2 - (SYM 82) Combatting the “untreatable” Hypothesis: Treatment Efficacy of Behavioral Therapy for Youth with Conduct Problems and Callous-unemotional Traits

Introduction: Conduct problems (CP) are highly heterogenous; callous-unemotional (CU) traits are key in understanding CP severity and persistence. The presence of such diagnostic labels has contributed to a stigmatizing view of youth who present with both CP and CU traits (CPCU). Given their persistent pattern of aggressive, antisocial behavior, these youth are frequently labeled as “untreatable.” One aspect that contributes to this view is how most research conflates ways of measuring treatment effects. Such methodology leads to inaccurate conclusions of treatment efficacy. In a sample of youth with CPCU, the current study parsed out “treatment response” (i.e., magnitude of pre-to-post-treatment change) from “treatment outcomes” (i.e., likelihood of normalization at post-treatment). In addition to these empirical findings, this talk will present results from similar studies and a recently published review to highlight the inaccuracies of the “untreatable” label.

Method: Participants were 67 youth (73% male, ages 7-12) enrolled in an eight-week summer treatment program designed for youth with externalizing problems. Outcomes included parent and teacher-reports of CP, CU traits, and impairment.

Results: Linear mixed models showed that youth with higher CP and CU traits showed larger reductions (treatment response) on parent- and teacher-reported CD (b’s = -.006 to -.003, p’s = .01) and teacher-reported callous behavior (b = -.30, p < .0001). In contrast, higher CU traits predicted a lower likelihood of normalization (treatment outcome) across all measures.

Discussion: Collectively, these findings, supported by other research studies in the field, greatly push back against the narrative that youth with CPCU are “untreatable.” This study highlights how youth with CPCU experience significant reductions in their CP and CU behavior during treatment. Indeed, youth with CPCU are no different from other clinical populations in that the appear to require tailored treatments to achieve best treatment outcomes possible (i.e., reaching normalization thresholds). Such work is imperative to educate the scientific and overall public surrounding treatment prognosis for this population of youth, in turn reducing the stigma that these youth endure.