Describe intervention to reduce aggression.

 Treatment needs to be targeted at major modifiable risk factors and its outcome measured objectively. It should preferably be at an early age as conduct disorder can be reliably detected early, has high continuity, is amenable to treatment at a young age, and is very hard to eradicate in older children.

1. Parent Training Programmes for Reducing Antisocial Behaviour in Children

Little published evidence exists that individual psychotherapy whether psychodynamic or cognitive behavioural, pharmacotherapy, general eclectic family work, or formal family therapy are effective in treating conduct disorder. Behaviourally based programmes to help parents, however, have consistently been shown to be effective. For example, the pioneering work of Patterson and colleagues showed that directly instructing parents while they interact with their children leads to significant and lasting reduction in behavioural problems. Many other studies have replicated this.

2. Developing a Programme

It is better to organise a training programme for the parents and teenage children and this can be done by two or three disciplines coming together. To get results the professionals need to be trained in the specific methods, and for this one needs a manual and a training centre with well qualified trainers. Most consistently effective programmes have at least 10 sessions, to increase the effects, a booster is desirable several months later. Also, intervention needs to be early, since teenage treatments have only small effects.

3. Training Using Videotapes

Although conventional one-to-one treatment is effective, a more cost effective approach is needed to treat larger numbers. One could have videos showing short vignettes of parents and children in common situations. They show the powerful effect of parents’ behaviour on their child’s activity, with examples of “right” and “wrong” ways to handle children. Ten to 14 parents attend a weekly two hour session for 12 weeks. Two therapists lead the group and promote discussion, so that all members grasp the principles; role play is used to practice the new techniques. Practical homework is set each week and carefully reviewed with a trouble shooting approach.

4. Other Training Programmes

Among more intensive programmes, the one developed by Puckering et al entails one day a week for 16 weeks. This programme has been shown to be effective in improving parenting in quite damaged families and enabling children to come off “at risk” child protection registers.

5. Failure of Parent Training

In many cases, aggression is caused by faulty parental behaviour, often because of parental psychiatric difficulties such as depression, drug and alcohol problems, and personality difficulties.

6. Management of Hyperactivity

Hyperactivity is distinct from conduct disorder, although they often coexist. Psychological treatment has to be rather different. Rewards have to be given more contingently and more frequently and have to be changed more often. Tasks have to be broken down into shorter components. Specific, clear rules have to be set for each different situation, as these children have difficulty generalising. School is often particularly difficult as the demands for concentration are great, the distractions from other children higher than at home, and the level of adult supervision lower. However, use of the principles outlined above can lead to useful improvements.

Management with drugs (usually methylphenidate or dexamphetamine) is reserved for children with severe symptoms in both home and school (hyperkinetic syndrome). This syndrome occurs in just over 1% of boys. The short term effects of drug treatment are large; less is known about long term benefits.

7. Interventions at Schools

Early preventive educational programmes can reduce later aggressive behaviour.

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