Case Conference for Early Childhood Onset Conduct Disorder
A case conference is beneficial and should be pursued for a child under 10 with early childhood onset conduct disorder, as it facilitates the coordination of multimodal psychosocial interventions—which constitute first-line treatment with large effect sizes (Hedges' g = 0.82-0.88)—and ensures comprehensive assessment across multiple informants and contexts. 1
Why Case Conferences Are Valuable in This Population
Multimodal treatment coordination is essential. Early childhood conduct disorder requires extensive, multimodal treatment involving individual and family psychotherapeutic approaches, medication when indicated, and sociotherapy. 1 A case conference provides the structured forum to coordinate these multiple treatment modalities effectively.
Multi-informant assessment improves diagnostic accuracy. Children with conduct disorder display context-specific behaviors that vary across settings (home, school, clinical environments). 1 Case conferences allow integration of reports from parents, teachers, and clinicians who observe the child in different contexts, addressing the inherent limitations of single-informant assessments.
Early intervention is critical for preventing progression. Early disruptive behavior problems exhibit considerable stability and confer risk for later psychopathology, family dysfunction, and criminality. 1 Case conferences facilitate early, coordinated intervention that is more likely to succeed and prevent progression to more severe disorders like adolescent conduct disorder and substance abuse. 1
What the Case Conference Should Accomplish
Establish behavioral treatment as the primary intervention. Behavioral parent management training demonstrates the strongest evidence (effect size 0.88) for early disruptive behavior problems and should be initiated as first-line treatment. 1, 2 The conference should identify appropriate behavioral intervention programs and ensure parent engagement.
Assess for comorbid conditions requiring specific treatment. The conference should systematically evaluate for:
- ADHD, present in the majority of conduct disorder cases, which responds to stimulant medication 3, 4
- Oppositional defiant disorder, the most common comorbidity 1, 3
- Anxiety and depressive disorders, especially important to identify 3
Identify contextual risk factors and protective factors. The conference should map out biological, psychological, and social factors contributing to the disorder, including presence of young siblings (4-fold increased risk), exposure to intimate partner violence, and family dysfunction. 5, 6
Coordinate multi-informant monitoring. Establish a system for ongoing assessment across contexts, as informants differ in their reports based on the specific behaviors and contexts they observe. 1 This prevents the common pitfall of relying on a single perspective.
Critical Pitfalls to Avoid
Do not delay psychosocial intervention while pursuing extensive evaluations. The evidence strongly supports immediate initiation of behavioral parent training rather than prolonged assessment periods. 1
Avoid premature medication use. In the absence of controlled trials evaluating psychotropic interventions for early conduct disorder, psychosocial treatments should constitute first-line treatment. 1 Medication should only be considered for specific comorbidities (e.g., ADHD) or when psychosocial interventions have been thoroughly implemented without adequate response.
Do not assume conduct disorder exists in isolation. Multiple disorders are almost always the rule rather than the exception, and structured interviews covering all psychiatric disorders must be used. 3 The case conference should systematically address comorbidity rather than focusing narrowly on conduct symptoms alone.
Ensure the conference addresses treatment retention strategies. Families of children with conduct disorder have high dropout rates from treatment. 7 The conference should proactively identify barriers to engagement and develop specific retention strategies.