Treatment Of Behavioral Disorders Research Articles

The Development and Treatment of Conduct Disorder: A Hypothetical Applied Behavior Analytic Perspective

This paper discusses conduct disorder-312.8x (F91.x) as a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Axis 1 condition from an applied behavior analytic perspective. It explores the definition, development, causes, consequences, and coexisting conditions of conduct disorder. The paper also reviews a theoretical intervention treatment approach that utilizes parent management training (PMT) to support the view that if conduct disorder is diagnosed early, the child can live a “normal” life, especially with appropriate parental training and support. This intervention utilizes an applied behavior analytic perspective to provide training that targets socially unacceptable behavior, parent buy-in, and parental willingness to learn and use parent management training.

Can pediatric bipolar disorder be successfully treated when comorbid with conduct disorder? A secondary analysis of clinical trials of risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole.

Pediatric bipolar disorder (BP) is frequently comorbid with conduct disorder (CD) and its presence adds to the morbidity of BP. While there are no known pharmacological treatments for CD, pediatric BP is responsive to treatment with medications initially indicated for the treatment of psychosis, several of which have Food and Drug Administration (FDA) approval for the treatment of pediatric mania. The main aim of this secondary analysis was to examine whether pediatric BP comorbid with CD responds similarly to treatment with such selected medications. Considering the well-documented morbidity of CD, this finding could have important clinical and public health significance. We conducted a secondary analysis of six prospective 8-week open-label trials of selected medications (risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) using identical methodology in youth with BP with and without comorbid CD. Results: Of 165 youths with BP, 54% (N = 89) met criteria for comorbid CD. The antimanic effects observed did not significantly differ between BP youths with and without comorbid CD, as measured either by a reduction in Young Mania Rating Scale (YMRS) ⩾ 30% or Clinical Global Impression (CGI)-Improvement ⩽ 2 (p = 0.23), or by the more stringent definition of a reduction in YMRS ⩾ 50% (p = 0.61). Pediatric BP can be effectively treated with the abovementioned medications in the context of comorbid CD. Based on previous research showing that remission of BP is associated with remission of CD, if confirmed, these findings raise the possibility that antimanic treatment of youth with BP comorbid with CD could have secondary benefits in mitigating the morbidity associated with CD. This is a pilot scale finding, the results of which are promising and should be confirmed by larger and long-term follow-up studies.

Neuroendocrine Stress Response in Female and Male Youths With Conduct Disorder and Associations With Early Adversity.

Conduct disorder (CD) involves aggressive and antisocial behavior and is associated with blunted cortisol stress response in male youths. Far less is known about cortisol stress responsivity in female youths with CD or other neuroendocrine responses in both sexes. Although CD is linked to early adversity, the possibility that neuroendocrine alterations may mediate the relationship between early adversity and CD has not been systematically investigated. Within the European FemNAT-CD multi-site study, salivary cortisol, testosterone, the testosterone/cortisol ratio, oxytocin, and psychological stress response to a standardized psychosocial stress test (the Trier Social Stress Test [TSST]), together with common pre- and postnatal environmental risk factors, were investigated in 130 pubertal youths with CD (63% female, 9-18 years of age) and 160 sex-, age-, and puberty-matched healthy controls (HCs). The TSST induced psychological stress in both CD and HCs. In contrast, female and male youths with CD showed blunted cortisol, testosterone, oxytocin, and testosterone/cortisol stress responses compared to HCs. These blunted stress responses partly mediated the relationship between environmental risk factors and CD. Findings from this unique sample, including many female youths with CD, provide evidence for a widespread attenuated stress responsivity of not only stress hormones, but also sex hormones and neuropeptides in CD and its subgroups (eg, with limited prosocial emotions). Results are the first to demonstrate blunted neuroendocrine stress responses in both female and male youths with CD. Early adversity may alter neuroendocrine stress responsivity. Biological mechanisms should be investigated further to pave the way for personalized intervention, thereby improving treatments for CD.

