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The Prevention, Treatment and Management of Conduct Problems in Childhood and Adolescence

The Prevention, Treatment and Management of Conduct Problems in Childhood and Adolescence. David M Fergusson Christchurch Health & Development Study Department of Psychological Medicine University of Otago, Christchurch February 2013. Introduction. In this talk I will attempt three tasks:

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The Prevention, Treatment and Management of Conduct Problems in Childhood and Adolescence

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  1. The Prevention, Treatment and Management of Conduct Problems in Childhood and Adolescence David M Fergusson Christchurch Health & Development Study Department of Psychological Medicine University of Otago, Christchurch February 2013

  2. Introduction In this talk I will attempt three tasks: • A brief overview of evidence of the linkages between conduct problems in childhood and subsequent developmental outcomes • An overview of the evidence of effective programmes for preventing and treating childhood conduct problems • An examination of the translation of this evidence in the development of New Zealand policy.

  3. The Christchurch Health andDevelopment Study The Christchurch Health and Development Study (CHDS) is a longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. This cohort has been studied at birth, 4 months, 1 year, annual intervals to 16, and at 18, 21, 25 and 30 (a total of 22 occasions). As part of this research, extensive data was gathered on childhood behavioural adjustment and outcomes in young adulthood.

  4. Summary of Key Research Findings Data from the Christchurch Health and Development Study was used to examine linkages between the development of conduct problems in middle childhood and later development to the age of 25. The study findings showed that early conduct problems were associated with significant increases in rates of: • crime, arrest and imprisonment • substance use • anxiety/depression • suicidal behaviour • sexual risk taking

  5. Major Conclusion These findings show the pervasive effects of early conduct problems on later development. It may be argued, plausibly, that no other common childhood condition has such pervasive and far reaching consequences for later development, as childhood conduct disorders.

  6. Development of a Policy Response In response to the evidence from the CHDS and similar evidence from the Dunedin Multidisciplinary Health and Development Study (DMHDS), the NZ government convened an expert panel to provide advice on the prevention, treatment and management of childhood conduct problems. This group – the Advisory Group on Conduct Problems (AGCP) – comprised consultants from Life Course Research, Education and Psychiatry.

  7. The Work of the AGCP The AGCP has been in operation for over three years. Key tasks have involved: • Reviewing the literature to identify evidence based interventions • Making policy recommendations • Providing assistance with programme implementation • Developing research designs to evaluate policy changes

  8. Promising/Recommended Programmes for 3-7 Year Olds 8

  9. Promising/Recommended Programmes for 8-12 Year Olds 9

  10. Promising/Recommended Programmes for 13-17 Year Olds 10

  11. Overview of Promising/ Recommended Approaches

  12. Common Features of Successful Interventions All take a problem-solving rather than a punitive focus All are founded in behavioural psychology, including social learning therapy, cognitive behavioural theory and related approaches All are manualised and can be transferred to new settings The majority have been developed in university settings rather than by service providers 12

  13. What is Not on the List Wilderness Programmes Military Style Training (Boot Camps) Mentoring Restorative Justice 13

  14. Policy Outputs The work of the AGCP has underwritten the development of the Positive Behaviour for Learning (PB4L) policy announced by the Ministry of Education in 2010. PB4L is centred around the implementation and evaluation of three of the programmes recommended by the AGCP: The Incredible Years Basic Parent Programme The Incredible Years Teacher Training Programme School-Wide Positive Behaviour Support 14

  15. Policy Implementation To introduce these programmes to the Education sector, the Ministry then held a series of meetings throughout New Zealand to introduce teachers, health workers and social workers to the reasoning underlying PB4L and the evidence supporting the programme choices. These meetings were well attended with over 1000 participants in 12 centres, and very well received by the sector. This effort laid the groundwork for the implementation of PB4L. 15

  16. Programme Implementation By 2014, PB4L intends to deliver: School Wide Positive Behaviour Support to 400 NZ Schools Incredible Years Basic Parent Programme to 12,000 parents Incredible Years Teacher Programme to 5,000 teachers This represents a very large investment in evidence based services within the education sector. 16

  17. Evaluation The reports of the AGCP have emphasised the need for thorough evaluation of programmes before they are widely implemented. The Ministries involved have been responsive to this view and a research unit has been set up in the Ministry of Social Development to evaluate evidence based programmes in this area. The first evaluation planned is a first phase assessment of the Incredible Years Basic Parent programme. 17

  18. Evaluation of Incredible Years Parent Programme The evaluation planned involves: 150 families from three sites who will be studied at: baseline, mid programme, end of programme, and 3 months after programme completion At least 50 families will be Māori Assessments will be made of child behaviour, parenting practices and family functioning before, during and after the programme 18

  19. Evaluation of Incredible Years Parent Programme These assessments will be supplemented by single subject studies of 30 families (10 per site) and client satisfaction studies. The overall aim will be to build up a clear picture of the changes that families display following the introduction of the programme and to compare these results with benchmarks derived from existing randomised trials. 19

  20. Some Preliminary Results from the IYP Trial (1) Pre/Post Comparisons on Child Behaviour Ratings 20

  21. Some Preliminary Results of the IYP Trial (2) Overview of Single Subject Findings

  22. Concluding Comments • There is now abundant evidence on effective methods for treating and managing conduct problems in childhood. • The major task ahead is that of translating this body of evidence into effective and well evaluated programmes. • The New Zealand experience suggests that the success of this enterprise depends critically on the ability of public servants to accept, institute and evaluate evidence based programmes.

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