title: Response to treatments in youth with disruptive behavior disorders.
abstract: OBJECTIVE
  Predictors of poor response to treatments in youths with disruptive behavior disorders (DBDs), including conduct disorder (CD) and oppositional defiant disorder (ODD), are under-studied. Multimodal psychosocial interventions are the best option, but a significant portion of patients needs adjunctive pharmacotherapy. The concept of "psychopathy", and namely, the callous (lack of empathy and guilt) and unemotional (shallow emotions) trait, has been considered a possible specifier indicating a more severe subgroup of patients. We explored whether the callous-unemotional trait (CU) may affect the response to multimodal treatment in referred youths with DBDs.
  
  
  METHODS
  118 youths (102 males, age range 6-14years, mean age 11.1±2.5years) completed a 12-month multimodal intervention, 48 of whom (41%) needed an associated pharmacotherapy. The patients were assessed according to psychopathological profile (Child Behavior Checklist, CBCL), severity and improvement (Clinical Global Impression-Severity and Improvement scores, CGI-S and CGI-I), functional impairment (Children-Global Assessment Scale, C-GAS), and psychopathic dimension (Antisocial Process Screening Device, APSD), including CU dimension.
  
  
  RESULTS
  58 patients (49.2%) were non-responders. They had more frequently a diagnosis of CD than ODD, presented a comorbid mood disorder, higher CBCL scores in rule-breaking behavior, and higher APSD ("psychopathic") scores. Subjects with higher or lower CU differed only according to the rate of responders (35% vs. 60%, p<.05). The linear blockwise regression indicated that pre-treatment functional impairment (C-GAS) and baseline CU trait were predictors of non-response. The logistic regression indicated that only the value of baseline APSD-CU trait was a predictor of non-response.
  
  
  CONCLUSIONS
  A careful assessment of baseline clinical functioning and psychopathological features, namely the psychopathic traits, can identify the most problematic patients, and has specific prognostic and treatment implications.
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy. Electronic address: gabriele.masi@inpe.unipi.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.forename: Pietro
authors.initials: P
authors.lastname: Muratori
authors.forename: Azzurra
authors.initials: A
authors.lastname: Manfredi
authors.forename: Francesca
authors.initials: F
authors.lastname: Lenzi
authors.forename: Lisa
authors.initials: L
authors.lastname: Polidori
authors.forename: Laura
authors.initials: L
authors.lastname: Ruglioni
authors.forename: Filippo
authors.initials: F
authors.lastname: Muratori
authors.forename: Annarita
authors.initials: A
authors.lastname: Milone
mesh_terms: D000293:Adolescent; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D002653:Child Behavior Disorders / Q000523:psychology / Q000628:therapy*; D019955:Conduct Disorder / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome