tag:theconversation.com,2011:/uk/topics/conduct-disorder-8879/articlesConduct disorder – The Conversation2018-05-17T13:44:57Ztag:theconversation.com,2011:article/881052018-05-17T13:44:57Z2018-05-17T13:44:57ZHow living in violent communities can affect children’s antisocial behaviour<figure><img src="https://images.theconversation.com/files/218513/original/file-20180510-34024-1qoaycb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>The <a href="http://www.bbc.co.uk/news/uk-14436499">English riots</a> of August 2011 were shocking and unsettling for many who saw them, either in person or on the news. But what might the longer-term effects be? How does seeing violence and destruction on that scale affect children’s mental health – and the risk of them becoming violent themselves? </p>
<p>Although riots are an extreme form of public disorder, exposure to community violence is a common experience for many children. In the most high-risk areas – urban areas with high levels of poverty – up to <a href="https://sigmapubs.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1547-5069.2001.00167.x">90% of children</a> have been exposed to some level of community violence. </p>
<p>Community violence refers to deliberate acts of interpersonal violence committed in a neighbourhood. It might involve a chase, a physical attack or a verbal threat. It can be experienced directly by the victim, or indirectly – through witnessing an incident happening to someone else.</p>
<p>Exposure to community violence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821658/">is known to be related</a> to a range of mental health problems, such as anxiety, depression and post-traumatic stress disorder. It is also associated with an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124247/">increased risk</a> of developing antisocial behaviour and delinquency. So it seems likely that children and adolescents with “conduct disorder” are a group who are more likely than their peers to have been exposed to community violence.</p>
<p><a href="https://www.rcpsych.ac.uk/healthadvice/parentsandyoungpeople/parentscarers/behaviouralproblems.aspx">Conduct disorder</a> is a psychiatric diagnosis defined by aggressive and antisocial behaviour that harms or violates the rights of others. It has a highly negative effect on the young person – frequently leading to school dropout and educational failure – as well as on their families, teachers, and society.</p>
<p>To date, most research has included a mixture of healthy and clinically impaired children and adolescents when examining links between community violence and antisocial behaviour. So we don’t know what the strength of the association would look like if healthy children and adolescents were investigated separately from youths with conduct disorder. </p>
<p>Would we find similar effects of community violence on antisocial behaviour in a group with no pre-existing problems and in one that shows clinically significant levels of antisocial behaviour?</p>
<p>We tried to answer this question by <a href="https://www.google.com/url?hl=en&q=https://www.frontiersin.org/articles/10.3389/fnbeh.2017.00219/full&source=gmail&ust=1526127901124000&usg=AFQjCNH3OjiZc5L0FdMeZ9vfnBRG4MK84Q">investigating the impact</a> of community violence exposure on antisocial behaviour in a large sample of children and adolescents – with and without conduct disorder. </p>
<p>In total, 1,178 children and young people were included across eight European countries. Importantly, the study included children living in relatively wealthy countries, such as Switzerland or the UK, as well as less wealthy ones, such as Hungary or Greece.</p>
<p><a href="https://www.frontiersin.org/articles/10.3389/fnbeh.2017.00219/full">Our findings</a> showed that children and adolescents who experience community violence show higher levels of antisocial behaviour than young people who are not exposed to community violence. More importantly, this was true for young people with conduct disorder –but also for healthy children and adolescents. </p>
<p>So it’s not just as simple as putting conduct disorder down to the sort of neighbourhoods children are brought up in.</p>
<p>We also found that many European children and adolescents are exposed to high levels of community violence. These findings should strengthen efforts to prevent this from happening.</p>
<h2>Breaking the cycle</h2>
<p>Our study shows that community violence is a serious problem for many children and adolescents across Europe. It is an issue of great urgency.</p>
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<p>Prevention programs have been developed, which tend to target either family, school, or community factors. Family-based programs typically involve parent training. School-based programmes occur within the school setting and are aimed at both individual children and groups. </p>
<p>Community-based prevention programs involve mentoring programmes or making changes in the environment to reduce risk. For example, the Washington DC subway was designed to <a href="https://books.google.co.uk/books?id=YJqBAgAAQBAJ&pg=PT251&lpg=PT251&dq=washington+dc+subway+designed+to+avoid+loitering&source=bl&ots=sk2oEIggZk&sig=TiG69hqRxrq7N0DhCpBzUqyMt2o&hl=en&sa=X&ved=0ahUKEwjYhb_l1P3aAhVBAsAKHeYeDNcQ6AEIezAJ#v=onepage&q&f=false">make it unsuitable for crime</a>. The architects deliberately chose not to build toilets, lockers or excess seating space, to discourage people from loitering. </p>
<p><a href="https://www.researchgate.net/publication/230910508_A_Systematic_Meta-Review_of_Evaluations_of_Youth_Violence_Prevention_Programs_Common_and_Divergent_Findings_from_25years_of_Meta-Analyses_and_Systematic_Reviews">Important research</a> has also been dedicated to finding out “what works best” in terms of prevention strategies. </p>
<p>Positive effects have been achieved through parent training and school-based interventions. There has been less work looking into community based approaches, but so far it suggests that environmental crime prevention strategies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660218/">can also work</a>. It makes sense that the greatest impact would be achieved by implementing prevention strategies in all three areas (family, school, community) to break the cycle of violence exposure and later perpetration. </p>
<p>Priority should now be given to implementing targeted programs in neighbourhoods with higher rates of violence – rather than universal ones which target all children and communities regardless of risk.</p>
<p>We hope that drawing attention to the high rates of community violence exposure amongst children and its damaging effects will trigger changes in governmental policy – which are urgently needed by young people and their communities.</p><img src="https://counter.theconversation.com/content/88105/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graeme Fairchild has received funding from the European Commission, the UK Medical Research Council, the Economic and Social Research Council, the Waterloo Foundation, the Mexican Council for Science and Technology (CONACYT) and the charity Kids Company. </span></em></p><p class="fine-print"><em><span>Christina Stadler has received funding from the European Commission, the Swiss National Foundation and the Foundation of the Psychiatric Hospital of the University of Basel
</span></em></p>Young people need more protection while they’re growing up.Graeme Fairchild, Reader in Developmental Psychopathology, University of BathChristina Stadler, Professor of Developmental Psychopathology, University of BaselLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/611102016-06-17T16:58:04Z2016-06-17T16:58:04ZAntisocial behaviour – it’s all in the brain<figure><img src="https://images.theconversation.com/files/126944/original/image-20160616-15117-ifl1rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=M-XHZCuE_D165T-07XrI8g&searchterm=vandalism&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=323615651">VeronikaChe/Shutterstock.com</a></span></figcaption></figure><p>For many years, scientists have believed that there is a connection between severe antisocial behaviour and abnormal brain development. But there has been very little research testing this idea. </p>
<p>In <a href="http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12581/abstract">a recent study</a>, we used MRI to study the brains of teenagers diagnosed with <a href="http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Conduct-Disorder-033.aspx">conduct disorder</a>, a psychiatric disorder involving severe antisocial behaviour and aggression. Our results suggest that the brain develops differently in young people with conduct disorder compared with young people without behaviour problems. They also provide further evidence that conduct disorder is a real psychiatric disorder and not, as some experts claim, an exaggerated form of teenage rebellion. </p>
<p>We scanned the brains of 58 young people (aged 16 to 21) with conduct disorder and 25 healthy controls in the same age range. We used the scans to measure the thickness of 68 different parts of the outer layer of the brain (the cortex) – <a href="https://en.wikipedia.org/wiki/Cerebral_cortex">which plays a role</a> in areas such as awareness, perception, attention, memory and language among other things. We then measured the degree of similarity between these different regions of the cortex. </p>
<p>This measure of similarity tells us something about whether different areas of the cortex develop at similar rates (suggesting that they “grow together” – which might indicate that they work together and are functionally connected) or alternatively, whether they develop at very different rates (which would suggest that they have different functions). We expected to find that the young people with conduct disorder would show the latter, so less similarity between the thickness of different parts of the cortex than the healthy controls. </p>
<p>We were surprised by the results. They showed clear differences between young people whose behaviour problems started early in life and those whose behaviour problems started in the teenage years. Although both groups differed from healthy controls. </p>
<p>We found that different parts of the cortex were much more similar to each other in terms of thickness in the teenagers who had developed behaviour problems early in life compared with healthy controls. This suggests that brain development proceeds in a more synchronised way in children with early-starting behaviour problems. It could mean that their brains are less specialised, whereas in typically developing children, parts of the cortex that are close to each other develop at similar rates while others that are further away from each other, or that have different functions, develop at different rates – meaning their brains are more specialised into different networks with different functions. But we don’t know how specialism specifically relates to antisocial behaviour.</p>
