Treatment of Conduct Disorder
Prevention, although the aim and goal, does not frequently occur.
Prevention is an ideal which requires cooperation from many people (parents, teachers, community leaders, politicians, and the child), and these programs are frequently expensive to maintain and control.
Although treatment tends to be more costly in the long run, the need for prevention has only recently come to the attention of policy makers and is slow in being implemented.
Treatment of conduct disorder is the model, rather than prevention.
Treatment has many areas in common with prevention.
The most effective model includes as many areas of the child's life as possible.
Teaching and information about the child's disorder and methods to use in concert with therapy for the child are similar to prevention methods.
Parents need to be taught skills in dealing with their child, as well as parenting skills that are most likely missing or inept.
Teachers, siblings, pastors, community centers, and anyone involved in the child's life, although friends and peers are likely unwilling, should be involved in intervention.
Of 82 studies reviewed by Brestan and Eyberg (1998), two models stood out as most efficacious.
These methods included a videotaped modeling parenting program and parent-training based on Patterson and Gullion's (1968) manual Living with Children.
These programs are aggressive parenting programs with specific examples of what to do in specific circumstances.
How to set limits, how to use discipline effectively, and boundary issues are taught and practiced.
Proper positive reinforcement techniques need to be taught.
Studies of children without antisocial behavior have shown that parents have consistently reinforced prosocial behavior.
Another recommendation is a system of reward of helpful behaviors, cooperation, and affection, whereas antisocial behaviors should be ignored or punished.
This appears to be the case in children without severe conduct problems.
In children with conduct problems, a cycle of negativity exists which reinforces negative behaviors.
Treatment is rarely brief as it takes time to change lifelong behaviors and beliefs.
Adolescents with conduct disorder rarely seek treatment for themselves and have very little motivation to change.
They do not believe there is anything wrong with their behavior.
Parents, social workers, teachers and the legal community are concerned with altering behavior and frequently seek treatment.
The average length of effective treatment is three years.
The most promising therapeutic techniques appear to be a combination of behavioral and cognitive approaches.
Inappropriate beliefs and cognitions are as much a part of this disorder as poor behavior patterns.
Medications are ineffective except where a comorbid disorder exists.
Punitive measures, such as incarceration and other legal measures, are likewise ineffective as motivators for change.
In fact, incarceration tends to worsen behavior, as they learn new deviant behaviors from peers with which they are incarcerated.
"Tough Love" and "zero tolerance" programs have not been evaluated for long-term effectiveness, but their approach appears punitive, and the child who is on the receiving end may view them as one more example of "how the world is out to get them.
" References: Brestan, E.
V.
, & Eyberg, S.
M.
(1998).
Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies and 5272 kids.
Journal of Clinical Child Psychology, 27, 180-189.
Patterson, G.
R.
& Gullion, L.
(1968).
Living with children.
Champaign, IL: Research Press.
Prevention is an ideal which requires cooperation from many people (parents, teachers, community leaders, politicians, and the child), and these programs are frequently expensive to maintain and control.
Although treatment tends to be more costly in the long run, the need for prevention has only recently come to the attention of policy makers and is slow in being implemented.
Treatment of conduct disorder is the model, rather than prevention.
Treatment has many areas in common with prevention.
The most effective model includes as many areas of the child's life as possible.
Teaching and information about the child's disorder and methods to use in concert with therapy for the child are similar to prevention methods.
Parents need to be taught skills in dealing with their child, as well as parenting skills that are most likely missing or inept.
Teachers, siblings, pastors, community centers, and anyone involved in the child's life, although friends and peers are likely unwilling, should be involved in intervention.
Of 82 studies reviewed by Brestan and Eyberg (1998), two models stood out as most efficacious.
These methods included a videotaped modeling parenting program and parent-training based on Patterson and Gullion's (1968) manual Living with Children.
These programs are aggressive parenting programs with specific examples of what to do in specific circumstances.
How to set limits, how to use discipline effectively, and boundary issues are taught and practiced.
Proper positive reinforcement techniques need to be taught.
Studies of children without antisocial behavior have shown that parents have consistently reinforced prosocial behavior.
Another recommendation is a system of reward of helpful behaviors, cooperation, and affection, whereas antisocial behaviors should be ignored or punished.
This appears to be the case in children without severe conduct problems.
In children with conduct problems, a cycle of negativity exists which reinforces negative behaviors.
Treatment is rarely brief as it takes time to change lifelong behaviors and beliefs.
Adolescents with conduct disorder rarely seek treatment for themselves and have very little motivation to change.
They do not believe there is anything wrong with their behavior.
Parents, social workers, teachers and the legal community are concerned with altering behavior and frequently seek treatment.
The average length of effective treatment is three years.
The most promising therapeutic techniques appear to be a combination of behavioral and cognitive approaches.
Inappropriate beliefs and cognitions are as much a part of this disorder as poor behavior patterns.
Medications are ineffective except where a comorbid disorder exists.
Punitive measures, such as incarceration and other legal measures, are likewise ineffective as motivators for change.
In fact, incarceration tends to worsen behavior, as they learn new deviant behaviors from peers with which they are incarcerated.
"Tough Love" and "zero tolerance" programs have not been evaluated for long-term effectiveness, but their approach appears punitive, and the child who is on the receiving end may view them as one more example of "how the world is out to get them.
" References: Brestan, E.
V.
, & Eyberg, S.
M.
(1998).
Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies and 5272 kids.
Journal of Clinical Child Psychology, 27, 180-189.
Patterson, G.
R.
& Gullion, L.
(1968).
Living with children.
Champaign, IL: Research Press.
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