Conduct disorders are the largest single group of psychiatric conditions in children and adolescents. They are characterised by a repetitive and persistent pattern of antisocial, aggressive or defiant behaviour, which may include destroying property, theft, deceit or serious rule breaking. This type of behaviour is more severe than ordinary childish mischief or rebellion, and it goes beyond one-off antisocial acts. Conduct disorders are often associated with attention deficit hyperactivity disorder (ADHD), depression, learning disabilities (particularly dyslexia) and substance misuse.
Community-based surveys estimate that 6.9% of boys and 2.8% of girls aged five to 10 in the UK have conduct disorders. For children aged 11-16 the number rises to 8.1% for boys and 5.1% for girls. There are several risk factors that can predispose children to conduct disorders. These can be environmental or associated with the family or the children themselves. Environmental risk factors include social disadvantage, homelessness, low socio-economic status, poverty, overcrowding and social isolation. Family risk factors include marital discord, substance misuse, criminal activities and abusive parents. Children with a difficult temperament, brain damage, epilepsy, chronic illness or cognitive deficits are also more prone to conduct disorders.
Many children with conduct disorders will have problems that persist into adolescence and adulthood – resulting in future health and social problems. About 40% of children with conduct disorders become young offenders and nearly all young offenders have a history of conduct disorders during childhood. It is therefore crucial that these disorders are diagnosed early and treated effectively.
However, many children with conduct disorders will not receive treatment because of limited resources, the high prevalence of the condition and the suitability of treatment available for some families.
Parent-training/education programmes focus on improving the relationship between a parent or carer and the child. There are two main types of programmes – behavioural and relationship. Behavioural programmes focus on teaching the parenting skills needed to address the causes of problem behaviours. Relationship programmes aim to help parents improve communications and understand the emotions and behaviour of themselves and their child.
Programmes tend to be focused and short term, usually one-and-a-half to two hours hours a week for eight to 12 weeks. They can be run by psychologists, therapists, counsellors, social workers, community workers and voluntary agencies, and they can be held in various settings, including hospitals, clinics or homes. These programmes can be conducted in groups of six to 12 participants or individually.
In a review last year, the Social Care Institute for Excellence and the National Institute for Health and Clinical Excellence (Nice) found these programmes to be effective in improving children’s behaviour. The Nice/Scie guidance recommends group-based parent training/education programmes in the management of conduct disorders in children younger than 12, or in children with a developmental age of under 12. Individual-based parent training/education programmes are recommended only where the family’s needs are too complex for group-based programmes, or where there are particular problems in engaging with the parents.
However, Scie’s work with Nice also indicates that more work is required to adapt parent training to the needs of parents, particularly as up to 40% withdraw from programmes. The report calls for “qualitative research looking at parental satisfaction and preferenceso that programmes [can] be sensitised to the needs of black and minority ethnic families and more socially excluded families, and possibly to decrease poor attendance/concordance”.
Evidence suggests that social care or health professionals or agencies that commission parent training/education programmes should ensure that the programmes:
● Are based on principles of social learning theory (an approach to learning that includes learning from observing other people).
● Include ways to improve family relationships
● Include role play during sessions and homework between sessions so that parents can apply what they have learned to their own family’s situation.
● Are given by people who are suitably trained, skilled and supervised.
There should also be independent evidence that programmes work well, and programme providers should ensure that there is support to help parents to take part.
The available evidence on children with conduct disorders shows gaps in some areas. More evidence or examination would be beneficial on:
● Parent training/education programmes in disadvantaged areas.
● The impact of parent-training/education programmes on the quality of life of children with conduct disorders, their parents, carers, siblings and the wider community.
● The impact of parent-training/education programmes on parents or children with learning disabilities.
● The long-term effects these programmes have on outcomes such as educational achievement and criminality.
● Nice/Scie guidance on parent-training/education programmes in the management of children with conduct disorders
● ADDISS (the national Attention Deficit Disorder Information and Support Service), 020 8906 0354
● ADHD UK Alliance, 020 7608 8760
● The National Family and Parenting Institute, 020 7424 3460
● NHS Direct online may also be a good starting point for finding out more.
● Your local Patient Advice and Liaison Service (PALS) may also be able to give advice and support.
This article appeared in the 10 May issue under the headline “Conduct disorder programmes”