Preventing Antisocial and Criminal Behaviour: A Cochrane Review of the Effectiveness and Cost-Effectiveness of Group-Based Parenting Programmes for Childhood Conduct Problems

Introduction: Conduct problems in children are common and have attracted considerable interest in recent years, not least because of their significant negative psychological and economic consequences, including: an increased risk of future antisocial and criminal behaviour; early school leaving; low occupational status; and greater utilisation of health, education, social and legal services. This substantial Cochrane review, undertaken over a two-year period, systematically evaluated the effectiveness of group-based parenting programmes for conduct problems in children aged 3 to 12 years.

Methods: More than 20 databases were searched, including CENTRAL, EMBASE, MEDLINE, CINAHL, and PsycINFO. Searches yielded 16,012 articles, 86% of which were electronically searched and the remainder of which were hand searched from reference lists. Studies were eligible for inclusion if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) they incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.

Results: A total of 13 high quality randomised controlled trials and two economic evaluations (n=1078 families) were assessed as eligible for inclusion in the review on the basis of stringent inclusion criteria. Results indicated moderate statistically significant improvements in child conduct problems, parental mental health and parenting practices across different settings (research and service), levels of disadvantage, diagnostic categories, and within services demonstrating a high level of implementation fidelity. The parent training cost approximately $2500 (£1712/€2217) per family to bring the average child with clinically significant conduct problems into the non-clinical range. These costs are modest in the context of the long-run social and economic benefits to society (e.g. in terms of savings in crime-related costs). 

Conclusions: Behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. This Cochrane review provides the most definitive and methodologically rigorous evidence, to date, that behavioural, group-based parenting programmes can play an important role in preventing antisocial and criminal behaviour in later years.