Uncaring, callous or unemotional traits in children can be difficult to manage – especially when Early Childhood Education (ECE) staff are expected to address the problem on top of performing their core duties. But studies show that, while ECE staff can play a significant role in addressing these behaviours, often it’s up to the parents to take the steps to make real changes in how they interact with their children. Journalist Sara El Sayed explores the issue.
Understanding the typical signs and best practice methods – as conducted by child psychologists – can help ECE staff in directing children and their families to the right places, and subsequently allow ECE staff to continue to do what they do best: educating young people.
Callous and unemotional traits: what are the signs?
Callous and unemotional traits are evident when children show a lack of empathy, uncaring attitudes, and ‘shallow’ emotions. Associate Professor Eva Kimonis from the School of Psychology at UNSW Science explained the nature of such behaviours.
“Children with these traits may exhibit uncaring attitudes towards others, as well as a lack of care about how well they perform in school or in other types of important structured activities,” Kimonis said.
“They may also struggle to recognise distressed emotions in others, and have difficulty paying attention to cues of fear and sadness in others.
“Children who have shallow experiences of emotions would find it easy to turn emotions on or off to get things that they want, or might use emotions in ways that are more for their benefit.
“If they do get upset it tends to be a shallow experience of that negative emotion, so they recover quickly.”
Another sign of callous and unemotional traits is a child who has a fearless temperament.
“For example, in new social situations, they might not be afraid to do things that other children would be anxious about, like climbing trees, approaching a new person, or other typical experiences that children might find frightening.”
Who is responsible?
When and how children develop these traits is still an area of ongoing research.
“There’s the idea that it comes from more of a temperamental feature of the child, and emerges very early in life.
“We can typically start to measure these problems in children at roughly three years of age.
“However, there is also research showing that, even at around five weeks old, babies who are more interested in objects rather than their parents’ faces go on to be more likely to develop callous unemotional traits later in life.”
When managing children who possess these traits, it often comes down to teachers who initially identify the problem.
“Parents may not realise that they are outside of the norm for a child of that age as they may not have other children to compare with.
“Therefore, often times it might not be until children reach preschool when a teacher, who does have other points of comparison, can see that a child shows lower levels of empathy or lower levels of caring for others.”
To address the problem, Kimonis suggested a multi-faceted approach: where parents and teachers work together, especially when the behaviours are exhibited at home and at preschool.
“When the issue is severe you tend to see behaviours across settings, as well as when there is comorbidity.
“When a child is also struggling, for example, with attention and impulsivity problems like ADHD, then it’s quite common that there will be cross setting consistency in the behaviours.”
Parent management training works
Kimonis said parent management training interventions were among the most effective strategies to address these issues.
“These programs teach parents skills they need to manage the child’s behaviour.”
One parent management training approach is Parent-Child Interaction Therapy (PCIT).
Kimonis recently conducted a successful trial of PCIT – adapted to suit the needs of children who exhibit callous unemotional traits.
As a result of the intervention, child conduct problems and callous- unemotional traits decreased, and empathy increased.
By three months post treatment, 75% of children who had completed the treatment no longer showed clinically significant conduct problems, and parents reported a high level of satisfaction with the program.
“PCIT has two phases: one phase is relationship building, working on the attachment and bond between parent and child, and the second phase is working on discipline and teaching parents how to give effective commands and to follow through to get the child’s compliance.
“A therapist is placed behind a one way mirror, observing the parent and the child who are engaged in play on the other side of the mirror.
“The parent wears an earpiece so the therapist can coach the parent in the moment, in real time, as they’re interacting with the child.
“They’re able to get intensive feedback to help modify the child’s behaviour, and to help the parent to apply the skills they’ve learnt.”
Kimonis and her colleagues adapted PCIT for children with callous unemotional traits as they saw these children did not respond as well to best available evidence based treatment programs like PCIT.
“One adaptation was that we heavily worked on increasing the parents’ levels of warmth with the child, because we know that children with callous unemotional traits tend to experience parenting that is less warm.
“The second element we introduced, as we know that children with callous unemotional traits are quite insensitive to punishment, was a reward orientated approach to change behaviour.”
Families also received an additional treatment module designed to address the child’s insensitivity to other people’s distress cues.
“The third aspect was we heavily worked on improving the child’s emotional skills.”
How do teacher led approaches compare?
Kimonis outlined that there were specific approaches geared towards teacher intervention which could also be effective, but the strongest evidence of improvement was seen when parents made the change.
One teacher led approach was contingency management.
“This is where teachers use behavioural modification techniques within the classroom, or work with parents to make sure that there is reinforcement of the desirable behaviours from the classroom at home,” Kimonis said.
Cognitive behavioural therapies are also effective for older school age children and adolescents.
“These are used especially when the child struggles with anger problems, and have been found to be effective when working with children in groups.
“But really, the strongest evidence base, especially for young children with these problems, is parent management training.
“Certainly combining parent management training with contingency management or cognitive behavioural skills training will likely yield the strongest results, but for young children, parent management training is a very effective approach.”
Kimonis will be extending this work to early childhood centres and schools in 2019.
“We will be building a clinic space within a school accessible by preschools, where families will be able to engage in the PCIT program directly.
“This also allows us to work with the teachers so we can develop the strong partnership needed between parents, teachers and schools to address these issues in a more holistic way.”