<p>This pattern of increased similarity between different parts of the cortex in teenagers with early behavioural problems could be explained by delays in the development of regions that normally develop early in childhood. Or it could be because the development of regions that normally mature later happens earlier in life. </p>
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<img alt="" src="https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126945/original/image-20160616-15101-9z6plt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Researchers found widespread changes across virtually the entire outer layer of the brain.</span>
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<p>Another thing that surprised us was the extent of the structural changes. Rather than finding differences between the groups (antisocial versus healthy controls) in very specific parts of the brain that have previously been linked to antisocial behaviour – such as the frontal cortex – we found widespread changes across virtually the whole cortex. </p>
<p>However, we also found a very different pattern of changes in thickness in the teenagers who had developed behaviour problems in adolescence (the “late starters”). Different parts of their cortex were even less similar to each other compared with the typically developing teenagers. Again, this was a widespread pattern affecting many different parts of the brain, rather than just one or two specific regions. This finding might reflect changes in brain development that occur specifically during adolescence. For example, brain regions that normally develop in late childhood or adolescence might develop more slowly in this group compared with healthy controls.</p>
<h2>Opening new avenues</h2>
<p>These results provide some of the strongest evidence to date that abnormalities in brain development may contribute to the development of serious antisocial behaviour in childhood or the teenage years. They also suggest that there are important differences in brain structure between those who develop behaviour problems early in life and those who go “off the rails” in their teenage years. </p>
<p>Studies that track changes in brain development and antisocial behaviour over time are needed to study whether the person’s behaviour improves if the development of their brain becomes more normal. They also need to examine whether the person’s behaviour becomes worse if the development of their brain becomes more abnormal. And the method that we used to study the “wiring map” of the brain could also be used in the future to study the impact of psychological or drug therapies, or early interventions, targeting high risk children – such as the younger siblings of young offenders – before they develop serious behaviour problems. </p>
<p>It will also be important to examine whether the changes we see in the brains of teenagers with behaviour problems are caused by environmental risk factors, such as abuse, neglect, or mothers smoking or using alcohol in pregnancy, or whether they are partly caused by genetic differences between those with behaviour problems and typically developing teenagers.</p><img src="https://counter.theconversation.com/content/61110/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graeme Fairchild has received funding from the Wellcome Trust, the Medical Research Council, and the European Commission. </span></em></p>Conduct disorder is not just teen rebellion, as some experts claim. Brain scans suggest that it’s a psychiatric disorder.Graeme Fairchild, Associate professor, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/341412015-01-07T19:26:58Z2015-01-07T19:26:58ZThe eyes have it: changing kids’ minds about bad behaviour<figure><img src="https://images.theconversation.com/files/67197/original/image-20141215-6057-w65ci5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Conduct problems in childhood are the most common precursor to a variety of disorders affecting mental and physical health in adulthood.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/expose_switch/4566783151">Sergio Vassio Photography/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Aggression and oppositional behaviour in childhood doesn’t just make short-term problems for children, their friends and families. It also places kids at risk of long-term issues with mental and physical health. And while there are some effective treatments around, not all children respond to them. Now, neuroscience is helping guide better treatment. </p>
<p>Temper tantrums, breaking rules, playground fights, or just seeming to delight in annoying other people – most children will show one or more of these behaviours at least occasionally while growing up. And some level of contrariness might even be a sign of healthy development. </p>
<p>But, for some children, such behaviour can escalate into more persistent patterns of violating other people’s rights and hurting their feelings. This creates significant problems for both the child and the people around them. </p>
<p>Being consistently oppositional towards the world, or more overt actions such as aggression, theft, and destruction of property, are collectively referred to in the field of child and adolescent mental health as disruptive behaviours or conduct problems. </p>
