GPs should look for possible conduct disorders in children and young people, particularly in those with mental health and neurodevelopmental problems, NICE advises.
In new guidance out today, NICE calls for earlier identification of children who have or are at high risk of developing a conduct disorder, to make sure they and their parents or carers can access treatment and support and prevent them suffering long-term emotional and social consequences.
According to the guidance, produced jointly with the Social Care Institute for Excellence, 30% of a typical GP’s consultations with children are for behavioural problems.
Around 8% of boys and 5% of girls aged 11 to 16 years are diagnosed with an actual conduct disorder, which often coincides with other mental health problems and is particularly common in children with a diagnosis of ADHD.
Children with conduct disorder repeatedly misbehave in worse ways than would be expected for a child of the same age, for example by stealing, fighting, vandalising property and harming people or animals. They often perform badly at school and are more likely to have a substance misuse problem and to be caught up by the criminal justice system.
To identify potential conduct disorder, NICE recommends asking parents or guardians, or a teacher, to complete the Strengths and Difficulties Questionnaire to assess the child’s emotional symptoms, behaviour and peer relationships.
What should GPs look for?
> Mental health problems, such as depression and post-traumatic stress disorder
> Neurodevelopmental conditions, in particular ADHD and autism
> Learning disability or difficulty
> Substance misuse in young people
NICE advises that children aged nine to 14 years should be offered specialised group social and cognitive problem-solving programmes, while parents and foster carers or guardians of young children, aged three to 11 years, should be offered training programmes specifically tailored to their needs. In addition, children and young people aged 11 to 17 years may benefit from ‘multimodal’ therapy.
Dr Jane Roberts, RCGP clinical champion for youth mental health, said the guidance would ensure youth mental health became a ‘core part of holistic continuing care’ for GPs
She said: ‘We look forward to referring to it as part of our work to develop useful tools to help GPs develop expertise in this area,’ she said.