REEXAMINING THE OVERLAP BETWEEN CONDUCT DISORDER AND BIPOLAR DISORDER IN PEDIATRIC PSYCHIATRY: CLINICAL, SCIENTIFIC, AND THERAPEUTIC IMPLICATIONS

This Symposium addresses the issue of conduct disorder (CD) and the implications of its significant overlap with pediatric bipolar disorder. Amy Yule, MD, addresses identification of and screening for CD and its high rate of comorbidity with bipolar disorder. Joseph Biederman, MD, presents data suggesting that in a longitudinal study when bipolar disorder remits in children, CD also remits, holding promise that the treatment of bipolar disorder could mitigate CD. Janet Wozniak, MD, presents data showing that bipolar disorder can be successfully addressed when comorbid with CD and, coupled with Dr. Biederman’s findings, addresses the implications of treating bipolar disorder when comorbid with CD as a strategy to attenuate the morbidity of CD. Stephen Faraone, PhD, provides new data supporting the notion of a genetic variant associated with aggressive behavior suggestive of CD. David Axelson, MD, provides synthesizing comments providing perspective on the topic of CD and pediatric bipolar disorder and addresses the strengths and weaknesses of the presentations as well as the direction for future work. This Symposium comprises 4 presentations with analysis of various data sets: Child Behavior Checklist data of children with and without CD, longitudinal outcome data of children with ADHD and bipolar disorder, clinical trials data of second-generation antipsychotic medications for pediatric bipolar disorder, and a genome-wide association study (GWAS) meta-analysis of disruptive behavior disorders. CD is highly morbid and comorbid, can be identified/screened for, is likely associated with a genetic variant, remits when bipolar disorder remits, and can be addressed indirectly by treating comorbid bipolar disorder when present. There are no known pharmacologic treatments for CD. However, treatment of CD when it occurs comorbidly with bipolar disorder holds promise for mitigating the morbidity of CD. Dr. Axelson comments on the strengths and weaknesses of the presentations and directions for future work.

22.1 Can Pediatric Bipolar Disorder be Successfully Treated When Comorbid With Conduct Disorder? A Secondary Analysis of Six Clinical Trials of Second Generation Antipsychotics

Pediatric bipolar disorder (BP) is highly comorbid with conduct disorder (CD) and its presence adds to the high morbidity of BP disorder. While there are no known pharmacological treatments for CD, pediatric BP is responsive to treatment. Yet, it is not known whether antimanic treatments remain efficacious in the context of comorbid CD. The main aim of this secondary analysis study was to examine whether pediatric BP responds to second-generation antipsychotics (SGAs) when comorbid with CD. This finding could have important clinical and public health significance by providing a pharmacological option for this highly morbid comorbid condition. We conducted a secondary analysis of 6 prospective 8-week open-label trials of second-generation antipsychotics (SGAs; risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) using identical methodology in youth with BP with and without comorbid CD. Of 165 youths with BP, 54% (N = 89) met criteria for comorbid CD. The antimanic effects observed were almost identical in BP youths with and without comorbid CD, as measured either by a reduction in Young Mania Rating Scale (YMRS) ≥30% or Clinical Global Impression (CGI)-Improvement scale ≤2 (p = 0.23), or by the more stringent definition of a reduction in YMRS ≥50% (p = 0.61). Pediatric BP can be effectively treated with SGAs in the context of comorbid CD. Based on previous research showing that remission of BP is associated with remission of CD, if confirmed, these findings raise the possibility that antimanic treatment of youth with BP comorbid with CD could have secondary benefits in mitigating the morbidity associated with CD.

