Child conduct challenges and evidence-based parent training

This pilot randomised controlled trial examined a new intervention for children whose conduct challenges persisted after evidence-based parent training. The study included 105 children aged four to 10 years and their parents. Over 70% of children who completed parent training continued to experience clinically significant conduct problems. Based on parent reports, children who received Reflective Interpersonal Therapy for Children and Parents (RICAP) showed greater improvements in emotional and behavioural difficulties than children receiving usual care. However, similar improvements were not observed in teacher-reported outcomes. RICAP shows promise as a second-stage intervention for families where parent training is insufficient, particularly for improving parent-reported emotional and behavioural difficulties.

Why is this important?

• Disruptive behavioural disorders, including conduct disorder and oppositional defiant disorder, affect around 5% of children and can have long-term impacts on education, relationships, mental health and involvement with the justice system.
• In the UK, group-based parent training programs (such as the Incredible Years video-based program) are the recommended first-line treatment for families with a child with a behavioural disorder. However, many families do not complete the program or attend the group sessions. Furthermore, a substantial number of children whose parents complete the training remain in the clinical range after the program.
• There is limited evidence about what works for children who do not respond to parent training.

What did they do?

• The authors recruited 105 children aged four to 10 years who had been referred to UK child and adolescent mental health services because of conduct problems.
• In phase one of the study, all families received the Incredible Years parent training program. Children whose conduct problems remained in the clinical range after treatment were invited to participate in the phase two of the study.
• In phase two, 62 children were randomly allocated to either Reflective Interpersonal Therapy for Children and Parents (RICAP)* or clinical-treatment-as-usual (CTAU). RICAP is a new child- and parent-focused therapeutic intervention that aims to strengthen both the parent’s and the child’s understanding of thoughts, feelings and relationship patterns. The approach combines individual sessions for children with parallel parent sessions, focusing on building reflection, emotional understanding and positive parent–child relationships.
• Outcomes were assessed using parent and/or teacher reports of children’s emotional and behavioural difficulties, aggression, parenting practices and caregiver mental health.
• Outcomes were measured before phase one; four months after phase one (before phase two); and 12 to 14 months after phase two.

What did they find?

• Over 70% of children in the study who completed the parent training program (phase one) continued to experience clinically significant conduct problems.
• In phase two, families engaged well with the new intervention. Nearly 75% of families attended at least six of the 14 RICAP sessions. Follow-up rates were high across both treatment groups.
• Based on parent-reported outcomes, children who received RICAP showed greater improvements in behavioural and emotional difficulties compared with CTAU. These improvements were generally small to moderate in size.
• In addition, a larger proportion of children receiving RICAP moved out of the clinical range for behavioural and emotional difficulties compared with children receiving CTAU.
• However, these improvements were not seen in teacher reports. Based on teacher reports, children who received CTAU showed greater improvement in some outcomes compared with RICAP. This suggests that interventions may need to include stronger school-based components if improvements are to be seen beyond the home environment.

What does this mean for practice?

• Children whose conduct problems persist after parent training may benefit from additional therapeutic support that works with both the child and parent, rather than focusing solely on parenting strategies.
• RICAP shows promise as a second-stage intervention that could be used following existing programs, particularly for improving parent-reported emotional and behavioural difficulties.
• Interventions may be most effective when there is consistency across the key environments in a young person’s life. Collaboration between families, schools and other supports can help reinforce skills, expectations and coping strategies across settings.

This summary is one of the child mental health research highlights for July 2026, prepared by the Australian Institute of Family Studies (AIFS).