NICE recommends training programmes for parents to tackle children’s antisocial behaviourBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1984 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1984
New guidance on treating antisocial behaviour in children recommends early intervention to try to prevent problems getting worse—though it admits that it is a challenge to identify which programmes work and with which groups of children.
Published this week by the National Institute for Health and Clinical Excellence, the guidance says that better identification and earlier intervention are needed.1
One in 20 children between the ages of 5 and 16 years has a conduct disorder, says NICE. Such disorders are commoner in boys than in girls, often occur together with mental health problems such as attention-deficit/hyperactivity disorder (ADHD), and are linked to poor educational performance and, in adolescence, with drug misuse and law breaking.
Conduct disorders in childhood often predict mental health problems in adulthood; half the children exhibiting the disorders go on to have antisocial personality disorders.
Children of south Asian origin are less likely than children in general to display bad conduct, while those of African-Caribbean origin are more likely to do so. Harsh and inconsistent parenting styles, poverty, and being in care all increase prevalence. There is a deep social class gradient, with prevalence three to four times higher in social classes D and E than in A.
The guidance lists the interventions available. The best established are parenting programmes that focus on younger children, it says, while programmes for older children are less widely used. It doesn’t recommend drugs for the routine management of conduct disorders unless they include ADHD, in which case methylphenidate (Ritalin) or atomoxetine (Strattera) can be prescribed. Where the conduct disorder includes episodes of explosive anger that have not responded to psychosocial interventions, risperidone (Risperdal) may be considered.
The guidance sets some key priorities, including how best to assess the presence of conduct disorders; training programmes for parents and for foster carers and guardians; and child focused programmes for selected groups of children aged between 9 and 14.
It makes a number of recommendations for research, including measuring the effectiveness of parent training programmes for children over 12, discovering what strategies best encourage the uptake of treatment, and assessing whether any benefits are long lasting or are followed by relapses.
Two other strategies deserve investigation, it adds: combining treatment for conduct disorder with that for mental health problems in parents, and assessing whether classroom based interventions are appropriate.
Peter Fonagy, chief executive of the Anna Freud Centre and professor of psychoanalysis at University College London, said that there was abundant and strong evidence that parenting programmes worked and that conduct disorders were distinct from simple naughtiness. “Many children may be naughty in one context,” he said, “but if the behaviour is severe and persistent in different social situations—children who hurt people, break things, are deceitful, and break pretty fundamental rules—these children are not just naughty.”
Stephen Pilling, also from University College London, led the group that produced the guideline. He said that the cost effectiveness of such interventions was unquestionable. “Not only are they cost effective in health terms, but if we include criminal justice costs, they actually save money,” he said. “It’s a compelling case.”
Cite this as: BMJ 2013;346:f1984