Neuropsychological Education in Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) and conduct disorders (CDs) is a prevalent condition (between 5% and 10%). It is common for symptoms to manifest for many years, sometimes continuing into adulthood, such as severe personality disorders, including alcohol and drug abuse and criminal behavior. Prevalence has shown to have increased considerably over the second half of the twentieth century (Harrison, Cowen, Burns, & Fazel, 2018). The historical cultural neuropsychology allows us to think and work in a new, different way, which has shown itself to be very promising, with good results (Quintino-Aires, 2012, 2016a, 2020a). This article presents the work of our team in neuropsychological education, guided by neuropsychological rehabilitation proposed by Luria (1963, 1966b, 1970) with these children and young people. It also refers the way we use the theory of the formation of mental actions step-by-step by P. Gal’perin, both in structuring the therapeutic session with the child or adolescent ODD and CD, as well as in the pedagogical work with the parents. The case A.B., 10-year-old boy, adopted at the age of five, helps to illustrate the way these cases are usually followed in child psychiatry and clinical psychology, and what may be different within the approach of historical cultural neuropsychology. A brief review of neuroscience research is presented, particularly in neuroimaging studies, so that we can better integrate the clinical work with the boy A.B. The results of our clinical practice suggest that this may be a good working approach for the treatment of ODD and CD. More systematized and extended studies are needed with a greater number of clients.

The association of childhood symptoms of conduct disorder and collision risk in adulthood

IntroductionDespite limited research, existing evidence suggests that there is an association between conduct disorder (CD) and various risky driver behaviours, such as driver aggression and driving after drinking. The current study sought to estimate the association between probable CD during childhood and past-year collision risk. MethodsData were based on interviews with 5297 respondents who reported having driven in the past year, derived from the 2011–2013 cycles of the CAMH Monitor, a cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression was conducted of self-reported collision involvement in the previous 12 months, assessing demographic characteristics, driving exposure, demonstrated symptoms of ADHD, mild driver aggression, driving after drinking, and childhood (before age 15 years) symptoms of CD. ResultsThe unadjusted odds ratio of past-year collision involvement for those reporting childhood symptoms of CD was 1.76 (95% CI = 1.10, 2.82). Adjusting for potential covariates, self-reporting childhood symptoms of CD was significantly associated with a 77% increase in the odds of a crash (OR = 1.77; 95% CI = 1.01, 3.11). ConclusionThese findings add to a growing literature and suggest that treatment for CD should include a focus on driver safety.

Conduct disorder in adolescent females: current state of research and study design of the FemNAT-CD consortium

Conduct disorder (CD) is a common and highly impairing psychiatric disorder of childhood and adolescence that frequently leads to poor physical and mental health outcomes in adulthood. The prevalence of CD is substantially higher in males than females, and partly due to this, most research on this condition has used all-male or predominantly male samples. Although the number of females exhibiting CD has increased in recent decades, the majority of studies on neurobiological measures, neurocognitive phenotypes, and treatments for CD have focused on male subjects only, despite strong evidence for sex differences in the aetiology and neurobiology of CD. Here, we selectively review the existing literature on CD and related phenotypes in females, focusing in particular on sex differences in CD symptoms, patterns of psychiatric comorbidity, and callous-unemotional personality traits. We also consider studies investigating the neurobiology of CD in females, with a focus on studies using genetic, structural and functional neuroimaging, psychophysiological, and neuroendocrinological methods. We end the article by providing an overview of the study design of the FemNAT-CD consortium, an interdisciplinary, multi-level and multi-site study that explicitly focuses on CD in females, but which is also investigating sex differences in the causes, developmental course, and neurobiological correlates of CD.

Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study

Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P—Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a ‘no intervention’ scenario, using a health sector perspective. The model targeted a cohort of 5–9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471–1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146–39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

Acute effects of methylphenidate on impulsivity and attentional behavior among adolescents comorbid for ADHD and conduct disorder

Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) experience deficits in neuropsychological measures of attention, inhibition, and reward processes. Methylphenidate treatment for ADHD and CD has acute effects on these processes. Some of these same aspects of performance are separately described in the Behavioral Model of Impulsivity, which uses a modified approach to measurement. This study characterized the acute effects of methylphenidate attention, initiation, inhibition, and reward processes described in this model of impulsivity. Thirty-one adolescents from the United States of America with comorbid ADHD and CD completed measures of impulsivity (response initiation, response inhibition, and consequence) and attention following placebo, 20 mg, and 40 mg of a long-acting dose of methylphenidate. Methylphenidate effects on attentional performance was more robust than on any of the measures of impulsivity. Adolescent performance from this behavioral perspective is interpreted in the context of divergence from previous neuropsychological tests of acute methylphenidate effects.

