Conduct Disorder

Definition:

Children with Conduct Disorder would exhibit a range of problematic behaviors; these may include aggression towards other people and serious defiance of rules, laws and behaviors that are considered to be socially normal or appropriate.  It is thought that there are many causes of Conduct Disorder some of these are brain damage, child abuse, school failure, traumatic experiences and genetic susceptibility.  Children with Conduct Disorder are often viewed as bad or as a delinquent, but not as mentally ill.

Conduct Disorder is a more serious childhood psychiatric disorder than Oppositional Defiant Disorder (ODD) or Attention Deficit/Hyperactivity Disorder (ADHD).  Conduct Disorder is less common that ODD, but it is more severe and is more disruptive to the child.  Furthermore, Conduct Disorder is a lot more problematic to treat.  It is estimated that 6-10% of boys and 2-9% of girls have this disorder.  Children with Conduct Disorder seriously misbehave with aggressive or non-aggressive behaviors against people, animals or property.

Symptoms of Conduct Disorder:

If a child or adolescent is considered to have Conduct Disorder they must exhibit behaviors that are of a belligerent, destructive, threatening, physically cruel, deceitful, disobedient or dishonest nature.  This includes behaviors such as stealing, intentional injury and forced sexual activity.  Conduct behaviors must be repetitive and persistent, demonstrated within the last 6 to 12 months and cause impairment in social, academic or work settings. There are four categories of Conduct Disorder each with different behaviors.  A child or adolescent with ODD would also exhibit some or many of these behaviors.

• Aggression to people or animals
• Bullies, threatens or intimidates
• Starts physical fights
• Has used a weapon
• Has been physically cruel to people and animals
• Has stolen while confronting a victim (e.g. mugging or armed robbery)
• Forced someone into sexual activity

• Destruction of property
• Has intentionally started a fire to cause serious damage
• Has purposely destroyed others’ property

• Deceitfulness or theft
• Has broken into houses, buildings or cars
• Lies to obtain goods, favors or avoids commitments
• Stolen items without confronting victims (e.g. shoplifting, not including breaking and entering)

• Serious violation of rules
• Stays out of the home regardless of parental disapproval (before 13 years of age)
• Has run away from home
• Is often absent from school
  

Types of Conduct Disorder:

• Childhood-Onset Type
• Any of the diagnostic criterions of Conduct Disorder began before the age of 10.
• Adolescent-Onset Type
• This is marked by the absence of any Conduct Disorder characteristics before the age of 10.

There are also three distinguishable severities of Conduct Disorder, these are:

• Mild
• This form of Conduct Disorder is present if only the minimum symptoms are present and the conduct problems cause only minor harm to others.
• Moderate
• A moderate form of Conduct Disorder is when the conduct problems effect or harm others intermediately.
• Severe
• This is where the child demonstrates conduct behaviors that are excessive or cause significant harm to others.

Treatment for Conduct Disorder:

Conduct Disorder is very challenging to treat, a mental health professional should complete evaluations and early intervention should be employed is possible.  If children and adolescents do not receive treatment for Conduct Disorder they may be unable to adapt to their environment and may break laws and behave in an antisocial manner.  The treatment can be complex and challenging, especially when considering the child’s uncooperativeness, fear or distrusting behavior.  Treatment plans are developed by healthcare professionals using information from the child, family and teachers to understand the cause and the severity of the disorder.

• Because of the high degree of overlap with Conduct Disorder and Attention-Deficit/Hyperactivity Disorder (ADHD) healthcare professionals will need to take this into consideration if the child presents both of these conditions, especially when medication is prescribed.  However, it has been reported that when ADHD is not present, treating Conduct Disorder with medication is not consistently effective.  There are many medications available that treat aggression; however it has been reported that some of these medications have adverse effects or individuals require ongoing monitoring while on these medications.
   
• Behavior modification and psychotherapy are useful and necessary to help the child to express and control their antisocial behavior.  Further help may be needed for children with learning disabilities.  There are various parenting training programs that help parents manage their child’s behavior and assist social skill development.  Parents may also learn appropriate reinforcement and disciplinary techniques, effective communication, negotiation and problem solving skills.  Behavior management includes providing the family with strategies on behavioral contracting, contingency management and encouraging parents to engage in positive interaction with the child.