Adolescent Outcomes of Childhood Conduct Disorder Among Clinic-Referred Boys: Predictors of Improvement The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials Comparison of Treatments of Persistent Conduct Problems in Primary School Children: A Preliminary Evaluation of a Modified Cognitive-Behavioural Approach Screening for Conduct Disorder in an Adolescent Male Sample from Colombia Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Treatment of oppositional defiant and conduct problems in young Norwegian children Baseline predictors of response to divalproex in conduct disorder. Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Children aged 4–8 years treated with parent training and child therapy because of conduct problems: generalisation effects to day-care and school settings Randomized trial of two parent-training programs for families with conduct-disordered children. A pilot double blind randomized placebo controlled trial of a prototype computer-based cognitive behavioural therapy program for adolescents with symptoms of depression. Outcome evaluation of behavioral parent training and client-centered parent counseling for children with conduct problems. Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children Treating Children With Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training
Much remains to be learned about the adolescent outcomes of clinic-referred boys whose childhood conduct problems are serious enough to meet diagnostic criteria for conduct disorder ( CD ) .  Six structured diagnostic assessment s were conducted over 7 years of 73 clinic-referred 7–12-year-old boys who met criteria for CD in Wave 1 . There were substantial individual differences in the adolescent outcomes of CD , ranging from worsening to sustained recovery , with most boys showing persistent , but fluctuating levels of CD . Improvement in CD was not accounted for by treatment or incarceration , but more positive outcomes over Waves 2–7 were predicted prospect ively with substantial accuracy , using a combination of baseline predictors : less initial severity of CD , fewer symptoms of attention-deficit hyperactivity disorder , higher child verbal intelligence , greater family socioeconomic advantage , and not having antisocial biological parents Background Conduct problems are common , disabling and costly . The prognosis for children with conduct problems is poor , with outcomes in adulthood including criminal behaviour , alcoholism , drug abuse , domestic violence , child abuse and a range of psychiatric disorders . There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems  in a number of countries over the past 10 years . Existing review s of parent training have method ological limitations such as inclusion of non-r and omised studies , the absence of investigation for heterogeneity prior to meta- analysis or failure to report confidence intervals . The objective of the current study was to systematic ally review r and omised controlled trials of parenting programmes for the treatment of children with conduct problems .  Methods St and ard systematic review methods were followed including duplicate inclusion decisions , data extraction and quality assessment . Twenty electronic data bases from the fields of medicine , psychology , social science and education were comprehensively search ed for RCTs and systematic review s to February 2006 . Inclusion criteria were : r and omised controlled trial ; of structured , repeatable parenting programmes ; for parents/carers of children up to the age of 18 with a conduct problem ; and at least one measure of child behaviour . Meta- analysis and qualitative synthesis were used to summarise included studies . Results 57 RCTs were included . Studies were small with an average group size of 21 . Meta-analyses using both parent ( SMD -0.67 ; 95 % CI : -0.91 , -0.42 ) and independent ( SMD -0.44 ; 95 % CI : -0.66 , -0.23 ) reports of outcome showed significant differences favouring the intervention group . There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes . Conclusion Parenting programmes are an effective treatment for children with conduct problems . The relative effectiveness of different parenting programmes requires further research Objective : Treatment for persistent conduct problems in primary school children was developed using a modification of cognitive-behavioural therapy ( MCBT ) . Its effectiveness was evaluated by comparing it with conjoint family therapy ( FT ) and eclectic therapy ( ET ) . Method : Children with persistent conduct problems were r and omly assigned to one of three treatment groups . They were assessed prior to treatment and then 6 months after . Measures included symptoms of the child ; parents ' mental health ; stress of parenting ; family functioning ; and parental relationship . In addition , parents ' and children 's perception of the therapy were assessed and a treatment record was developed to track the treatment process . Results : Thirty-two children were recruited for the study . No statistically significant differences were found in terms of effectiveness between the three groups . In terms of parents ' perception of the therapy , there was no difference on the perception of the qualities of the therapists , but on the perception of