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A STUDY OF THE EFFICACY OF UTILIZING EVIDENCE-BASED MODELS IN THE TREATMENT OF CONDUCT DISORDERS

CHAPTER FIVE

DISCUSSION OF THE FINDINGS

Conduct Disorder (CD) has significant long-term adverse effects like unstable relationships, mental health issues, and risk of criminality that affect the individual and the society in general (Frick, 2012). Therefore, healthcare practitioners have a momentous task of identifying and preventing CD through referring to efficacious intervention of evidence-based practices for CD in young children and adolescents (Bakker et al., 2017). The psychosocial therapies have emerged as the most common intervention techniques among the treatments developed in the last two decades for CD (Golmaryami et al., 2013). It is based on this premise that Fairchild et al. (2019) emphasizes the need to evaluate the current techniques of treatment of CD in order to equip healthcare practitioners and other stakeholders with updated information to incorporate in their decision-making processes in relation to treatment. Current reviews and guidelines describing the effectiveness of CD treatments differ in terms of their methods, scope, and conclusions and hence none is considered definitive (Gatti et al., 2019), while other are noted to be of low quality (Weisman & Montgomery, 2019).

Therefore, the purpose of this study was to evaluate the most effective treatment for conduct disorder among young children and adolescents, as well as to consolidate findings from empirical studies examining the efficacy of these evidence-based treatments for conduct disorder in order to build on the empirical knowledge of the treatment of conduct disorder by providing evidence for the efficacy of specific treatment for conduct problems. To achieve this objective, several research questions were developed to act as a guide. Firstly, what are the current (2016-2020) psychosocial evidence-based interventions and empirical support for conduct disorder in adolescents and young children? Secondly, how effective are the psychosocial treatment techniques in addressing the needs of the young children and adolescents and that of their families effectively, using elements of the Child Behavior Checklist as a measure? And thirdly, how do treatment factors (i.e., number of sessions, settings, modality, and dropout rates) impact treatment efficacy?

This study was guided by the social learning theory, which indicates that children learn from observation. SLT has four elements, namely; attention, retention, reproduction, and motivation (Bandura & Hall, 2018). The theory offers a basis for students to retain more information than merely studying educational material and allows individuals to learn new behavioral patterns (Horsburgh & Ippolito, 2018). Participants in live settings should be given opportunities to learn through hands-on experience since social learning motivates individuals to observe the behavior of their instructors and peers and apply this experience to model the desired behavioral pattern (Nicholson & Higgins, 2017). In this study, social learning theory was vital due to its applicability to a wide range of situations. In particular, Bandura’s social learning theory was the most preferred because it explains how to model the behaviors of both children and adults. The social learning theory also helps explain how peer influences among adolescents are related to aggression.

To adequately respond to these research questions, a comprehensive review of literature in the recent past (2016 – 2022) with empirical evidence of psychosocial interventions for CD was conducted. The literature search was guided by a list of preset criteria that the articles had special population group as adolescents and young children aged between 3 to 18 years, inclusive, evidence-based interventions for conduct problems in which healthcare practitioners and families with adolescents and young children were key figures, and studies reporting findings for psychosocial evidence-based interventions in promoting well-being or decreasing symptoms. In addition, the studies needed to have used some form of child behavior checklist in assessing CD.

From the literature search, 13 published papers were included in the final round and used to inform this research study. Two of the 13 papers focused on the child-based interventions, 5 of the 13 papers focused on the parents-based interventions, 3 of the 13 studies focused on family-based interventions, while the other 3 of the 13 papers focused on multi-component interventions. The studies collectively covered a total of 4,132 participants ranging from children aged between approximately 3 to 18 years and/or their parents, families, and professional practitioners. The approaches covered in the studies had an intervention period ranging from 70 days to 24 months and all used some form of checklist with similarities to the CBCL to assess CD at at-least two time points, pre-intervention, post intervention and for some sometime after intervention. All the 13 papers contributed to all the three research questions in the study.

