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Family/parenting interventions for delinquency

Systematic review
Results
Comment

Repetitive and persistent antisocial behaviour in adolescents is probably familiar to all of us. Technically it is called conduct disorder, and affects between 1 and 3% (though it often seems much more common than that). Delinquency is a special category of this where children break the law. About 2% of children and adolescents enter the juvenile justice system each year, and a minority persist and account for a large amount of police and court time. A new systematic review tells us that family and parenting interventions can make a difference [1].

Systematic review


The review had a heroic search strategy looking at many databases and contacting experts. Included were randomised trials of family and/or parenting interventions for children or adolescents aged 10-17 with conduct disorder and/or delinquency. Conduct disorder was assessed by a standardised psychological checklist or psychiatric diagnosis. Delinquency was defined as referral to a justice system or similar for a serious crime (eg assault) and re-offending on at least two occasions. Sex and drug offences were excluded, as these are unlikely to be wholly related to conduct disorder. Only objective or validated outcomes were used.

Results


Eight trials were found with 749 children. Seven of the trials were blind and follow up was good. The follow up period varied between two months and four years. Interventions were usually quite intensive and the control was predominantly usual care. There was a predominance of boys in most studies, and two were 100% male.

Four studies (Figure 1) had information on days spent in an institution (prison, detention, community treatment centre). In each of these the average number of days was lower for the family and parenting intervention, with a weighted mean difference of 51 days and high statistical significance.

Figure 1: Average institutional days in delinquent adolescents with family and parenting intervention or usual care



Five studies reported the number of delinquents who had been re-arrested during follow up. Family and parenting reduced the risk of re-arrest in four of the five studies (Figure 2). With usual care the re-arrest rate was 65% and with family and/or parenting interventions it was 37%. The relative risk was 0.66 (95% confidence interval 0.44 to 0.98) and the number needed to treat to prevent one adolescent delinquent being re-arrested was 3.7 (2.8 to 5.4). Higher quality studies gave a lower (better) NNT of 2.7.

Figure 2: Re-arrest rates in delinquent adolescents with family and parenting intervention or usual care



The rate of subsequent arrests over one to three years was reported in five trials, with an average of nearly one fewer arrest in the treated group. Other outcomes were reported in few studies.

Comment


Most of us are lucky enough not to face these problems with adolescent children. The evidence here is that family and parenting interventions can help. There are hints that it may also benefit siblings. This is a bit outside drugs and surgery, but social issues affect health and wellbeing, and there are times when we need to know what to do to help.

References:

  1. SR Woolfenden et al. Family and parenting interventions for conduct disorder and delinquency: a meta-analysis of randomised controlled trials. Archives of Diseases in Childhood 2002 86: 251-256.
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