limitations of treatment for antisocial and narcissistic PD

Group 3: Discuss the limitations of treatment for antisocial and narcissistic PD and what can be done from a psychopharmacological perspective.

Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 200 words, scholarly written, APA formatted, and referenced. A minimum of 2 scholarly references are required (other than your text). attached lecture for the theme.

Antisocial personality
disorder: prevention and
management

Clinical guideline

Published: 28 January 2009
www.nice.org.uk/guidance/cg77

© NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of-
rights). Last updated 27 March 2013

https://www.nice.org.uk/guidance/cg77

Your responsibility Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful

consideration of the evidence available. When exercising their judgement, professionals and

practitioners are expected to take this guideline fully into account, alongside the individual needs,

preferences and values of their patients or the people using their service. It is not mandatory to

apply the recommendations, and the guideline does not override the responsibility to make

decisions appropriate to the circumstances of the individual, in consultation with them and their

families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be

applied when individual professionals and people using services wish to use it. They should do so in

the context of local and national priorities for funding and developing services, and in light of their

duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of

opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a

way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable

health and care system and should assess and reduce the environmental impact of implementing

NICE recommendations wherever possible.

Antisocial personality disorder: prevention and management

(CG77)

© NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights). Last updated 27 March 2013

Page 2
of 35

https://www.nice.org.uk/about/who-we-are/sustainability

Contents Contents
Overview ………………………………………………………………………………………………………………………………………………………….. 4

Who is it for? ……………………………………………………………………………………………………………………………………………………………….. 4

Introduction …………………………………………………………………………………………………………………………………………………….. 5

Key priorities for implementation ………………………………………………………………………………………………………………. 7

1 Guidance ……………………………………………………………………………………………………………………………………………………….. 9

1.1 General principles for working with people with antisocial personality disorder ………………………………….. 9

1.2 Prevention of antisocial personality disorder – working with children and young people and their
families …………………………………………………………………………………………………………………………………………………………………………. 12

1.3 Assessment and risk management of antisocial personality disorder ……………………………………………………… 15

1.4 Treatment and management of antisocial personality disorder and related and comorbid disorders .. 19

1.5 Psychopathy and dangerous and severe personality disorder …………………………………………………………………… 22

1.6 Organisation and planning of services …………………………………………………………………………………………………………….. 23

Finding more information and resources ……………………………………………………………………………………………………27

2 Research recommendations ………………………………………………………………………………………………………………………28

2.1 Severity as a potential moderator of effect in group-based cognitive and behavioural interventions . 28

2.2 Group-based cognitive and behavioural interventions for populations outside criminal justice
settings …………………………………………………………………………………………………………………………………………………………………………. 28

2.3 Effectiveness of multisystemic therapy versus functional family therapy ……………………………………………….. 29

2.4 Interventions for infants at high risk of developing conduct disorders …………………………………………………….. 30

2.5 Treatment of comorbid anxiety disorders in antisocial personality disorder ………………………………………….. 30

2.6 Using selective serotonin reuptake inhibitors to increase cooperative behaviour in people with
antisocial personality disorder in a prison setting ……………………………………………………………………………………………….. 31

2.7 A therapeutic community approach for antisocial personality disorder in a prison setting …………………. 32

3 Definitions of psychological interventions ………………………………………………………………………………………………33

References …………………………………………………………………………………………………………………………………………………………………… 34

Update information …………………………………………………………………………………………………………………………………………35

Antisocial personality disorder: prevention and management (CG77)
© NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights). Last updated 27 March 2013

Page 3
of 35

This guideline is the basis of QS88.

Overview Overview
This guideline covers principles for working with people with antisocial personality disorder,

including dealing with crises (crisis resolution). It aims to help people with antisocial personality

disorder manage feelings of anger, distress, anxiety and depression, and to reduce offending and

antisocial behaviour.

Who is it for? Who is it for?

• Healthcare professionals

• People with antisocial personality disorder, their families and carers

Page 4
of 35

Introduction Introduction
This guideline makes recommendations for the treatment, management and prevention of

antisocial personality disorder in primary, secondary and forensic healthcare. This guideline is

concerned with the treatment of people with antisocial personality disorder across a wide range of

services including those provided within mental health (including substance misuse) services, social

care and the criminal justice system.

People with antisocial personality disorder exhibit traits of impulsivity, high negative emotionality,

low conscientiousness and associated behaviours including irresponsible and exploitative

behaviour, recklessness and deceitfulness. This is manifest in unstable interpersonal relationships,

disregard for the consequences of one’s behaviour, a failure to learn from experience, egocentricity

and a disregard for the feelings of others. The condition is associated with a wide range of

interpersonal and social disturbance.

People with antisocial personality disorder have often grown up in fractured families in which

parental conflict is typical and parenting is harsh and inconsistent. As a result of parental

inadequacies and/or the child’s difficult behaviour, the child’s care is often interrupted and

transferred to agencies outside the family. This in turn often leads to truancy, having delinquent

associates and substance misuse, which frequently result in increased rates of unemployment, poor

and unstable housing situations, and inconsistency in relationships in adulthood. Many people with

antisocial personality disorder have a criminal conviction and are imprisoned or die prematurely as

a result of reckless behaviour.

Criminal behaviour is central to the definition of antisocial personality disorder, although it is often

the culmination of previous and long-standing difficulties, such as socioeconomic, educational and

family problems. Antisocial personality disorder therefore amounts to more than criminal

behaviour alone, otherwise everyone convicted of a criminal offence would meet the criteria for

antisocial personality disorder and a diagnosis of antisocial personality disorder would be rare in

people with no criminal history. This is not the case. The prevalence of antisocial personality

disorder among prisoners is slightly less than 50%. It is estimated in epidemiological studies in the

community that only 47% of people who meet the criteria for antisocial personality disorder have

significant arrest records. A history of aggression, unemployment and promiscuity were more

common than serious crimes among people with antisocial personality disorder. The prevalence of

antisocial personality disorder in the general population is 3% in men and 1% in women.

Under current diagnostic systems, antisocial personality disorder is not formally diagnosed before

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the age of 18 but the features of the disorder can manifest earlier as conduct disorder. People with

conduct disorder typically show antisocial, aggressive or defiant behaviour, which is persistent and

repetitive, including aggression to people or animals, destruction of property, deceitfulness, theft

and serious rule-breaking. A history of conduct disorder before the age of 15 is a requirement for a

diagnosis of antisocial personality disorder in the Diagnostic and Statistical Manual of Mental

Disorders, fourth edition (DSM-IV).

The course of antisocial personality disorder is variable and although recovery is attainable over

time, some people may continue to experience social and interpersonal difficulties. Antisocial

personality disorder is often comorbid with depression, anxiety, and alcohol and drug misuse.

