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Eur Psychiatry. 2019 Apr;57:1-9. doi: 10.1016/j.eurpsy.2018.12.009. Epub 2019 Jan 15.

Awareness and perceptions of clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: A qualitative survey with academic experts.

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Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, the Netherlands. Electronic address:
Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, the Netherlands; De Opvoedpoli, Child and Youth Psychiatry, Rode Kruisstraat 32, 1025 KN, Amsterdam, the Netherlands.
VU University Medical Centre, Department of Child and Adolescent Psychiatry, 1007 MB, Amsterdam, the Netherlands; Intermetzo/Pluryn, Research and Development Department, PO Box 53, 6500 AB, Nijmegen, the Netherlands.
Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Hippocratespad 21, 2333 ZD, Leiden, the Netherlands.
University of Oslo, Norwegian Center for Child Behavioral Development, PO Box 7053 Majorstuen, 0306, Oslo, Norway.
University of Coimbra, Faculty of Psychology and Education Sciences - CINEICC, Rua do Colégio Novo, 3000-115, Coimbra, Portugal.
University of Helsinki and Helsinki University Hospital, Children' Hospital, Child Psychiatry, Lastenlinnantie 2, 00250, Helsinki, Finland.
University of Trás-os-Montes and Alto Douro, Department of Education and Psychology, Pólo I - ECHS 5000-801, Vila Real, Portugal.
VU University of Amsterdam, Department of Biological Psychology, Van der Boechorststraat 1, room 2B-29, 1081 BT, Amsterdam, the Netherlands.
Curium-LUMC, Academic Centre of Child and Youth Psychiatry, Endegeesterstraatweg 27, 2342 AK Oegstgeest, the Netherlands; Lucertis - de Jutters, Child and Adolescent Psychiatry, Parnassia Group, the Netherlands.



Severe behavioural problems (SBPs1) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe.


An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries.


Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs.


This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population.


Attention deficit - hyperactivity disorder (ADHD); Conduct disorder; Epidemiology; Psychiatry in Europe; Psychometry and assessments in psychiatry; Violence

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