In general, this chapter provides an in-depth discussion of the findings provided in the previous chapter. The chapter begins with a discussion of the findings guided by the research questions and refereeing to other evidence in literature in an attempt to adequately answer the research questions. The chapter also includes a discussion on the implications for both professional practice and research before concluding the study.

Discussion of Finding

This section discusses the findings for every research question with connection to reference in

Literature.

Research Question One

RQ1: What are the current (2016-2022) psychosocial evidence-based interventions and empirical support for conduct disorder in adolescents and young children?

There are many evidence-based approaches identified in literature for treating and alleviating symptoms of conduct disorder. However, from the 13 articles included in this review, a number of interventions were identified that can be classified into four major categories namely, child-focused, parents-focused, family-focused, and multicomponent interventions. This classification resonates with other reviews in literature. For example, Ward (2021) conducted a systematic review of evidence-based treatments for conduct disorder and anchors the approach to four evidence-based treatments: Parent-Child Interaction Therapy (PCIT), Multisystem Therapy (MST), Problem-Solving Skills Training (PSST), and Parent Management Training (PMT). These four classifications correspond to each of the four categories identified in this systematic review. Gatti et al. (2019) on the other hand had a similar classification of child-focused, parents-focused, family-focused, and multicomponent interventions.

Two studies were identified that met the inclusion criteria whose analyzed approaches were considered as child focused. Kyranides et al. (2018) assessed the efficiency of a school-based Problem-Solving Skills Training (PSST) developed using the aspects of the Cognitive Behavioral Therapy (CBT). Goertz-Dorten et al. (2019b) assessed the efficiency of computer-assisted social competence training for children with aggressive behavior (ScouT). The two approaches covered children aged 7 – 9 years and 6 – 12 years respectively. The child-focused interventions emphasize on building the child’s capacity to recognize stimuli associated with antisocial and aggressive behavior, to face cognitive distortions, to improve their problem-solving abilities, and to cope with frustrations and anger and in turn reduce behaviors associated with conduct disorder (Carr, 2019; Gatti et al., 2019).

Five studies were identified that met the inclusion criteria whose analyzed approaches were considered as parent focused. Mills et al. (2018) studied the efficiency of Parent Management Training (PMT), particularly, Behavioral Parenting Training (BPT). Ward et al. (2020) studied Parenting for Lifelong Health (PLH) while Scavenius et al. (2020) compared a BPT called Parent Management Training — Oregon model (PMTO) against a Family-based Services as Usual (SAU) intervention. Lewis et al. (2020) studied the efficiency of the Positive Parenting Program or Triple Ps while Dadds et al. (2019) compared Face to face (FTF) versus online delivered/ Electronic Intervention (EI) interventions focusing on the parenting approaches. The parent-focused programs are approaches that focus more on parents and employs operant conditioning to change parent behavior, child functioning, and parent-child interactions, based on the attribution of conduct disorder to dysfunctional parent–child interactions or relationships (Mills et al., 2018). The parent-based programs for prevention and treatment of conduct disorders are designed to improve parents’ skills in managing behavior and the standard of the parent–child relationship. The interventions can be behavioral or relationship where behavioral approaches focus on enabling parents and guardians to learn skills necessary to address the underlying reasons for problem behaviors while relationship is created to help parents understand both their own and their child’s emotions and behavior and thus enhance their communication and issues resolution (Gatti et al., 2019).

Four studies were identified that met the inclusion criteria whose analyzed approaches were considered as family focused. One used as control in parent-focused intervention. Vidal and Connell (2019) compared five approaches namely, Parent Management Training, Brief Strategic Family Therapy, Parent-Child Interaction Therapy (PCIT), parenting with Love and Limits, and Treatment As Usual (TAU). Abrahamse et al. (2016) compared PCIT and Family Creative Therapy (FCT) while Chacko et al. (2016) compared the efficiency of the modified approaches Multiple family group (MFG) MFG plus MY MFG treatment. Scavenius et al. (2020) used the Family-based Services as Usual (SAU) as a control to compare to PMTO. For what concerns intervention on the family, family therapy scholars have abstracted child conduct problems not as the result of cognitive deficits in the child or incompetent parenting practices but, instead, as the result of maladaptive interactions and dynamics in the family (Gatti et al., 2019). Therefore, family-based approaches cover parents, guardians, and siblings to collectively shape the behavior of a child with conduct disorder to alleviate and eliminate its symptoms through collective family effort in relationship and interaction.

