title: Practitioner Review: Involving young people with callous unemotional traits in treatment--does it work? A systematic review.
abstract: BACKGROUND
  Children and adolescents with callous unemotional (CU) traits are at risk of severe and persistent antisocial behavior. It is commonly assumed that these children are difficult to treat but it has been proposed that they may benefit from being involved in interventions that go beyond typical parent training programs. This systematic review sought to answer two previously unanswered questions: do interventions involving young people reduce levels of CU traits? Do CU traits predict the effectiveness of interventions for antisocial behavior involving young people?
  
  
  METHODS
  Studies were included that adopted an randomized controlled trial, controlled or open trial design and that had examined whether treatment was related to reductions in CU traits or whether CU traits predicted or moderated treatment effectiveness.
  
  
  RESULTS
  Treatments used a range of approaches, including behavioral therapy, emotion recognition training, and multimodal interventions. 4/7 studies reported reductions in CU traits following treatment. There was a mixed pattern of findings in 15 studies that examined whether CU traits predicted treatment outcomes following interventions for antisocial behavior. In 7/15 studies, CU traits were associated with worse outcomes, although three of these studies did not provide data on baseline antisocial behavior, making it difficult to evaluate whether children with high CU traits had shown improvements relative to their own behavioral baseline, despite having the worst behavioral outcomes overall. CU traits did not predict outcomes in 7/15 studies. Finally, a single study reported that CU traits predicted an overall increased response to treatment.
  
  
  CONCLUSIONS
  Overall, the evidence supports the idea that children with CU traits do show reductions in both their CU traits and their antisocial behavior, but typically begin treatment with poorer premorbid functioning and can still end with higher levels of antisocial behavior. However, there is considerable scope to build on the current evidence base.
authors.affiliation: Department of Child and Adolescent Mental Health, Great Ormond Street & Royal London Higher Training Scheme, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Wilkinson
authors.affiliation: Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Waller
authors.affiliation: Division of Psychology and Language Sciences, University College London, London, UK.
authors.forename: Essi
authors.initials: E
authors.lastname: Viding
mesh_terms: D000293:Adolescent; D000987:Antisocial Personality Disorder / Q000628:therapy*; D002648:Child; D006801:Humans; D017063:Outcome Assessment, Health Care
keywords: Callous unemotional traits; antisocial behavior; intervention; treatment