An Individualized Program to Treat a Child Who is "Gaming the System:" A Case Report.

Children with disruptive behavior disorders (DBD) and callous-unemotional traits (CU; i.e., lack of guilt, uncaring) are at risk for a variety of negative trajectories (Frick & White, 2008), and frequently exhibit poorer response-to-treatment than children without CU traits (Haas et al., 2010; Hawes & Dadds, 2005). The current single-case design study describes the process of developing individualized modifications of a Daily Report Card intervention for a nine-year, eleven-month-old boy receiving treatment for disruptive behavior and CU traits in the context of a highly controlled, well-staffed Summer Treatment Program setting. After the child showed an initial non-response to the standard components of the behavior modification program, several treatment adaptations were attempted to maximize treatment response. During the 8-week program, one strategy emerged as superior in which the child was not told which target behaviors were being evaluated until immediately before the reward was given ("mystery" Daily Report Card targets). Results are discussed in the context of ways in which treatment can be maximized for children with both DBD and co-occurring CU traits. Our findings suggest that clinicians who are working with children who initially demonstrate an insufficient response to treatment should consider using iterative, data-driven treatment planning and progress monitoring strategies. [ABSTRACT FROM AUTHOR]