Families or carers are important in prevention and treatment of antisocial

personality

disorder.

This guideline uses the term ‘families or carers’ to apply to all family members and other people,

such as friends and advocates, who have regular close contact with the person with antisocial

personality disorder.

This guideline draws on the best available evidence. However, there are significant limitations to

the evidence base, notably a relatively small number of randomised controlled trials (RCTs) of

interventions with few outcomes in common. Some of the limitations are addressed in the research

recommendations.

At the time of publication (January 2009), no drug has UK marketing authorisation for the

treatment of antisocial personality disorder. The guideline assumes that prescribers will use a

drug’s summary of product characteristics to inform their decisions for each person.

NICE has also developed a separate guideline on borderline personality disorder: recognition and

management.

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http://www.nice.org.uk/guidance/cg78

Key priorities for implementation Key priorities for implementation
Developing an optimistic and trusting relationship Developing an optimistic and trusting relationship

• Staff working with people with antisocial personality disorder should recognise that a positive

and rewarding approach is more likely to be successful than a punitive approach in engaging

and retaining people in treatment. Staff should:

－ explore treatment options in an atmosphere of hope and optimism, explaining that

recovery is possible and attainable

－ build a trusting relationship, work in an open, engaging and non-judgemental manner, and

be consistent and reliable.

Assessment in forensic/specialist personality disorder services Assessment in forensic/specialist personality disorder services

• Healthcare professionals in forensic or specialist personality disorder services should consider,

as part of a structured clinical assessment, routinely using:

－ a standardised measure of the severity of antisocial personality disorder such as

Psychopathy Checklist–Revised (PCL-R) or Psychopathy Checklist–Screening Version

(PCL-SV)

－ a formal assessment tool such as Historical, Clinical, Risk Management-20 (HCR-20) to

develop a risk management strategy.

Treatment of comorbid disorders Treatment of comorbid disorders

• People with antisocial personality disorder should be offered treatment for any comorbid

disorders in line with recommendations in the relevant NICE clinical guideline, where

available. This should happen regardless of whether the person is receiving treatment for

antisocial personality disorder.

The role of psychological interventions The role of psychological interventions

• For people with antisocial personality disorder with a history of offending behaviour who are

in community and institutional care, consider offering group-based cognitive and behavioural

interventions (for

example, programmes such as ‘reasoning and rehabilitation’) focused on

reducing offending and other antisocial behaviour.

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Multi-agency care Multi-agency care

• Provision of services for people with antisocial personality disorder often involves significant

inter-agency working. Therefore, services should ensure that there are clear pathways for

people with antisocial personality disorder so that the most effective multi-agency care is

provided. These pathways should:

－ specify the various interventions that are available at each point

－ enable effective communication among clinicians and organisations at all points and

provide the means to resolve differences and disagreements.

Clearly agreed local criteria should also be established to facilitate the transfer of people

with antisocial personality disorder between services. As far as is possible, shared

objective criteria should be developed relating to comprehensive assessment of need and

risk.

• Services should consider establishing antisocial personality disorder networks, where possible

linked to other personality disorder networks. (They may be organised at the level of primary

care trusts, local authorities, strategic health authorities or government offices.) These

networks should be multi-agency, should actively involve people with antisocial personality

disorder and should:

－ take a significant role in training staff, including those in primary care, general, secondary

and forensic mental health services, and in the criminal justice system

－ have resources to provide specialist support and supervision for staff

－ take a central role in the development of standards for and the coordination of clinical

pathways

－ monitor the effective operation of clinical pathways.

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1 1 Guidance Guidance

In March 2013, recommendations 1.2.3.1–1.2.3.2, 1.2.4.1–1.2.4.2, 1.2.4.4–1.2.4.5,

1.2.5.1–1.2.5.3, 1.2.6.1–1.2.6.2, 1.2.7.1–1.2.7.7 and 1.2.8.1–1.2.8.4 were deleted and replaced

by the NICE guidance on antisocial behaviour and conduct disorders in children and young

people.

The following guidance is based on the best available evidence. The full guideline gives details of

the methods and the evidence used to develop the guidance.

People have the right to be involved in discussions and make informed decisions about their

care, as described in your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or

certainty) of our recommendations, and has information about professional guidelines,

standards and laws (including on consent and mental capacity), and safeguarding.

1.1 1.1 General principles for working with people with General principles for working with people with
antisocial personality disorder antisocial personality disorder

People with antisocial personality disorder have tended to be excluded from services, and policy

implementation guidance from the Department of Health, ‘Personality disorder: no longer a

diagnosis of exclusion’ (2003)[1], aims to address this. To change the current position, staff need to

work actively to engage people with antisocial personality disorder in treatment. Evidence from

both clinical trials and scientific studies of antisocial personality disorder shows that positive and

reinforcing approaches to the treatment of antisocial personality disorder are more likely to be

successful than those that are negative or punitive.

1.1.1 1.1.1 Access and assessment Access and assessment

1.1.1.1 People with antisocial personality disorder should not be excluded from any

health or social care service because of their diagnosis or history of antisocial or

offending behaviour.

1.1.1.2 Seek to minimise any disruption to therapeutic interventions for people with

antisocial personality disorder by:

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http://www.nice.org.uk/guidance/cg158

http://www.nice.org.uk/guidance/CG77/evidence

http://www.nice.org.uk/about/nice-communities/public-involvement/your-care

http://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/making-decisions-using-nice-guidelines

• ensuring that in the initial planning and delivery of treatment, transfers from

institutional to community settings take into account the need to continue treatment

• avoiding unnecessary transfer of care between institutions whenever possible during

an intervention, to prevent disruption to the agreed treatment plan. This should be

considered at initial planning of treatment.

1.1.1.3 Ensure that people with antisocial personality disorder from black and minority

ethnic groups have equal access to culturally appropriate services based on

clinical need.

1.1.1.4 When language or literacy is a barrier to accessing or engaging with services for

people with antisocial personality disorder, provide:

• information in their preferred language and in an accessible format

• psychological or other interventions in their preferred language

• independent interpreters.

1.1.1.5 When a diagnosis of antisocial personality disorder is made, discuss the

implications of it with the person, the family or carers where appropriate, and

relevant staff, and:

• acknowledge the issues around stigma and exclusion that have characterised care for

people with antisocial personality disorder

• emphasise that the diagnosis does not limit access to a range of appropriate

treatments for comorbid mental health disorders

• provide information on and clarify the respective roles of the healthcare, social care

and criminal justice services.

1.1.1.6 When working with women with antisocial personality disorder take into

account the higher incidences of common comorbid mental health problems and

other personality disorders in such women, and:

• adapt interventions in light of this (for example, extend their duration)

• ensure that in inpatient and residential settings the increased vulnerability of these

women is taken into account.

