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Übersichtsarbeit

Verhaltenstherapie bei Kindern mit aggressiv-dissozialen Störungen

Published Online:September 01, 2006https://doi.org/10.1024//1422-4917.30.1.41

Abstract

Zusammenfassung: Aggressiv-dissoziale Störungen bei Kindern und Jugendlichen kommen häufig vor und haben eine schlechte Prognose; sie werden stets mehr als chronische Störung aufgefasst, die sowohl Behandlung als lebenslange Betreuung erfordert. Verhaltenstherapie gilt als effektivste Behandlung, wobei unterschieden wird zwischen Elterntrainings und sozial-kognitiven Problemlösetrainings. Bei jüngeren Kindern ist ein Elterntraining indiziert, bei älteren Kindern zusätzlich ein Problemlösetraining. Die Effekte von Elterntrainings wurden in zahlreichen Studien nachgewiesen; Elterntrainings gelten als «empirically supported treatment», das strengste Kriterium, dem psychologische Behandlungen entsprechen müssen. Auch mit sozial-kognitiven Problemlösetrainings wurden bei klinischen Gruppen signifikante Veränderungen erzielt; sie entsprechen dem etwas weniger strengen Kriterium «probably efficacious». Probleme von Elterntrainings und Problemlösetrainings sind die hohe Abbruchrate bei den Eltern mit den meisten Risikofaktoren und die Tatsache, dass viele Kinder nach einem Problemlösetraining zwar signifikante Verbesserungen erreicht haben, aber immer noch im klinischen Bereich für aggressives Verhalten bleiben. Zur Optimierung des Behandlungserfolgs wurden in den letzten Jahren komplexe Präventionsprogramme entwickelt, die die Entwicklung von delinquentem Verhalten und einer antisozialen Persönlichkeit verhindern sollen. Die bisherigen Ergebnisse sind widersprüchlich; die ersten Resultate zweier noch laufender Studien (FAST- und LIFT-Studie) sind jedoch positiv. Ein höherer Stellenwert von Dissozialität in der kinderpsychiatrisch-psychotherapeutischen Versorgung wäre angesichts der Prävalenz und Folgenschwere der Störung angezeigt.


Behavior Therapy in Children with Conduct Disorder

Summary: Conduct disorder in children and adolescents is prevalent and has a poor prognosis: it is now considered to be a chronic condition that requires treatment as well as life-long monitoring. Two forms of behavior therapy, parent management training and training in problem-solving skills are currently seen as the most effective treatment. Parent management training is the treatment of choice for younger children, while for older children it should be supplemented with training in problem-solving skills. Parent management training is one of the best-researched therapy techniques for conduct disorder, deserving the criterion “empirically supported treatment” defined by the American Psychological Association. Training in problem-solving skills has led to therapeutic change in clinical samples and is qualified as “probably efficacious treatment”. Limitations of both treatments include the high drop-out rate among parents and the fact that many youth improve but remain outside the range of normative functioning. To optimize treatment effectiveness, complex prevention programs have been developed in recent years. Results to date are mixed; however, two large ongoing studies, the FAST and the LIFT study, report positive first outcomes. A higher priority of conduct disorder and related problems in child-psychiatric and psychotherapeutic services would be desirable.

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