Treatment Engagement and Multiple Specifiers among Boys and Girls with Conduct Disorder

Callous-unemotional (CU), daring-impulsive (DI), and grandiose-manipulative (GM) specifiers are considered informative for the treatment of youth with conduct disorder (CD), but empirical evidence is limited. This study examined the relationship between the specifiers and treatment engagement (TE) in boys (n = 286) and girls (n = 69) with a CD diagnosis. CD symptoms and diagnosis were assessed via a diagnostic interview and self-report questionnaires were used to assess the specifiers, TE, internalizing problems, and features of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Multiple linear regression analyses were performed to examine unique associations between the specifiers and TE, after controlling for their overlap and control variables (i.e., number of CD symptoms, internalizing problems, and ADHD and ODD features). At the zero-order level, the three specifiers were negatively correlated to TE in boys, while no significant correlations were found in girls. After controlling for their overlap and control variables, only CU traits were significantly negatively related to TE in boys, while GM traits were unexpectedly but significantly positively related to two TE dimensions in girls. Additional analyses revealed significant sex differences in the associations between TE and GM traits. Results underscore the importance of CU traits in boys and GM traits in girls with CD for understanding individual differences in TE levels. The unexpected positive link between GM traits and TE in girls warrants replication, though further investigation is required to clarify (sex-specific) associations between the proposed specifiers and clinically relevant correlates other than TE, such as treatment outcomes.