Family Therapy Can Combat Conduct Disorders

Family therapy can help quell substance abuse and conduct disorders in children and adolescents, but is not as effective when the diagnosis is attention deficit hyperactivity disorder (ADHD), researchers said here today.

A 10-year review of published research found that two types of family therapy, parent management training and behavioral family therapy, are especially effective for conduct disorders, said Allan Josephson, M.D., of Bingham Child Guidance in Louisville.

Dr. Josephson, co-author of the review, which will be published in the September issue of the Journal of Child and Adolescent Psychiatry, presented the findings at a back-to-school health briefing sponsored by the American Medical Association and the National PTA.

Parent-management training teaches parents techniques such as positive reinforcement and working with children to develop problem-solving skills. Dr. Josephson said that studies suggests that parent-management training can be an effective for conduct disorders for up to 14 years—long enough for a child to complete elementary and high school.

Behavioral family therapy is a similar technique but it also incorporates “into treatment a variety of family, parent, and child factors that have been implicated as leading to disruptive disorders (e.g. parental stress, cognitions about the child, child temperament).”

The literature review suggested that ADHD core symptoms are better controlled by a combination of pharmacotherapy and board based interventions that include psychosocial interventions and may include family therapy.

Likewise, there is no evidence that family therapy is effective for treatment of depression although some “new treatments for depression and anxiety are emerging that focus on attachment, parenting practices, and general family functioning,” the authors wrote. These new studies “suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety,” they said.

Finally, Dr. Josephson said that family-based therapy may help in some of the current concerns about the side effects of pharmacotherapy, such as suicidal ideation. “When physicians and parents are partners in monitoring patients’ safety, the family serves as a safety net that can facilitate several treatment goals.”

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