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1.1.1.7 Staff, in particular key workers, working with people with antisocial personality

disorder should establish regular one-to-one meetings to review progress, even

when the primary mode of treatment is group based.

1.1.2 1.1.2 People with disabilities and acquired cognitive impairments People with disabilities and acquired cognitive impairments

1.1.2.1 When a person with learning or physical disabilities or acquired cognitive

impairments presents with symptoms and behaviour that suggest antisocial

personality disorder, staff involved in assessment and diagnosis should consider

consulting with a relevant specialist.

1.1.2.2 Staff providing interventions for people with antisocial personality disorder

with learning or physical disabilities or acquired cognitive impairments should,

where possible, provide the same interventions as for other people with

antisocial personality disorder. Staff might need to adjust the method of

delivery or duration of the intervention to take account of the disability or

impairment.

1.1.3 1.1.3 Autonomy and choice Autonomy and choice

1.1.3.1 Work in partnership with people with antisocial personality disorder to develop

their autonomy and promote choice by:

• ensuring that they remain actively involved in finding solutions to their problems,

including during crises

• encouraging them to consider the different treatment options and life choices

available to them, and the consequences of the choices they make.

1.1.4 1.1.4 Developing an optimistic and trusting relationship Developing an optimistic and trusting relationship

1.1.4.1 Staff working with people with antisocial personality disorder should recognise

that a positive and rewarding approach is more likely to be successful than a

punitive approach in engaging and retaining people in treatment. Staff should:

• explore treatment options in an atmosphere of hope and optimism, explaining that

recovery is possible and attainable

• build a trusting relationship, work in an open, engaging and non-judgemental manner,

and be consistent and reliable.

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of 35

1.1.5 1.1.5 Engagement and motivation Engagement and motivation

1.1.5.1 When providing interventions for people with antisocial personality disorder,

particularly in residential and institutional settings, pay attention to motivating

them to attend and engage with treatment. This should happen at initial

assessment and be an integral and continuing part of any intervention, as people

with antisocial personality disorder are vulnerable to premature withdrawal

from treatment and supportive interventions.

1.1.6 1.1.6 Involving families and carers Involving families and carers

1.1.6.1 Ask directly whether the person with antisocial personality disorder wants their

family or carers to be involved in their care, and, subject to the person’s consent

and rights to confidentiality:

• encourage families or carers to be involved

• ensure that the involvement of families or carers does not lead to a withdrawal of, or

lack of access to, services

• inform families or carers about local support groups for families or carers.

1.1.6.2 Consider the needs of families and carers of people with antisocial personality

disorder and pay particular attention to the:

• impact of antisocial and offending behaviours on the family

• consequences of significant drug or alcohol misuse

• needs of and risks to any children in the family and the safeguarding of their interests.

1.2 1.2 Prevention of antisocial personality disorder – Prevention of antisocial personality disorder –
working with children and young people and their working with children and young people and their
families families

The evidence for the treatment of antisocial personality disorder in adult life is limited and the

outcomes of interventions are modest. The evidence for working with children and young people

who are at risk, and their families, points to the potential value of preventative measures. There are

definitions of the psychological interventions referred to in the recommendations in section 3.

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1.2.1 1.2.1 General principles General principles

1.2.1.1 Child and adolescent mental health service (CAMHS) professionals working

with young people should:

• balance the developing autonomy and capacity of the young person with the

responsibilities of parents and carers

• be familiar with the legal framework that applies to young people, including the Mental

Capacity Act, the Children Acts and the Mental Health Act.

1.2.2 1.2.2 Identifying children at risk of developing conduct problems Identifying children at risk of developing conduct problems

1.2.2.1 Services should establish robust methods to identify children at risk of

developing conduct problems, integrated when possible with the established

local assessment system. These should focus on identifying vulnerable parents,

where appropriate antenatally, including:

• parents with other mental health problems, or with significant drug or alcohol

problems.

• mothers younger than 18 years, particularly those with a history of maltreatment in

childhood

• parents with a history of residential care

• parents with significant previous or current contact with the criminal justice system.

1.2.2.2 When identifying vulnerable parents, take care not to intensify any stigma

associated with the intervention or increase the child’s problems by labelling

them as antisocial or problematic.

1.2.3 1.2.3 Early interventions for preschool children at risk of Early interventions for preschool children at risk of
developing conduct problems and potentially subsequent developing conduct problems and potentially subsequent
antisocial personality disorder antisocial personality disorder

1.2.3.1 This recommendation has been deleted

1.2.3.2 This recommendation has been deleted.

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1.2.4 1.2.4 Interventions for children with conduct problems younger Interventions for children with conduct problems younger
than 12than 12 years and their families years and their families

1.2.4.1 This recommendation has been deleted.

1.2.4.2 This recommendation has been deleted.

1.2.4.3 Additional interventions targeted specifically at the parents of children with

conduct problems (such as interventions for parental, marital or interpersonal

problems) should not be provided routinely alongside parent-training

programmes, as they are unlikely to have an impact on the child’s conduct

problems.

1.2.4.4 This recommendation has been deleted.

1.2.4.5 This recommendation has been deleted.

1.2.5 1.2.5 How to deliver interventions for children with conduct How to deliver interventions for children with conduct
problems aged younger than 12problems aged younger than 12 years and their families years and their families

1.2.5.1 This recommendation has been deleted.

1.2.5.2 This recommendation has been deleted.

1.2.5.3 This recommendation has been deleted.

1.2.6 1.2.6 Cognitive behavioural interventions for children aged Cognitive behavioural interventions for children aged
88 years and older with conduct problems years and older with conduct problems

1.2.6.1 This recommendation has been deleted.

1.2.6.2 This recommendation has been deleted.

1.2.7 1.2.7 How to deliver interventions for children aged 8How to deliver interventions for children aged 8 years and years and
older with conduct problems older with conduct problems

1.2.7.1 This recommendation has been deleted.

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1.2.7.2 This recommendation has been deleted.

1.2.7.3 This recommendation has been deleted.

1.2.7.4 This recommendation has been deleted.

1.2.7.5 This recommendation has been deleted.

1.2.7.6 This recommendation has been deleted.

1.2.7.7 This recommendation has been deleted.

1.2.8 1.2.8 How to deliver interventions for young people with conduct How to deliver interventions for young people with conduct
problems aged between 12 and 17problems aged between 12 and 17 years and their families years and their families

1.2.8.1 This recommendation has been deleted.

1.2.8.2 This recommendation has been deleted.

1.2.8.3 This recommendation has been deleted.

1.2.8.4 This recommendation has been deleted.

1.2.9 1.2.9 Transition from child and adolescent services to adult Transition from child and adolescent services to adult
services services

1.2.9.1 Health and social care services should consider referring vulnerable young

people with a history of conduct disorder or contact with youth offending

schemes, or those who have been receiving interventions for conduct and

related disorders, to appropriate adult services for continuing assessment and/

or treatment.

