Impact VR: An Emotion Recognition and Regulation Training Program for Youth with Conduct Disorder

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ABSTRACT Conduct disorder (CD) remains one of the most common, impairing, and costliest psychiatric disorders among youth. Youth with CD often face lifelong adjustment, mental health, legal, social, occupational, and physical health problems. A subset of youth with CD display callous-unemotional (CU) traits. Youth with CD and CU traits are more likely to engage in chronic criminal behaviors and develop psychopathology into adulthood when compared to youth with CD only. Although both CD and CU traits are inextricably linked to poor outcomes, there remains a scarcity of targeted interventions for CD and CU traits. One of the most significant challenges for treatment is that youth with CD are often perceived as treatment-resistant and treatment disrupters. This leads to poor treatment retention and further isolation from treatment opportunities. Interventions that do exist largely focus on reducing antisocial behavior rather than disrupting the developmental mechanisms of CD and CU traits. Arche VR, LLC, a Virginia-based small business, aims to offer a solution to this problem by providing a culturally appropriate, cutting-edge virtual reality (VR) intervention for CD and CU traits called Impact VR. Impact VR provides brief psychoeducational programming for emotion regulation and emotion recognition training using immersive gameplay and storylines that are engaging and relevant to youth. At the center of Impact VR is an individualized training program that teaches youth to effectively identify emotional expressions in others. Impact VR uses cutting-edge technologies, including integrated eye-tracking and real-time adaptive programming to adjust instruction based on the youths' performance. This ensures that youth receive tailored, individualized treatment without the risk of floor and ceiling effects. The overall objective of the proposal is to refine Impact VR to be an engaging and topic-relevant intervention that youth with CD will want to participate in, and to determine the feasibility and usability of the deployment of Impact VR across treatment settings (i.e., in the home, school, and mental health settings). Lastly, this study includes a randomized control trial (RCT) to assess the preliminary efficacy of Impact VR for reducing CD, CU traits, and conduct problems (CP) and improving emotion recognition and regulation. During our early-stage focus groups with mental health professionals and educators, we discovered a critical need for Impact VR to be available to Spanish-speaking youth. To address this unanticipated need, this administrative supplement (PA-20-272) is requesting funds to include Spanish-speaking youth, which will also bolster our recruitment opportunities for the project. The supplement will support translating Impact VR to Spanish, as well as including Spanish-speaking youth in the development process (SA1 and SA2) and evaluation of Impact VR (SA3). Research has shown that mental health among Spanish-speaking youth has worsened in recent years, and this is largely due to the reduction in Spanish-language mental health services. This supplement will strengthen the existing study by increasing recruitment opportunities, as well as provide equitable research and treatment opportunities to Spanish-speaking youth.