Introduction

This quality standard covers the recognition and management of antisocial behaviour and conduct disorders in children and young people (aged under 18 years). For more information see the conduct disorders in children and young people topic overview.

Why this quality standard is needed

Conduct disorders, and associated antisocial behaviour, are the most common mental and behavioural problems identified in children and young people. Conduct disorders are characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations. The World Health Organization's ICD-10 classification of mental and behavioural disorders divides conduct disorders into:

  • socialised conduct disorder

  • unsocialised conduct disorder

  • conduct disorders confined to the family context

  • oppositional defiant disorder.

The major distinction between oppositional defiant disorder and the other subtypes of conduct disorder is the extent and severity of the antisocial behaviour. Oppositional defiant disorder is more common in children aged 10 years or younger; the other subtypes of conduct disorder are more common in those aged 11 years or older.

The prevalence of conduct disorders increases throughout childhood and they are more common in boys than girls. Prevalence rates are also linked to deprivation, with a 3- to 4‑fold increase in prevalence among children from more deprived households compared with those in the most affluent. Almost 40% of looked-after children, those who have been abused and those on child protection and safeguarding registers have been identified as having a conduct disorder.

The behaviour associated with conduct disorders can become more severe and problematic as the child gets older. There is evidence to suggest that up to 50% of children and young people with a conduct disorder go on to develop an antisocial personality disorder in adulthood. Selective prevention and early intervention can help to reduce the likelihood of the child developing more complex behavioural problems.

The quality standard is expected to contribute to improvements in the following outcomes:

  • Emotional wellbeing of children and young people.

  • Emotional wellbeing of the parents and carers of children and young people.

  • Reducing contact with the youth justice system.

  • Educational attainment.

  • Number of 16–18 year olds in education, employment or training.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

4 Ensuring that people have a positive experience of care

Improvement areas

Improving children and young people's experience of healthcare

4.8 Children and young people's experience of outpatient services

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.3 Pupil absence

1.4 First-time entrants to the youth justice system

1.5 16–18 year olds not in education, employment or training

1.12 Violent crime (including sexual violence)

2 Health improvement

Objective

People are helped to live health lifestyles, make healthy choices and reduce health inequalities

Indicators

2.8 Emotional wellbeing of looked-after children

2.10 Self-harm

Coordinated services

The quality standard for antisocial behaviour and conduct disorders in children and young people specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole antisocial behaviour and conduct disorder care pathway. This is particularly important for this population because local authorities, health services and Child and Adolescent Mental Health Services (CAMHS) share responsibility for recognition, assessment, management and interventions for children and young people with conduct disorders. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to children and young people with a conduct disorder.

Children and young people with conduct disorders may present to a variety of agencies within the health, education, social care and voluntary sectors and the justice system. It is important that agencies work collaboratively so that cases of conduct disorders can be identified early and that they refer appropriately in order for early intervention to occur.

It is important that all relevant agencies recognise that coexisting conditions, for example, attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD), are common in children and young people with a conduct disorder, and take account of this when working in collaboration with other services.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for children and young people with a conduct disorder and their families or carers, are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in assessing, caring for and supporting children and young people with conduct disorders and their families or carers should have sufficient and appropriate training and competencies to deliver the assessments, interventions and other actions described in the quality standard. For psychiatrists, this would include the specialist training in child and adolescent psychiatry that covers specific competencies in the assessment and management of young people with conduct disorders[1].

Role of families and carers

Quality standards recognise the important role families and carers have in supporting children and young people with a conduct disorder. Whenever possible, and if appropriate, health, public health and social care practitioners should ensure that family members and carers are involved in all aspects of care. This includes involvement in the decision-making process about assessments and any treatment or support options. For children and young people with conduct disorders, health, public health and social care practitioners should be aware that multiple parents and carers may be involved.



[1] Royal College of Psychiatrists. A competency-based curriculum for specialist training in psychiatry [accessed March 2014]