Management

Engagement of the family is particularly important for this group of children and families as drop-out from treatment is high, at around 30 to 40 per cent. Practical measures such as assisting with transport, providing childcare, holding sessions in the evening or at other times to suit the family will all help. Many of the parents of children with conduct disorder may themselves have difficulty with authority and officialdom and be very sensitive to criticism. Therefore the approach is more likely to succeed if it is respectful of their point of view, does not offer overly prescriptive solutions, and does not directly criticize parenting style. Practical homework tasks increase changes, as do problem-solving telephone calls from the therapist between sessions.

Parenting interventions may need to go beyond skill development to address more distal factors that prevent change. For example, drug or alcohol abuse in either parent, maternal depression, and a violent relationship with the partner are all common. Assistance in claiming welfare and benefits and help with financial planning may reduce stress from debts.

A multimodal approach is likely to result in larger changes. Therefore involving the school in treatment by visiting and offering strategies for managing the child in class is usually helpful, as is advocating for extra tuition where necessary. If the school seems unable to cope despite extra resources, consideration should be given to moving the child to a different school that specializes in the management of behavioural difficulties. Avoiding antisocial peers and building self-esteem may be helped by encouraging the child to attend after-school clubs and holiday activities.

Where parents are not coping or a damaging abusive relationship is detected, it may be necessary to liaise with the social services department to arrange respite for the parents or a spell of foster care. It is important during this time to work with the family to increase their skills so the child can return to the family. Where there is permanent breakdown, long-term fostering or adoption may be recommended.

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