<p>Beyond their immediate consequences, conduct problems in childhood are the most common precursor to a variety of disorders affecting mental and physical health, as well as social function, in adulthood. So intervening early in conduct problems is important both in the short term and to prevent longer-term issues as children mature.</p>
<p>But effective interventions depend on understanding what causes aggression and other conduct problems in the first place. Why do some children seem angry all the time, or act as if they just don’t care about the feelings of others? </p>
<p>As frustrating as this kind of behaviour is, and tempting as it might be to just try to stop it with punishment, many parents find that just doesn’t work. What appears to work better is designing interventions based on understanding how a given child’s emotions or ways of thinking might be contributing to the way they’re acting. And how family or other communities might be interacting with the child to elicit such behaviour. </p>
<h2>Different conduct problems</h2>
<p>Not all children with conduct problems are alike. <a href="http://bjp.rcpsych.org/content/200/3/177.long">Developmental psychology</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24105343">cognitive neuroscience</a> studies suggest such aggressive behaviour may be of at least two distinct types. </p>
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<span class="caption">Consistently having temper tantrums, breaking rules, and playground fights are some of the symptoms of conduct problems.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/22326055@N06/8378024526">Philip Howard/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>The more common type is associated with the fight-or-flight response, which is the set of emotional and physiological reactions people (as well as animals) have in response to feeling threatened. It may include the release of hormones such as adrenaline and cortisol, faster heart rate, and blood flow being directed to the muscles to prepare for action. </p>
<p>Since it’s important to respond to danger quickly, these reactions often start before the person has a chance to determine whether something is actually a threat. And once the response is underway, you have to exert self-control to stop and think. If you find this difficult for some reason, then there’s greater risk of inappropriate behaviour. </p>
<p>This is the child with an explosive temper who impulsively does something harmful often because he or she feels threatened, but who feels quite remorseful afterwards. Beneath the bravado, many of these children suffer from significant anxiety, which contributes to their tendency to interpret other people as being hostile, and reacting accordingly. </p>
<p>Most existing treatments for conduct problems work well for this group, especially if intervention takes place early. But the second type of conduct problems is more challenging. </p>
<p>These children use aggression to get something they want in a more callous way. Instead of high levels of anxiety, they may show less emotional reaction to experiences most people would find distressing. Other people’s feelings seem to just not matter to these kids and now neuroscience is helping explain why. </p>
<p><a href="http://link.springer.com/article/10.1007%2Fs11920-009-0086-x">Brain imaging studies</a> show their amygdala (the brain region that normally increases activity in response to a potential threat) doesn’t display the expected reactivity. <a href="http://rstb.royalsocietypublishing.org/content/363/1503/2519.long">Studies in twins</a> have suggested that while the hyper-aroused type of aggression is often associated with external risks, such as growing up in an unsafe environment, this second type appears more strongly genetic. </p>
<h2>Seeing other people’s feelings</h2>
<p>So what might cause this kind of behaviour? One <a href="http://bjp.rcpsych.org/content/200/3/191.long">clue comes from research</a> suggesting part of the answer may lie in the neural systems underpinning attention. </p>
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<img alt="" src="https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67203/original/image-20141215-6051-1xnbjvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Children with the callous type of conduct problems are known to not pay attention to other people’s eyes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/adselwood/4510703986">Adam Selwood/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Children in the second group have been found to often have difficulty recognising when other people look fearful. This failure has been linked to them paying less attention to other people’s eyes, the part of the face that reveals the most about what someone is feeling. </p>
<p>When the children were directed by researchers to look at other people’s eyes, their ability to recognise fear improved. This suggests improving attention to emotional cues may play a helpful in their treatment. </p>
<p>What isn’t known, though, is whether redirecting their attention will result in a more normal response in the relevant brain regions. Whether the amygdala is able to respond when the right cues are being seen. </p>
