Parent Training and Emotion Coaching for Children with Limited Prosocial Emotions

患有对立违抗性障碍（ODD）的儿童在童年后期、青春期和成年期出现一系列负面结果的风险显著增加。这些结果可能包括犯罪、过早和危险的性行为、较差的学业和职业适应、较差的人际关系以及各种精神障碍的风险增加。ODD的有效治疗通常基于基于社会学习的“家长管理培训”（PMT）模式。尽管有强有力的证据表明PMT有效，但它并非对所有儿童都有效，多达三分之一的儿童未能显示出可靠和持续的改善。具有有限的亲社会情绪（例如，缺乏内疚和同理心，无情地利用他人）似乎是减轻传统PMT影响的一个因素。亲社会情绪有限的ODD患儿表现出更严重的行为问题，行为结果更差。因此，开发基于经验的方法来提高“传统”经前情绪治疗对ODD和亲社会情绪有限的儿童的疗效是很重要的。最近的荟萃分析研究表明，成功的基于家庭的干预方法的一个关键组成部分是教会父母与情感沟通有关的技能。有证据表明，具有有限亲社会情绪的ODD儿童在意识/识别情绪和移情方面存在缺陷，将以情绪为中心的干预（这不是PMT的重点）纳入传统的PMT应该可以提高这些儿童的治疗效果。

Children with oppositional defiant disorder (ODD) are at significantly increased risk for a host of negative outcomes in later childhood, adolescence, and adulthood. These outcomes can include delinquency, early and risky sexual behavior, poor academic and occupational adjustment, poor interpersonal relations, and increased risk for various mental disorders. Effective treatment for ODD has typically been based on a social learning-based �parent management training� (PMT) model. Despite strong evidence for PMT, it is not effective with all children, with up to one third failing to show reliable and sustained improvement. Having limited prosocial emotions (e.g., lack of guilt and empathy, callous use of others) appears to be one factor that mitigates the effects of traditional PMT. Children with ODD with limited prosocial emotions present with more severe conduct problems and have poorer behavioral outcomes. It is therefore important to develop empirically based methods to enhance the efficacy of �traditional� PMT for those children with ODD and limited prosocial emotions. Recent meta-analytic research indicates that one key component of successful family based intervention approaches involves teaching parents skills related to emotional communication. Given evidence that children with ODD with limited prosocial emotions have deficits in the awareness/recognition of emotion and in empathy, incorporating an emotion-focused intervention (which has not been a focus of PMT) into traditional PMT should enhance outcomes for these children. Consistent with the aims of the R34 mechanism, the primary goal of this application is to develop and test the feasibility of a brief emotion-coaching (EC) intervention in combination with an evidence-based PMT program, Helping the Noncompliant Child (HNC; Forehand & McMahon, 1981; McMahon & Forehand, 2003), for use with clinic-referred children with ODD who have limited prosocial emotions. The Specific Aims are to: 1) develop and refine an empirically based combined HNC-EC parenting intervention to reduce CP in children with ODD and limited prosocial emotions; and 2) assess the viability of a later clinical trial by a) pilot testing the newly developed HNC-EC intervention compared to HNC alone with mothers and their 3-7 year-old children who have been referred for treatment of significant levels of oppositional behavior (and who also have limited prosocial emotions) in a community mental health center setting, and b) establishing the treatment feasibility (family and therapist-level feasibility, treatment fidelity, participant satisfaction) and research feasibility of the HNC-EC intervention compared to HNC alone. While pilot studies should not be used to estimate effect sizes, (Kraemer et al., 2006; Sherrill et al., 2009), we will explore trends in the data to facilitate consideration of possible designs for later statistical modeling in a larger trial. Promising findings would form the basis of a research proposal for a randomized clinical outcome study comparing HNC alone and in combination with an EC intervention for children with ODD and limited prosocial emotions. Should this combined intervention (which is focused on improving outcomes in this hard-to-treat population) prove to be effective, it will be one of the first interventions targeting known developmental mechanisms related to limited prosocial emotions in children. Given the increased likelihood that children with an early onset of CP and limited prosocial emotions are at increased likelihood of multiple negative outcomes extending into adulthood, at extraordinary social and economic cost, improving response rates to PMT (which is a low-cost, low-restrictiveness intervention) will have substantial public health impact.