU traits reduced significantly but again did not differ between groups. The putative mechanism of emotional engagement through reciprocated eye gaze proved to be impervious to sustained change, and thus failed to have a specific impact of conduct problems or levels of CU traits. The development of novel treatment approaches to children with high levels of CU is a challenging endeavour, and these results indicate that focussing on children with stable levels at pretreatment should be a priority.