Introduction

Scott (2008) provided an update on interventions for conduct disorder. He stated the common theme in many treatments is the importance of changing the environment around the child.

Scott suggested interventions need to be provided on an outpatient bases in community settings. Interventions need to focus on developing the strengths
of the child and the family, treat comorbid conditions (e.g., depression, ADHD), and promote learning. Parent management training is useful for parents of children three to twelve years either individually or in groups. For teenagers, functional family therapy has demonstrated empirical support over the years.

Scott reports pharmacological interventions have not demonstrated effectiveness despite being used relatively frequently. In this review, there is some support for psychostimulants (methylphenidate and dexamphetamine) to be used for ADHD comorbid with conduct disorder. There is evidence demonstrating reduced hyperactivity and impulsivity also resulted in fewer conduct problems.1

Psychotherapy

Parenting programs using behavioural and cognitive-behavioural group-based interventions were found to improve conduct problems in children ages three to 12 years. These programs also demonstrated improvements in parental mental health and a reduction in negative or harsh parenting practices.2

A review of eight randomized controlled trials (RCT), seven of which included children and adolescents with conduct disorder and/or delinquency already involved in the juvenile justice system and only one included participants who had not yet been involved in the juvenile justice system. The findings of this review suggest at follow-up, family and parenting interventions reduced the amount of time these youth spent in institutions. These interventions may also reduce the rates of subsequent arrest; however, due to the variability among studies, caution is suggested in interpreting these results.3

An update was performed on a previously completed meta-analysis which assessed the effects of programs aimed at deterring delinquent behaviour in youth, mostly males ages 15-17 years (e.g., Scared Straight). This meta-analysis demonstrated such programs often cause increased rates of delinquency and do more harm than good.4

Parent Management Training (PMT) has demonstrated effectiveness in treating primary school-age children with conduct problems regardless of the presence of a comorbid diagnosis.5

Evidence has been found for both parent-training and child-training for youth with ODD and CD. The authors of this review recommend based on the evidence presented thus far (2007), that clinicians parent training be used as the first line of psychosocial treatment for young children and direct child-training approaches be used for older youth who have the potential to benefit from the cognitive-behavioural approaches within child training programs. These authors expand on their recommendations to stress the importance of matching treatments to family cultural preferences, parent personality styles, child developmental levels, and other individual differences.6

The authors of a meta-analysis of behaviour treatments for attention-deficit/hyperactivity disorder report strong evidence of the effectiveness of behavioural treatments in children with ADHD.7

A systematic review of RCTs of parenting programs for children with conduct problems was performed and the findings indicate parenting programs are an effective treatment for children and youth (up to age 18 years). This review found insufficient evidence to recommend one form of parenting program delivery over another.8

Pharmacological Treatment

A review of seven research studies found Risperidone led to a reduction in aggressive behaviours and conduct problems to some extent after six weeks of treatment. Themedication was found to be safe for children during this period of time although there was found to be significant weight gain. It is difficult to provide a large scale recommendation on the use of Risperidone for children with Conduct Disorder since the studies were inconsistent with their outcome measures. All seven studies included children over five years.9

Pharmacological treatment can alleviate symptoms of ADHD but it does not help children who have difficulty with social interactions. A meta-analysis of eleven trials was conducted to determine the effects of social skills training on children’s social competencies, general behaviour, ADHD symptoms, and school performance (children ages five and 12 years). The results found the trials had high risk of bias due to systematic errors and suggest that there is little evidence to support or negate social skills training for adolescents with ADHD.10

A variety of antiepileptic medications have been used to treat persistent aggression. A systematic review was conducted to determine the evidence related to this intervention. Sodium valproate/divalproex was superior to placebo in treating youths with conduct disorder. Carbamazepine was not found to be effective in treating children with conduct disorder. Phenytoin demonstrated effectiveness with adult males but not on the frequency of ‘behavioural incidents’ in delinquent acts by boys. The authors conclude at this stage there is insufficient evidence to provide a recommendation about the use of antiepileptic medication in the treatment of aggression and associated impulsivity.11

 

1Scott, S. (2008). An update on interventions for conduct disorder. Advances in Psychiatric Treatment, 14, 61-70. DOI: 10.1192/apt.bp.106.002626 ++programs mentioned in this article
2Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S.M. & Donnelly, M. Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008225. DOI:10.1002/14651858.CD008225.pub2
3Woolfenden, S., Williams, K.J. & Peat, J. Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10-17. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003015. DOI: 10.1002/14651858.CD003015
4Petrosino, A., Turpin-Petrosino, C., Hollis-Peel, M.E. & Lavenberg, J.G. ‘Scared Straight’ and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD002796. DOI: 10.1002/14651858.CD002796.pub2
5Costin, J. & Chambers, S.M. (2007). Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clinical Child Psychology and Psychiatry, 12(4), 511-524. DOI: 10.1177/1359104507080979
6Eyberg, S.M., Nelson, M.M. & Boggs, S.R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behaviour. Journal of Clinical Child & Adolescent Psychology, 37(1), 215-237. DOI: 10.1080/15374410701820117
7Fabiano, G.A., Pelham Jr., W.E., Coles, E.K., Gnagy, E.M., Chronis-Tuscano, A. & O’Connor, B.C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129-140. DOI: 10.1016/j.cpr.2008.11.001
8Dretzke, J., Davenport, C., Frew, E., Barlow, J., Stewart-Brown, S., et al. (2009). The clinical effectiveness of different parenting programmes for children with conduct problems: A systematic review of randomized controlled trials. Child and Adolescent Psychiatry and Mental Health, 3(7). DOI: 10.1186/1753-2000-3-7
9Loy, J.H., Merry, S.N., Hetrick, S.E., & Stasiak, K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008559. DOI: 10.1002/14651858.CD008559.pub2
10Storebø, O.J., Skoog, M., Damm, D., Thomsen, P.H., Simonsen, E. & Gluud, C. Social skills training for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD008223. DOI: 10.1002/14651858.CD008223.pub2
11Huband, N., Ferriter, M., Nathan, R. & Jones, H. Antiepileptics for aggression and associated impulsivity. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD003499. DOI: 10.1002/14651858.CD003499.pub3