Le trouble des conduites chez l'enfant et l'adolescent : une revue des abords thérapeutiques

Conduct disorder (CD) is the most common psychiatric disorder in youth from the community and encompasses one-third to one-half of all referrals to child and adolescent clinics. The treatment of this condition is often complex and requires a multimodal approach. In order to help clinicians, we propose a review of therapeutics tools for which randomized controlled studies are available. First, three psychosocial treatments are briefly described as they have been shown to be effective in treating CD: (i) parents training programs, well evaluated and more effective among younger patients (ii), cognitive psychotherapy, more effective among adolescents and (iii) multisystemic therapy that should be given to most severe cases because of its cost. Second, a complete review of placebo-controlled studies evaluating psychotropic drugs in CD is provided. These drugs belong to three pharmacological groups of compounds: (i) neuroleptics when aggressivity is high or to obtain rapid sedation, (ii) mood stabilizers especially useful in case of mood liability, (iii) stimulants especially when there is a comorbid attention-deficit/hyperactivity disorder. However, the evidence for an effective role of pharmacotherapy in CD is still limited. Treatment should be multimodal and individualised to each patient's specific condition after a careful evaluation of the child's psychopathology and context.