Children with conduct problems and callous-unemotional traits (i.e., lack of empathy, guilt, and lack of caring behaviors)(CP + CU) show poor response to empirically supported interventions for treating disruptive behaviors. Children with CP + CU are specifically less responsive to discipline components of parent training, although they respond well to reward-based behavioral strategies. This case study presents the treatment of a 5-year-old boy with severe disruptive behavior (CP, attention-deficit/hyperactivity disorder) and pronounced CU traits using Parent-Child Interaction Therapy, followed by the delivery of an adjunctive token economy system. Interventions that treat children with CP + CU are critically needed and have the potential for significant societal impact given the stability of their traits and severe behavioral outcomes. Findings from this case report (a) document an improvement in CP that was maintained to follow-up and (b) provide preliminary support for adapting parent-training interventions to modify severe CP in young children with CU traits. © The Author(s) 2012.
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