Project Summary Oppositional defiant disorder (ODD) and conduct disorder (CD), collectively known as disruptive behavior disorders (DBDs), involve physical or verbal confrontations, antisocial behavior, emotional outbursts, and destruction of property. Children and adolescents with DBD often have poor social perspective-taking skills, which contributes significantly to deficits in empathy and prosocial behavior. Strategies to improve perspective taking in youth with DBD have shown promise but are limited by the extensive duration, motivation, and cognitive capacity often required. Virtual reality (VR) has exciting potential as a therapeutic tool to address perspective-taking deficits because it can provide naturalistic yet controlled environments in which users can easily experience social interactions from multiple viewpoints. To examine whether VR has potential to improve perspective taking in youth with DBD, we will recruit boys and girls aged 9-12 with DBD to undergo a VR “alternate perspective” treatment. In the R61 phase, participants will experience interpersonal conflicts with VR and answer questions regarding their ability to understand the virtual counterpart's perspective. Participants will then re-experience scenarios in one of three manners: an audiovisual-only perspective from the virtual counterpart's point-of-view; an “enriched” perspective via the virtual counterpart, that adds internal dialogue, context, and background information; or a control perspective, which replays the original point-of- view. We will then assess changes to perspective taking and engagement of neural mechanisms underlying self- perspective and other-perspective pain, to achieve the following specific aims: (1) To determine if experiencing alternate perspectives within a VR scenario via (a) an audiovisual-only perspective or (b) an enriched perspective engages social perspective-taking processes in youth with disruptive behavior disorders; and (2) To evaluate whether VR perspective-taking scenarios increase neural sensitivity to pain experienced by virtual counterparts. The investigation will proceed to the R33 phase if milestone criteria are met (Cohen's d effect size ≥ 0.5) for engagement of both psychological and neural targets: improvement of social perspective taking and relatively higher neural sensitivity to the virtual counterpart's pain. In the R33 phase, we aim to replicate engagement of perspective taking mechanisms during a multi-session, at-home VR treatment, with a variety of interpersonal conflicts and settings. We will compare re-experiencing scenarios through the VR alternate and control perspectives with an additional arm directing participants to imagine their virtual counterpart's perspective. We will assess changes in psychological and neural markers of perspective taking, along with post- treatment empathic concern, attribution biases, and prosocial behavior. This investigation can confirm the potential for VR to be used to help improv...