Conduct disorder can be highly challenging to deal with at school. Special educational consultant Michael Farrell looks at the disorder in detail

Conduct disorder may be among the most challenging that SENCOs encounter. It can include a range of behaviours such as aggression, destroying property, stealing, housebreaking, and truanting and is commonly associated with other disorders including attention deficit hyperactivity disorder and substance abuse disorders.

The main aspect of conduct disorder as classified under the DSM-IV-TR (American Psychiatric Association, 2000) involves the violation of the rights of others or the transgression of ‘major age-appropriate social norms’ (ibid p98 criterion A). Because strategies that work are different for children and adolescents, these are considered separately below.

Children (three to 10 years old)
Among approaches considered effective for younger children are: parent training; social skills training and anger management; and classroom contingency management.

Typically, parent training is based on behavioural management principles drawn from social learning theory and may include role-play, behavioural rehearsal and homework exercises.

One programme, the ‘Incredible Years Training Series’ consists of three training curricula for: parents, children aged two to eight years, and teachers. It seeks to improve parents’ competence, for example by encouraging them to work together, increasing positive parenting, and reducing negative parenting.

A school-based strategy ‘Coping Power’ (Lochman and Wells, 1996) is aimed at primary school children with conduct problems. Thirty-three structured sessions are administered in the children’s school days. Children review examples of social interactions, discussing social cues and motives, and there are problem-solving components to the programme. Particular skills are practised to manage anger arousal, as well as anger control strategies such as self-talk.

One study (Barkley et al, 2000) compared many behavioural interventions, the effect of parent training and the combined treatments. Among the classroom interventions were a token system, over-correction, response cost, and time out. Also included were group cognitive-behavioural self-control training, group anger control training, group social skills training, and support for home based reinforcement.

Benefits such as showing less aggression were found for the multiple behavioural interventions, but no effects were discernable for parent training. Perhaps this was because parents had not sought out the training for themselves and may not have been committed to it. Unfortunately, benefits have not been shown to generalise to other settings such as the child’s home or to continue beyond the end of the programme. This may be because some interventions do not ensure that suitable behaviour is linked with more naturally occurring reinforcers before the programme ends, which is more likely to extend benefits beyond the duration of the programme.

Adolescents (10 to 17 years)
Interventions that appear effective with adolescents include: combination packages and school-based interventions. For adolescents, it is difficult to endorse a positive impact of individual skills programmes such as social and problem-solving skills training; anger management; and training in moral reasoning. But there are indications that combinations may be more effective in addressing the multiple causes of conduct disorders. One package, Equipping Youth to Help One Another (EQUIP) brings together anger management, social skills training, moral reasoning training and problem solving skills training in a group setting (Gibbs, Potter, Barriga and Liau, 1996).

An evaluation of a programme aimed
at tackling gang involvement, Gang Resistance Education and Training (GREAT), showed significant positive effects (Esbensen and Osgood, 1999). Law enforcement officers taught a nine-week curriculum to middle school pupils. These included exercises and interactive approaches intended to underline the consequences of gang violence. Activities taught goal setting, conflict resolution and standing up to peer pressure. As a result, participating students had lower levels of self-reported delinquency and gang membership than a comparison group.

Medication
It is argued that medication cannot be justified as the ‘first line of treatment’ for conduct problems (Fonagy et al, 2005, p192). For SENCOs (and all teachers), the main issues include being aware of the intended effects and the potential side effects where medication is prescribed. This includes possible impact on learning and other aspects of behaviour. Also, where other strategies for dealing with disorders of conduct are clearly evaluated, medication may be seen as less necessary. Summaries of evidence of the effectiveness of drugs used for conduct disorder are available (See Fonagy et al, 2005, pp182-192).

References

  • American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Washington DC, APA
  • Barkley, RA, Shelton, TL, Crosswait, CC, Moorehouse, M, Fletcher, K, Barrett, S, Jenkins, L and Metevia, L (2000) ‘Multi-Method Psychoeducational Intervention for Preschool Children with Disruptive Behaviour: Preliminary Results at Post Treatment’ Journal of Child Psychology and Psychiatry 41, 319-332
  • Esbensen, FA and Osgood, DW (1999) ‘Gang Resistance Education and Training (GREAT): Results from the National Evaluation’ Journal of Research in Crime and Delinquency 36, 194-225
  • Fonagy, P, Target, M, Cottrell, D, Phillips,
  • J and Kurtz, Z (2005) What Works for Whom? A Critical Review of Treatments for Children and Adolescents New York, The Guilford Press
  • Gibbs, JC, Potter, GB, Barriga, AQ and Liau, AK (1996) ‘Developing the Helping Skills and Prosocial Motivation of Aggressive Adolescents in Peer Group Programmes’ Aggression and Violent Behaviour 1, 283-305
  • Lochman, JE and Wells, KC (1996) ‘A Social-cognitive Intervention with Aggressive Children: Prevention Effects and Contextual Implementation Issues’ in Peters, RE and McMahon, RJ (eds) Preventing Childhood Disorders, Substance Abuse and Delinquency (pp111-143) Thousand Oaks, CA: Sage

Further reading
Farrell, M (2008) Educating Special Children: An Introduction to Provision for pupils with disabilities and disorders London, Routledge

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