therapy  MCBT  was considered to be higher in cognitive-behavioural orientation . Conclusion : Further research using a larger sample is required to evaluate MCBT . The study supports the idea that controlled treatment studies can be carried out within busy mental health services This study assessed the validity , reliability , and utility of a screening measure for detecting the signs or symptoms of Conduct Disorder in male adolescents from schools in Medellín , Colombia . A first study examined the differences between 70 male offender adolescents ( aged 12 - 16 years ) attending alternative education institutions , and 68 ( sex , age , and socioeconomic status (SES)-matched ) adolescent controls attending regular schools . A CD checklist ( CD-CL ) was constructed to be used by mothers ( CD-CL-M ) and for self-report by adolescents ( CD-CL-SR ) . The validity of the screener for CD diagnosis was supported by significant differences between groups ( ANOVA , p < .001 ) . The CD-CL-SR had better sensitivity/specificity with a diagnostic cut-off point of 5 ( sensitivity = 95.3 % and specificity = 90.5 % ) than the CD-CL-M. A second study used the CD-CLSR with a r and om sample of 190 male adolescents ( aged 12 to 16 years ) from schools of low , middle and high SES .  Reliability as assessed by Cronbach ’s alpha was 0.86 . An epidemiological cut point of 5 classified 35.5 % of the adolescents assessed as probable CD cases . A psychometric cut point at T score > 59 ( 85th percentile ) estimated 16.8 % of the sample as probable CD cases . A psychometric cut point at T score > 64 ( 90th percentile ) revealed that 10.5 % of the sample would be severe CD cases . Some significant differences ( p < 0.001 ) in proportions of CD adolescents were found between age and SES groups . It was concluded that such a high frequency of conduct problems in adolescence argues for the need for preventive programs in Colombian schools OBJECTIVE To assess critically the efficacy and safety of lithium and replicate earlier findings in a larger sample of aggressive children with conduct disorder and to assess the utility of the Profile of Mood States ( POMS ) in this population . METHODS Children hospitalized for treatment-refractory severe aggressiveness and explosiveness and with diagnosed conduct disorder were subjects in this double-blind , placebo-controlled clinical trial . After a 2-week placebo baseline period , children were r and omly assigned to lithium or placebo treatment for 6 weeks of placebo . The main outcome measures were the Global Clinical Judgments ( Consensus ) Scale , Children 's Psychiatric Rating Scale , Conners Teacher Question naire , Parent-Teacher Question naire , and the POMS . RESULTS Fifty children ( mean age 9.4 years ) completed this study . The mean optimal daily dose of lithium was 1,248 mg and the mean serum level was 1.12 mEq/L. Lithium was superior to placebo , although the effects on some measures were more modest than in a previous study . CONCLUSIONS Lithium appears to be an effective treatment for some severely aggressive children with conduct disorder . Although the POMS appeared to be reliable , it did not detect any response to lithium OBJECTIVE To evaluate effectiveness of the Adolescent Coping With Depression ( CWD-A ) course , a cognitive-behavioral group intervention for depressed adolescents with comorbid conduct disorder . METHOD Between 1998 and 2001 , 93 nonincarcerated adolescents ( ages 13 - 17 years ) meeting criteria for major depressive disorder and conduct disorder were recruited from a county juvenile justice department and r and omly assigned to the CWD-A or a life skills/tutoring control condition . Participants were assessed post-treatment and at 6- and 12-month follow-up . Dichotomous outcomes were analyzed with logistic regression ; dimensional measures were analyzed using r and om effects regression . RESULTS Major depressive disorder recovery rates post-treatment were greater in CWD-A ( 39 % ) compared with life skills/tutoring control ( 19 % ) ( odds ratio 2.66 , 95 % confidence interval = 1.03 - 6.85 ) . CWD-A participants reported greater reductions in Beck Depression Inventory-II ( r2 = 0.055 , p = .033 ) and Hamilton Depression Rating Scale ( r2 = 0.047 , p = .039 ) scores and improved social functioning ( r2 = 0.064 , p = .019 ) post-treatment . Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant , as were differences in conduct disorder both post-treatment and during follow-up . CONCLUSIONS This is the first r and omized , controlled trial of a psychosocial intervention with adolescents with major depressive disorder and conduct disorder . Although the CWD-A appears to be an effective acute treatment for depression in adolescents with multiple disorders , findings emphasize the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid population s focus directly on each specific disorder This study examines the treatment outcomes of 139 , 6–11 year-old , clinical ly referred boys and girls diagnosed with Oppositional Defiant Disorder ( ODD ) or Conduct Disorder ( CD ) who were r and omly assigned to a modular-based treatment protocol  that was applied by research study clinicians either in the community ( COMM ) or a clinic office ( CLINIC ) . To examine normative comparisons , a matched sample of 69 healthy control children was included . Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints ( pretreatment to 3-year follow-up ) to evaluate changes in the child ’s behavioral and emotional problems , psychopathic features , functional impairment , diagnostic status , and service involvement . Using HLM and logistic regression models , COMM and CLINIC showed significant and comparable improvements on all outcomes . By 3-year follow-up , 36 % of COMM and 47 % of CLINIC patients no longer met criteria for either ODD or CD , and 48 % and 57 % of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range . We discuss the nature and implication s of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders BACKGROUND Stimulants are not considered appropriate for the treatment of children with conduct disorders ( CDs ) . The postulated differences in stimulant effect between children with attention deficit hyperactivity disorder ( ADHD ) and CD led to the hypothesis that methylpheni date hydrochloride , which is effective in ADHD , would not significantly improve symptoms of CD . METHODS We r and omly assigned 84 children with CD , between the ages of 6 and 15 years , to receive methylpheni date hydrochloride ( up to 60 mg/d ) or placebo for 5 weeks . Behavior was evaluated by parent , teacher , and clinician reports and by direct classroom observations . Two thirds of the children also met criteria for ADHD . RESULTS Contrary to prediction , ratings of antisocial behaviors specific to CD were significantly reduced by methylpheni date treatment . The magnitude of methylpheni date effect indicated meaningful clinical benefit . Partialling out severity of ADHD did not alter the significant superiority of methylpheni date on CD ratings specifically ( P < .001 ) . CONCLUSIONS Methylpheni date has short-term positive effects on children and adolescents with CD . Key aspects of antisocial adjustment appear to be treatment responsive . This effect was independent of severity of the children 's initial ADHD symptoms The efficacy of the Incredible Years parent training and child therapy programs was examined in a r and omized controlled study including 127 Norwegian children aged 4–8 years . Children diagnosed with oppositional defiant disorder ( ODD ) or conduct disorder ( CD ) were r and omized to parent training ( PT ) , parent training combined with child therapy ( PT + CT ) , or a waiting-list control condition ( WLC ) . Assessment s were carried out at baseline , posttreatment and at a one-year follow-up using st and ardized measures and a semi-structured interview . Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC , while differences between the two treatment conditions were small and nonsignificant . About two thirds of the treated children functioned within normal variation after treatment , and the same proportion no longer received an ODD diagnosis at the one-year follow-up . Parental use of positive strategies increased after treatment , and the use of harsh and inconsistent discipline decreased as did mother experience of stress . The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home . The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries BACKGROUND Successful treatment of conduct disorder remains difficult . On the basis of a positive response to divalproex among adolescent boys with conduct disorder , we conducted an analysis of the impact of baseline comorbid diagnoses and personality factors on the likelihood of treatment response to divalproex . METHOD Seventy-one adolescent boys with conduct disorder ( DSM-IV ) and a history of at least 1 offense against persons were r and omly assigned to receive high- or low-dose divalproex for 7 weeks . Evaluations included best estimate diagnoses , the Clinical Global Impressions-Severity of Illness scale ( CGI-S ) and CGI-Improvement scale ( CGI-I ) , the 62-item Weinberger Adjustment Inventory ( WAI-62 ) assessment of distress and restraint , the Response Evaluation Measure assessment of immature and mature defenses , and the Achenbach Youth Self-Report assessment of overall psychopathology . All were conducted at study entry and exit , and the WAI-62 was conducted weekly throughout the 7-week study period . Treatment response was defined as a rating of much improved or very much improved on the CGI-I. Data were collected from June 1997 to April 1998 . RESULTS Fifty-eight subjects completed the study and were eligible for inclusion in the analysis . Plasma divalproex level ( p = .003 ) and immature defenses ( p = .004 ) were significant positive predictors of treatment response , while restraint ( p = .01 ) and level and range of psychopathology ( p = .04 ) were significant predictors of nonresponse . Comorbidities or distress ( p = .06 ) were not significantly associated with treatment outcome . CONCLUSION Predictors of response to divalproex treatment for conduct disorder were identified , despite the small sample size in this study . The pattern of positive and negative predictors of response to divalproex , an antikindling agent , tends to support a model of kindling-reinforced reactive/affective/defensive/impulsive aggression among adolescent boys with conduct disorder . Additional studies are needed to identify more subtle predictors of treatment response and to