1 The Prevention, Treatment And Management Of Conduct Problems David M Fergusson Christchurch Health & Development Study Department of Psychological Medicine University of Otago, Christchurch February 2009

2 BACKGROUND In the region of 5% to 10% of children and adolescents show disruptive problem behaviours including aggression, violence, dishonesty, and oppositional behaviours. The terminology describing these behaviours varies with discipline. In psychology and psychiatry they are typically described as conduct disorder or oppositional deficit disorder. In education, terms such as challenging behaviours are used. The term conduct problems is proposed as a neutral terminology that spans disciplines.

3 CONSEQUENCES OF CONDUCT PROBLEMS New Zealand longitudinal research has shown that childhood conduct problems are precursors of a wide range of adverse outcomes. These include: crime; traffic offences; mental health problems; substance abuse; suicidal behaviours; early parenthood; partner violence; poor physical health; poor dental health. There is no other common childhood condition that is associated with such a wide range of outcomes.

4 EFFECTIVE PREVENTION METHODS Some home visiting programmes: Nurse Family Partnership; Early Start Some centre-based interventions: Abercedarian; Perry Pre-School

5 EFFECTIVE TREATMENT/MANAGEMENT METHODS Parent management training Teacher management training Classroom intervention Cognitive behaviour therapy Functional family therapy Treatment foster care

6 A RECOMMENDED MENU OF INTERVENTIONS Age Intervention Parent Management Training – Teacher Management Training Combined Parent/Teacher Programmes – Classroom Based Intervention – Cognitive Behaviour Therapy– Multi-Systemic Therapy– Functional Family Therapy– Treatment Foster Care

7 THE PREVENTION SCIENCE PARADIGM Programme selection is based on review and meta- analysis. Programmes are subject to adequate piloting to develop skills and infra-structure. Programme efficacy is assessed using randomised controlled trials. Programmes are progressively taken to scale with regular monitoring of programme effectiveness and fidelity.

8 CULTURAL ISSUES There is a clear tension between the Western science approach exemplified by the prevention science model and the emerging Kaupapa Maori framework for programme development and evaluation. One solution to this tension is to see these issues in terms of Articles 2 and 3 of the Treaty of Waitangi. Briefly: The development of mainstream prevention science programmes for all New Zealanders including Maori is consistent with Article 3 The development of Kaupapa Maori based programmes is consistent with Article 2.

9 BARRIERS TO PROGRESS Lack of recognition of the literature on conduct problems and issues of treatment, management and prevention. Lack of Government infra-structure to implement and evaluate evidence-based programmes. Lack of enthusiasm of bureaucrats and politicians to have cherished beliefs exposed to critical challenge. Debates about ownership rights and control of processes of programme development and evaluation.