Conduct disorders are a serious, but frequently unrecognised mental health condition in children and young people. A new NICE guideline highlights the central role of parents and guardians in the management of conduct disorders and antisocial behaviour, recommending specific training sessions to help support parents and carers.

Conduct disorders are characterised by repeated and persistent misbehaviour much worse than would normally be expected in a child of that age. This may include stealing, fighting, vandalism and harming people or animals. These disorders are the most common reason for children to be referred to mental health services, with around 5% of all children aged between 5 and 16 years diagnosed with the condition. Conduct disorders also often coexist with other mental health disorders, most commonly attention deficit hyperactivity disorder (ADHD).

NICE, the healthcare guidance body, has today published a clinical guideline on the recognition and management of antisocial behaviour and conduct disorders in children and young people. This guidance has been developed jointly by NICE and the Social Care Institute for Excellence (SCIE).

Professor Gillian Leng, Deputy Chief Executive, NICE, said: "Conduct disorders, and associated antisocial behaviour, are the most common mental and behavioural problems in children and young people - around half of children with a conduct disorder not only miss out on parts of their childhood but go on to have serious mental health problems as adults. The new NICE guideline is the first national clinical guideline in this area and includes a number of recommendations to support healthcare professionals to accurately diagnose and treat conduct disorders. It aims to significantly improve the lives of young people with a conduct disorder, which is a serious but frequently unrecognised mental health problem."

Professor Stephen Pilling, Director, National Collaborating Centre for Mental Health; Professor of Clinical Psychology and Clinical Effectiveness, UCL and facilitator of the Guideline Development Group, said: "Conduct disorder has real consequences for the child and their families, schooling is disrupted, family life can become very stressful and problems with drug and alcohol misuse and the criminal justice system are common. But the problems associated with conduct disorder are often lifelong; with adults who had a conduct disorder during their childhood being far more likely to develop another mental health disorder when they are an adult - nearly half go on to develop antisocial personality disorder. The costs to individuals, families and society of untreated conduct disorder are enormous.

"The new guideline highlights the importance of supporting the child's parents or guardians in the treatment of the condition - recommending training programmes tailored specifically for them - as aspects of parenting have been repeatedly found to have a long-term association with antisocial behaviour. Many parents do an excellent job in caring for a child with a conduct disorder, but it can be incredibly challenging. Parent training programmes provide them with strategies for dealing with difficult children and how to better handle them going forward."

Andrea Sutcliffe, Chief Executive, Social Care Institute for Excellence, said: "The lives of children and young people with conduct disorder can be devastatingly affected so it is clearly vital that they have access to an accurate diagnosis and appropriate treatment. It is important not to concentrate solely on their clinical needs but also to consider their whole lives - as part of a family, school and local community. That is why it is crucial that everyone in health, social care and education work well together to provide the information and person-centred care necessary to improve the quality of life and life chances for children, young people, their families and carers."

Professor Peter Fonagy, Chief Executive, Anna Freud Centre, Freud Memorial; Professor of Psychoanalysis, UCL and member of the Guideline Development Group, said: "All children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norm for their age. Recognising and accurately diagnosing a conduct disorder is vital to ensuring children and their families are able to access the treatment and support they need to manage the condition.

"A number of effective interventions have already been developed for children with conduct disorder and related problems. However, uptake of these programmes has been variable. Treating conduct disorders needs all those agencies that can help to work together - this includes healthcare, education and social care, as well as the criminal justice system if needs be. We hope that the development of NICE guidance in this area will help ensure that children and their families receive the best possible support, wherever they live."

Fiona, mother of a child with a conduct disorder, said: "Caring for a child with a conduct disorder can be incredibly challenging. It is not just the child who is affected by a conduct disorder; it can have a significant impact on their brothers or sisters, their parents, family members, teachers and other people they come into contact with. Real practical support and advice is needed to help parents manage their child's condition, such as what to say to calm the child when they are very distressed to avoid inflaming the situation. I hope that this guideline will help people understand more about conduct disorders, and help parents improve their child's quality of life."

Recommendations include:

• Initial assessment of children and young people with a possible conduct disorder: Assess for the presence of the following significant complicating factors:
  
  - a coexisting mental health problem (for example, depression, post-traumatic stress disorder)
  
  - a neurodevelopmental condition (in particular ADHD and autism)
  
  - a learning disability or difficulty
  
  - substance misuse in young people.
• Parent training programmes: Offer a group parent training programme to the parents of children and young people aged between 3 and 11 years who: have been identified as being at high risk of developing oppositional defiant disorder or conduct disorder or have oppositional defiant disorder or conduct disorder or are in contact with the criminal justice system because of antisocial behaviour.