<p>My colleagues and I are using functional neuroimaging to study the effects on brain activity of changing what children with conduct problems pay attention to. Working with kids displaying callous types of aggression, we’re trying to find out if refocussing their attention normalises response in areas of their brain related to emotional activity. </p>
<p>We also want to know whether the same intervention in the children with more reactive aggression might have the negative effect of over-stimulating an already aroused fight-or-flight system. </p>
<p>Better understanding the differences between children with conduct problems is an essential step in making sure they receive the right treatment. It will help kids and their families decrease problem behaviours, and hopefully prevent some of the long-term issues that arise in the absence of timely intervention.</p><img src="https://counter.theconversation.com/content/34141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhoshel K. Lenroot receives funding from Australian Rotary Health, Perpetual Philanthropic Services, Beyond Blue, the National Health and Medical Research Council, the Australian Research Council, and the Stanley Medical Research Foundation. She is affiliated with the Royal Australian and New Zealand College of Psychiatry, the Australian Medical Association, the Australian Neuroscience Society, the Australasian Society for Autism Research, the Society for Neuroscience, and the Society for Mental Health Research.</span></em></p>Aggression and oppositional behaviour in childhood doesn’t just make short-term problems for children, their friends and families. It also places kids at risk of long-term issues with mental and physical…Rhoshel K. Lenroot, Professor of Infant, Child and Adolescent Psychiatry, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/223892014-02-06T03:42:30Z2014-02-06T03:42:30ZABC TV’s ‘Kids on Speed?’ shows drugs are not the answer<figure><img src="https://images.theconversation.com/files/40847/original/6ys4d9vb-1391648710.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The series is an excellent demonstration of real-world challenges facing families and practitioners.</span> <span class="attribution"><span class="source">ABC TV Publicity</span></span></figcaption></figure><p>The new three-part documentary starting on ABC1 at 8:30 tonight, “Kids on Speed?” is timely given attention deficit hyperactivity disorder is <a href="http://www.bmj.com/content/347/bmj.f6172.pdf%2Bhtml">attracting controversy</a> because of growing evidence it’s <a href="https://theconversation.com/moving-the-diagnostic-goalposts-medicalising-adhd-8675">overdiagnosed</a>.</p>
<p>The show highlights the importance of a multidisciplinary approach (psychology, medicine, and education) for effective intervention and the need for treatments to be based on evidence. </p>
<h2>Starting at the wrong end</h2>
<p>A <a href="https://www.mja.com.au/journal/2011/194/8/children-attending-paediatricians-study-national-prospective-audit-outpatient?0=ip_login_no_cache%3Dc1bcc605af4397f80d4b8be7b33e8d2d">recent Australian study</a> found one in five consultations to paediatricians was for attention deficit hyperactivity disorder, with an average diagnostic consultation time of 48 minutes. </p>
<p>That doesn’t seem like enough time to comply with the National Health and Medical Research Council’s new <a href="http://www.nhmrc.gov.au/guidelines/publications/mh26">Clinical Practice Points on the Diagnosis, Assessment and Management of ADHD in Children and Adolescents</a>.</p>
<p>The assessment period in “Kids on Speed?” is much longer but, unfortunately, experts here also make their diagnoses before treatment begins. Assessment is essential before any treatment can commence, but does a diagnosis need to happen in the first few weeks? As the show aptly demonstrates, diagnoses change when there’s more information.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/40846/original/f83wn6g7-1391648461.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The behaviours of the children in ‘Kids on Speed?’ are extreme and represent a spectrum of conduct problems.</span>
<span class="attribution"><span class="source">ABC Publicity</span></span>
</figcaption>
</figure>
<p>Does it matter if kids with extremely challenging behaviours are given a diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder, before they and their parents get help? </p>
<p>In the words of two mothers from the series, they have been on the “medico roundabout” for many years. Why is a label important when diagnoses are based on longer-term observation, vary between practitioners and over time, and treatment can begin after an assessment?</p>
<h2>The right option</h2>
<p>The behaviours of the children seen in “Kids on Speed?” are extreme and represent a spectrum of conduct problems. Luckily, there are effective, evidence-based interventions for these problems although the first line of treatment (medication or psychological intervention) is often debated.</p>
<p>Both have shown effectiveness <a href="http://www.ncbi.nlm.nih.gov/pubmed/22336837">in the short</a> and <a href="http://www.sciencedirect.com/science/article/pii/S0890856709600666">medium term</a> for symptom reduction. And for children with conduct problems like the ones in “Kids on Speed?”, there’s evidence that a group of psychological interventions called parent management training is <a href="http://www.ncbi.nlm.nih.gov/pubmed/22336837">also effective</a>. </p>