Three studies were identified that met the inclusion criteria whose analyzed approaches were considered as multimodal or multi-component approaches. Goertz-Dorten et al. (2019) and Gudice et al. (2022) assessed the efficacy of Treatment Program for Children with Aggressive Behavior (THAV). August et al. (2016) assessed the efficacy of different Adaptive Treatment Strategies (ATS) – Youth only, youth then parent, parent only, parent then youth ATS. This approach integrates elements of more than one approaches that target various intervention aspects like individual, parent, family, peer, and school.

However, it is important to note that there were some interventions that could have been classified differently. While the theme classifies the interventions according to the subject that the technique focuses on, others focus on other issues like the location or setting/ environment and mode of delivery. These were still classified by whom the approach focuses on. For example, Goertz-Dorten et al. (2019) focuses on individualized competence training for the child, which can still be categorized as child-focus, but the emphasis of the study was developing an individualized program. A different study focused on an individualized training program for the child using technology to complement the program’s strategies (Goertz-Dorten et al. (2019b). This individualized computer-assisted program also focused on the child and was classified as a child-focused approach although the real focus of the study was inclusion of technology to prepare individualized programs. Kyranides et al. (2018) on their research investigated a school-based training program and it could be argued that the study compared school-based and home-based interventions. However, the approach was centered around the child with conduct disorder and was classified as such. A different study by Dadds et al. (2019) compared Face to face (FTF) versus online delivered/ Electronic Intervention (EI) interventions but was classified as parent-focused since it used parent-based approaches as the basis for comparison.

Generally, the interventions have been classified differently by different authors. However, the majority of the authors classify the interventions to align with the individual that the intervention focuses on. The classification can be child, parent, family, or a combination of two or more. Some authors have also classified the interventions according to location where the approach is executed, home or school based interventions. Other authors have classified the approaches according to the characteristics of the intervention like individualized competence training and electronic interventions. Therefore, the classifications can be according to the focus, which can be the individual, the location where approach is executed, or characteristics of the approach.

Research Question Two

RQ2: How effective are psychosocial treatment techniques in addressing the needs of the young children and adolescents and that of their families effectively, using elements of the Child Behavior Checklist as a measure?

All the approaches included in the 13 articles identified through the inclusion criteria for this study indicate that the evidence-based models are effective in the treatment of conduct disorders. This is evident from the dominant theme of declining-recorded observed symptoms of conduct disorders from the respective conduct disorder measures in the various studies. Considering pre-treatment, post-treatment, and at follow-up on a time series display, the graph trends downwards for all the approaches in the different studies. The only notable difference is the effect size, or the percentage change realized on a difference in difference basis. This result resonates with evidence in literature.

For example, Ward (2021) conducted a review of the efficacy of evidence-based interventions for treating conduct disorders focusing on four approaches: Parent-Child Interaction Therapy (PCIT), Multisystemic Therapy (MST), Problem-Solving Skills Training (PSST), and Parent Management Training (PMT). The results indicated that all the four approaches were efficacious in the treatment of conduct disorders (Ward, 2021). These four categories have been shown in the first research question to be analogous to the classification identified as the dominant theme in the first research question. In a different review on the efficacy of parent-based interventions by Mingebach et al. (2018), the results indicated significant and moderate effects of parent-based interventions on child behavior that are stable over time by means of reducing child problem behavior overall and externalizing child behavior in particular.