1.3 1.3 Assessment and risk management of antisocial Assessment and risk management of antisocial
personality disorder personality disorder

In primary and secondary care services, antisocial personality disorder is under-recognised. When

it is identified, significant comorbid disorders such as treatable depression or anxiety are often not

detected. In secondary and forensic services there are important concerns about assessing risk of

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violence and risk of harm to self and others.

1.3.1 1.3.1 Assessment Assessment

1.3.1.1 When assessing a person with possible antisocial personality disorder,

healthcare professionals in secondary and forensic mental health services

should conduct a full assessment

of:

• antisocial behaviours

• personality functioning, coping strategies, strengths and vulnerabilities

• comorbid mental disorders (including depression and anxiety, drug or alcohol misuse,

post-traumatic stress disorder and other personality disorders)

• the need for psychological treatment, social care and support, and occupational

rehabilitation or development

• domestic violence and abuse.

1.3.1.2 Staff involved in the assessment of antisocial personality disorder in secondary

and specialist services should use structured assessment methods whenever

possible to increase the validity of the assessment. For forensic services, the use

of measures such as PCL-R or PCL-SV to assess the severity of antisocial

personality disorder should be part of the routine assessment process.

1.3.1.3 Staff working in primary and secondary care services (for example, drug and

alcohol services) and community services (for example, the probation service)

that include a high proportion of people with antisocial personality disorder

should be alert to the possibility of antisocial personality disorder in service

users. Where antisocial personality disorder is suspected and the person is

seeking help, consider offering a referral to an appropriate forensic mental

health service depending on the nature of the presenting complaint. For

example, for depression and anxiety this may be to general mental health

services; for problems directly relating to the personality disorder it may be to a

specialist personality disorder or forensic service.

1.3.2 1.3.2 Risk assessment and management Risk assessment and management

Risk assessment is part of the overall approach to assessment and care planning as defined in the

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framework of the Care Programme Approach, and the following recommendations should be

regarded in that context.

Primary care services Primary care services

1.3.2.1 Assessing risk of violence is not routine in primary care, but if such assessment

is required consider:

• current or previous violence, including severity, circumstances, precipitants and

victims

• the presence of comorbid mental disorders and/or substance misuse

• current life stressors, relationships and life events

• additional information from written records or families and carers (subject to the

person’s consent and right to confidentiality), because the person with antisocial

personality

disorder might not always be a reliable source of information.

1.3.2.2 Healthcare professionals in primary care should consider contact with and/or

referral to secondary or forensic services where there is current violence or

threats that suggest significant risk and/or a history of serious violence,

including predatory offending or targeting of children or other vulnerable

people.

Secondary care services Secondary care services

1.3.2.3 When assessing the risk of violence in secondary care mental health services,

take a detailed history of violence and consider

and record:

• current or previous violence, including severity, circumstances, precipitants and
victims

• contact with the criminal justice system, including convictions and periods of

imprisonment

• the presence of comorbid mental disorder and/or substance misuse

• current life stressors, relationships and life events
Antisocial personality disorder: prevention and management (CG77)
© NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights). Last updated 27 March 2013

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• additional information from written records or families and carers (subject to the

person’s consent and right to confidentiality), as the person with antisocial personality

disorder might not always be a reliable source of information.

1.3.2.4 The initial risk management should be directed at crisis resolution and

ameliorating any acute aggravating factors. The history of previous violence

should be an important guide in the development of any future violence risk

management plan.

1.3.2.5 Staff in secondary care mental health services should consider a referral to

forensic services where there is:

• current violence or threat that suggests immediate risk or disruption to the operation

of the service

• a history of serious violence, including predatory offending or targeting of children or

other vulnerable people.

Specialist personality disorder or forensic services Specialist personality disorder or forensic services

1.3.2.6 When assessing the risk of violence in forensic, specialist personality disorder or

tertiary mental health services, take a detailed history of violence, and consider

and record:

• current and previous violence, including severity, circumstances, precipitants and

victims
• contact with the criminal justice system, including convictions and periods of
imprisonment
• the presence of comorbid mental disorder and/or substance misuse
• current life stressors, relationships and life events
• additional information from written records or families and carers (subject to the
person’s consent and right to confidentiality), as the person with antisocial personality
disorder might not always be a reliable source of information.

1.3.2.7 Healthcare professionals in forensic or specialist personality disorder services

should consider, as part of a structured clinical assessment, routinely using:

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• a standardised measure of the severity of antisocial personality disorder (for example,

PCL-R or PCL-SV)

• a formal assessment tool such as HCR-20 to develop a risk management strategy.

1.3.3 1.3.3 Risk management Risk management

1.3.3.1 Services should develop a comprehensive risk management plan for people with

antisocial personality disorder who are considered to be of high risk. The plan

should involve other agencies in health and social care services and the criminal

justice system. Probation services should take the lead role when the person is

on a community sentence or is on licence from prison with mental health and

social care services providing support and liaison. Such cases should routinely

be referred to the local Multi-Agency Public Protection Panel.

1.4 1.4 Treatment and management of antisocial Treatment and management of antisocial
personality disorder and related and comorbid disorders personality disorder and related and comorbid disorders

The evidence base for the treatment of antisocial personality disorder is limited. In the

development of the recommendations set out below these limitations were addressed by drawing

on four related sources of evidence, namely, evidence for: (1) interventions targeted specifically at

antisocial personality disorder; (2) the treatment and management of the symptoms and

behaviours associated with antisocial personality disorder, such as impulsivity and aggression; (3)

the treatment of comorbid disorders such as depression and drug misuse; and (4) the management

of offending behaviour. Although the focus of several interventions is offending behaviour, the

interventions have the potential to help people with antisocial personality disorder address a wider

range of antisocial behaviours with consequent benefits for themselves and others.

1.4.1 1.4.1 General principles General principles

1.4.1.1 People with antisocial personality disorder should be offered treatment for any

comorbid disorders in line with recommendations in the relevant NICE

guideline, where available (see the NICE mental health and behavioural

conditions topic page, or search the NICE find guidance page). This should

happen regardless of whether the person is receiving treatment for antisocial

personality disorder.

1.4.1.2 When providing psychological or pharmacological interventions for antisocial

personality disorder, offending behaviour or comorbid disorders to people with

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https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions

https://www.nice.org.uk/guidance

antisocial personality disorder, be aware of the potential for and possible impact

of:

• poor concordance

• high attrition

• misuse of prescribed medication

• drug interactions (including with alcohol and illicit drugs).