<p>But when a child is given a diagnosis of attention deficit hyperactivity disorder (usually with conduct problems as symptoms), what generally follows is <a href="http://www.sciencedirect.com/science/article/pii/S1876285912000046">medication (principally psychostimulants)</a> rather than psychological intervention. The drugs are either given as the first line of treatment or as a “trial” to see if they help the child’s behaviour. </p>
<p>While medications can be beneficial in the short term, they can also have <a href="http://online.liebertpub.com/doi/abs/10.1089/cap.2012.0003?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&">harmful side effects</a>, and don’t address potential social deficits or provide skills to manage challenging behaviours. </p>
<p>And there are no medications specifically for the symptoms of oppositional defiant disorder, or conduct disorder (other disorders with conduct problem symptoms).</p>
<h2>Challenges for changing behaviour</h2>
<p>Appropriately, the psychological interventions in “Kids on Speed?” are based on evidence. The psychologist uses parent-training approaches grounded in social learning theory and attachment theory that have been trialled in many rigorous research studies. </p>
<p>Social learning theory emphasises how parents shape a child’s behaviour through reinforcement. If a child gets a lot of attention for misbehaviour (being noticed through discipline), for instance, but nothing when behaving appropriately (such as playing quietly), then she learns that behaving appropriately isn’t going to get any attention. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/BwCrsYjlntw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Social learning theory emphasises how parents shape a child’s behaviour through reinforcement.</span></figcaption>
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<p>Attachment theory suggests parental sensitivity to the child’s needs and the development of the parent-child relationship form important foundations for early (and later) development. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/kwxjfuPlArY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Attachment theory emphasises the parent-child relationship.</span></figcaption>
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<p>These are the components of successful parent management training interventions such as <a href="http://www.triplep.net/glo-en/home/">Triple P</a>, [Parent-Child Interaction Therapy](http://www.pcit.org/](http://www.pcit.org/), and <a href="http://incredibleyears.com/">The Incredible Years</a>. </p>
<p>When you combine a psychologist who uses an evidence-based intervention and parents who are willing to go the distance, positive changes in child behaviour are the usual outcome. But maintaining changes are more difficult because old habits return easily.</p>
<p>The experts agree some of the children on the show require medication to reduce their symptoms so therapeutic strategies (both psychological and educative) get a chance to take effect. </p>
<p>But all the children require intensive parent management training intervention; medication alone isn’t enough. Medication reduces symptoms for some but it doesn’t increase social competencies, family functioning, or academic achievement. </p>
<h2>A better way</h2>
<p>The series aptly demonstrates the challenges parents face when trying to implement evidence-based parenting strategies. As one of the mother’s astutely observes:</p>
<blockquote>
<p>Drugs are easy, take a pill and away we go. This is a lot harder because this is retraining us.</p>
</blockquote>
<p>It is difficult to get timely services for children with behaviour problems and their parents. Government and non-government services have long waiting times and private practitioners (medical, psychological, or educational) are expensive. Also sadly, evidence-based treatments such as the ones utilised on “Kids on Speed?” are not widely used. </p>
<p><a href="http://cmx.sagepub.com/content/17/1/11.short">Surveys from the United States</a> of professionals working in child welfare reveal a widespread lack of knowledge and use of evidence-based interventions. And <a href="http://link.springer.com/article/10.1007/s10488-013-0471-y#page-1">local research suggests</a> the situation is similar in Australia. Parents should expect and demand more.</p>
<p>I have worked as a psychologist with families very much like those in “Kids on Speed?” for over 20 years. This series is an excellent demonstration of real-world challenges for practitioners and families in implementing theory-driven strategies. </p>
<p>We have accumulated a lot of knowledge about effective evidence-based treatments but they are not as widely used as they should be. I admire the families in the show for allowing their difficult journey to be filmed.</p><img src="https://counter.theconversation.com/content/22389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rae Thomas has previously received funding from Queensland Department of Child Safety to implement Parent-Child Interaction Therapy.</span></em></p>The new three-part documentary starting on ABC1 at 8:30 tonight, “Kids on Speed?” is timely given attention deficit hyperactivity disorder is attracting controversy because of growing evidence it’s overdiagnosed…Rae Thomas, Research Fellow, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.