clarify the mechanisms contributing to the development of conduct disorder BACKGROUND Prior research indicates that conduct disorder ( CD ) is associated with a range of co-morbid mental disorders . However , the actual prevalence , subtypes and patterns of co-morbidity of DSM-IV-defined CD in the general US population remains unknown . METHOD Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents ( n=3199 ) in the National Comorbidity Survey Replication ( NCS-R ) . RESULTS The estimated lifetime prevalence of CD in the US is 9.5 % ( 12.0 % among males and 7.1 % among females ) , with a median age-of-onset of 11.6 ( 0.2 ) years . Latent class analysis ( LCA ) identified five CD subtypes characterized by rule violations , deceit/theft , aggression , severe covert behaviors , and pervasive CD symptoms . A dose-response relationship was revealed between CD subtype severity and risk of subsequent disorders . Results also indicated that CD typically precedes mood and substance use disorders , but most often occurs after impulse control and anxiety disorders . Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders , remitted CD is associated with significantly lower risk of subsequent disorders . CONCLUSIONS CD is prevalent and heterogeneous in the US population , and more severe subtypes and the presence of active CD are associated with higher risk of co-morbid disorders . Future prospect i ve studies using general population sample s will further inform the nature and course of this disorder In this study , generalisation effects to day-care/school setting s were examined in an outpatient clinic sample of 127 children aged 4–8 years treated because of oppositional conduct problems in the home with parent training ( PT ) and parent training combined with child therapy ( CT ) ( “ Incredible Years ” ) . Before treatment all children scored above the 90th percentile on the Eyberg Child Behavior Inventory ( ECBI ) for home problems , and met criteria for a possible or a confirmed diagnosis of either an oppositional defiant ( ODD ) or a conduct ( CD ) disorder . Further , 83 % of the children showed clinical levels of conduct problems both at home and in day-care/school before treatment . Although most children improved at home , the majority still showed clinical levels of conduct problems in day-care/school setting s after treatment and 1-year later . Combined PT and CT produced the most powerful and significant generalisation effects across the treatment period , however these improvements were not maintained 1-year later for most areas . The results of the present study , therefore , underline the need to target conduct problems not only exhibited at home but also in day-care/school setting s , and to develop strategies to maintain positive generalisation effects after treatment for this age and problem-group Department of Parent and Child NursingUniversity of WashingtonClinic mothers of 35 conduct-disordered children were r and omly assigned to awaiting list  control group  , 9 weeks of individual therapy , or 9 weeks of therapist-led group therapy based on a st and ardized videotape modeling program .  Mothers and their children were assessed at baseline , immediately after treatment , and 1year later by home visits , twice-per-week telephone reports , and question naires . One month after treatment , both groups of treated mothers showed significantattitudinal and behavioral improvements compared with untreated controls . Ad-ditionally , the children in the two treatment groups showed reductions in childnoncompliance compared with control children . At the 1-year follow-up , not onlywere most of the changes in mothers ' behaviors maintained , but both treatmentgroups of children continued to show significant reductions in noncompliant and deviant behaviors . There were no significant differences on any of the attitudinalor behavioral measures between individual and videotape modeling group discussion therapies at the immediate or 1-year follow-up . Total therapist time was approx-imately 251 hr for the entire individual group and 48 hr for the entire videotape discussion group . Although both treatments seem to offer equivalent and sustainedimprovements for parents and conduct-disordered children , the therapeutic efficiencyof the videotape modeling group format is more cost-effective . In response to the large numbers of childrenwith conduct disorders and the shortage ofprofessional personnel , there has been an in-creasing emphasis on training parents as ther-apists for their own children . Several excellent review s ( Berkowitz & Graziano , 1972 ; Gra-ziano , 1977 ; Johnson KMorel and , Schwebel , Beck , & Wells , 1982 ; Pawlicki BACKGROUND Depressive disorder is common in adolescents and largely untreated . Computers offer a way of increasing access to care . Computerized therapy is effective for depressed adults but to date little has been done for depressed adolescents . AIMS The objective of this study was to examine the feasibility , acceptability , and effects of The Journey , a computerized cognitive behavioural therapy ( cCBT ) program for depressed adolescents . METHOD Thirty-four adolescents ( mean age 15.2 years , SD = 1.5 ) referred by school counsellors were r and omly assigned to either cCBT or a computer-administered attention placebo program with psychoeducational content ( CPE ) .  