Therefore, the current (2016-2022) psychosocial evidence-based interventions and empirical support for conduct disorder in adolescents and young children are effective but only differ in the magnitude of efficiency. Mingebach et al. (2018) established that there is a great variability in the current literature regarding the effectiveness of parent-based interventions, ranging from small to large effects. In this review, despite all having significant reductions, the treatments had a high of 69% reduction in the observed symptoms of child conduct disorder and a low of 11% reduction between pre-treatment and follow up after treatment. Comparing pre-treatment and immediately post-treatment, the treatments resulted in up to a high of 80% and a low of 4% reduction in the observed symptoms of child conduct disorder. Comparing immediately post-treatment and follow up time, the treatments resulted in as high as 32% reduction and a low of 100% increase in the observed symptoms of child conduct disorder. On average, the treatments resulted in a reduction of the observed symptoms of child conduct disorder of 43%, 20%, and 48% with standard deviations of 23%, 70%, and 29% between pre-treatment and immediately post-treatment, immediately post-treatment and follow up after treatment, and pre-treatment and follow up after treatment respectively. The high variability indicated by the relatively high values of the standard deviations with respect to the means (coefficients of variation of 53%, 92%, and 61%) is testament of how variable the effect size of the treatment is in reducing the observed symptoms of child conduct disorder. Comment by Haussmann, Bob: Double check these stats–the SD’s seem really high (70% on a mean of 20%). It’s possible they are right but that would lead me to question the power of the study based on the variability in means. Comment by Haussmann, Bob: This doesn’t really say anything. I think you are trying to address my concern above, but you seem to be treating the high variability as a good thing, not negative.

Another interesting observation with respect to variation in effect size relates to the difference across studies for the same interventions. For example, PMT had an 80% reduction in the observed symptoms of child conduct disorder in one study (Mills et al., 2018) and 26% reduction in a different study (Vidal & Connell, 2019) when comparing pre-treatment and immediate post-treatment. PCIT had a 24% reduction in the observed symptoms of child conduct disorder in one study (Abrahamse et al., 2016) and 26% reduction in a different study (Vidal & Connell, 2019) when comparing pre-treatment and immediately post-treatment. Therefore, this variation indicates that there are factors that potentially contribute to an interventions’ success that are aspects of implementation.

It is important to note that the various studies included in the review did not utilize the same measure. This is a potential attribute to the aspects of variation highlighted here. It would have been ideal to compare the Child Behavior Checklist, as this would provide an ideal facilitation that does not hinder meaningful cross-study comparisons, interpretation, replication, and generalization of findings. The inconsistency in measuring and reporting child behavior needs to be addressed.

From the data on effectiveness, the biggest reduction in the observed symptoms of child conduct disorder are registered immediately after the intervention since there is only a slight drop in the value of the measures of the observed symptoms of child conduct disorder between immediately post-treatment and follow up after treatment. This observation hints at a potential fading effect of the treatments. Therefore, questions on sustainability of these approaches are necessary.

Research Question Three

RQ 3: How do treatment factors (i.e., number of sessions, settings, modality, and dropout rates) impact treatment efficacy?

As illustrated in the previous section on research question two, the identified evidence-based interventions in treatment of conduct disorders all result in significant drop in the measures of the observed symptoms of child conduct disorder but vary in their effect size within and across studies. In addition, in studies where the control was no intervention, the control did not have any significant difference with respect to the measure post-treatment while where the control was still an evidence-based intervention for treating conduct disorder in young children and adolescents, both treatment and control were significant but the difference in difference for the intervention considered as treatment in the study were significantly larger than the control difference in difference. Therefore, this implies that there are factors during implementation that significantly affect the efficacy of these approaches in treating conduct disorders in young children and adolescents. This observation is expected since the trials themselves use varying approaches in terms of the actual program implemented on the subjects. In addition, other reviews in literature covering a different time period and/or specific categories of the approaches selected for this study also hint at a similar finding; these interventions are effective but vary in effect size. Therefore, it is in the interest of stakeholders to attempt to understand what causes the variations in efficacy.