1.4.1.3 When providing psychological interventions for comorbid disorders to people

with antisocial personality disorder, consider lengthening their duration or

increasing their intensity.

1.4.2 1.4.2 The role of psychological interventions The role of psychological interventions

1.4.2.1 For people with antisocial personality disorder, including those with substance

misuse problems, in community and mental health services, consider offering

group-based cognitive and behavioural interventions, in order to address

problems such as impulsivity, interpersonal difficulties and antisocial behaviour.

1.4.2.2 For people with antisocial personality disorder with a history of offending

behaviour who are in community and institutional care, consider offering group-

based cognitive and behavioural interventions (for example, programmes such

as ‘reasoning and rehabilitation’) focused on reducing offending and other

antisocial behaviour.

1.4.2.3 For young offenders aged 17 years or younger with a history of offending

behaviour who are in institutional care, offer group-based cognitive and

behavioural interventions aimed at young offenders and that are focused on

reducing offending and other antisocial behaviour.

1.4.2.4 When providing cognitive and behavioural interventions:

• assess the level of risk and adjust the duration and intensity of the programme

accordingly (participants at all levels of risk may benefit from these interventions)

• provide support and encouragement to help participants to attend and complete

programmes, including people who are legally mandated to do so.

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1.4.3 1.4.3 The role of pharmacological interventions The role of pharmacological interventions

1.4.3.1 Pharmacological interventions should not be routinely used for the treatment of

antisocial personality disorder or associated behaviours of aggression, anger

and impulsivity.

1.4.3.2 Pharmacological interventions for comorbid mental disorders, in particular

depression and anxiety, should be in line with recommendations in the relevant

NICE guideline (see the NICE mental health and behavioural conditions topic

page, or search the NICE find guidance page). When starting and reviewing

medication for comorbid mental disorders, pay particular attention to issues of

adherence and the risks of misuse or overdose.

1.4.4 1.4.4 Drug and alcohol misuse Drug and alcohol misuse

Drug and alcohol misuse occurs commonly alongside antisocial personality disorder, and is likely to

aggravate risk of harm to self and others and behavioural disturbances in people with antisocial

personality disorder.

1.4.4.1 For people with antisocial personality disorder who misuse drugs, in particular

opioids or stimulants, offer psychological interventions (in particular,

contingency management programmes) in line with recommendations in the

relevant NICE guideline (see the NICE mental health and behavioural conditions

topic page, or search the NICE find guidance page).

1.4.4.2 For people with antisocial personality disorder who misuse or are dependent on

alcohol, offer psychological and pharmacological interventions in line with

existing national guidance for the treatment and management of alcohol

disorders.

1.4.4.3 For people with antisocial personality disorder who are in institutional care and

who misuse or are dependent on drugs or alcohol, consider referral to a

specialist therapeutic community focused on the treatment of drug and alcohol

problems.
Antisocial personality disorder: prevention and management (CG77)
© NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights). Last updated 27 March 2013

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https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions

https://www.nice.org.uk/guidance

https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions

https://www.nice.org.uk/guidance

1.5 1.5 Psychopathy and dangerous and severe personality Psychopathy and dangerous and severe personality
disorder disorder

People with psychopathy and people who meet criteria for dangerous and severe personality

disorder (DSPD) represent a small proportion of people with antisocial personality disorder.

However, they present a very high risk of harm to others and consume a significant proportion of

the services for people with antisocial personality disorder. In the absence of any high-quality

evidence for the treatment of DSPD, the Guideline Development Group drew on the evidence for

the treatment of antisocial personality disorder to arrive at their recommendations. Interventions

will often need to be adapted for DSPD (for example, a significant extension of the duration of the

intervention). People with DSPD can be seen as having a lifelong disability that requires continued

input and support over many years.

1.5.1 1.5.1 Adapting interventions for people who meet criteria for Adapting interventions for people who meet criteria for
psychopathy or DSPD psychopathy or DSPD

1.5.1.1 For people in community and institutional settings who meet criteria for

psychopathy or DSPD, consider cognitive and behavioural interventions (for

example, programmes such as ‘reasoning and rehabilitation’) focused on

reducing offending and other antisocial behaviour. These interventions should

be adapted for this group by extending the nature (for example, concurrent

individual and group sessions) and duration of the intervention, and by

providing booster sessions, continued follow-up and close monitoring.

1.5.1.2 For people who meet criteria for psychopathy or DSPD, offer treatment for any

comorbid disorders in line with existing NICE guidance (browse the NICE

mental health and behavioural conditions topic page, or search the NICE find

guidance page). This should happen regardless of whether the person is

receiving treatment for psychopathy or DSPD because effective treatment of

comorbid disorders may reduce the risk associated with psychopathy or DSPD.

1.5.2 1.5.2 Intensive staff support Intensive staff support

1.5.2.1 Staff providing interventions for people who meet criteria for psychopathy or

DSPD should receive high levels of support and close supervision, due to

increased risk of harm. This may be provided by staff outside the unit.

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https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions

https://www.nice.org.uk/guidance

1.6 1.6 Organisation and planning of services Organisation and planning of services

There has been a considerable expansion of services for people with antisocial personality disorder

in recent years involving a wider range of agencies in the health and social care sector, the non-

statutory sector and the criminal justice system. If the full benefit of these additional services is to

be realised, effective care pathways and specialist networks need to be developed.

1.6.1 1.6.1 Multi-agency care Multi-agency care

1.6.1.1 Provision of services for people with antisocial personality disorder often

involves significant inter-agency working. Therefore, services should ensure

that there are clear pathways for people with antisocial personality disorder so

that the most effective multi-agency care is provided. These pathways should:

• specify the various interventions that are available at each point

• enable effective communication among clinicians and organisations at all points and

provide the means to resolve differences and disagreements.

Clearly agreed local criteria should also be established to facilitate the transfer of

people with antisocial personality disorder between services. As far as is possible,

shared objective criteria should be developed relating to comprehensive assessment

of need and risk.

1.6.1.2 Services should consider establishing antisocial personality disorder networks,

where possible linked to other personality disorder networks. (They may be

organised at the level of primary care trusts, local authorities, strategic health

authorities or government offices.) These networks should be multi-agency,

should actively involve people with antisocial personality disorder and should:

• take a significant role in training staff, including those in primary care, general,

secondary and forensic mental health services, and in the criminal justice system

• have resources to provide specialist support and supervision for staff

• take a central role in the development of standards for and the coordination of clinical

pathways

• monitor the effective operation of clinical pathways.

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1.6.2 1.6.2 Inpatient services Inpatient services

1.6.2.1 Healthcare professionals should normally only consider admitting people with

antisocial personality disorder to inpatient services for crisis management or for

the treatment of comorbid disorders. Admission should be brief, where possible

set out in a previously agreed crisis plan and have a defined purpose and end

point.

