Conduct disorders are the largest single group of psychiatric disorders in children and adolescents, and they are the main reason for referral to child and adolescent mental health services. These disorders, which include oppositional defiant disorder (ODD), are characterised by a repetitive and persistent pattern of antisocial, aggressive or defiant behaviour, which may include destroying property, theft, deceitfulness or serious rule breaking. This type of behaviour is more severe than 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 in between the ages of five and 10 in the UK the have conduct disorders. For children aged between 11 and 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 factors can be environmental or associated with the family or the children themselves. Environmental risk factors include social disadvantage, homelessness, low socioeconomic status, poverty, overcrowding and social isolation. Family risk factors include marital discord, substance misuse, criminal activities and abusive parents. Children with brain damage, epilepsy, chronic illness or cognitive deficits are also more prone to conduct disorders.
These disorders are usually addressed through interventions targeted at both the child and the family. Child-focused therapies include behavioural therapy, cognitive therapy, psychotherapy, social skills training, play therapy, music/art therapy and occupational therapy. Family therapy usually involves a therapist meeting with the whole family to explore personal interactions that could be contributing to or sustaining a child’s problem behaviours. However, many children with conduct disorders will not receive treatment because of the limited resources currently available, the high prevalence of the condition, and the difficulty of engaging some families in treatment.
Parent-training/education programmes focus on improving the relationship between a parent or carer and the child. There are two main types of these 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. Parent-training/education programmes tend to be focused and short term, usually 1.5-2 hours every week for 8-12 weeks. They can be run by psychologists, therapists/counsellors, social worker, community workers and voluntary agencies, and they can be held in a variety of settings including hospitals, clinics or homes. These programmes can be conducted in groups of 6-12 participants or individually.
In a review of parent training/education programmes, Scie and the National Institute for Health and Clinical Excellence (2006) found that these programmes are effective in improving children’s behaviour. The results showed that behavioural programmes are the most effective in modifying children’s behaviour, as measured by a combination of parent-report outcome measures and independent observations of children’s behaviour. Fourteen out of 15 rigorous studies showed parent/training education programmes to have positive long-term effects on children (monitoring between one and 10 years after treatment). There was also evidence that parents can benefit from these programmes as many reported improvements in depression, self-esteem and stress for up to four and half years after the treatment.
The Nice/Scie guidance recommends group-based parent training/education programmes in the management of conduct disorders in children under 12 years old, or in children with a developmental age of below 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.
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 further advice and support.
This article appeared in the 3 April issue under the headline “Helping parents of children with conduct disorders”