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For enquiries about The POLICY RESEARCH BUREAU's past work, email dghate@prb.org.uk. |
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Interventions for Children At Risk of Developing Anti-Social Personality Disorder - A Review
Background
This selective review considers what is known about the effectiveness of
interventions for children whose conduct disorders place them at risk
of developing persistent and intractable patterns of problem behaviour
in later life. It was commissioned by the Department of Health and the
Prime Minister's Strategy Unit to inform policy discussions preceding
publication of the Government's Action Plan on Social Exclusion (August,
2006). This lays emphasis on preventing 'deep exclusion' among a
small minority of children who run much higher risks than others of
experiencing a range of chronic social problems in adult life, including
poor physical and mental health and criminal behaviour, alongside
economic poverty.
A strong relationship exists between the presence of conduct disorder
in children and the later development of antisocial behaviour. A
wide ranging but consistent set of risk factors is implicated in the
underlying causes of problem behaviour in childhood, as are a set
of protective factors that can moderate the effects on children of
exposure to multiple risks. Knowledge of risk and protective factors
can be used to identify neighbourhoods where universal support services
are especially likely to prove effective. It can, likewise, help
identify children exposed to multiple risk factors for whom targeted
interventions (to prevent problems from escalating or reoccurring) may
be effective. Although they may be more intensive and their unit costs
proportionately high, such services can still be cost-effective given
the high social expense associated with the development of antisocial
personality disorder (ASPD). An understanding of 'what works' in
addressing risk factors and promoting protective factors, drawing on
examples of practice from successful interventions can, therefore, guide
policy and practice development in the UK.
What does the research focus on?
The Action Plan on Social Exclusion highlights Government proposals to
pilot and evaluate a number of preventive services in the fields of
parenting education, home visiting, treatment foster care and family
therapy that international research shows to be highly promising
ways of reducing children's exposure to risk. Evidence concerning
the key features, design, implementation and effectiveness of these
services provides the main focus of the review. It examines targeted
interventions that have demonstrated good results in improving behaviour
among children and young people with conduct disorders who are,
consequently, at heightened risk for ASPD as adults. These are:
All have been rigorously evaluated in their country of origin (the
United States or, in the case of Triple P Australia) but have also been
replicated - or been actively considered for piloting - in the UK. The
review also considers a sixth intervention that has also achieved
positive results in the treatment of conduct disorders and has some
history of use in the UK, Functional Family Therapy (FFT).
What does the research involve?
In considering 'what works?' the overview follows the approach to
evidence taken by the Communities that Care initiative in its 2005
Guide to Promising Approaches, which is similar to that described by
Moran, Ghate and van der Merwe in their 2004 PRB report on parenting
support programmes for the Home Office and the DfES. This asserts the
importance of basing policy and practice judgments on evaluations whose
design and methods would support conclusions that any positive outcomes
were attributable to the programme, rather than other influences. In
practice, this requires evaluations using comparison designs and
conducted as randomised controlled trials (RCTs) or 'quasi-experiments'.
The review provides a general overview of parenting programmes in an
international and UK context and 'what works' in policy and practice,
before giving a more detailed review of The Incredible Years and
Triple P whose implementation is being piloted as part of the DfES
'Respect Early Intervention Pathfinder' for children aged 8-13 at risk
of anti-social behaviour. Detailed assessments are also made of the
Nurse-Family Partnership home visiting programme (which is being piloted
in Britain with funding from the Department of Health) and Multisystemic
Therapy and Treatment Foster Care in which there is also increasing
UK Government interest. The section on Functional Family Therapy also
describes a CD-Rom version known as Parenting Wisely which has been used
in England and Wales by Youth Offending Teams and in the Republic of
Ireland.
Timescale and final products of the research
The was carried out in summer 2006 and published as a report
in PRB's "Messages" series in March 2007. Hard copies may be obtained free
of charge by contacting d.ghate@ioe.ac.uk,
or downloaded from the web here. See
Publications for
further details.
Last updated February 2008
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