Conduct disorder and delinquency are significant problems for children and adolescents and their families, with the potential to consume much of the resources of the health, social care and juvenile justice systems. A number of family and parenting interventions have been recommended and are used for these conditions. The aim of this review was to determine if these interventions are effective in the management of conduct disorder and delinquency in children and adolescents, aged 10-17.
To determine if family and parenting interventions improve the child/adolescent's behaviour; parenting and parental mental health; family functioning and relations; and have an effect on the long term psychosocial outcomes for the child/adolescent.
Randomised controlled trials were identified in September 1999 through searching the Cochrane Controlled Trial Register (CCTR), databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Sociofile, ERIC, Healthstar), reference lists of articles and contact with authors.
Randomised controlled trials with a major focus on parenting and/or family functioning were eligible for inclusion in the review. Trials needed to include at least one objective outcome measure (e.g. arrest rates) or have used a measure that had been published in peer review publications and validated for the relevant purpose. Studies were required to have a control group, which could be a no intervention group, a wait list group or a usual intervention group (e.g. probation).
Trials in children and adolescents aged 10 to 17 years with conduct disorder and/or delinquency and their families were considered. Conduct disorder was defined by a standardised psychological assessment (for example, using a child behaviour checklist), or a psychiatric diagnosis. Delinquency was defined by a referral from a juvenile justice or another legal system for a child/adolescent who has committed a serious crime e.g assault and/or offended on at least two occasions.
Data collection and analysis
Two reviewers independently reviewed all eligible studies for inclusion, assessed study quality (allocation concealment, blinding, follow up, clinically important outcomes) and extracted data. Heterogeneity was assessed using the Chi squared test of heterogeneity along with visual inspection of the data. A significance level less than 0.1 was interpreted as evidence of statistically significant heterogeneity. For data where heterogeneity was found the reviewers looked for an explanation. If studies with heterogeneous results were thought to be comparable the statistical synthesis of the results was done using a random effects model. This model takes into account within-study sampling error and between-studies variation in the assessment of uncertainty and will give wider confidence intervals to the effect size and hence a more conservative result.
Sensitivity analysis was performed to explore the effects of the varying quality of the studies included on the results.
Of the nine hundred and seventy titles initially identified through the search strategy, eight trials met the inclusion criteria. A total of 749 children and their families were randomised to receive a family and parenting intervention or to be in a control group. In seven of these studies the participants were juvenile delinquents and their families and in only one the participants were children/adolescents with conduct disorder who had not yet had contact with the juvenile justice system.
At follow up, family and parenting interventions significantly reduced the time spent by juvenile delinquents in institutions (WMD 51.34 days, 95%CI 72.52 to 30.16). There was also a significant reduction in the risk of a juvenile delinquent being re arrested (RR 0.66, 95%CI 0.44 to 0.98) and in their rate of subsequent arrests at 1-3 years (SMD -0.56, 95% CI -1.100 to - 0.03). For both of these outcomes there was substantial heterogeneity in the results suggesting a need for caution in interpretation. At present there is insufficient evidence that family and parenting interventions reduce the risk of being incarcerated (RR=0.50, 95% CI 0.20 to 1.21). No significant difference was found for psychosocial outcomes such as family functioning, and child/adolescent behaviour.
The evidence suggests that family and parenting interventions for juvenile delinquents and their families have beneficial effects on reducing time spent in institutions. This has an obvious benefit to the participant and their family and may result in a cost saving for society. These interventions may also reduce rates of subsequent arrest but at present these results need to be interpreted with caution due to the heterogeneity of the results.
藉由搜尋Cochrane Controlled Trial Register (CCTR) ，MEDLINE、EMBASE、PsycINFO、CINAHL、Sociofile、ERIC、Healthstar等資料庫，文章的參考文獻，以及和文章作者連絡，找出相關的隨機對照試驗 (randomised controlled trials) 。
符合此回顧的隨機對照試驗，其主題必須著重於養育和家庭功能。這些試驗必須包括下列至少一項客觀的結果參數 (比如，被逮捕率) ，或者，曾使用一種被同儕審核且公開發表的評估方法，且這方法亦證實是合宜的。這些被搜納進來的試驗，必須有對照組 (不論是沒有接受介入處理、等待接受介入、或者接受其他一般介入，比如緩刑見習的方法均可) 。試驗對象針對10到17歲，有行為規範障礙或犯罪行為的孩童、青少年，並考慮他們的家庭。定義行為規範障礙的方法，包括使用標準化的生理心理評估 (舉例來說，使用孩童行為核對清單) ，或者使用精神病學的診斷。犯罪行為則被定義為，因為參與嚴重的犯罪 (舉例來說，有至少兩次的施暴行為) ，而由青少年司法機關或相關法律機構轉介而來的狀況。
有兩位文獻回顧工作者，各自獨立的回顧所有合宜的文獻，評估文獻品質 (包括分組隱匿 (allocation concealment) 、盲法 (blinding) 、追蹤、臨床上重要的結果) ，並擷取出資料。利用卡方測定 (Chi squared test) 以及資料的目測來評估異質性 (heterpgeneity) 。顯著水準 (significance level) 小於0.1被視為有統計學上意義的異質性。對於有異質性存在的資料，文獻回顧者會進一步去尋找對其異質性的解釋。當這些資料被視為是可收納來比較時，則利用隨機效果模式 (random effects model) 來作結果的統合。這個模式因考慮到研究裡的取樣誤差 (sampling error) 和各研究之間對於評估不確定性的差異，給予效應值 (effect size) 較寬廣的信賴區間 (confidence intervals) ，所以結果較為保守。使用敏感度分析 (sensitivity analysis) 來探測這些不同的文獻品質所造成的影響。
在使用最初的搜尋步驟找到的970篇文獻中，有8篇符合選擇標準。總共有749名孩童和他們的家屬，被隨機分佈到接受家庭和養育介入，或是對照組。參與分析的對象方面，其中的七篇文獻是針對青少年犯罪者和其家屬，只有一篇文獻是針對有行為規範障礙，尚未涉入司法系統的孩童或青少年。追蹤下來，家庭和養育的介入，在減少青少年犯罪者處於機構中的期間長短上 (WMD 51.34天，95% CI 72.52天至30.16天) 有顯著意義。對於青少年犯罪者再次被逮捕的風險 (RR 0.66，95% CI 0.44至0.98) 和1至3年內接續被逮捕的比率 (SMD −0.56，95% CI −1.100至0.03) 也有顯著意義的減低。這些結果仍有實際異質性的存在，所以在詮釋上需要注意。沒有足夠的證據顯示，家庭和養育的介入能減低被監禁的風險性 (RR = 0.50，95% CI 0.20至1.21) 。在心理社會面向的預後，譬如家庭功能和孩童及青少年的行為，亦無顯著意義之差異。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。