1.6.2.2 Admission to inpatient services solely for the treatment of antisocial personality

disorder or its associated risks is likely to be a lengthy process and should:

• be under the care of forensic/specialist personality disorder services

• not usually be under a hospital order under a section of the Mental Health Act (in the

rare instance that this is done, seek advice from a forensic/specialist personality

service).

1.6.3 1.6.3 Staff training, supervision, support Staff training, supervision, support

Working in services for people with antisocial personality disorder presents a considerable

challenge for staff. Effective training and support is crucial so that staff can adhere to the specified

treatment programme and manage any emotional pressures arising from their work.

Staff competencies Staff competencies

1.6.3.1 All staff working with people with antisocial personality disorder should be

familiar with the ‘Ten essential shared capabilities: a framework for the whole of

the mental health practice'[2] and have a knowledge and awareness of antisocial

personality disorder that facilitates effective working with service users,

families or carers, and colleagues.

1.6.3.2 All staff working with people with antisocial personality disorder should have

skills appropriate to the nature and level of contact with service users. These

skills include:

• for all frontline staff, knowledge about antisocial personality disorder and

understanding behaviours in context, including awareness of the potential for

therapeutic boundary violations (for example, inappropriate relations with service

users)

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• for staff with regular and sustained contact with people with antisocial personality

disorder, the ability to respond effectively to the needs of service users

• for staff with direct therapeutic or management roles, competence in the specific

treatment interventions and management strategies used in the service.

1.6.3.3 Services should ensure that all staff providing psychosocial or pharmacological

interventions for the treatment or prevention of antisocial personality disorder

are competent and properly qualified and supervised, and that they adhere

closely to the structure and duration of the interventions as set out in the

relevant treatment manuals. This should be achieved through:

• use of competence frameworks based on relevant treatment manuals

• routine use of sessional

outcome measures

• routine direct monitoring and evaluation of staff adherence, for example through the

use of video and audio tapes and external audit and scrutiny where appropriate.

Supervision and support Supervision and support

1.6.3.4 Services should ensure that staff supervision is built into the routine working of

the service, is properly resourced within local systems and is monitored.

Supervision, which may be provided by staff external to the service, should:

• make use of direct observation (for example, recordings of sessions) and routine

outcome measures

• support adherence to the specific intervention

• promote general therapeutic consistency and reliability

• counter negative attitudes among staff.

1.6.3.5 Forensic services should ensure that systems for all staff working with people

with antisocial personality disorder are in place that provide:

• comprehensive induction programmes in which the purpose of the service is made

clear

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• a supportive and open environment that encourages reflective practice and honesty

about individual difficulties such as the potential for therapeutic boundary violations

(such as inappropriate relations with service users)

• continuing staff support to review and explore the ethical and clinical challenges

involved in working in high-intensity environments, thereby building staff capacity and

resilience.

[1] See Department of Health.

[2] The Essential Shared Capabilities

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http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009546

http://www.eftacim.org/doc_pdf/10ESC

Finding more information and resources Finding more information and resources
You can see everything NICE says on antisocial personality disorder: prevention and management

in our interactive flowcharts on antisocial behavior and conduct disorders in children and young

people and personality disorders.

To find out what NICE has said on topics related to this guideline, see our web page on personality

disorders.

For full details of the evidence and the guideline committee’s discussions, see the evidence reviews.

You can also find information about how the guideline was developed, including details of the

committee.

NICE has produced tools and resources to help you put this guideline into practice. For general help

and advice on putting NICE guidelines into practice, see resources to help you put guidance into

practice.

Page 27
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https://pathways.nice.org.uk/pathways/antisocial-behaviour-and-conduct-disorders-in-children-and-young-people

https://pathways.nice.org.uk/pathways/personality-disorders

https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/personality-disorders

http://www.nice.org.uk/Guidance/CG77/evidence

http://www.nice.org.uk/Guidance/CG77/documents

http://www.nice.org.uk/guidance/cg77/resources

https://www.nice.org.uk/about/what-we-do/into-practice/resources-help-put-guidance-into-practice

2 2 Research recommendations Research recommendations
The Guideline Development Group has made the following recommendations for research, based

on its review of evidence, to improve NICE guidance and patient care in the future. The relatively

large number of recommendations made reflects the paucity of research in this area.

2.1 2.1 Severity as a potential moderator of effect in group-Severity as a potential moderator of effect in group-
based cognitive and behavioural interventions based cognitive and behavioural interventions

Does the pre-treatment level of the severity of disorder/problem have an impact on the outcome of

group-based cognitive and behavioural interventions for offending behaviour? A meta-analysis of

individual participant data should be conducted to determine whether the level of severity

assessed at the beginning of the intervention moderates the effect of the intervention. The study

(for which there are large data sets that include over 10,000 participants) could inform the design

of a large-scale RCT (including potential modifications of cognitive and behavioural interventions)

to test the impact of severity on the outcome of cognitive and behavioural interventions.

Why this is important Why this is important

Research has established the efficacy of cognitive and behavioural interventions in reducing

reoffending. However, the effects of these interventions in a range of offending populations are

modest. The impact of severity on the outcome of these interventions has not been systematically

investigated, and post hoc analyses and meta-regression of risk as a moderating factor have been

inconclusive. Expert opinion suggests that severe or high-risk individuals may not benefit from

cognitive and behavioural interventions, but if they were to be of benefit then the cost savings

could be considerable.

2.2 2.2 Group-based cognitive and behavioural Group-based cognitive and behavioural
interventions for populations outside criminal justice interventions for populations outside criminal justice
settings settings

Are group-based cognitive and behavioural interventions effective in reducing the behaviours

associated with antisocial personality disorder (such as impulsivity, rule-breaking, deceitfulness,

irritability, aggressiveness and disregard for the safety of self or others)? This should be tested in an

RCT that examines medium-term outcomes (including cost effectiveness) over a period of at least

18 months. It should pay particular attention to the modification and development of the

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interventions to ensure the focus is not just on offending behaviour, but on all aspects of the

challenging behaviours associated with antisocial personality disorder.

Why this is important Why this is important

Not all people with antisocial personality disorder are offenders but they exhibit a wide range of

antisocial behaviours. However, the evidence for the treatment of these behaviours outside the

criminal justice system is extremely limited. Following publication of the Department of Health’s

policy guidance, ‘Personality disorder: no longer a diagnosis of exclusion’ (2003), it is likely that

there will be an increased requirement in the NHS to offer treatments for antisocial personality

disorder.

