Prioritizing treatment targets for youths with disruptive behaviours and callous-unemotional traits: a modified Delphi study

BACKGROUND: Youths with disruptive behaviours (DB) and callous-unemotional (CU) traits experience significant impairments and impose substantial costs on families and society. Treatment outcome studies of current DB treatments highlight the need for tailored treatments. Identifying priority treatment targets that integrate empirical evidence with stakeholder perspectives may inform more effective treatment tailoring. METHOD: = 43.38, SD = 10.44, 76% female) rated the priority of candidate treatment targets across behavioural, emotional, cognitive, parental/home, peer, environmental/school, and temperament/personality domains. Ratings were completed separately for children (ages 3-12) and adolescents (ages 13-18). Experts also rated the feasibility of addressing candidate treatment targets within typical outpatient psychosocial treatment settings. RESULTS: Overall, 26 treatment targets for children and 30 for adolescents were identified as high priority; no targets reached consensus as low priority. Developmental differences emerged: parental/home targets were consistently prioritized for children, whereas adolescents showed broader priorities including emotional, cognitive, and peer targets. Among consensus priority targets, 13 child and 17 adolescent targets were rated as at least moderately feasible to address within outpatient care. Feasibility ratings did not differ across stakeholder groups. CONCLUSIONS: Findings identify stakeholder prioritized candidate treatment targets for youth with DB + CU, including both well-established and under-addressed targets. These results support consideration of treatment approaches that retain core DB components while extending attention to CU-relevant emotional, cognitive, and relationship processes, particularly for adolescents. By integrating lived experience, clinical expertise, and research expertise, this study provides a stakeholder-informed foundation for future treatment development, tailoring, and empirical evaluation for youths with DB + CU.