Consensus study maps treatment priorities for youths with disruptive behavior

A modified Delphi study involving 86 parents, clinicians and researchers identified 26 high-priority treatment targets for children aged 3 to 12 and 30 for adolescents aged 13 to 18 with disruptive behavior and callous-unemotional traits. The consensus exercise provides a stakeholder-informed map for developing and testing treatments rather than identifying a single recommended intervention, and it did not test whether addressing any target improves outcomes. The findings were published in BMC Psychology.

Researchers evaluated 42 potential targets spanning behavioral, emotional, cognitive, family, peer, school and personality domains. Panel members rated targets for children and adolescents separately and also assessed their practical feasibility in real-world settings. The modified Delphi method is designed to build consensus among experts. Of the targets receiving high-priority ratings, 13 for children and 17 for adolescents were considered at least moderately feasible to address in outpatient care.

For children, the strongest priorities centered on the home. Panel members emphasized inconsistent parenting, low parental involvement and negative parental beliefs toward the child. Emotional skills, including empathy and the ability to regulate emotions, were also important, along with selected school and environmental factors. For adolescents, family and parenting factors remained important, but the priorities broadened to include peer-related and emotional targets, including difficulties with empathy, emotion processing and motivation to change. Several cognitive factors were also prioritized, including deviant goals and values and difficulties with moral reasoning. Aggressive, defiant and conduct-related behaviors remained core targets across both age groups.

Joyce Lui, an assistant professor in Concordia University’s Department of Psychology and the paper’s corresponding author, said the results do not point to one new treatment to pursue. Instead, they show which areas stakeholders consider important and feasible. The priorities may help researchers decide which elements to include in interventions and how those elements might be sequenced and dosed in future studies. Some peer- and school-related priorities could require greater involvement from and coordination with institutions outside clinical environments, particularly schools, rather than relying on outpatient care alone.

The findings also underscore the need for treatment to address more than a reduction in disruptive behavior. Lui noted that treatments focused on disruptive behavior already exist and work well, but they may need to be expanded to address the emotional, cognitive and relationship stresses associated with callous-unemotional traits, especially among adolescents. Callous-unemotional traits can include reduced empathy, limited guilt and lack of concern for others. The authors said they were not aware of an existing treatment designed specifically for youths with a callous and unemotional subgroup, and that evidence is mixed when standard treatments are adapted for those cases. The study itself did not compare treatments, establish their effectiveness or determine whether any prioritized target leads to better clinical outcomes. Further research is therefore needed to evaluate the usefulness, sequencing and dosing of different treatment components. The authors also cautioned that callous-unemotional traits are not fixed and should not be used to assume that affected youths cannot benefit from treatment.

Subject of Research: Stakeholder-prioritized treatment targets for youths with disruptive behavior and callous-unemotional traits

Article Title: Youths with disruptive behaviour and callous-unemotional traits need a broad range of treatments, Concordia study shows

Article References: Youths with disruptive behaviour and callous-unemotional traits need a broad range of treatments, Concordia study shows. Original publication (Bibliographic details unavailable.)

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Keywords: child mental health, adolescent mental health, disruptive behavior, callous-unemotional traits, Delphi consensus, treatment priorities, parenting, emotional regulation, empathy, school coordination, clinical psychology, Youths