Parent Training and Conduct Disorder Outcome

Three previous posts examined the clinical neuroscience disorder antisocial personality disorder (ASPD).  This condition results in high societal costs for crime and incarceration for individuals with ASPD.

ASPD appears to have significant genetic contributions and brain imaging studies show abnormal brain maturational patterns in the premotor cortex area as well as impaired processing of facial emotional expression.

Antisocial personality is an early age of onset disorder with conduct disorder symptoms emerging during childhood and adolescence.   Their is no evidence-based consensus on pharmacological treatment options in conduct disorder and ASPD.

This leaves psychological and behavioral interventions as the current primary treatment option.  But do these types of interventions work and do they produce lasting changes in the longitudinal trajectory of ASPD.

Drugli and colleagues from Norway published an outcome study of conduct disorder following a randomized controlled trial of a parental training intervention known as "The Incredible Years".

The Incredible Years parent training program emphasized developing parental skills to improve the child's social and behavioral development.  Key features include instruction on how to play with other children, social and emotional skills training, establishment of routines and rules to promote responsibility, strategies to manage misbehavior and teaching problem solving.  More information about The Incredible Years program can be found here.

Drugli and colleagues followed a subgroup of children in their initial randomized trial.  This follow up lasted five to six years.  Control children in the original study were on a wait list for six months and then received The Incredible Years intervention so no controlled group outcome can be made.  However,  in the follow up analysis the research team found only one third of children enrolled with an initial diagnosis of oppositional defiant disorder or conduct continued to meet diagnostic criteria for the disorder.

Predictors for persistence of a clinical diagnosis at outcome included:

1. female gender
2. living with mother only
3. a baseline diagnosis of conduct disorder rather than oppositional defiant disorder
4. higher levels of conduct disorder symptoms
5. higher baseline levels of internalizing symptoms such as anxiety or depression
6. maternal depressive symptoms after treatment intervention
7. maternal stress rating of parenting

The predictor findings suggest that parental factors play a key role in the effectiveness of the parental training intervention.  Single mothers and those with higher stress and depression symptoms may have more trouble in continuing to use the skills learned with the intervention.

Additionally, this intervention may not be as effective for children with more severe conduct disorders.  

Parental training in childhood behavioral disorders provides a reasonable first step for early treatment of those at risk of antisocial personality.  However, such an intervention strategy is limited by frequent parental emotional and behavioral problems found in the families of high-risk children.

Increased research targeting the secondary prevention of aggressive behaviors and ASPD in children with conduct disorder should be a priority.

Photo of a flicker searching for food from the author's file.

Drugli MB, Larsson B, Fossum S, & Mørch WT (2010). Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training. Journal of child psychology and psychiatry, and allied disciplines, 51 (5), 559-66 PMID: 20015193