PREVENTION AND TREATMENT
There are many good reasons for trying to alle-
viate childhood behavioural disorders. As well as
causing distress and damage to individual chil-
dren and families, conduct disorders are known to
have a considerable cost to the wider society. Scott
et al
. have shown that by the age of 28 years, costs
for people with CD were 10 times higher than for
those with no problems. These costs include crime,
extra educational provision, foster and residential
care, and state benefits as well as smaller costs to
the health service [19].
As parenting practices have been identified
as relevant aetiological factors in the develop-
ment and maintenance of childhood behavioural
disorders, there has been considerable interest in
the use of parenting programmes as a form of
prevention and treatment.
In 2006, the National Institute for Health and
Clinical Excellence (NICE) and Social Care Insti-
tute for Excellence (SCIE) jointly commissioned
a review of parenting programmes in the manage-
ment of children aged 12 years or younger [1]. They
concluded that group-based parenting/education
programmes are to be recommended in the man-
agement of children with conduct disorders. For
those parents with whom it is difficult to engage
or for whom problems are more complex, similar
individual-based programmes can be used instead.
Parenting programmes aim to improve the
child’s behaviour by helping parents to change
the ways in which they approach parenting
and to improve their relationship with their
children. Whilst most group-based programmes
focus upon the actions of parents without the
direct involvement of the child, some individual
programmes include observation of parent–child
interactions, allowing these to be modified as
necessary. Most parenting programmes comprise
behavioural management techniques based upon
social learning theory. These teach parents how
to increase desired behaviours through posi-
tive reinforcement, whilst decreasing unwanted
behaviours by reducing social reinforcement, such
as by ignoring behaviours or using Time Out
techniques. Programmes will also usually include
elements to help parents to understand their chil-
dren’s feelings and behaviours and subsequently
improve
understanding
and
communication
between parent and child [1].
Analysis of relevant research studies indicates
that such interventions are clinically effective at
improving children’s behaviour, may lead to an
improvement in maternal mental health, and are
cost-effective ways of treating children with con-
duct disorders [20].
There is now a wide variety of group-based par-
enting programmes devised to prevent the devel-
opment of childhood behavioural disorders as
well as to help treat those children who have
already developed such problems. Examples of
effective programmes include the Triple P, Positive
Parenting Programme and the Webster– Stratton
Incredible Years Programme, with evidence that
these effects continue over several years [18].
Several long-term follow-up studies in the USA
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