Question Oppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders?
Study selection and analysis We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty-seven RCTs met inclusion criteria—evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis.
Findings For prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events.
Conclusions Considerable RCT evidence favours prevention.
Clinical implications Effective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings.
- public health
- preventive medicine
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Contributors CW developed the idea for the review and wrote the manuscript. CS extracted relevant data, interpreted the data and contributed to the manuscript. CA and JLB conducted the literature searches, extracted relevant data and contributed to the manuscript. DY extracted relevant data and contributed to the manuscript. All authors approved the final version.
Funding This work was supported by the Canada Research Chairs Program (grant number 950-228413, dated 1 March 2013) and by the British Columbia Ministry of Children and Family Development (grant number SL00444S01, dated 11 April 2011, modified 30 December 2015).
Competing interests CW is coleading a randomised controlled trial on Nurse-Family Partnership, one of the interventions is discussed in this systematic review.
Provenance and peer review Not commissioned; externally peer reviewed.
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