2.3 2.3 Effectiveness of multisystemic therapy versus Effectiveness of multisystemic therapy versus
functional family therapy functional family therapy

Is multisystemic therapy or functional family therapy more clinically and cost effective in the

treatment of adolescents with conduct disorders? A large-scale RCT comparing the clinical and cost

effectiveness of multisystemic therapy and functional family therapy for adolescents with conduct

disorders should be conducted. It should examine the medium-term outcomes (for example,

offending behaviour, mental state, educational and vocational outcomes and family functioning)

over a period of at least 18 months. The study should also be designed to explore the moderators

and mediators of treatment effect, which could help to determine the factors associated with

benefits or harms of either multisystemic therapy or functional family therapy.

Why this is important Why this is important

Multisystemic therapy and functional family therapy are two interventions with a relatively strong

evidence base in the treatment of adolescents with conduct disorders, but there have been no

studies directly comparing their clinical and cost effectiveness. Their use in health and social care

services in the UK is increasing. Both interventions target the same population, but although they

share some common elements (that is, work with the family), multisystemic therapy is focused on

both the family and the wider resources of the school, community and criminal justice systems, and

through intensive individual case work seeks to change the pattern of antisocial behaviour. In

contrast, functional family therapy focuses more on the immediate family environment and uses

the resources of the family to change the pattern of antisocial behaviour. The study should be

designed to facilitate the identification of sub-groups within the conduct disorder population who

may benefit from either multisystemic therapy or functional family therapy.

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2.4 2.4 Interventions for infants at high risk of developing Interventions for infants at high risk of developing
conduct disorders conduct disorders

Do specially designed parent-training programmes focused on sensitivity enhancement (a set of

techniques designed to improve secure attachment behaviour between parents and children)

reduce the risk of behavioural disorders, including conduct problems and delinquency, in infants at

high risk of developing these problems? An RCT comparing parent-training programmes focused on

sensitivity enhancement with usual care should be undertaken. It should examine the long-term

outcomes over a period of at least 5 years, but with consideration given to the possibility of a

further 10-year follow-up. The study should also be designed to explore the moderators and

mediators of treatment effect that could help determine the factors associated with benefits or

harms of the intervention.

Why this is important Why this is important

There is limited evidence from non-UK studies that interventions focused on developing better

parent–child attachment can have benefits for infants at risk of developing conduct disorder.

Determining the criteria and then identifying children at high risk (usually via parental risk factors)

is difficult and challenging. Even when these factors are agreed, engaging parents in treatment can

be difficult. It is important that a range of effective interventions is developed to increase the

treatment choice and opportunities for high-risk groups. Several interventions, such as

Nurse–Family Practitioners, are being developed and trialled in the UK. It is important for this

group of children to have an alternative, effective intervention.

2.5 2.5 Treatment of comorbid anxiety disorders in Treatment of comorbid anxiety disorders in
antisocial personality disorder antisocial personality disorder

Does the effective treatment of anxiety disorders in antisocial personality disorder improve the

long-term outcome for antisocial personality disorder? An RCT of people with antisocial

personality disorder and comorbid anxiety disorders that compares a sequenced treatment

programme for the anxiety disorder with usual care should be conducted. It should examine, over a

period of at least 18 months, the medium-term outcomes for key symptoms and behaviours

associated with antisocial personality disorder (including offending behaviour, deceitfulness,

irritability and aggressiveness, and disregard for the safety of self or others), as well as drug and

alcohol misuse, and anxiety. The study should also be designed to explore the moderators and

mediators of treatment effect which could help determine the role of anxiety in the course of

antisocial personality disorder.
Antisocial personality disorder: prevention and management (CG77)
© NICE 2020. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights). Last updated 27 March 2013

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Why this is important Why this is important

Comorbidity with Axis I disorders is common in antisocial personality disorder, and chronic anxiety

has been identified as a particular disorder that may exacerbate the problems associated with

antisocial personality disorder. There are effective treatments (psychological and pharmacological)

for anxiety disorders but they are often not offered to people with antisocial personality disorder.

Current treatment guidelines set out clear pathways for the stepped or sequenced care of people

with anxiety disorders. An RCT to test the benefit of this approach in the treatment of anxiety

would potentially lead to a significant reduction in illness burden but a reduction in antisocial

behaviour would have wider societal benefits. The study should provide important information on

the challenges of delivering these interventions for a population that has typically both rejected

and been refused treatment.

2.6 2.6 Using selective serotonin reuptake inhibitors to Using selective serotonin reuptake inhibitors to
increase cooperative behaviour in people with antisocial increase cooperative behaviour in people with antisocial
personality disorder in a prison setting personality disorder in a prison setting

Although there is evidence that selective serotonin reuptake inhibitors (SSRIs), such as paroxetine,

increase cooperative behaviour in normal people and do so independently of the level of sub-

syndromal depression, this has yet to be tested in other settings. Given that people with antisocial

personality disorder are likely to have difficulties cooperating with one another (because of a host

of personality traits that include persistent rule-breaking for personal advantage, suspiciousness,

grandiosity, etc.). An RCT should be conducted to find out whether these reported changes of

behaviour with an SSRI in normal people generalises to clinical populations in different settings.

Why this is important Why this is important

There is little evidence in the literature on the pharmacotherapy of antisocial personality disorder

to justify the use of any particular medication. However, multiple drugs in various combinations are

used in this group either to control aberrant behaviour or in the hope that something might work.

Current interventions lack a clear rationale. This recommendation has the potential to advance the

field in that (a) it is linked to a clear hypothesis (that cooperative behaviour is linked to a

dysregulation of the serotonin receptors – for which there is substantial evidence) and (b) that it is

feasible to obtain an answer to this question, given that there are a large number of individuals

detained in prison settings who would meet ASPD criteria. Constructing an experimental task that

requires cooperative activity would not be difficult in such a setting, since all of those who might be

willing to participate are already detained. The successful execution of this research would be

important in that it (a) would establish the feasibility of conducting such a trial in a prison setting

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with this group, and (b) provide a clear and sensible outcome measure of antisocial behaviour that

might be generalised to other settings.

2.7 2.7 A therapeutic community approach for antisocial A therapeutic community approach for antisocial
personality disorder in a prison setting personality disorder in a prison setting

Is a therapeutic community approach in a prison setting more clinically and cost effective in the

treatment and management of antisocial personality disorder than routine prison care? There

should be a large-scale RCT comparing the clinical and cost effectiveness of the therapeutic

community approach for adults with antisocial personality disorder with routine care. It should

examine the medium-term outcomes (for example, offending behaviour, mental state and

vocational outcomes) over a period of at least 18 months following release from prison. The study

should also be designed to explore the moderators and mediators of treatment effect, which could

help to determine the factors associated with benefits or harms of the therapeutic community

approach.

