Opportunities for prevention

Conduct disorder should offer good opportunities for prevention since:

1. it can be detected early reasonably well;

2. early intervention is more effective than later intervention;

3. there are a number of effective interventions.

In the United States a number of comprehensive interventions based on up-to-date empirical findings are being carried out. Perhaps the best known is Families and Schools Together/64) Here the most antisocial 10 per cent of 5- to 6-year-olds in schools in disadvantaged areas were selected, as judged by teacher and parent reports. They were then offered intervention, which was given for a whole year in the first instance and comprised the following:

1. weekly parent training in groups with videotapes;

2. an interpersonal skills' training programme for the whole class;

3. academic tutoring twice a week;

4. home visits from the parent trainer;

5. a pairing programme with sociable peers from the class.

Almost 1000 children were randomized to receive this intervention or to act as controls; the project has cost over $US 50 million. However, so far, preliminary reports of outcome have been limited, with no improvement of antisocial behaviour at home on questionnaire measures and modest improvements in the classroom. There are a number of possible reasons for the smaller effects compared with those obtained in trials with clinically referred populations. The motivation of families may be less as they do not perceive that they have a problem, starting levels of antisocial behaviour are lower, and so there is not so far to go to reach normal levels, and keeping up the quality of the intervention across several sites is harder. It remains to be seen whether longer-term effects will be greater.

In the United States, preschool education programmes for disadvantaged children have been evaluated in terms of adult outcomes. The best known is the Perry/Highscope project, where 2- to 4-year-olds received intensive nursery education half-time for 2 years. At the age of 27, the individuals fared better than controls on several psychosocial outcomes, including a third of the number of arrests for criminal offences, better jobs, higher income, and more stable marriages. (65>

In the United Kingdom, in 1999 the government stressed the importance of helping parents of children in the first 3 years of life and put substantial resources (£540 million) into 'SureStart' centres in specifically targeted high-risk neighbourhoods to support parenting. It is too early to evaluate outcome. Separate from conduct-disorder prevention, but related, is crime prevention, which can include reducing the opportunities for antisocial behaviour by tighter policing, reducing access to drugs and guns, and so on.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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