Evidence-based management of conduct disorders

Purpose of review It is becoming increasingly apparent that antisocial children often grow up to inflict considerable damage on others at a high cost, and also lead very impoverished lives themselves. There is rising public and governmental concern to get on top of aggressive and criminal behaviour, which is especially prevalent in the socially and economically disadvantaged. Recent findings While parent training has been around for some 30 years, it has now been supplemented by efficacious child problem-solving and teacher-training programmes. For severe delinquency, community-based multisystemic interventions are reasonably effective when applied diligently. They cover social skills, and keep youths very closely supervised while giving them immediate rewards for compliance. Summary Despite popular impressions to the contrary, a lot is know about the causes of antisocial behaviour and conduct disorders, and now there are effective interventions to reduce it. However, many policymakers and commissioners are still unaware that effective programmes exist, or that when implemented, insufficient attention is paid to the need for fidelity to the model used and to the development of therapist skill. Effectiveness is then often disappointing in 'real life' conditions. However, when these factors are addressed, the evidence is clear that substantial gains can be made.