Dialectical behavior therapy approaches with disruptive behavior disorders

Disruptive behaviour disorders comprise the diagnosis conduct disorder (CD) and in adults the diagnosis antisocial personality disorder (APD). CD is seen as a difficult-to-treat disorder with a high risk for persistent behavioral problems. In addition, CD is seen as the precursor to antisocial personality disorder (Kretschmer et al., 2014). Dialectical behavior therapy (DBT) was originally developed by Marsha Linehan (1991) for the treatment of borderline personality disorder, but because of the core deficits in emotion regulation in disruptive behavior disorders, DBT is also increasingly being recommended for the treatment of CD and APD. This review presents DBT adaptions for the forensic setting and for the treatment of CD/APD. Clinical implications are discussed.

The Cost of Oppositional Defiant Disorder and Disruptive Behavior: A Review of the Literature

This purpose of this paper is to review the literature on the treatment of Oppositional Defiant Disorder, with a specific focus on cost analyses. In general the literature shows that while there has been substantial research on Oppositional Defiant Disorder there has been little focus on the costs involved. A search of the major databases in psychology and the social sciences yielded only seven articles even marginally appropriate for a review of costs associated with Oppositional Defiant Disorder and related disruptive behavior. Interestingly, only two of these studies investigated treatment costs specifically associated with Oppositional Defiant Disorder. These studies showed that the treatment of Oppositional Defiant Disorder is much less expensive than the treatment of Conduct Disorder and family therapy is the most cost effective approach. Overall, the review showed that there is a dearth of literature related to treatment costs, which leads to the conclusion that much more research is needed on the cost of treating Oppositional Defiant Disorder.

Antipsychotic prescribing for behavioral disorders in US youth: physician specialty, insurance coverage, and complex regimens.

To assess antipsychotic prescribing patterns according to insurance coverage type and physician specialty in the outpatient treatment of behavioral disorders (BD) in US youth. We used 2003-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data to compare antipsychotic prescribing in the outpatient treatment of BD in youth (6-19 years) according to insurance coverage (public vs. private) and physician specialty (psychiatrist vs. non-psychiatrist) using population-weighted Chi-square and multivariable analyses. Also, we examined co-prescribing of antipsychotics with other psychotropic medication classes. Subgroup analyses were conducted in BD visits with no other clinician-reported psychiatric diagnosis (non-comorbid BD visits). A large majority (71.0%) of BD visits were provided by non-psychiatrists. However, psychiatrists prescribed antipsychotics far more frequently than non-psychiatrists (24.2% vs. 4.6%; adjusted odds ratio (AOR) = 5.1 [95% confidence interval (CI), 2.8-9.2]) in total BD visits as well as in non-comorbid BD visits (18.6% vs. 3.6%; AOR = 5.8 [95% CI, 3.2-10.5]). Antipsychotic prescribing was nearly two-fold greater in visits by publicly insured 6-12 year olds (11.3% vs. 5.8%; AOR = 1.9 [95% CI, 1.1-3.5]) and 13-19 year olds (16.2% vs. 8.9%; AOR = 2.0 [95% CI, 1.1-3.6]) compared with their privately insured counterparts. In more than one-third of antipsychotic-prescribed BD visits, antipsychotics were prescribed concomitantly with ≥2 psychotropic medication classes regardless of age group, insurance coverage, or even in the absence of psychiatric comorbidities. In outpatient visits by youth for BD, antipsychotics were primarily prescribed by psychiatrists, concomitantly, and for the publicly insured. These treatment patterns merit further investigation.