One potential cause of the differences is that while these approaches in the different studies are considered under one classification of evidence-based interventions for treating conduct disorder in young children and adolescents, some differences exists in terms of metrics definitions and program execution. For example, the concept of ‘conduct or behavioral disorder’ includes behavioral symptoms that are significantly different from one another and may require some intervention. In this regard, it should be borne in mind, for example, that aggressive behavior and theft involve very different problems, which change differently over time and are supported by different risk factors (Gatti et al., 2019). In particular, the developmental mechanisms of physical violence and theft during adolescence and adulthood are distinct and closely related to neurocognitive functioning. Indeed, important long-term studies have shown that most studies show an increase in the frequency of theft from adolescence to adulthood, while only a few shows an increasing frequency of physical violence. Moreover, neurocognitive mechanisms appear to be different, in that high performance and verbal IQ performance are negatively correlated with high frequency of physical violence but positively related to high frequency of theft (Gatti et al., 2019). However, the inclusion criteria attempted to address these concern variations in definitions and measures by including studies that used elements of the Child Behavior Check List (CBCL) in measuring conduct disorder but since studies focus varied across treatments, not all elements of the CBCL were assessed and hence the score may be misleading. For example, Goertz-Dorten et al. (2019b) only covered peer-related aggressive behavior as an indicator for conduct disorder. This makes it difficult to compare the various studies especially because very few studies have used a similar measure for conduct disorder.

Kyranides et al. (2018) indicated that one of the basic strengths of integrating the child-focused approach with a school-based environment was the fact that it was classroom-focused and school-based. Since nowadays schools are expected to do more than their resources allow them, it is important to focus on prevention efforts aiming to diminish possible negative outcomes that are costly and difficult to overcome. The school-based programs can be used as a universal approach for preventing the development of conduct disorders (Kyranides et al., 2018). Goertz-Dorten et al. (2019b) also tested an individualized approach but coupled with computer facilitation and attributes the treatment effect to the use of a computer- facilitated treatment program in contrast to a traditional therapy setting. Mills et al. (2018) attribute the success of the PMT studied to conducting a thorough diagnostic evaluation to establish relevant diagnoses for the child with conduct disorders to guide treatment. Importantly, assessment included not only the Diagnostic and Statistical Manual of Mental Disorder (DSM) diagnoses but also information on Amy’s functioning in a broad variety of settings, including parent and family functioning

In addition, there are other factors identified in the selected literature as drivers of intervention efficacy. Mingeback et al. (2018) indicated that there are hints of cost-effectiveness and positive long-term effects when using parents-based interventions compared to other approaches. Family interventions have shown greater efficacy in older youths, whereas multi-component and multimodal treatment approaches have yielded moderate effects in both childhood and adolescence. (Gatti et al., 2019). Lewis et al. (2020) indicated that the barriers to engagement preclude involvement in evidence-based treatments, which are associated with both symptom and functional improvements. That means that dropping out of program and lack of full engagement reduces the overall effect size of the intervention. Further, it emerges that the choice of intervention should be age-specific and should consider developmental differences in cognitive, behavioral, affective, and communicative abilities (Gatti et al., 2019). Parent-child focused EBPs are identified to be ideal interventions to serve as an effective remedy that is less restrictive and more conducive to healthy development of children and adolescents (Vidal & Connell, 2019).

