(PS6-68) Change in Callous-unemotional Behaviors in Children with Attention-deficit/hyperactivity Disorder and Disruptive Behavior Disorders: Impact of the Summer Treatment Program for Pre-kindergarteners

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. Children with ADHD often experience negative outcomes such as impaired social and academic functioning, and difficulties with emotion regulation, which are exacerbated by comorbid disruptive behavior disorders (DBD; e.g., oppositional defiance disorder [ODD] and conduct disorder [CD]). Additionally, callous-unemotional (CU) traits, which include low empathy and guilt, amplify impairments associated with ADHD and DBDs and can impact treatment response. One widely regarded psychosocial intervention for ADHD and comorbid DBD is the Summer Treatment Program (STP), which has been adapted for preschoolers (STP-PreK) and has shown success in improving externalizing behavior problems and school readiness outcomes. However, limited studies have examined the efficacy of multimodal treatments on reducing CU behaviors. The current study examined the trajectory of CU behaviors in young children with ADHD (with and without DBD) participating in the STP-PreK compared to typically developing (TD) peers across the following school year (e.g., baseline, 6-month/post-intervention, and 1-year follow-up/end of school year).

The current sample consisted of 323 young children: ADHD Only (n = 46, M^age = 5.65, SD = 0.81), ADHD+DBD (n = 129, M^age = 5.48, SD = 0.66), and TD children (n = 148, M^age = 5.41, SD = 0.84). The majority of the sample identified as White (86.6%) and Hispanic (81.4%). For the ADHD only and ADHD+DBD group, they also had to attend a 7 to 8-week STP prior to the start of kindergarten or first grade (Graziano et al., 2014). A multi-informant approach to measuring CU behaviors was used consisting of parent only, teacher only, and combined parent/teacher (P/T) report on the abbreviated Inventory of Callous-Unemotional Traits (ICU). Separate linear mixed models (LMMs) with random intercepts were conducted for parent, teacher, and combined CU outcomes and dummy codes were created for group comparisons. Regarding the combined P/T model, significant differences in the slope of CU improvements were noted between (a) children in the ADHD+DBD group and children in the TD group (b = .37, SE = .06, p < .001), and (b) children in the ADHD only group and children in the TD group (b =.23, SE = .08, p = .006). Similarly, results indicated significant differences in the slope of CU improvement (per teacher report) between (a) children in the ADHD+DBD group and children in the TD group (b = .41, SE = .07, p < .001), and (b) children in the ADHD only group and children in the TD group (b =.36, SE = .11, p < .001). No significant differences in slope were noted between all three groups in the parent only model. Per teacher report and the combined P/T model, both ADHD groups experienced substantial decrease in CU behaviors over time, with moderate effect sizes (Cohen’s d = .67-.76). At the 1-year follow-up, children in the ADHD Only group no longer significantly differed from TD peers, while the ADHD+DBD group continued to exhibit significantly higher CU scores. The findings suggest that the STP-PreK has a positive impact on reducing CU behaviors in children with ADHD during the transition to kindergarten or first grade.