Note from the National Guideline Clearinghouse (NGC): The National Institute for Health and Clinical Excellence (NICE) commissioned an independent academic centre to perform a systematic literature review on the technology considered in this appraisal and prepare an assessment report. The assessment report for this technology appraisal was prepared by the West Midlands Health Technology Assessment Collaboration (WMHTAC), Department of Public Health and Epidemiology, The University of Birmingham. (See the "Availability of Companion Documents" field.)
Methods for Reviewing Effectiveness
Search Strategy
Electronic Databases
Due to the nature of the topic, databases (n=20) from the fields of medicine, social science, and education were searched. Sensitive search strategies were employed in order to identify all potentially relevant studies. Text and Medical Subject Heading (MeSH) words relating to the condition and intervention of interest were combined with filters for randomised controlled trials. There were no language restrictions. Full details of the search strategies can be found in Appendix 4 of the Assessment Report (see the "Availability of Companion Documents" field).
The following electronic databases were searched:
- MEDLINE (Ovid) 1966 to September week 3 2003E
- Excerpta Medica Database (EMBASE) (Ovid) 1980 to 2003 week 38
- Cumulative Index of Nursing and Allied Health Literature (CINAHL) (Ovid) 1982 to September week 3 2003
- Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3 2003
- National Health Service (NHS) Centre for Reviews and Dissemination Health Technology Assessment (HTA) database
- ISI Proceedings (Science and Technology and Social Sciences and Humanities) 1990 to September 2003
- Social Science Citation Index 1981 to September 2003
- International Bibliography of Social Sciences (BIDS) 1966 to September 2003
- Applied Social Sciences Index and Abstracts (ASSIA) 1987 to September 2003
- Educational Resources Information Center (ERIC) (CSA) 1966 to September 2003
- British Education Index (Dialog) 1976 to June 2003
- Australian Education Index (Dialog) 1976 to September 2003
- Sociological Abstracts (CSA) 1963 to September 2003
- Social Sciences Abstracts (CSA) 1980 to September 2003
- PsycINFO 1974 to present (searched 7/10/2003)
- ZETOC (British Library) 1995 to present (searched 7/10/2003)
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) databases 1995 to present
- United States (US) National Criminal Justice Reference Service (NCJRS ) databases 1970 to September 2003
- Evidence Based Mental Health (EBMH) Online 1998 to October 2003
- Social Care Institute for Excellence's (SCIE's) database (Caredata) was searched using SCIE's enhanced in-house search facility
Ongoing/Unpublished Trials
The National Research Register Issue 3 2003 was searched to identify ongoing and unpublished research. Submissions from manufacturers, professional and patient groups, and commentators were checked, and all parties were contacted with a preliminary list of included studies as an opportunity to highlight any potential omissions.
Citation Searches
Citation lists of systematic reviews (n=16) and included studies (n=34) were checked (although the results of these citation checks have not been included for the peer review version of this report).
Inclusion and Exclusion Criteria
Two reviewers initially scanned all identified citations, and hardcopies of potentially relevant studies were retrieved. Where there was disagreement on whether to retrieve a study, a third reviewer was consulted. An inclusion and exclusion pro-forma (see Appendix 3 of the Assessment Report [refer to the "Availability of Companion Documents" field]) was then used to formally include or exclude the retrieved studies. Two reviewers applied the inclusion and exclusion criteria independently, with disagreements resolved by a third reviewer. Reasons for exclusion were noted. Where there were insufficient details to make a decision, the authors of the study were contacted.
Inclusion Criteria
Study Design: Randomized controlled trials
Population: Parents (or carers) of children or adolescents up to the age of 18 where at least 50% have a behavioural disorder (compulsive disorder [CD], oppositional defiant disorder [ODD], or other more or less severe behavioural problems); no exclusion on the basis of co-morbidities.
Studies were included if:
- A diagnosis of conduct disorder or oppositional defiant disorder was made using the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) criteria or similar OR
- If the children were in an elevated or clinical range of a behavioural scale (such as the Eyberg Child Behaviour Inventory [ECBI]) OR
- If the children were described as having behavioural problems, one or more of which would be recognised as being characteristic of conduct disorder or oppositional defiant disorder
Intervention: A parent-training/education programme
- Where the content is documented and repeatable and which is run over a defined time period
- Where the treatment focused exclusively on parents only.
There were no restrictions regarding the theoretical basis of a programme, the length, setting, or mode of delivery (e.g., group, individual or self-administered)
Comparator: Any; for example a control group (e.g., waiting list) and/or a different parent-training/education programme and/or a different intervention
Outcomes: At least one measure of child behaviour
Exclusion Criteria
Study Design: Any other study design (e.g., quasi-randomised controlled trials, nonrandomized controlled studies, non-controlled before- and after studies)
Population: Children at risk of a behavioural disorder or children with another disorder only (e.g., Attention Deficit Hyperactivity Disorder [ADHD], learning disabilities) with no evidence that they would fall into one of the categories (a-c) listed under the inclusion criteria
Intervention: A child, family, or teacher focused intervention; a non-structured parent-focused intervention such as a support group or informal home visits; a parent training/education programme in conjunction with another intervention (e.g., a parent training/education programme that also includes children in at least some of the sessions)
Review of Previous Economic/Cost Evaluations of Parent Training/Education Programmes
Search Strategy
A comprehensive search for literature on quality of life in children with conduct disorder and their families, and the costs and cost-effectiveness of parent-training/education programmes was conducted. The following bibliographic databases were searched: Cochrane Library (National Health Service Economic Evaluation Database [NHS EED], and Centre for Reviews and Dissemination databases (Database of Abstracts of Reviews of Effectiveness [DARE]) Issue 3 2003, MEDLINE (Ovid) 1966 to August week 4 2003, EMBASE (Ovid) 1980 to 2003 week 38. The September 2003 issue of the Office of Health Economics Evaluations Database was also searched. Search strategies used are in Appendix 4 of the Assessment Report (see "Availability of Companion Documents" field). Internet sites of national economic units were also interrogated.