Interventions are often more effective when associated with specific people and statistics. In addition, teens benefit more from direct treatment than from parental programs (Renk et al., 2017). Fortunately, PCIT, PSST, PMT, and MST can all be manipulated and manipulated to better serve individuals. However, deep-seated programs, such as MST, appear to be especially needed in older adults with a long history of behavioral problems that have resulted in poor parent-child relationships, requiring a parent-centered focus (Renk et al., 2017). Physicians should consider starting (children compared to adolescents) in order to better predict treatment outcomes and prognosis as well as better selection and integration of individual strategies. Physicians should also consider various age-related factors. The CD-type type of children is more frequent and is linked to disruptive and unhealthy behaviors as well as poor parent-child relationships and parenting strategies, rather than the first type of adolescents (Renk et al., 2017). The nature of adolescent onset, although not permanent, is still relevant, largely due to adolescent desire for independence and peer pressure from peers and peers that can exacerbate symptoms and contribute to treatment and diagnosis (Renk et al., 2017). With different early years, young people also have different developmental needs to consider. For example, children have high levels of confidence and low levels of independence, while adolescents are often at odds. Additional parental therapy (i.e., PCIT, PMT) is suitable for children, while individual-centered therapy (i.e., PSST, MST) is preferable for adolescents. PCIT, given its 23rd performance by ODD, may also work on a child CD, given the same age of children with two disorders (Ward, 2021).

New Knowledge Comment by Microsoft Office User: Under this heading, please add a paragraph to highlight the new knowledge that was created as a result of your study and findings.

Implications for Professional Practice

From the study findings, the classifications of the evidence-based approaches for treating conduct disorder are made according to the focus of the intervention, which can be the individual, the location where approach is executed, or characteristics of the approach. The classifications arrange resources, in this case the interventions, to support discovery, selection, combination, integration, analysis, and other purposeful activity in every organizing system. In addition, classifications facilitate understanding of the intervention’s domain by highlighting the important resources and relationships in it, supporting the training of stakeholders who work in the domain and their acquisition of specialized skills for it. While the need to have a standard set of classifications and respective terminology is understood, the use of the different approaches to classifying these interventions is necessary. Classifications are systematic when they follow principles that govern the structure of categories and their relationships. However, being systematic and principled does not necessarily ensure that a classification will be unbiased or satisfy all users’ requirements. 

Therefore, researchers and practitioners making use of the different findings from the various studies need to be aware that there are different ways to classify and name the approaches when interacting with the research studies. This implies that the stakeholders making use of the published information must go an extra mile to comb through the specific interventions bundled under the same classification to identify if they could be classified in a different way using a different classification approach. For example, Goertz-Dorten et al. (2019) focus on individualized competence training for the child whose emphasis is developing an individualized program. After going further into the information, it is clear that the approach is centered on the child with conduct disorder; hence, it can still be categorized as child focused.

As shown in the findings, different authors use varying approaches to measure and report child behavior. This inconsistency impedes meaningful cross-study comparisons, interpretation, replication, and generalization of findings. In addition, inconsistent and misapplied terminology of classifying the evidence-based interventions for treating conduct disorder represent a barrier to inter-professional communication and meaningful translation of findings to direct patient care. Problems with reporting quality and terminology may be due in part to several systemic challenges including differences in the professional background of investigators engaged in child behavior intervention research, the large number and variety of publishing journals, and limited awareness and uptake of conduct disorder intervention measuring and reporting approaches. To improve the measuring and reporting quality, we recommend that authors, journal editors, and reviewers use the Child behavior Checklist to inform study design, dissemination, and peer review. We also recommend an inter-professional consensus meeting to develop and adopt shared language that accurately reflects the emerging continuum of conduct disorder interventions, which will ultimately improve communication, collaboration, and meaningful uptake of findings to improve the efficiency of conduct disorder interventions.

On the specific issue of reporting, authors need to be more granular in reporting the interventions under study to allow for meaningful comparison. For example, while different studies may report varying levels of efficacy for a given intervention, potentially, a more granular look at the interventions would reveal that they were not identical in how they were executed. Stakeholders seeking to apply research findings to direct patient care should conduct due diligence to reach out to authors to provide specific details of how the interventions were designed and executed. In essence, authors need to investigate treatment factors and report them in more detail. The details entail aspects like the number of sessions, settings, modality, and dropout rates and how they impact intervention efficacy.