Participants completed the intervention at school . Data were collected at baseline , post-intervention and at a 1-month follow-up . The primary outcome measure was the Child Depression Rating Scale Revised ( CDRS-R ) ; secondary outcome measures were : RADS-2 ; Pediatric Quality of Life Inventory ; Adolescent Coping Scale ( short form ) ; response and remission rates on CDRS-R. Completion rates and self-reported satisfaction ratings were used to assess feasibility and acceptabililty of the intervention . RESULTS Ninety-four percent of cCBT and 82 % of CPE participants completed the intervention . Eighty-nine percent liked The Journey a lot or thought it was " okay " and 89 % of them would recommend it for use with others as is or after some improvement . Adolescents treated with cCBT showed greater symptom improvement on CDRS-R than those treated with CPE program ( mean change on cCBT = 17.6 , CI = 14.13 - 21.00 ; CPE = 6.06 , CI = 2.01 - 10.02 ; p < .001 ) . CONCLUSIONS It is feasible , acceptable and efficacious to deliver computerized CBT to depressed adolescents in a school setting . Generalizability is limited by the size of the study The central question addressed was , how effective is parent training in reducing conduct problems in children in comparison to client-centered parent counseling ? A secondary question was the relative effectiveness of the two treatment groups in comparison to a wait control group that when untreated during the 8-week period of treatment provided the other groups . Families of 36 , 5- to 12-year-old conduct problem children were screened and assigned at r and om to treatment groups , but wait control group assignment depended upon therapist availability . Supervised graduate student therapists conducted 10 treatment sessions for each family . Parent reports and paper and pencil tests of child deviance and parent satisfaction showed a superior outcome for behavioral over the client-centered and wait control groups , and no differences between the latter two groups . At follow-up there was no maintenance of this superiority . Home observation data showed no advantage of behavioral over client-centered treatment  , and these two groups did not improve significantly more than the wait control group . These results were discussed in the light of possible interactions between treatment and measurement , and method ological and sampling differences between this and other studies Parents of 43 conduct- problem children , aged 3– 8 years , were r and omly assigned to one of two treatments : an individually self- administered video-tape modeling treatment ( IVM ) and IVM treatment plus therapist consultation ( IVMC ) . R and omization also included a waiting- list control group ( CON ) . Compared with the control group , both treatment groups of mothers reported significantly fewer child behavior problems , reduced stress levels , and less use of spanking . Home visit data indicated that both treatment groups exhibited significant behavioral changes . There were relatively few differences between the two treatment conditions . However , the IVMC children were significantly less deviant than the IVM children , suggesting that the IVMC ( with therapist consultation ) treatment was superior to self- administered treatment with no therapist involvement . The added benefits of therapist involvement are discussed Families of 159 , 4- to 8-year-old children with oppositional defiant disorder ( ODD ) were r and omly assigned to parent training ( PT ) ; parent plus teacher training ( PT + TT ) ; child training ( CT ) ; child plus teacher training ( CT + TT ) ; parent , child , plus teacher training ( PT + CT + TT ) ; or a waiting list control . Reports and independent observations were collected at home and school . Following the 6-month intervention , all treatments result ed in significantly fewer conduct problems with mothers , teachers , and peers compared to controls . Children 's negative behavior with fathers was lower in the 3 PT conditions than in control . Children showed more prosocial skills with peers in the CT conditions than in control . All PT conditions result ed in less negative and more positive parenting for mothers and less negative parenting for fathers than in control . Mothers and teachers were also less negative than controls when children received CT . Adding TT to PT or CT improved treatment outcome in terms of teacher behavior management in the classroom and in reports of behavior problems
Comorbidity , gender , age , number of sessions , duration , intervention type , setting , medication use or dropout percentage did not influence the effect of treatment .
CONCLUSIONS Psychological treatments have a small effect in reducing parent- , teacher- and observer-rated CD problems  in children and adolescents with clinical CD problems/diagnosis .
There is not enough evidence to support one specific psychological treatment over another .
Many reports failed to provide detailed information to allow optimization of psychological treatment strategies
BACKGROUND This meta- analysis evaluates the efficacy of nonpharmacological treatments for conduct disorder ( CD ) problems in children and adolescents , based on child , parent and teacher report .