Randomized controlled trial of functional family therapy for offending and antisocial behaviour in UK Youth

Background: Youth offending and antisocial behavior (ASB) are associated with low quality mental health and relationships and usually lead to poor adult functioning; they are very costly for society. Family interventions are effective in children but there are few reliably effective and inexpensive interventions for adolescents. Functional Family Therapy (FFT) is an evidence-based intervention but seldom tested outside the US. Methods: 111 adolescents (10-17 years of age, M = 15.0, SD = 1.63) and their families were randomized to FFT + Management As Usual (MAU) (n=65) or to MAU (n=46). Assessments were made at baseline, 6, and 18 months after randomization and included interviews and questionnaires of parenting behaviors, Conduct Disorders and offending. Parent-child interaction was directly observed and police records obtained. Trial registration: ISCRTN27650478. Results: 89 (80%) were followed-up. In both groups, there were large reductions over time in all measures of offending and antisocial behavior (e.g. primary outcome p < 0.001), but no significant changes over time in parenting behavior or the parent-child relationship. However, there were no differences between intervention and control groups at 6 or 18 months on self-reported delinquency, police records of offending, symptoms or diagnoses of Conduct Disorders, parental monitoring or supervision, directly-observed child negative behavior, or parental positive or negative behavior. Against predictions, the intervention group showed lower levels of directly-observed child positive behavior at 18 months compared to controls. Conclusions: In contrast to most previous trials of FFT, FFT+MAU did not lead to greater reductions in youth ASB and offending compared to MAU alone, and did not lead to improvements in parenting or the parent-child relationship. This may be because the trial was more rigorously conducted than prior studies; equally, the possibility that MAU was effective requires further research