The findings herein from the selected research studies have indicated that all the evidence- based interventions for treating conduct disorder in young children and adolescents are effective and only differ in terms of the effect size. Different approaches have worked for different individuals in varying settings. It is therefore crucial for stakeholders in practice to make a judgment on which approach best aligns with the young child or adolescent in question. Integrated or multi-component approaches have been found to be most effective. Therefore, the stakeholders should aim at combining different approaches based on the child’s behavior, school and family settings in order to achieve optimum change in conduct. Based on the key themes in the articles that included customized approaches, the general idea is to establish the specific needs or gaps with respect to an individual child with conduct disorder and design an intervention in a way that ensures that the specific needs are addressed. Therefore, this would be a 4-step process; assess the needs, design an intervention, execute the intervention, and measure the efficacy.

Recommendations for Research

The findings have shown that there are some elements of variability in the effectiveness of the various evidence-based interventions for conduct disorder. The variability is evident even when using the same study. This hints at a possibility of ‘how’ an intervention is executed affecting its outcomes. Therefore, future research should look at assessing the impact of the treatment factors to ascertain and quantify their respective impact. While this study has established that some treatment factors have some impact on the outcomes of an intervention, these are not quantified which makes application to practice difficult. For example, one cannot prioritize; hence, efficient resource allocation is impossible. In addition, some interventions had lower scores as time passed which hints at lack of sustainability. Therefore, there is a need to conduct research to ascertain and quantify the impact of treatment factors and in addition, determine the factors that contribute to the effects an intervention not lasting. For this type of research, a randomized control trial (RCT) would facilitate answers to the questions herein. The RCT should take a mixed methods approach to include both qualitative and quantitative data and also both primary and secondary. The goal would be to execute a similar intervention across different subjects and characterize with varying treatment factors, measure impacts across time (longitudinal), while making observations to generate new treatment factors that would potentially explain dwindling impact of an intervention across time. Comment by Haussmann, Bob: I would talk about ways to reduce the variability in findings (it would depend on the original studies, but at the very least increasing the sample size, possibly looking at specific cohorts to reduce variability whether that be age range, geography, etc.)

The findings here have indicated that studies have been conducted piecewise, while focusing on different aspects, and using different measures for conduct disorder, some even using partial measures of it. It is therefore necessary to conduct robust studies that comprehensively compare and assess the efficacy of these evidence- based approaches in treating conduct disorder among young children and adolescents. These studies should use similar participant characteristics, similar measures for conduct disorder, and measure conduct disorder at the same time points. Further, the study has identified that approaches that integrate multiple approaches work better as they provide a focus to individuals. Therefore, there is need to develop a framework that assesses the child with conduct disorder pre-treatment, develops the best suited individualized program in the appropriate settings, and aligns ideal assistive technologies.

The first potential approach for addressing future research needs in this area would be a causal-comparative/quasi experimental research study that could help to establish cause-effect relationships among the variables. For this, researchers should investigate past data/ studies concerning specific elements of CD identified with children in the study, the approach taken to customize them, the identified customization approaches with the best impact or treatment outcome, and offer recommendations to make these approaches standard. A second approach would be to test the effect of the proposed standards through experimental approaches. Randomized control trials should be set up where treatment groups would be treated using the customized approaches and the outcomes measured at different time points (longitudinal) to compare their effectiveness. Iteratively, this process would lead to suggestions on improving the framework to make it enhanced.

Conclusion

The findings herein from the selected research studies have indicated that all the evidence-based

Interventions for treating conduct disorder in young children and adolescents are effective and

only differ in terms of the effect size. Every addition to the approaches of child- focused, parent-

focused, family- focused, and multidimensional work to improve the efficiency of the

intervention program. These additions include issues like individualized programs, school-based

settings, face-to-face approaches, and computer integrated approaches. While there is need to

execute a comprehensive study to understand which approach is more effective, a better step

forward is developing frameworks to facilitate the assessment of young children and adolescents

with conduct disorder with respect to their fit to different approaches and also facilitate building

of a well-integrated multi-dimensional intervention program for the individual child.