The moderating role of child callous-unemotional traits in an Internet-based parent-management training program.

Although parent management training (PMT) is generally considered the treatment of choice for children with conduct problems, some specific adaptations might be essential for various subgroups of parents or children to benefit well from PMT. The aim of this study was to examine the influence of child callous-unemotional (CU) traits on the outcome of an Internet-based PMT program for parents of children with conduct problems (n = 57; mean age 6.65). Within a randomized controlled trial of PMT, children assigned to the intervention group were categorized and compared as either "high-CU" (n = 8) or "low-CU" (n = 49) based on a cut-off score on the CU subscale of the Antisocial Process Screening Device (APSD; Frick & Hare, 2001). CU traits in children were associated with more severe conduct problems at baseline, as well as more hyperactivity and peer-related problems. Treatment outcome, in terms of conduct-problem reduction, was poor in the high-CU group compared with the low-CU group, despite the fact that parents in both groups improved equally in parenting skills. The same pattern of results emerged after controlling for initial difficulties of conduct problems and other pretreatment differences between the groups. Elevated levels of CU traits in children seem to contribute to an inferior treatment response in PMT. These findings call for more attention on empathy and emotional patterns in the assessment of children with conduct problems.