Why this is important Why this is important

There is evidence from RCTs that the therapeutic community approach is of value with drug and

alcohol misusers in a prison setting at reducing the incidence of offending behaviour on release.

However, there are no equivalent studies of a programme in the prison system on antisocial

personality disorder populations that do not have significant drug or alcohol problems. Data that

do exist are from non-UK settings. Answering this question is of importance because outcomes for

adults with antisocial personality disorder are poor and there are already considerable resources

devoted to a therapeutic community approach in the UK prison system (for example, HMP

Grendon Underwood). The study could inform policy and resources decisions about the

management of antisocial personality disorder in the criminal justice system.

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3 3 Definitions of psychological interventions Definitions of psychological interventions
Anger control: Anger control: usually offered to children who are aggressive at school, anger control includes a

number of cognitive and behavioural techniques similar to cognitive problem-solving skills training

(see below). It also includes training of other skills such as relaxation and social skills.

Brief strategic family therapy: Brief strategic family therapy: an intervention that is systemic in focus and is influenced by other

approaches. The main elements include engaging and supporting the family, identifying

maladaptive family interactions and seeking to promote new and more adaptive family

interactions.

Cognitive problem-solving skills training: Cognitive problem-solving skills training: an intervention that aims to reduce children’s conduct

problems by teaching them different responses to interpersonal situations. Using cognitive and

behavioural techniques with the child, the training has a focus on thought processes. The training

includes:

• teaching a step-by-step approach to solving interpersonal problems

• structured tasks such as games and stories to aid the development of skills

• combining a variety of approaches including modelling and practice, role-playing and

reinforcement.

Functional family therapy: Functional family therapy: a family-based intervention that is behavioural in focus. The main

elements include engagement and motivation of the family in treatment, problem-solving and

behaviour change through parent-training and communication-training, and seeking to generalise

change from specific behaviours to positively influence interactions both within the family and with

community agencies such as schools.

Multidimensional treatment foster care: Multidimensional treatment foster care: using strategies from family therapy and behaviour

therapy to intervene directly in systems and processes related to antisocial behaviour (for example,

parental discipline, family affective relations, peer associations and school performances) for

children or young people in foster care and other out-of-home placements. This includes group

meetings and other support for the foster parents and family therapy with the child’s biological

parents.

Multisystemic therapy: Multisystemic therapy: using strategies from family therapy and behaviour therapy to intervene

directly in systems and processes related to antisocial behaviour (for example, parental discipline,

Page 33
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family affective relations, peer associations and school performances) for children or young people.

Parent-training programmes: Parent-training programmes: an intervention that aims to teach the principles of child behaviour

management, to increase parental competence and confidence in raising children and to improve

the parent/carer–child relationship by using good communication and positive attention to aid the

child’s development. Examples of well-developed programmes are the Triple P (Sanders et al. 2000)

and Webster-Stratton (Webster-Stratton et al. 1988).

Self-talk:Self-talk: the internal conversation a person has with themselves in response to a situation. Using

or changing self-talk is a part of anger control training (see above).

Social problem skills training: Social problem skills training: a specialist form of cognitive problem-solving training that aims to:

• modify and expand the child’s interpersonal appraisal processes through developing a more

sophisticated understanding of beliefs and desires in others

• improve the child’s capacity to regulate his or her own emotional responses.

References References

Sanders MR, Markie-Dadds C, Tully LA et al. (2000) The triple positive parenting program: a

comparison of enhanced, standard, and self-directed behavioral family intervention for parents of

children with early onset conduct problems. Journal of Consulting and Clinical Psychology 68:

624–40.

Webster-Stratton C, Kolpacoff M, Hollinsworth T (1988) Self-administered videotape therapy for

families with conduct-problem children: comparison with two cost-effective treatments and a

control group. Journal of Consulting and Clinical Psychology 56: 558–66.

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Update information Update information
March 2013:March 2013: Recommendations 1.2.3.1–1.2.3.2, 1.2.4.1–1.2.4.2, 1.2.4.4–1.2.4.5, 1.2.5.1–1.2.5.3,

1.2.6.1, 1.2.7.1–1.2.7.3, 1.2.7.6–1.2.7.7 and 1.2.8.3–1.2.8.4 have been deleted and replaced by the

NICE guidance on antisocial behaviour and conduct disorders in children and young people.

Minor changes since publication Minor changes since publication

August 2018: August 2018: Recommendations 1.4.11, 1.4.3.2, 1.4.4.1 and 1.5.1.2 have been updated to link to

NICE topic pages so readers can easily find related guidance.

September 2013:September 2013: Further corrections to the March 2013 list of replaced recommendations, to

include 1.2.6.2 and 1.2.7.4. Recommendation 1.2.6.2 was deleted from the key priorities for

implementation.

August 2013:August 2013: Corrections to the March 2013 list of replaced recommendations to include 1.2.7.5

and 1.2.8.1–2.

January 2012: January 2012: Minor maintenance.

Accreditation Accreditation

Page 35
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http://www.nice.org.uk/guidance/cg158

https://www.nice.org.uk/

Finding more information and resources
2 Research recommendations
2.1 Severity as a potential moderator of effect in group-based cognitive and behavioural interventions
2.2 Group-based cognitive and behavioural interventions for populations outside criminal justice settings
2.3 Effectiveness of multisystemic therapy versus functional family therapy
2.4 Interventions for infants at high risk of developing conduct disorders
2.5 Treatment of comorbid anxiety disorders in antisocial personality disorder
2.6 Using selective serotonin reuptake inhibitors to increase cooperative behaviour in people with antisocial personality disorder in a prison setting
2.7 A therapeutic community approach for antisocial personality disorder in a prison setting
3 Definitions of psychological interventions
References
Update information
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Thorough Proofreading

We thoroughly read your final draft to identify errors.

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We understand your guidelines first before delivering any writing service. You can discuss your writing needs and we will have them evaluated by our dedicated team.

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We Handle Your Writing Tasks to Ensure Excellent Grades

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Areas of Expertise

Essay

Thesis

Presentation

Dissertation

Term Paper

Research Paper

Book Review

Assignment

Report

Case Study

Letter

Article

Coursework

Speech

Q & A

Critical Thinking

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Our Services

Academic Writing

Professional Editing

Thorough Proofreading

Thorough Proofreading

Delegate Your Challenging Writing Tasks to Experienced Professionals

Check Out Our Sample Work

It May Not Be Much, but It’s Honest Work!

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Happy Clients

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Words Written This Week

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Ongoing Orders

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Customer Satisfaction Rate

Process as Fine as Brewed Coffee

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See How We Helped 9000+ Students Achieve Success

We Analyze Your Problem and Offer Customized Writing

We Mirror Your Guidelines to Deliver Quality Services

We Handle Your Writing Tasks to Ensure Excellent Grades