New NICE guidance on managing conduct disorders and antisocial behaviour in children
Conduct disorders are a serious, but frequently unrecognised mental health condition in children and young people. A new NICE guideline highlights the central roles of healthcare, education and social care in the management of conduct disorders and antisocial behaviour.
Conduct disorders, and associated antisocial behaviour, are the most common mental health and behavioural problems in children and young people and they have real consequences for children and their families. Schooling is disrupted, family life can become very stressful and problems with drug and alcohol misuse and the criminal justice system are common. The problems associated with conduct disorder are often lifelong; people who had a conduct disorder during their childhood are far more likely to develop another mental health disorder when they are an adult. Indeed, nearly half go on to develop antisocial personality disorder. The costs to individuals, families and society of untreated conduct disorder are enormous.
All children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children exhibit 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.
It is important not to concentrate solely on the clinical needs of these young people, but also to consider their whole lives, as part of a family, school and local community. That is why it is crucial that everyone in health, social care and education works well together to provide the information and person-centred care necessary.
A number of effective interventions have already been developed for children with conduct disorder and related problems. However, uptake of these programmes has been variable. The new NICE guideline, developed jointly with the Social Care Institute for Excellence (SCIE), is the first national clinical guideline in this area and includes a number of recommendations to support healthcare professionals to accurately diagnose and treat conduct disorders. Recommendations include:
- selective prevention, involving interventions targeted to individuals or groups whose risk of developing a conduct disorder is significantly higher than average, due to individual, family and social risk factors
- classroom-based emotional learning and problem-solving programmes. These should be offered for children aged typically between three and seven years in schools where classroom populations have a high proportion of children identified to be at risk of developing oppositional defiant disorder or conduct disorder as a result of any of the following factors: low socio-economic status, low school achievement, child abuse or parental conflict, separated or divorced parents, parental mental health or substance misuse problems, or parental contact with the criminal justice system
- group parent training programmes for parents of children and young people aged between three and 11 years who have been identified as having, or being at high risk of developing, oppositional defiant disorder or conduct disorder, or are in contact with the criminal justice system because of antisocial behaviour
- child-focused programmes, offering group social and cognitive problem-solving programmes to children and young people aged between nine and 14 years who have been identified as having, or being at high risk of developing, oppositional defiant disorder or conduct disorder, or are in contact with the criminal justice system because of antisocial behaviour.
Professor Mark Baker is Director of Clinical Practice at the National Institute for Health and Care Excellence (NICE). The new NICE guideline on conduct disorder can be found at: