A successful cognitive-behavioural intervention that failed: a case study of adolescent conduct disorder at a school for the disadvantaged

Abstract

Conduct Disorder (CD) is a widespread problem in southern Africa. The aim of the study was to design, implement and evaluate a multi-modal cognitive-behavioural intervention based on treatments developed overseas, in order to investigate whether this approach can be transported to a South African school for deprived children. The target adolescent had a history of severely disruptive behaviour and was facing expulsion from a shelter for homeless children and his school. A thorough assessment served as the basis for a case formulation and treatment plan. Intervention included 23 individual sessions focussing on bereavement and the learning of self-control skills and prosocial behaviours, as well as contingency management training for school and shelter staff. Progress was tracked with a behaviour checklist completed daily by the teacher and regular interviews with school and shelter staff. After four months, the disruptive behaviour was eliminated. However, he was involved in stealing with some other learners and expelled anyway. Nevertheless the case study provides evidence for the transportability of the cognitive-behavioural approach to this kind of setting and documents the way in which a comprehensive intervention can be tailored to the needs of a child with a severely deprived background and little social support.

Journal of Child and Adolescent Mental Health 2005, 17(2): 69–78