ABSTRACT Conduct disorder (CD) remains one of the most common, impairing, and costliest psychiatric disorders among youth. Youth with CD often face lifelong adjustment, mental health, legal, social, occupational, and physical health problems. A subset of youth with CD display callous-unemotional (CU) traits (termed “limited prosocial emotions”). Youth with CD and CU traits are more likely to engage in chronic criminal behaviors and develop psychopathology into adulthood when compared to youth with CD only. Although both CD and CU traits are inextricably linked to poor outcomes, there remains a scarcity of targeted interventions for CD and CU traits. One of the most significant challenges for treatment is that youth with CD are often perceived as treatment-resistant and treatment disrupters. This leads to poor treatment retention and further isolation from treatment opportunities. Interventions that do exist largely focus on reducing antisocial behavior rather than disrupting the developmental mechanisms of CD and CU traits. Arche VR, LLC, a Virginia-based small business, aims to offer a solution to this problem by providing a culturally appropriate, cutting-edge virtual reality (VR) intervention for CD and CU traits called Impact VR. Impact VR provides brief psychoeducational programming for emotion regulation and emotion recognition training using immersive gameplay and storylines that are engaging and relevant to youth. Impact VR is developed using evidence-based strategies to improve emotion regulation. At the center of Impact VR is an individualized training program that teaches youth to effectively identify emotional expressions in others. Impact VR uses cutting-edge technologies, including integrated eye-tracking and real- time adaptive programming to adjust instruction based on the youths' performance. This ensures that youth receive tailored, individualized treatment without the risk of floor and ceiling effects. Further, Impact VR provides a resource-efficient and standardized treatment approach for systems (e.g., schools, hospitals) to help improve access to evidence-based mental health treatment for youth with CD by targeting the mechanisms of CD and CU traits. The overall objective of this proposal is to refine Impact VR to be an engaging and topic-relevant intervention that youth with CD will want to participate in, and to determine the feasibility and usability of the deployment of Impact VR across treatment settings (i.e., in the home, school, and mental health settings). Lastly, this study includes a randomized control trial (RCT) to assess the preliminary efficacy of Impact VR for reducing CD, CU traits, and conduct problems (CP) and improving emotion recognition and regulation. Outcomes from this Phase I study include overall improvements in Impact VR as a deployment-ready, effective, and engaging treatment strategy for youth with CD and CU traits.

Project Narrative Conduct disorder (CD) is one of the most prevalent and impairing psychiatric disorders among youth, yet, treatment options are limited and those treatments that do exist largely focus on behavior management rather than targeting the mechanisms that contribute to the development and stability of CD. This project aims to evaluate a new and innovative treatment for CD, called Impact VR, a Virtual Reality emotion recognition and regulation training program, specifically designed to target the developmental mechanisms of CD. Our goal is to assess its acceptability among youth with CD, and its feasibility for deployment across settings (e.g., schools, hospitals), as well as conduct a randomized control trial to assess its preliminary effectiveness for reducing CD and callous-unemotional traits.