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YoungMinds, 102-108 Clerkenwell Road, London EC1M 5SA

Tel: 020 7336 8445; Fax: 020 7336 8446; Email: enquiries@youngminds.org.ukParents’ Information Service: 0800 018 2138; Website: www.youngminds.org.uk

Conduct disorder is even more damaging

than the Government realises

14 October 2002

YoungMinds’ response to the Department of Health consultation, on apossible NICE / SCIE appraisal on Parent Training programmes, fortreatment and prevention of conduct disorder

YoungMinds is the national children’s mental health charity. We bring together 24 associations of 

children’s professionals and children’s mental health professionals.

We are very much in favour of NICE looking at the clinical and cost effectiveness of parent training

as a treatment for conduct disorder. The case is well made in the Department proposal. Conductdisorder is a major problem for both the Department of Health and the Home Office, and there

seems to be sufficient evidence for making parent training programmes universally available. We

would like to amplify the potential benefits. Conduct disorders are far more damaging even thanthe proposal argues.

n  Additional potential benefits to providing parent training

Criterion 2 for decision on whether to refer to NICE for appraisal:

‘Is the technology (or appropriate use of the technology) likely to have a significant impact on

other government health-related policies?’ 

The proposal refers to benefits relating to the Department of Health and the Home Office.

However there are major benefits to a number of other government objectives:

n  Educational benefits

Those with conduct disorder are at high risk of exclusion from school. In addition to the

consequences of conduct disorders for crime, exclusion has severe educational consequences.That will remain true even in the context of Pupil Referral Units.

Even where children and young people with conduct disorders are not excluded, their educationwill suffer dramatically, since they are frequently not able to behave, be motivated and work hard.

n  Recommendations

1.  The Department of Health should consider all the potential benefits, as specified below,when considering whether to ask NICE and SCIE to appraise parent training

programmes.

2.  If NICE and SCIE are asked to appraise parent training programmes, they should alsotake into account the full range of potential benefits as discussed below.

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Conduct disorder is even more damaging-than the Government realises

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They are rarely able to achieve their potential. There would also be benefits to classmates fromreduced disruption, if conduct disorders could be reduced.

n  Employment benefits

There are also serious consequences for employment outcomes, through three main routes. Thereis continuity between anti-social behaviour in childhood and adulthood. If parents do not get the

help they need, children with conduct disorders will usually be difficult to employ in adulthood. 2They will be even less employable if they get involved with crime. Thirdly, the damage done to theyoung person’s education means he or she has fewer skills to offer employers.

n  Social benefits

Bringing up a child with a conduct disorder is very stressful. It can damage the mental health of 

other family members, both parents and children. Once adult, the young person is likely to be lesscapable as a parent himself or herself. Mental health problems are also strongly associated with

homelessness.

None of the benefits above are accounted for in the cited study by Stephen Scott, who restrictedhis analysis to those costs which are easier to estimate. For example, he estimated the crimecosts of catching, trying, and punishing young offenders. However, he did not include the damage

done by a criminal record, nor by any time in prison, to the young person’s chances of employment. He estimated the costs to social services in supporting the family, but not the costs

of the worse outcomes for that family and for the young person’s own children.

n  Current criteria for NICE work

(See Clinical guidance from the national institute for clinical excellence: Timing and selection of topics for appraisal - A discussion paper)

When the Department and NICE consider the benefits of parent training identified in criterion 2,and compare them to the costs (criterion 3), and effectiveness (criterion 1), they should take into

account a much wider range of potential benefits even than those identified in the existingproposal.

Parenting programmes are very far from universally available, so there is ample potential for NICEto ‘add value’ (criterion 4) by studying the evidence and, if proven to be clinically effective,

recommending parenting programmes.