National Institute for Health and Clinical Excellence (NICE)
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Early diagnosis and intervention key for conduct disorders

Diagnosing conduct disorders at an early stage is key to ensuring that children and their families are able to access the treatment and support they need to manage the condition, says NICE.

Conduct disorders are a serious, but frequently unrecognised, mental health condition characterised by repeated and persistent misbehaviour that 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 per cent of all children aged between 5 and 16 years diagnosed with the condition

If left untreated, many children will go on to have serious mental health problems as adults. The cost of not treating these children early on is huge not just to the NHS but also to society.

In the first national guideline in this area, NICE suggests using the Strengths and Difficulties Questionnaire for the initial assessment of a child or young person with a suspected conduct disorder.

GPs should assess for the presence of the following 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.

If any significant complicating factors are present then the child or young person should be referred to a specialist CAMHS for a comprehensive assessment.

Pharmaceutical interventions should not be offered for the routine management of behavioural problems in children and young people with oppositional disorder or conduct disorder.

The guidance also recommends group parent training programmes be offered to help support parents and carers 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.

Group social and cognitive problem-solving programmes should be offered to children and young people aged between 9 and 14 years who are 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.

Professor Gillian Leng, Deputy Chief Executive, NICE, said: “The new NICE guideline 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.”

Dr Jane Roberts, Royal College of General Practitioners Clinical Champion for Youth Mental Health, said: “The RCGP is keen that youth mental health become a core part of the 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. We look forward to referring to it as part of our work to develop useful tools to help GPs develop expertise in this area.”

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