Conduct Disorder

The pioneering work of Gerald Patterson, Rex Forehand, and Bob Wahler brought family management to the fore as a critical component of systematic parent-training programs. These programs often produced observable changes in parenting strategies, which, in turn, positively affected child behavior. Interventions that improve school organization and support teachers' proactive behavior management also show promise in preventing antisocial behaviors at school, which are highly relevant to CD.

In general, interventions that encourage adults to manage the family context, promote prosocial classroom norms, and foster proactive supervision of school behavior generate reductions in antisocial behavior. Reviewers of the treatment literature on CD concur that interventions emphasizing family management practices are among the most effective strategies to date (Kazdin 1993).

Intervention research also addresses the power of the peer group in contributing to CD. Random assignment studies show that treatments that combine youth into groups lead to escalations in drug use, increased problem behavior at school, and long-term negativity. In one study, assignment of high-risk children to summer camps was associated with a ten-fold increase in risk for thirty-year negative outcomes (Dishion, McCord, and Poulin 1999). Treatment strategies that combine high-risk youth run the risk of exacerbating the problem behavior, with less-supervised intervention groups being more likely to produce iatrogenic or negative effects. This finding is disturbing, given that aggregating high-risk youth into treatment groups is a frequently employed therapeutic approach. Reviews of the literature also indicate that 29 percent of reported outcome analyses yield negative effects for youth with behavior problems (Lipsey 1992). Given that most evaluations of interventions with negative effects are unpublished, this is likely an underestimate of iatrogenic treatment effects, particularly for youth with CD.