Expert panel maps treatment priorities for young people with disruptive behavior and callous-unemotional traits

The study used a modified Delphi method, a structured way of gathering opinions from a group and looking for agreement. The 86 participants included parents, clinicians and researchers. Their average age was 43.38 years, and 76% were female.

Participants rated possible treatment targets for young people with disruptive behaviors and callous-unemotional traits. Disruptive behaviors can include aggression, defiance and serious rule-breaking. Callous-unemotional traits can include reduced empathy, limited guilt and less concern about others.

The panel considered targets across several areas: behavior, emotions, thinking, parenting and home life, peers, school or other environmental factors, and temperament or personality. They rated children ages 3 to 12 separately from adolescents ages 13 to 18. They also considered whether targets could realistically be addressed in typical outpatient psychosocial care, meaning therapy and related support provided without a hospital stay.

The researchers identified 26 high-priority targets for children and 30 for adolescents. No possible target reached agreement as a low priority. For children, parenting and home-related targets were consistently prioritized. For adolescents, priorities were broader and included emotional, cognitive and peer-related areas as well as family factors.

Among the targets judged high priority, 13 for children and 17 for adolescents were rated at least moderately feasible to address in outpatient care. Feasibility ratings did not differ across the parent, clinician and researcher groups.

The findings suggest that treatment developers may want to preserve core approaches aimed at disruptive behavior while also considering emotional, thinking and relationship processes linked to callous-unemotional traits, particularly for teenagers. But this is a map of stakeholder priorities, not evidence that a broader treatment package improves symptoms, relationships or daily life.

The study also does not establish which treatment elements should come first, how much support is needed, or which young people may benefit most. The authors say these questions need empirical evaluation in future research. Studies that compare tailored approaches with existing care and measure outcomes over time would be needed to know whether this framework leads to better results.