Children and teens with disruptive behaviour problems present major challenges to the people in their environment. But when parents seek mental health treatment for symptoms including aggression, defiance and serious rule-breaking, clinicians and researchers may not agree on the best approaches to take.
This can be even more pronounced when the child exhibits callous/unemotional (CU) traits, such as reduced empathy, limited guilt and lack of concern for others.
In a new paper published in the journal BMC Psychology, Concordia researchers consulted parents, scientists and mental health providers to identify and prioritize areas to address in treatment.
Using a consensus-based method, the three groups identified 26 treatment targets for children and 30 for adolescents as high priorities.
For children aged three to 12, the strongest priorities focused on the home. These included inconsistent parenting, low parental involvement and negative parental beliefs toward the child. Emotional skills, such as empathy and the ability to regulate emotions, were also identified as important, along with some school and environmental factors.
For adolescents aged 13 to 18, family and parenting factors remained important, but the list of priorities became broader. Experts identified peer-related and emotional targets as priorities, 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 behaviours remained a core treatment target across both age groups.
"While the results do not speak to one new treatment to pursue, they do give treatment developers a map of different areas that are stakeholder-informed," says Joyce Lui, an assistant professor in Concordia's Department of Psychology and the paper's corresponding author.
"These findings can help us think about testing which of these elements to include in treatments that would actually improve outcomes, and think about the sequencing and dosing of treatments in future research."
Realistic targets needed
For this study, the researchers used a modified Delphi study, a method specifically designed to achieve consensus among experts. They consulted a panel of 86 parents, clinicians and researchers and had them rate 42 potential targets across behavioural, emotional, cognitive, family, peer, school and personality domains.
Targets for children and adolescents were rated separately. The targets were also rated on their feasibility according to real-world situations - an important consideration given constrained resources, Lui adds.
The panel ultimately identified 26 high-priority targets for children and 30 for adolescents. Of these, 13 child targets and 17 adolescent targets were considered at least moderately feasible to address in outpatient care.
The researchers also found that some peer and school-related priorities could require increased involvement from and coordination with institutions outside clinical environments, especially schools.
Importantly, the researchers note that treatments need to focus on more than simply reducing disruptive behaviour. Lui notes that many such treatments already exist and work well. These treatments need to be expanded to address the emotional, cognitive and relationship stresses associated with CU traits, especially in adolescents.
"To our knowledge, there is no existing treatment designed specifically for the callous and unemotional subgroup, and the evidence is quite mixed when standard treatment is adapted to be applied in those cases," Lui says.
"More study is needed in terms of figuring out how to best treat these youth, but it is important to point out that these are not fixed traits. These young people are treatable. There are things we can do to improve and reduce these traits."
PhD candidate Jennifer Diep and Ellfie Chen, BA 2025, co-authored this study. The American Psychological Foundation John and Polly Sparks Early Career Grant provided funding.
Read the paper: "Prioritizing treatment targets for youths with disruptive behaviours and callous-unemotional traits: a modified Delphi study"
