Parenting and parent-child attachment relationships in young children with conduct problems and callous-unemotional traits

Children with conduct problems exhibit temper outbursts, and impulsive, oppositional, or antisocial behaviours that significantly impact their ability to function at home, school, and within their community. If untreated, conduct problems can set children on a high-risk trajectory into adolescence and adulthood. Developmental psychopathology research has identified two distinct pathways to developing conduct problems in childhood according to the presence or absence of high levels of callous-unemotional (CU) traits. Children with conduct problems and high CU traits show earlier and more severe and persistent conduct problems and, subsequently, more problematic cognitive, emotional, physiological and personality characteristics than children with conduct problems alone. This makes them an important focus for research and intervention. CU traits in childhood have strong genetic and biological foundations; but are also changeable. A developing literature identifies that negative parenting and problematic parent-child relationships relate to higher CU traits and more severe conduct problems for children with high CU traits in early and middle childhood(for a review, see Waller, Gardner, & Hyde, 2013). The current study extends this literature by providing an in-depth profile of the current quality of parenting and parent-child attachment relationships for children with conduct problems with varying levels of CU traits. Participants were mothers (n = 92) and fathers (n = 36) of 92 children (72% boys)between 3 and 9 years of age who were referred to an outpatient mental health clinic at a large metropolitan children's hospital. The children were diagnosed with Oppositional Defiant Disorder and/or Conduct Disorder. A multi-method approach was used, including: • a narrative interview question to elicit parent representations of their child's mental states, • doll play narrative and family drawing techniques to obtain children's representations of attachment, • questionnaires to assess for parents' perceptions of their parenting styles, caregiving helplessness and parenting stress, and • an observational measure to assess for parent-child dyadic emotional availability. It was expected that more problematic parenting experiences and perceptions of the parent-child relationship, less optimal emotional availability between parent and child during various interaction tasks, and more problematic child representations of their parents and family would be associated with more severe conduct problems and CU traits (examined separately), including diagnostic thresholds. Hypotheses were mostly supported with respect to conduct problems (results were more compelling for mothers than fathers), but findings related to CU traits were equivocal. Mothers of children with more severe conduct problems used more negative descriptors of their child's mental states, reported higher parenting stress, and described more feelings of helplessness when caring for their children. In addition, in cases where the child met the "With Limited Prosocial Emotions" specifier of Conduct Disorder (American Psychiatric Association, 2013), mothers reported that more child caregiving (where the child tended to take charge) was related to more severe conduct problems. Mothers of children with more severe conduct problems were also observed to be less emotionally available when interacting with their child. Children with more severe conduct problems showed more: negative representations of their parents and dysregulated aggression in their doll story narratives; dysfunctional representations of their family relationships in their drawings; and pathology in performing these tasks. The study did not find significant associations among parenting or parent-child attachment relationships and child conduct problems for fathers. However, effects for fathers' parenting stress and father-child dyadic emotional availability were at trend level. Significant findings relating to hypotheses about child CU traits were limited to the parent self-report measures. Parents (mothers and fathers) of children with higher CU traits reported fewer positive parenting practices, less child caregiving and more parenting stress. In relation to the severity of child CU traits, mothers (not fathers) reported more parent helplessness, and fathers (not mothers) reported more frightened or frightening caregiving. Fathers' use of more negative mental descriptors of their child were also related to higher child CU traits. Results are discussed in relation to their novel contribution to our current level of understanding of the quality of parenting, and parent-child attachment relationships experienced by children with conduct problems and varying severity of CU traits, including the unique contribution of mothers'/fathers' caregiving. Given that measures of attachment used in the current study had very limited or no previous application in investigating CU traits and related conduct problems in clinic-referred samples, the current results extend previous research and the theoretical implications are discussed. There were several unexpected findings. These included non-significant relations among negative parenting practices, parent and child emotional availability, parental mind mindedness, or child representations of attachment and child CU traits. These unexpected findings are discussed in the context of previous research, theoretical understandings of conduct problems and attachment theory, and limitations in the current study's design. Limitations included: a cross-sectional design and absence of a control group; a small group of fathers; reliance on parent-report measures of CU traits and conduct problems; limited assessment of child, parent and family risk-factors known to contribute to child CU traits; and demographics of the clinic-referred sample. Finally, the study makes recommendations for intervention with child CU traits and conduct problems based on the current results. Interventions focusing on improving positive parenting practices, caregiving helplessness and parenting stress for mothers and fathers maybe helpful in reducing CU traits in children. Improving maternal emotional availability, caregiving helplessness and parenting stress could also reduce disturbances in children's representations of attachment that, together, could be effective in improving child conduct problems. Including both mothers and fathers appears important for assisting the most behaviourally-disturbed children.