Outcomes, moderators, and mediators of empathic-emotion recognition training for complex conduct problems in childhood

Impairments in emotion recognition skills are a trans-diagnostic indicator of early mental health problems and may be responsive to intervention. We report on a randomized controlled trial of “Emotion-recognition-training” (ERT) versus treatment-as-usual (TAU) with N=195 mixed diagnostic children (mean age 10.52 years) referred for behavioral/emotional problems measured at pre- and 6 months post-treatment. We tested overall outcomes plus moderation and mediation models, whereby diagnostic profile was tested as a moderator of change. ERT had no impact on the group as a whole. Diagnostic status of the child did not moderate outcomes; however, levels of callous-unemotional (CU) traits moderated outcomes such that children with high CU traits responded less well to TAU, while ERT produced significant improvements in affective empathy and conduct problems in these children. Emotion recognition training has potential as an adjunctive intervention specifically for clinically referred children with high CU traits, regardless of their diagnostic status.