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Interventions for Children At Risk of Developing Anti-Social Personality Disorder - A Review


This selective review considers what is known about the effectiveness of interventions for children whose conduct disorders place them at risk of developing persistent and intractable patterns of problem behaviour in later life. It was commissioned by the Department of Health and the Prime Minister's Strategy Unit to inform policy discussions preceding publication of the Government's Action Plan on Social Exclusion (August, 2006). This lays emphasis on preventing 'deep exclusion' among a small minority of children who run much higher risks than others of experiencing a range of chronic social problems in adult life, including poor physical and mental health and criminal behaviour, alongside economic poverty.

A strong relationship exists between the presence of conduct disorder in children and the later development of antisocial behaviour. A wide ranging but consistent set of risk factors is implicated in the underlying causes of problem behaviour in childhood, as are a set of protective factors that can moderate the effects on children of exposure to multiple risks. Knowledge of risk and protective factors can be used to identify neighbourhoods where universal support services are especially likely to prove effective. It can, likewise, help identify children exposed to multiple risk factors for whom targeted interventions (to prevent problems from escalating or reoccurring) may be effective. Although they may be more intensive and their unit costs proportionately high, such services can still be cost-effective given the high social expense associated with the development of antisocial personality disorder (ASPD). An understanding of 'what works' in addressing risk factors and promoting protective factors, drawing on examples of practice from successful interventions can, therefore, guide policy and practice development in the UK.

What does the research focus on?

The Action Plan on Social Exclusion highlights Government proposals to pilot and evaluate a number of preventive services in the fields of parenting education, home visiting, treatment foster care and family therapy that international research shows to be highly promising ways of reducing children's exposure to risk. Evidence concerning the key features, design, implementation and effectiveness of these services provides the main focus of the review. It examines targeted interventions that have demonstrated good results in improving behaviour among children and young people with conduct disorders who are, consequently, at heightened risk for ASPD as adults. These are:

  • Parent Management Training, including:
    • The Incredible Years
    • Triple 'P' (Positive Parenting Programme)
  • Home visiting including:
    • The Nurse-Family Partnership home visiting programme
  • Multisystemic Therapy (MST)
  • Treatment (or Therapeutic) Foster Care including:
    • Multidimensional Treatment Foster Care (MTFC)

All have been rigorously evaluated in their country of origin (the United States or, in the case of Triple P Australia) but have also been replicated - or been actively considered for piloting - in the UK. The review also considers a sixth intervention that has also achieved positive results in the treatment of conduct disorders and has some history of use in the UK, Functional Family Therapy (FFT).

What does the research involve?

In considering 'what works?' the overview follows the approach to evidence taken by the Communities that Care initiative in its 2005 Guide to Promising Approaches, which is similar to that described by Moran, Ghate and van der Merwe in their 2004 PRB report on parenting support programmes for the Home Office and the DfES. This asserts the importance of basing policy and practice judgments on evaluations whose design and methods would support conclusions that any positive outcomes were attributable to the programme, rather than other influences. In practice, this requires evaluations using comparison designs and conducted as randomised controlled trials (RCTs) or 'quasi-experiments'.

The review provides a general overview of parenting programmes in an international and UK context and 'what works' in policy and practice, before giving a more detailed review of The Incredible Years and Triple P whose implementation is being piloted as part of the DfES 'Respect Early Intervention Pathfinder' for children aged 8-13 at risk of anti-social behaviour. Detailed assessments are also made of the Nurse-Family Partnership home visiting programme (which is being piloted in Britain with funding from the Department of Health) and Multisystemic Therapy and Treatment Foster Care in which there is also increasing UK Government interest. The section on Functional Family Therapy also describes a CD-Rom version known as Parenting Wisely which has been used in England and Wales by Youth Offending Teams and in the Republic of Ireland.

Timescale and final products of the research

The was carried out in summer 2006 and published as a report in PRB's "Messages" series in March 2007. Hard copies may be obtained free of charge by contacting, or downloaded from the web here.

Utting, D, Monteiro, H and Ghate, D (2007) Interventions for Children at Risk of Developing Antisocial Personality Disorder London: PRB with Department of Health and the Cabinet Office

See Publications for further details.

Last updated February 2008