NICE publish first guideline for conduct disorders and antisocial behaviour in children and young people

Conduct disorders are the most common reason why children are referred to mental health services and it’s estimated that around 5% of all UK children aged 5-16 have a diagnosis of the condition.

Around half of the young people affected by conduct disorders go on to have a serious mental health problem as an adult. Family life can be very difficult, schooling can be ruined and problems with drugs or the criminal justice system are common.

Conduct disorders are characterised by repeated and persistent misbehaviour much worse than would normally be expected in a child of that age. This may include stealing, fighting, vandalism and harming people or animals.

NICE and SCIE (the Social Care Institute for Excellence) have updated the 2006 technology appraisal on conduct disorder in children with this new guideline (PDF) that covers the recognition, treatment and management of antisocial behaviour and conduct disorders.

Key priorities in the guidance include:

The guidance suggests that words like “no” may actually be a trigger for bad behaviour for some children affected by conduct disorders

Initial assessment of children and young people with a possible conduct disorder
Comprehensive assessment
Parent training programmes
Foster carer/guardian training programmes
Child-focused programmes
Multimodal interventions
Pharmacological interventions
Improving access to services

One headline recommendation from the guidance that received media coverage last week is that parents should adopt a consistent approach to caring for children affected by conduct disorder, which focuses on encouraging positive behaviour rather than disciplining their children. It also suggests that words like “no” may actually be a trigger for bad behaviour for some children affected by the condition.

Other recommendations include:

Initial assessment of children and young people with a possible conduct disorder: Assess for the presence of the following significant complicating factors:
- A coexisting mental health problem (for example, depression, post-traumatic stress disorder)
- A neurodevelopmental condition (in particular ADHD and autism)
- A learning disability or difficulty
- Substance misuse in young people.
Parent training programmes
- Offer a group parent training programme to the parents of children and young people aged between 3 and 11 years who: have been identified as being at high risk of developing oppositional defiant disorder or conduct disorder or have oppositional defiant disorder or conduct disorder or are in contact with the criminal justice system because of antisocial behaviour.
Child-focused programmes
- Offer group social and cognitive problem-solving programmes to children and young people aged between 9 and 14 years who: have been identified as being at high risk of developing oppositional defiant disorder or conduct disorder or have oppositional defiant disorder or conduct disorder or are in contact with the criminal justice system because of antisocial behaviour.
Improving access to services: Provide information about the services and interventions that constitute the local care pathway, including the:
- Range and nature of the interventions provided
- Settings in which services are delivered
- Processes by which a child or young person moves through the pathway
- Means by which progress and outcomes are assessed
- Delivery of care in related health and social care services.

Future research recommendations include:

The problems associated with conduct disorder are often lifelong; as those who had a conduct disorder during their childhood are far more likely to develop another mental health disorder when they are an adult

Parent training programmes for children aged 12 years and over with a conduct disorder
Improving uptake of and engagement with interventions for conduct disorders
Maintaining the benefits of treatment and preventing relapse after successful treatment for conduct disorder
Combining treatment for mental health problems in parents with treatment for conduct disorders in their children
Classroom-based interventions for conduct disorders

Professor Stephen Pilling, Director, National Collaborating Centre for Mental Health; Professor of Clinical Psychology and Clinical Effectiveness, UCL and facilitator of the Guideline Development Group, said:

Children with conduct disorders are different. It’s not a bit of tantruming or getting into trouble now and then. It’s picking up the 14-inch TV and throwing it through the window. The problems associated with conduct disorder are often lifelong; with adults who had a conduct disorder during their childhood being far more likely to develop another mental health disorder when they are an adult – nearly half go on to develop antisocial personality disorder. The costs to individuals, families and society of untreated conduct disorder are enormous.

Professor Peter Fonagy, Chief Executive, Anna Freud Centre, Freud Memorial; Professor of Psychoanalysis, UCL and member of the Guideline Development Group, said:

All children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norm for their age. Recognising and accurately diagnosing a conduct disorder is vital to ensuring children and their families are able to access the treatment and support they need to manage the condition.