Conduct disorders

Conduct disorder (CD) is a frequently occurring psychiatric disorder characterized by a persistent pattern of aggressive and non-aggressive rule breaking antisocial behaviours that lead to considerable burden for the patients themselves, their family and society. This review paper updates diagnostic and therapeutic approaches to CD in the light of the forthcoming DSM-5 definition. The diagnostic criteria for CD will remain unchanged in DSM-5, but the introduction of a specifier of CD with a callous-unemotional (CU) presentation is new. Linked to this, we discuss the pros and cons of various other ways to subtype aggression/CD symptoms. Existing guidelines for CD are, with few exceptions, already of a relatively older date and emphasize that clinical assessment should be systematic and comprehensive and based on a multi-informant approach. Non-medical psychosocial interventions are recommended as the first option for the treatment of CD. There is a role for medication in the treatment of comorbid syndromes and/or in case of insufficient response to psychosocial interventions and severe and dangerous aggressive and violent behaviours.

Gender differences in comorbidity of conduct disorder among adolescents in Northern Finland

Objectives: Conduct disorder (CD) refers to a pattern of severe antisocial and aggressive behaviour manifested in childhood or adolescence, with heavy costs to society. Though CD is a common psychiatric diagnosis among adolescents of both genders, gender differences in comorbidity of CD have been little studied. In this study we examined gender differences among adolescents with CD in causes for hospitalization, comorbid psychiatric diagnoses and somatic conditions.Study design: The original study sample consisted of 508 inpatient adolescents in Northern Finland (age 12–17); 155 of them (65 girls, 92 boys) fulfilled the DSM-IV criteria for CD.Methods: Diagnosis of CD and psychiatric comorbidities were obtained from the K-SADS-PL and somatic conditions from the EuropAsi.Results: As compared to boys with CD, suicidality (including suicidal ideation and behaviour) was significantly more commonly the cause of hospitalization among girls with CD (43% vs. 24%, p=0.013). Among somatic conditions, there was a significant predominance in self-reported allergies among girls (60% vs. 25%, p<0.001). Girls had more often diagnosed comorbid post-traumatic stress disorder (13% vs. 3%, p=0.025) and marginally significantly more major depressive disorder (36% vs. 23%, p=0.086).Conclusions: Girls with CD seem to have an increased tendency to develop both comorbid psychiatric and somatic conditions as well as suicidality. New clinical aspects in treatment of CD and comorbid disorders among girls are discussed.

Predicting Treatment Response for Oppositional Defiant and Conduct Disorder Using Pre-treatment Adrenal and Gonadal Hormones.

Variations in adrenal and gonadal hormone profiles have been linked to increased rates of oppositional defiant disorder (ODD) and conduct disorder (CD). These relationships suggest that certain hormone profiles may be related to how well children respond to psychological treatments for ODD and CD. The current study assessed whether pre-treatment profiles of adrenal and gonadal hormones predicted response to psychological treatment of ODD and CD. One hundred five children, 6 - 11 years old, participating in a randomized, clinical trial provided samples for cortisol, testosterone, dehydroepiandrosterone, and androstenedione. Diagnostic interviews of ODD and CD were administered up to three years post-treatment to track treatment response. Group-based trajectory modeling identified two trajectories of treatment response: 1) a High-response trajectory where children demonstrated lower rates of an ODD or CD diagnosis throughout follow-up, and 2) a Low-response trajectory where children demonstrated higher rates of an ODD or CD diagnosis throughout follow-up. Hierarchical logistic regression predicting treatment response demonstrated that children with higher pre-treatment concentrations of testosterone were four times more likely to be in the Low-response trajectory. No other significant relationship existed between pre-treatment hormone profiles and treatment response. These results suggest that higher concentrations of testosterone are related to how well children diagnosed with ODD or CD respond to psychological treatment over the course of three years.

