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Section 19
Prevention and Intervention for Conduct Disorder

Question 19 | Test | Table of Contents


Anger-coping intervention programs
The anger-coping intervention programs seek to train children and adolescents with conduct disorder in perspective-taking, awareness of physiological arousal as a precursor to anti-social action, use of self instruction or self-talk procedures and problem-solving strategies (Kendall et al., 1990; Lockman, 1992; Lochman and Dunn, 1993). Specific cognitive behavioral techniques that have been used as part of anger-coping intervention programs include role-plays, modeling, biofeedback and behavioral experiments in appropriate ecological settings. Role-plays involve reactions to hypothesized social situations and possible consequences to the self and others. Participants of the role-plays are usually the adolescent with conduct disorders and the therapist, or a peer if a group intervention is being used (Kendall et al., 1990; Batsche, 1996). Modeling techniques are used to teach appropriate appraisal of and response to potentially ambiguous social situations. Emphasis in role-playing is on the need to engage in extensive information processing before selecting a solution, as well as procedures in correct solution implementation. Use is made of video, bibliotherapy, and role-plays. Biofeedback training, as part of anger-coping intervention is meant to assist the child with a conduct disorder to recognize physiological symptoms that prelude aggressive and irrational solutions to social problems, and prime the child to take preventive action (e.g., thought diversion; muscle relaxation). Home-work tasks are given to enable try-outs of the newly learnt behaviors in real-life situations.

Problem-solving skills training programs
The focus of problem-solving skills training is on teaching children and adolescents with conduct disorder cognitive-behavioral methods of self-regulation and impulse control (Elias and Weissberg, 1989; Kazdin, 1996). Therefore, problem-solving skills training seeks to remedy both cognitive deficiencies (e.g., impulse control) and cognitive distortions (e.g., inappropriate attributions). The specific procedures used are: (a) stop, calm down, and think before you act; (b) say the problem and how you feel; (c) set positive goals; (d) think ahead of consequences; and (e) go ahead and try the best plan. Participants are trained to self-question (e.g., `What am I supposed to do?') and to self-prompt in seeking alternative solutions (e.g., `I have to look at all my possibilities?'), perspective-taking (e.g., `How could a peer, or a parent or counselor consider the situation?'); selecting a pro-social solution (e.g., `How does my selected solution meet my goals or needs?'; `How is my chosen solution likely to affect other people who may be involved?'), self-monitoring in solution implementation (e.g., `Am I achieving my intended goal?'; `Is there anything else I need to consider?'), solution evaluation or appraisal in relation to original goal (e.g., `I did a good job'; or `I could do even better'); and solution sharing (e.g., `I would like to share my success with a peer, counselor, sibling, parent'). Use is made of video, live modeling, didactic presentation, small group discussion and competitive and cooperative games (Spivack et al., 1976; Elias and Weissberg, 1989; Kazdin, 1996). Problem-solving skills training has been complimented with a parent management training program to create a supportive environment in the home for the skills learnt in therapy (Kazdin, 1996; Kazdin and Weisz, 1998).

Problem-solving skills training programs share many elements with anger-coping intervention programs with the exception that problem-solving skills apply to self-management in wider range of behaviors. Empirical studies support the effectiveness of problem-solving skills training in improving children and adolescents' problem-solving, social relations with peers, school adjustment and reducing the incidence of minor delinquent acts (Spivack et al., 1976; Elias and Weissberg, 1989; Kazdin, 1996). However, like with the anger-coping intervention programs, problem-solving skills training is less effective with early-onset or more severe forms of conduct disorder (Short and Shapiro, 1993; Kazdin, 1996). Treatment effects also tend to erode over time (Kendall, 1987; Lochman, 1992).

Attribution retraining
Attribution retraining is primarily targeted at remedying cognitive distortions in children and adolescents with conduct disorder (e.g., inaccurate attribution of hostile intent to others). It seeks to encourage children and adolescents with conduct disorder to associate inconsistent or uninterpretable social cues by others to uncontrollable or accidental causes, and avoid inappropriate retaliatory aggression. The gist of the training is `When in doubt, act as if it was an accident', or `Give others the benefit of the doubt'.

In attribution retraining (e.g., Hudley and Friday, 1996), adolescents with conduct disorder participate in role-plays, video demonstrations and social situation analysis with peers without conduct disorders under the supervision of trained educational aides. The core of attribution retraining is encouraging participants with conduct disorders to search for, interpret and accurately categorize verbal, physical and behavioral social cues by others and to choose non-aggressive responses. Peers without conduct disorder are included in order to model non-aggressive behaviors and encourage social bonding with a non-deviant social group. The personal and social benefits of accurate perception or interpretation of socio-behavioral cues by others, and non-hostile responses are emphasized in the didactic exercises.

Attribution training was successful in reducing conduct disorder in adolescents (Hudley and Friday, 1996). There are no studies that have examined the long-term benefits of attribution retraining in adolescents with conduct disorder or its effectiveness with children.

Rational-emotive behavior therapy
Morris (1993), applied rational-emotive behavior therapy to treating conduct disorder. The goal of the treatment was to achieve reduction in trait anger and associated irrational thinking and depressed state in 12 adolescents with conduct disorders. The clients were taught how to identify awfulizing, low frustration tolerance, irrational beliefs, automatic thoughts and negative self-appraisal. The ultimate goal was to develop in participants: (a) good feelings about themselves; (b) a firm belief in the ability to succeed; (c) an appreciation of the ability to perform to one's best ability; (d) determination to achieve goals; and (d) relating to others in a tolerant and supportive way. Particular skills that were trained included goal-setting, time management, self-acceptance, self-confidence, self motivation and relationship skills. Adolescents with conduct disorder who underwent rational-emotive behavior therapy achieved the treatment goals better than a comparison sample with attention deficit hyperactivity disorder. Rational-emotive behavior therapy seemed to work best with relatively pure cases of conduct disorders rather than those adolescents with conduct disorder comorbid with other disorders. There are no studies that have examined the use of rational-emotive behavior therapy in treating conduct disorders in children.
- Mpofu, Elias and Ralph Crystal, Conduct disorder in children: challenges, and prospective cognitive behavioral treatments, Counselling Psychology Quarterly, Mar2001, Vol. 14 Issue 1, p21-32, 12p

Personal Reflection Exercise #3
The preceding section contained information about types of intervention strategies for treating conduct disordered youth. . Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Conduct Disorder

- Mohan, L., Yilanli, M., & Ray, S. (2023). Conduct Disorder. In StatPearls. StatPearls Publishing.

Peer-Reviewed Journal Article References:
Lavner, J. A., Barton, A. W., Adesogan, O., & Beach, S. R. H. (2021). Family-centered prevention buffers the effect of financial strain on parenting interactions, reducing youth conduct problems in African American families. Journal of Consulting and Clinical Psychology, 89(9), 783–791.

Porta, C. M., Bloomquist, M. L., Garcia-Huidobro, D., Gutiérrez, R., Vega, L., Balch, R., Yu, X., & Cooper, D. K. (2018). Bi-national cross-validation of an evidence-based conduct problem prevention model. Cultural Diversity and Ethnic Minority Psychology, 24(2), 231–241.

Reil, J., Lambie, I., Horwood, J., & Becroft, A. (2021). Children who offend: Why are prevention and intervention efforts to reduce persistent criminality so seldom applied? Psychology, Public Policy, and Law, 27(1), 65–78.

QUESTION 19
What types of intervention programs are suitable for conduct disordered youth? To select and enter your answer go to Test.

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