Key messages
There is currently little evidence to support personalising or tailoring interventions for children with conduct problems. What little evidence exists is of low quality. Therefore, it is unclear whether personalising interventions can improve outcomes for children with conduct problems. Further high-quality research is needed.
What are conduct problems?
Conduct problems are a range of disruptive behaviours in childhood that can have a negative impact on an individual's life. Conduct problems may lead to difficulties later in adolescence and adulthood, including antisocial behaviour, substance misuse, difficulties with education, and mental health problems.
It has been proposed that there are different subgroups of children with conduct problems. These subgroups include variations in the age conduct problems start, emotional difficulties, attention deficit hyperactivity disorder, parental characteristics, the level of aggression within antisocial behaviour, and the influence of genetic and environmental factors in relation to callous unemotional traits. These subgroups of children may respond differently to treatment, and it is therefore important to establish whether targeting interventions to these subgroups of children may result in better outcomes.
Targeted or 'personalised' interventions are those which tailor different aspects of treatment to the needs of particular subgroups of parents and children. For example, a subgroup of children with conduct problems experiencing interparental conflict (disagreements between parents) could potentially benefit from a parenting programme tailored to include additional sessions focusing on interparental conflict and offering particular techniques to address this issue. A non-personalised intervention would only provide the parenting programme, and not contain the additional sessions focusing on interparental conflict.
What did we want to find out?
This review assessed whether personalised interventions that have been adapted or developed for a specific subgroup of children with conduct problems are effective in improving conduct problems.
What did we do?
We undertook an extensive search of 13 databases. We also searched reference lists of included studies and contacted subject experts.
We only selected studies known as 'randomised controlled trials (RCTs)'. In this type of study, participants are allocated to groups randomly. One group receives the intervention and the other receives a different treatment or no treatment at all. RCTs aim to reduce the risk of introducing bias in clinical studies.
Subgroups of children with conduct problems were separated into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents) or familial/environmental circumstances (e.g. rural families).
All studies compared personalised interventions to non-personalised interventions.
We combined results from several studies that used the same measures to assess improvements in child conduct problems. Where this was not possible, we report studies individually.
What did we find?
We identified 13 RCTs with 858 participants to include in the review. Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies.
There was very little evidence from these studies that the personalised interventions were more effective than the non-personalised interventions in improving child conduct problems or disruptive behaviour.
What are the limitations of the evidence?
We have little confidence in the evidence because many of the studies had design limitations. There was also variation in the length of treatment and in how it was delivered. This means that we need to be cautious in interpreting the results that we found, and they may not be reliable.
How up to date is this evidence?
We searched for studies up to February 2022.
There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies.
Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems.
To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes.
We used standard, extensive Cochrane search methods. The latest search was 1 February 2022.
We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion.
We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2. adverse events. Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence.
We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review.
We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions.
Improvement in child conduct problems and disruptive behaviour
Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) −3.04, 95% confidence interval (CI) −6.06 to −0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD −6.25, 95% CI −16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD −2.19, 95% CI −6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain.
Personalised treatment outcomes, relevant to each subgroup
Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive.
Parenting skills and knowledge
Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive.
Adverse events
None of the trials reported monitoring adverse events.
Summary of results
In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention.