Authors
Waaler P.M., Bergseth J., Vaskinn L., Espenes K., Holtan T., Kjøbli J. & Bjørnebekk G.
Abstract
Adolescents with callous unemotional (CU) traits are at risk for poor quality-of-life outcomes such as incarceration, suicide, and psychopathy. It is currently unknown which treatments are implemented with CU adolescents specifically and which elements make up these interventions. A narrative systematic review was used to identify the treatments and common elements used with CU adolescents (12–18 years). Eligible studies were randomized controlled trials and quasi-experimental studies evaluating psychosocial interventions, delivered within a clinical context, and directed towards the adolescent or their family. Eight studies with 1291 participants were included. Significant decreases in CU traits were demonstrated only in a minority of studies. The most utilized practice elements were set goals for treatment, practice interpersonal/communication skills, prepare for termination, and teach parents skills and strategies; the most utilized process elements were formal therapy, practice exercises, important others, and flexible/adaptive. A majority of the studies did not report an implementation element. While theoretical frameworks for CU children are employed with CU adolescents, there is still uncertainty regarding their suitability for this age group. Given the limited empirical evidence, there is a critical need for further exploration.
Introduction
Serious antisocial behavior during adolescence is a catalyst for unfavorable developmental outcomes including poor school performance and social interactions, engagement in delinquent behaviors, such as substance abuse, and future antisocial adult outcomes, including arrests and personality disorder diagnosis [49, 56, 63]. This is especially true when these behaviors are exacerbated by callous unemotional (CU) traits [15].
Adolescents with CU traits “are characterized by a lack of guilt and remorse, a lack of concern for the feelings of others, shallow or superficial expression of emotions, and a lack of concern regarding performance in important activities” [25], p. 533). In addition, they use more extreme methods of aggression, are insensitive to punishment cues, and emphasize dominance and revenge when compared to those with serious antisocial behavior alone [23,24,25, 57]. Even though these traits are not immutable [46, 72], CU traits are relatively stable from adolescence to adulthood (r = 0.43–0.60; [25]), and without intervention, CU adolescents are at risk for complications later on in life, such as trouble with the law, substance abuse, homelessness, risky sexual behaviors, and suicide [15]. Furthermore, CU traits “constitute the core affective facets of adult psychopathy” ([15] p. 4), and adolescents who emanate these traits are at an increased risk for psychopathy [15, 27, 46] and committing serious violent crimes as adults [61, 62]. Despite this, systematic empirical evidence is lacking, and this is especially true when it comes to adolescents.