• Child-focused programmes: Offer group social and cognitive problem-solving programmes to children and young people aged between 9 and 14 years who: have been identified as being at high risk of developing oppositional defiant disorder or conduct disorder or have oppositional defiant disorder or conduct disorder or are in contact with the criminal justice system because of antisocial behaviour.

• Improving access to services: Provide information about the services and interventions that constitute the local care pathway, including the:
  
  - range and nature of the interventions provided
  
  - settings in which services are delivered
  
  - processes by which a child or young person moves through the pathway
  
  - means by which progress and outcomes are assessed
  
  - delivery of care in related health and social care services[1].

The guideline on the recognition and management of antisocial behaviour and conduct disorders in children and young people will be available on the NICE website from 27 March 2013.

Ends

Notes to Editors

About the guidance

1. The guideline on the recognition and management of antisocial behaviour and conduct disorders in children and young people will be available on the NICE website from 27 March 2013.

2. This guidance is an update of NICE technology appraisal guidance 102 Conduct disorder in children - parent-training/education programmes (published July 2006) and will replace it.

3. The Social Care Institute for Excellence (SCIE) improves the lives of people who use care services by sharing knowledge about what works. They are an independent charity working with adults, families and children's social care and social work services across the UK. They also work closely with related services such as health care and housing.

Further support for the NICE clinical guideline on the recognition and management of antisocial behaviour and conduct disorders in children and young people

Professor Sue Bailey, President of the Royal College of Psychiatrists, said: "We welcome this new guidance, which includes many helpful recommendations to support the accurate assessment, diagnosis and treatment of conduct disorders. Early onset conduct disorder is linked with violence and delinquency in adolescence and offending in adulthood. This means that early diagnosis and management is vital to ensure that the right support and treatment can be given to children and families in the context of their home, school and the community."

Bridget Robb, Interim Chief Executive of the British Association of Social Workers said: "This guidance presents a holistic approach to diagnosing and treating children and young people with conduct disorders, which is an excellent response to a significant issue.

"It recognises the discrimination faced by children and young people who have mental health issues and also supports the rights of children and young people to choose and be involved in all decision making.

"The varied options for treatment and different multi-agency proposals for support and diagnosis of children and young people who may have a conduct disorder are more than welcome.

"The details within the guidance of services which should be in place to support children, young people, carers and teachers are more than impressive, such as the need for health and social care to collaborate with education to ensure engagement in treatment programmes by providing crèche facilities, assistance with travel and advocacy services for parents and carers."

Marjorie Wallace, chief executive of the mental health charity SANE, said: "SANE welcomes this new guideline on conduct disorders. In our experience, the earlier the intervention in unhappy and disrupted family relationships and the associated behavioural problems, the better they can be resolved before they become entrenched."

Dr Jane Roberts, RCGP Clinical Champion for Youth Mental Health, said: "The Royal College of General Practitioners is keen that youth mental health becomes a core part of holistic continuing care for general practice, and we have therefore already made it one of our clinical priorities for the next three years.

"A significant proportion of adult mental illness starts during adolescence. Not only is long-term emotional wellbeing affected, but also people who develop mental or emotional problems in youth have significantly poorer social and economic problems. Early intervention is important in changing the trajectory of mental health problems and GPs and their teams can be key to helping make a huge difference.

"The RCGP welcomes guidance which acknowledges the continuity of care which GPs can provide. In addition, these new NICE guidelines highlight the role the social and structural determinants of health play in young people's mental health by referring to the steep social gradient seen in conduct disorders.

"We look forward to referring to it as part of our work to develop useful tools to help GPs develop expertise in this area."

Mark Johnson, Founder of User Voice, said: "It is encouraging that the voices of young people and families feature so strongly in these NICE guidelines. It is only by including people with the lived experience will we be able to support young people to access services effectively and increasing understanding between service users and practitioners."

About NICE

4. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

5. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies -guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
• social care - the Health and Social Care Act (2012) sets out a new responsibility for NICE to develop guidance and quality standards for social care. To reflect this new role, from 1 April 2013 NICE will be called the National Institute for Health and Care Excellence (NICE) and it will become a Non-Departmental Public Body.

6. NICE produces standards for patient care:

• quality standards - these describe high-priority areas for quality improvement in a defined care or service area
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
• CCG Outcomes Indicator Set (formerly known as COF) - NICE develops the potential clinical health improvement indicators to ensure quality of care for patients and communities served by the clinical commissioning groups (CCGs).

7. NICEprovides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.