A systematic review of evidence based treatments for conduct disorder in adolescents: are they aligned with the developmental pathways research for conduct disorder: towards a more effective treatment model

In the wake of the recent inclusion of a specifier in the DSM 5 (American Psychiatric Association (APA), 2013) for limited prosocial emotions, specifically callous-unemotional traits (CU traits) within conduct disordered (CD) children and adolescents, the current paper reviews the available research and literature on the utilisation of sub-typing CD for the purpose of informing assessment and subsequent treatment approaches. The review focused on three issues: Firstly on whether the practice of sub-typing CD is clinically important to informing the treatment type and level of intensity for adolescents with severe conduct problems (CPs); Next on whether the sub-typing of CD is routinely utilised in the assessment process by evidence based treatment modalities to inform treatments. In particular, differentiating between those with adolescent onset (A/O) and those with untreated childhood onset (C/O) for whom the ongoing risks are becoming more critical. Finally, coinciding with the recent addition of specifiers in the DSM – 5 (APA, 2013) which effectively designate a further subgroup of individuals with limited prosocial emotions (CU traits), the review examined whether the subject treatment modalities are adequately positioned to be effective. Results: Most studies did not take limited prosocial emotions (CU traits) into account as this is new research, only recently included in DSM 5. Additionally, the majority of studies tend to aggregate A/O and C/O together and treat them as a homogenous group (single pathway approach). Instead of utilising the developmental pathway approach to assessment and treatment that has been suggested in successive publications of the DSM including the DSM 5 (APA, 2013), a broad spectrum treatment based on the tenets of each particular treatment modality, is applied. An evidenced based model is presented that has been informed by the suggested developmental pathways that lead to CD. The aim of the model is to highlight the growing complexity and diversity of CD with increasing age and offer guidance with clinically informed assessment and treatment.