Peer-group interventions for conduct disorder

Domain XVI · Historical, discredited & harmful

What it is

"Peer-group interventions for conduct disorder" is not one therapy but a delivery format: placing young people with antisocial behaviour together in groups (group counselling, adolescent-only skills groups, group homes, special classes, camps, detention). The concern is iatrogenic: in groups of…

Format

• 1930s to 1970s: the Cambridge-Somerville Youth Study, a Massachusetts delinquency-prevention programme set up by Richard Clarke Cabot, followed boys for decades; Joan McCord's midlife follow-up found the treated group generally fared worse than controls (more repeat offending, earlier death,…
• 2010s: trials testing moderators (Zakriski et al., 2011, residential treatment; Lochman et al., 2015, group versus individual delivery).

Who practises it, and how they are trained or regulated

• 1999: Dishion, McCord and Poulin publish "When interventions harm", naming deviancy training as the mechanism.
• Recognition and assessment. Goal: identify whether a young person is in, or being referred to, an aggregated programme, and assess individual susceptibility (age, self-regulation, existing deviant peer ties, peer rejection). Move on when the format question and risks are clear.
• Session counts are those of the programmes NICE names: for example, group parent training typically 10 to 16 meetings of 90 to 120 minutes for parents of children aged 3 to 11; child-focused group problem-solving typically 10 to 18 weekly meetings of 2 hours for ages 9 to 14; multimodal interventions such as multisystemic therapy typically 3 to 4 sessions a week over 3 to 5 months for ages 11 to 17. For the…

Evidence status, as the guide reports it

• 2005 to 2006: counter-reviews (Weiss et al., 2005; Lipsey for the Duke panel; a Cannabis Youth Treatment Study analysis by Kaminer, Burleson and Dennis finding no contagion) and the Duke volume edited by Dodge, Dishion and Lansford, which cites studies showing harm and lists alternatives.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• rifts with colleagues; keep to the evidence. It is working when safeguards are added or the format changes.
• placement breakdown; a return to group placement by default. It is working when placement stability improves.
• the family feeling dismissed. It is working when the family chooses an evidence-based option or agrees to monitoring.
• advocacy that reads as criticism of individual staff. It is working when services adjust placements or add safeguards.
• supervision that reviews only content delivery. It is working when group process problems are spotted and corrected early.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.