Conduct disorder and adult psychiatric diagnoses: Associations and gender differences in the U.S. adult population

The authors’ objective was to examine the presence of Axis I and II psychiatric disorders among adult males and females with a history in childhood and/or adolescence of conduct disorder (CD).Data were derived from a large national sample of the U.S. population. Face-to-face interviews of more than 34,000 adults ages 18 years and older were conducted during 2004–2005 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule –DSM-IV Version.After adjusting for sociodemographic characteristics and psychiatric comorbidity, CD was associated with all Axis I and II disorders, particularly substance use disorders (SUD), bipolar disorder, and histrionic personality disorders. After adjusting for gender differences in the general population, men had significantly greater odds of social anxiety disorder and paranoid personality disorder, whereas women were more likely to have SUD. Furthermore, there was dose–response relationship between number of CD symptoms and risk for most psychiatric disorders.From a clinical standpoint, knowledge of the gender differences in associations of CD with other psychiatric disorders in adulthood may be informative of developmental pathways of the disorder, and of possible gender-specific risk factors. Early recognition and treatment of CD may help prevent the development of adult-onset disorders.

Risperidone in the treatment of conduct disorder in preschool children without intellectual disability

BackgroundThe DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th edition Textrevision) highlights the especially poor outcomes of early-onset conduct disorder (CD). The strong link between the patient's age at treatment and its efficacy points the importance of early intervention. Risperidone is one of the most commonly studied medications used to treat CD in children and adolescents. The aim of this study is to obtain preliminary data about the efficacy and tolerability of risperidone treatment in otherwise typically developing preschool children with conduct disorder and severe behavioral problems.MethodWe recruited 12 otherwise normally developing preschoolers (ten boys and two girls) with CD for this study. We could not follow up with 4 children at control visits properly; thus, 8 children (six girls, two boys; mean age: 42.4 months) completed the study. We treated the patients with risperidone in an open-label fashion for 8 weeks, starting with a daily dosage of 0.125 mg/day or 0.25 mg/day depending on the patient's weight (<20 kg children: 0.125 mg/day; >20 kg children: 0.25 mg/day). Dosage titration and increments were performed at 2-week interval clinical assessments. The Turgay DSM-IV Based Disruptive Behavior Disorders Child and Adolescent Rating & Screening Scale (T-DSM-IV-S) as well as the Clinical Global Impression Scale (CGI) assessed treatment efficacy; the Extrapyramidal Symptom Rating Scale (ESRS) and laboratory evaluations assessed treatment safety.ResultsThe mean daily dosage of risperidone at the end of 8 weeks was 0.78 mg/day (SD: 0.39) with a maximum dosage of 1.50 mg/day. Based on the CGI global improvement item, we classified all patients as "responders" (very much or much improved). Risperidone was associated with a 78% reduction in the CGI Severity score. We also detected significant improvements on all of the subscales of the T-DSM-IV-S. Tolerability was good, and serious adverse effects were not observed. We detected statistically significant prolactin level increments (p < 0.05), but no clinical symptoms associated with prolactinemia.ConclusionThe results of this study suggest that risperidone may be an effective and well-tolerated atypical antipsychotic for the treatment of CD in otherwise normally developing preschool children. The findings of the study should be interpreted as preliminary data considering its small sample size and open-label methodology.

Comorbid conduct disorder and substance use disorders.

[Clin Psychol Sci Prac 17: 337–349, 2010] Conduct disorder (CD) and substance use disorders (SUDs) commonly co-occur. The high rates of comorbidity, in conjunction with similar developmental trajectories for CD and SUDs, suggest a common etiology. Both disorders are heritable, indicating a common genetic influence. Research suggests that a developmental pathways approach to the etiology, correlates, comorbidities, prevention, and treatment of CD and SUDs may improve our understanding of these disorders. Research that examines the genetic, neurophysiological, behavioral, and environmental connections among the CD and SUDs is reviewed. Study of the causes of these two disorders, either singly or in combination, is essential to prevent their occurrence and ameliorate the associated negative outcomes.

Treatment fidelity as a predictor of behaviour change in parents attending group‐based parent training

Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome. To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme. Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome. Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment.