Treatments for aggressive and antisocial children

Many different types of treatment have been applied to conduct-disordered youths. Unfortunately, little outcome evidence exists for most of the techniques. Three treatments with the strongest evidence to date were highlighted in this article: PMT, PSST, and MST. Parent management training is directed at altering parent-child interactions in the home, particularly those interactions related to child-rearing practices and coercive interchanges. Cognitive problem-solving skills training focuses on cognitive processes that underlie social behavior. Multisystemic therapy focuses on the individual, family, and extrafamilial systems and their interrelations as a way to reduce symptoms and to promote prosocial behavior. Each of these treatments has multiple controlled studies on its behalf, and some of the techniques (e.g., PMT) have been extraordinarily well evaluated. Significant issues remain to be addressed to accelerate treatment advances. We cannot yet say that one intervention can ameliorate conduct disorder and overcome the poor long-term prognosis. On the other hand, much can be said. Much of what is practiced in clinical settings is based on psychodynamically oriented treatment, general relationship counseling, generic family therapy, and group therapy (with antisocial youths as members). These and other procedures, alone and in various combinations in which they are often used, have not been evaluated carefully in controlled trials. Of course, absence of evidence is not tantamount to ineffectiveness. At the same time, promising treatments have advanced considerably, and a very special argument might be needed to administer treatments that have neither basic research on their conceptual underpinnings in relation to conduct disorder nor outcome evidence from controlled clinical trials on their behalf. Promising treatments, at best, leave important questions unanswered. Further development of treatments clearly is needed. Apart from treatment studies, further progress in understanding the nature of conduct disorder is likely to have very important implications for improving treatment outcome. Improved triage of patients to treatments that are likely to work will require understanding of characteristics of children, parents, and families that will make them more or less amenable to current treatments.