Callous-Unemotional Traits, Proactive Aggression, and Treatment Outcomes of Aggressive Children with Attention-Deficit/Hyperactivity Disorder

Below:  Behavioral outcomes for groups with low, middle, and high scores at baseline on proactive aggression and callous-unemotional traits. Note: Each row shows associations between one behavioral outcome and baseline severity groups (low, middle, high) of proactive aggression and callous-nemotional traits. Panels on the left show behavioral outcomes with participants stratified by proactive aggression group. Panels on the right show callous-unemotional traits groups. The table within each chart shows the contrasts between the 3 severity groups (the differences in least-squares means and the 95% CI for that difference) at baseline and at the end of the stimulant monotherapy protocol. APSD C-U = Antisocial Process Screening Device Callous-Unemotional scale; CBCL = Child Behavior Checklist; ConnGI-P = Conners Global Index (Parent Version); R-MOAS = Retrospective-Modified Overt Aggression Scale; VAQ = Vitiello Aggression Scale.

82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio=0.94, 95% CI=0.80–1.11; proactive aggression, odds ratio=1.05, 95% CI=0.86–1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size=−0.379, 95% CI=−0.60 to −0.16) and proactive aggression (effect size=−0.463, 95% CI=−0.69 to −0.23).

Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements.

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