Conduct Disorder

Conduct Disorder

Conduct Disorder

Conduct disorders are characterized by repetitive and persistent patterns of aggressive, destructive, deceitful, and defiant behaviors far worse than would be expected in a child of that age.

The earlier conduct disorder signs are identified, the better the outcome. Some children are at increased risk of developing a conduct disorder — those growing up in poor households, those who have a history of abuse, etc. Parents, teachers, and health and social care workers are key to noticing the signs and getting them the help they need.

Prevalence

Conduct disorders are the most common type of mental and behavioral disturbance in children and adolescents. Approximately 5% of all people between five and sixteen years of age meet the diagnostic criteria for conduct disorder, and this condition is more common in boys than it is in girls.

Symptoms of Conduct Disorder:

  • Aggressiveness
  • Deceitfulness
  • Destructiveness
  • Violations

Conduct disorder is persistent and repetitive negative behavior which has become a pattern, and where the fallout from this conduct is the violation of other people’s basic rights and the violation of rules or age-appropriate social norms — breaking rules and boundaries set by parents or guardians, and over time, extending that behavior outside the home authority structure.

Symptoms of Conduct Disorder:

When diagnosing conduct disorder, the individual is often not willing to be completely truthful about the extent of their conduct, and caregivers may also think that the behaviors started later in life than they actually did.

Labeled as a serious emotional and mental disorder that typically occurs in children and teens, a diagnosis is made with the presence of 3 or more of the following criteria over the previous 12 months, and one of the criteria within the last 6 months:

  • Aggressive behavior

    • Intimidates, threatens, or bullies other people
    • Starts physical fights
    • Used or tried to use weapons to inflict serious bodily harm, or worse
    • Been cruel to people physically
    • Been cruel to animals physically
    • Engages in physically threatening theft like armed robbery, theft of a purse, extortion, or mugging
    • Rape – usually with threat of physical harm
    • Molestation
  • Deceitful behavior

    • Steals without any physical threats or violence
    • Forgery
    • Breaks and enters a home, business, or vehicle
    • Lies to con people out of goods or services
  •  Destructive behavior

    • Vandalizes and physically damages or destroys property
    • Sets fires to properties or structures
  • Violation of rules

    • Stays out later than allowed
    • Has people over when parents are away
    • Has run away from home
    • Skips class or days at school
    • Sexual activity at a very early age

Symptoms can be:

  • Mild – No extreme behavior issues but enough to be diagnosed. Likely issues include skipping class / school, lying, staying out later than allowed.
  • Moderate – Here the child is displaying multiple behavioral issues, and the issues have either a mild or severe impact on other people.
  • Severe – This category is for children who are exhibiting more symptoms than it takes for a diagnosis, and their conduct causes severe harm to other people.

Typically, girls with conduct disorder are more likely to exhibit breaking rules and deceit while males with conduct disorder are more likely to feature destructive and aggressive behaviors.

In addition to the behaviors, other symptoms include observations about the emotional response of the child in relation to their conduct. Examples could include:

  • Lack of remorse or regret for poor behavior
  • No concern regarding behavioral consequences
  • No empathy for others’ thoughts or feelings
  • No concern related to their performance at school or work
  • No emotional expression

Causes of Conduct Disorder:

To date, no one has found the exact cause of conduct disorders, but it is thought that genetic and environmental factors contribute to their development.

  • Childhood-Onset
    Children display at least one conduct disorder criterion characteristic before reaching ten years of age.

    Most often, children in this type have troubled relationships with their peers, frequently exhibit physical aggression toward others, may have previously been diagnosed with oppositional defiant disorder (ODD), and are typically male.

    Those in the childhood-onset category stand a higher chance of having persistent conduct disorder, as well as the potential to develop adult antisocial personality disorder.

  • Adolescent-Onset
    Children present conduct disorder criteria characteristics after reaching ten years of age.

    Individuals in this category have less tumultuous peer relationships and are less likely to develop adult antisocial personality disorder or to have persistent conduct disorder. The ratio for this category is not as overwhelmingly male as seen in the childhood-onset category.

Causes of Conduct Disorder:

One or more of the following could be a factor for a child diagnosed with conduct disorder:

  • Abuse, family violence, or conflict
  • Dysfunctional or disorganized home
  • Academic failure
  • Brain damage
  • Other mental health conditions such as anxiety disorder, posttraumatic stress disorder (PTSD), and attention-deficit
  • hyperactivity disorder (ADHD)
  • Poverty or disadvantaged upbringing
  • Parental addiction issues
  • Social issues
  • Substance abuse, including drugs or alcohol
  • Other trauma

There is also a connection between problems in the frontal lobe area of the brain and conduct disorder — frontal lobe issues will disrupt a child’s ability to learn from bad experiences or to take effective measures to stay out of harm.

