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Professor Nick Gould
Professor Nick Gould

Internal News - 31 August 2006

What works in relation to children with severe behavioural problems?

Professor Nick Gould, from the Department of Social and Policy Sciences, has acted as joint technical lead in the production of a report that addresses the clinical and cost effectiveness of parent education/training programmes in the management of children with conduct disorders.

Conduct disorder is the most common psychiatric disorder of childhood and the most regular reason for referral for psychological and psychiatric treatment.

It is defined as a repetitive and persistent - continuing for 12 months or more - pattern of aggressive, defiant or antisocial behaviour which far exceeds the conventional range of difficult behaviour. The criteria include serious aggression to people or animals and destruction of property.

The personal and social costs of conduct disorder are substantial and without effective intervention the prognosis is poor: 40-50% of children with conduct disorder go on to receive a diagnosis of antisocial personality disorder as adults. They are at high risk of experiencing future social exclusion through poor educational achievement, long-term unemployment and criminality.

This is the National Institute for Health and Clinical Excellence's (NICE) first technology appraisal to address both health and social care perspectives of conduct disorder and is the Institute's first collaboration with the Social Care Institute for Excellence, of which Professor Gould is a fellow.

On the basis of the systematic review of the evidence, NICE has now issued guidance to the NHS that certain programmes are recommended in the management of children with conduct disorders, and the guidance also specifies the characteristics of programmes that are effective.

Professor Gould explained: "The appraisal found that effective programmes are those that, among other factors, employ principles drawn from social learning theory (an approach to learning that includes learning from observing other people), allow parents to set their own objectives for change and give attention to family relationship difficulties.

"The report emphasises the need to give practical support to parents whose resources are stretched, so that they can participate in programmes."

Because this is the first appraisal undertaken as a joint collaboration, it has involved various innovations in NICE's usual methodology, including the synthesis of qualitative evidence and modelling of clinical effectiveness to include social costs and benefits.

Professor Gould commented: "Hopefully, this is a helpful contribution to the debates about 'what works?' in relation to children with severe behavioural problems, and implementation of the NICE guidance should help parents of such children access effective support".


National Institute for Health and Clinical Excellence:
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

Social Care Institute for Excellence:
SCIE's aim is to improve the experience of people who use social care by developing and promoting knowledge about good practice in the sector. Using knowledge gathered from diverse sources and a broad range of people and organisations, resources are developed and freely shared, supporting those working in social care and empowering service users.