Can reciprocated parent-child eye gaze and emotional engagement enhance treatment for children with conduct problems and callous-unemotional traits: a proof-of-concept trial.

BACKGROUND: High levels of callous-unemotional (CU) traits are associated with reduced effectiveness of parenting programmes for children with conduct problems. This may be due to low levels of emotional engagement (EE) by these children with their parents. We evaluate a theoretically driven strategy for improving emotional engagement in high CU traits children undergoing a parenting intervention (parent management training; PMT) for child conduct problems. METHODS: N = 40, 3- to 8-year-old children referred for conduct problems and showing stable, high levels of CU traits, were randomised to receive PMT+Emotional Engagement (EE), or the control condition PMT+Child Centred Play (CCP). A benchmarking sample of N = 70 children who received PMT only was also included. Observational coding of the parent-child interactions targeted by EE and CCP respectively was repeated throughout treatment and follow-up. RESULTS: Emotional engagement produced unique improvements in parent-child emotional engagement (shared eye gaze); however, these reverted to baseline levels after treatment. CCP produced unique improvements in parents' child centeredness and child positive play, but by post-treatment, all children had improved on these factors. Both interventions produced similar improvements in general parental warmth. Reductions in severity of conduct problems at post-treatment and follow-up were large in size and did not differ between conditions or from the benchmarking group. Levels of CU traits reduced significantly but again did not differ between groups. CONCLUSIONS: The putative mechanism of emotional engagement through reciprocated eye gaze proved to be impervious to sustained change, and thus failed to have a specific impact of conduct problems or levels of CU traits. The development of novel treatment approaches to children with high levels of CU is a challenging endeavour, and these results indicate that focussing on children with stable levels at pretreatment should be a priority.

Supporting Families Affected by Adversity: An Open Feasibility Trial of Family Life Skills Triple P.

This pilot feasibility study examined the effects of a new trauma-informed parenting program, Family Life Skills Triple P (FLSTP), in an open uncontrolled trial conducted in a regular service delivery context via video conferencing. FLSTP was trialed as a group-delivered 10-session intervention. Program modules target positive parenting skills (4 sessions) and adult life skills including coping with emotions, taking care of relationships, self-care, dealing with the past, healthy living, and planning for the future. Participants were 50 parents with multiple vulnerabilities, due to social disadvantage or adverse childhood experiences, who had children aged 3-9 with early onset behavior problems. Outcomes were assessed across four data collection points: baseline, mid-intervention (after Session 4), post-intervention, and 3-month follow up. Findings show moderate to large intra-group effect sizes for changes in child behavior problems, parenting practices and risk of child maltreatment, and medium effect sizes for parental distress, emotion regulation and self-compassion. Parents and practitioners reported high levels of consumer satisfaction with the program. Parents with lower levels of parental self-efficacy, lower personal agency and higher baseline scores on a measure of child abuse potential were at greater risk of not completing the program. The strength of these preliminary findings indicates that a more rigorous evaluation using a randomized clinical trial is warranted.

Processing memories of anger-eliciting events: the effect of asking 'why' from a distance.

Preliminary experimental evidence suggests that ruminating about anger-eliciting events exacerbates anger and associated affect. However, no research has investigated the effect of rumination on processing memories of these events. This study examined the impact of manipulating cognitive processing when recalling anger-eliciting events. Participants (N=60) outlined an anger-related experience and were randomly allocated to recall the event according to an experimental instruction that manipulated recall perspective and emotional focus (distanced-why, distanced-what, immersed-why or immersed-what). Participants completed measures of negative affect and implicit and explicit anger, and returned the following day to complete measures that indexed frequency of intrusive memories of the event and memory-related distress. Contrary to prediction, participants allocated to the distanced-why condition did not report reduced anger. However, participants instructed to think about 'why' they experienced the emotions they did during the event (compared with 'what' emotions they experienced) reported more intrusions 24h later, regardless of vantage perspective. These results accord with theoretical models that emphasise the negative impact of a ruminative 'why' focus on the processing of past events.

Enhancing thought suppression with hypnosis.

Much research indicates that attempts to suppress thoughts lead to increased accessibility of those thoughts, especially when additional cognitive load is present. On the premise that hypnosis may permit more effective management of cognitive load, it was hypothesized that hypnosis may enhance more effective thought suppression. The present research examined whether the obstacle of cognitive load could be bypassed using hypnosis to facilitate successful thought suppression. Thirty-nine high and 40 low hypnotizable participants were hypnotized and received either a suppression instruction or no instruction for a memory of an embarrassing experience and subsequently completed a sentence-unscrambling task that indexed accessibility of embarrassing thoughts. Whereas lows instructed to suppress displayed a delayed increase in suppressed thoughts, highs did not. These findings support the proposition that hypnosis facilitates thought suppression.

Outcomes, moderators, and mediators of empathic-emotion recognition training for complex conduct problems in childhood.

Impairments in emotion recognition skills are a trans-diagnostic indicator of early mental health problems and may be responsive to intervention. We report on a randomized controlled trial of "Emotion-recognition-training" (ERT) versus treatment-as-usual (TAU) with N=195 mixed diagnostic children (mean age 10.52 years) referred for behavioral/emotional problems measured at pre- and 6 months post-treatment. We tested overall outcomes plus moderation and mediation models, whereby diagnostic profile was tested as a moderator of change. ERT had no impact on the group as a whole. Diagnostic status of the child did not moderate outcomes; however, levels of callous-unemotional (CU) traits moderated outcomes such that children with high CU traits responded less well to TAU, while ERT produced significant improvements in affective empathy and conduct problems in these children. Emotion recognition training has potential as an adjunctive intervention specifically for clinically referred children with high CU traits, regardless of their diagnostic status.

Reduced eye gaze explains "fear blindness" in childhood psychopathic traits.

OBJECTIVE: Damage to the amygdala produces deficits in the ability to recognize fear due to attentional neglect of other people's eyes. Interestingly, children with high psychopathic traits also show problems recognizing fear; however, the reasons for this are not known. This study tested whether psychopathic traits are associated with reduced attention to the eye region of other people's faces. METHOD: Adolescent males (N = 100; age mean 12.4 years, SD 2.2) were stratified by psychopathic traits and assessed using a Tobii eye tracker to measure primacy, number, and duration of fixations to the eye and mouth regions of emotional faces presented via the UNSW Facial Emotion Task. RESULTS: High psychopathic traits predicted poor fear recognition (1.21 versus 1.35; p < .05) and lower number (1.85 versus 2.51; p < .001) and duration (375 versus 620 ms; p < .001) of eye fixations, and fewer first foci to the eye region (1.01 versus 2.01; p < .001). There were no differences in gaze indices to the mouth region. All indices of gaze to the eye region correlated positively with accurate recognition of fear for the high psychopathy group, especially the number of times that subjects looked at the eyes first (r = .50; p < .01). CONCLUSIONS: Attention to other people's eyes is reduced in young people with high psychopathic traits, thus accounting for their problems with fear recognition, and is consistent with amygdala dysfunction failing to promote attention to emotional salience in the environment.