Q. I would like to know of behavior management techniques that have been used successfully when working with conduct disorder in children (kindergarten through second grade). Do you have any suggestions?

A. Part of the difficulty in answering your question involves the word "successfully". As a recent review of conduct disorder (CD) treatment concluded (RD Nixon, Clin Psychol Rev 2002 May;22(4):525-46), we don't have many well-designed studies in preschool age children. Another review pointed out that "?studies of Parent Management Training and Cognitive-behavioral Therapy for the child have demonstrated that these interventions affect conduct disorder in children positively. However, most studies...are conducted in research conditions and are not representative of the treatment effectiveness in everyday clinical practice" (van de Wiel et al, Eur Child Adolesc Psychiatry 2002 Apr;11(2):79-84).

Basically, two forms of behavior therapy are currently seen as the most effective treatment for CD: (1) parent management training; and (2) training the child in problem-solving skills. Parent management training is the treatment of choice for younger children, while for older children, this should be supplemented with training in problem-solving skills.

Parent management training is one of the best-researched therapy techniques for conduct disorder, earning the designation, "empirically supported treatment" as defined by the American Psychological Association. For more specific information, I would recommend the article available at the website, http://www.aboutourkids.org/letter/novdec02.pdf.

You may also want to see the excellent website affiliated with Tufts University: www.cfw.tufts.edu for articles and information on this topic.

October 2003

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