Treatment for Conduct Disorder:

Behavior Therapy

Behavior therapy teaches children new behaviors to replace negative, harmful, and defiant ones, and it also enhances the parents’ disciplining skills to become more effective and fair.

Most behavior therapy includes a clear reward system, effective timeouts, giving praise, and delivering instruction with authority.

Choices include:

  • Vive – for parents of older children. Delivers intensive therapy using two therapists: a mentor for the child and a coach for the parents. The children develop the capacity to think more about their problems, and their families become more aware of their communication patterns in their family life.
  • Collaborative problem solving (CPS) – focuses on development of problem-solving skills rather than a reward / penalty currency. Used when the child is either too big, too strong, or too defiant for parents.
  • Parent-child interaction therapy (PCIT) – For children between the ages of two and seven. Helps parents improve at managing their kid’s behavior through coaching. Therapists are in an adjacent room watching through a one-way mirror and communicate advice to the parents as they observe structured interactions between the parent and child. This method creates an association in the child’s mind between the parenting skill and the parent instead of with the therapist.
  • Cognitive-behavioral therapy – deals with the root of the cruel or harmful behavior. Enables the child and the parents to spot and work on beliefs that lend toward conflict, and then set about taking that belief and thought process apart. Includes teaching the child the skills to reframe stressful events so that lashing out in anger is not the default response.
  • Family therapy and parent training – helps the parents establish more effective and consistent discipline. They learn how to:

    • change their reactions to both good and bad behaviors,
    • show the child what is expected,
    • give clear rewards and/or praise when behavior lines up with those expectations, and
    • follow a healthy consequence structure when the child’s behavior falls outside the expectations.

It might be necessary to ignore less significant bad behavior for a period in order to focus on larger adjustments. It is hard work to walk through the therapy with the child, and there could even be no initial visible progress for months, but it all pays off when the family is consistent and successfully on the other side of the therapy.

Outlook for Conduct Disorder?

  • Conduct disorder causes significant impairment in functioning at home, work, school, or social settings.
  • Children and adolescents with conduct disorder often have coexistent mental health problems such as attention deficit hyperactivity disorder.
  • Approximately 50 % of children with a diagnosis of conduct disorder develop serious mental health issues as adults, such as antisocial personality disorder. They are also at increased risk of incarceration and of developing addiction problems.

Symptoms of Conduct Disorder:

Conduct disorder includes a range of behaviors typical to the disorder, and these are broken down into four groups.

  • Aggressiveness
  • Deceitfulness
  • Destructiveness
  • Violations

Conduct disorder is persistent and repetitive negative behavior which has become a pattern, and where the fallout from this conduct is the violation of other people’s basic rights and the violation of rules or age-appropriate social norms — breaking rules and boundaries set by parents or guardians, and over time, extending that behavior outside the home authority structure.

Diafnosis of Conduct Disorder:

When diagnosing conduct disorder, the individual is often not willing to be completely truthful about the extent of their conduct, and caregivers may also think that the behaviors started later in life than they actually did.

Labeled as a serious emotional and mental disorder that typically occurs in children and teens, a diagnosis is made with the presence of 3 or more of the following criteria over the previous 12 months, and one of the criteria within the last 6 months:

  • Aggressive behavior

    • Intimidates, threatens, or bullies other people
    • Starts physical fights
    • Used or tried to use weapons to inflict serious bodily harm, or worse
    • Been cruel to people physically
    • Been cruel to animals physically
    • Engages in physically threatening theft like armed robbery, theft of a purse, extortion, or mugging
    • Rape – usually with threat of physical harm
    • Molestation
  • Deceitful behavior

    • Steals without any physical threats or violence
    • Forgery
    • Breaks and enters a home, business, or vehicle
    • Lies to con people out of goods or services
  •  Destructive behavior

    • Vandalizes and physically damages or destroys property
    • Sets fires to properties or structures
  • Violation of rules

    • Stays out later than allowed
    • Has people over when parents are away
    • Has run away from home
    • Skips class or days at school
    • Sexual activity at a very early age

Symptoms can be:

  • Mild – No extreme behavior issues but enough to be diagnosed. Likely issues include skipping class / school, lying, staying out later than allowed.
  • Moderate – Here the child is displaying multiple behavioral issues, and the issues have either a mild or severe impact on other people.
  • Severe – This category is for children who are exhibiting more symptoms than it takes for a diagnosis, and their conduct causes severe harm to other people.

Typically, girls with conduct disorder are more likely to exhibit breaking rules and deceit while males with conduct disorder are more likely to feature destructive and aggressive behaviors.

In addition to the behaviors, other symptoms include observations about the emotional response of the child in relation to their conduct. Examples could include:

  • Lack of remorse or regret for poor behavior
  • No concern regarding behavioral consequences
  • No empathy for others’ thoughts or feelings
  • No concern related to their performance at school or work
  • No emotional expression

Types of Conduct Disorder:

To date, no one has found the exact cause of conduct disorders, but it is thought that genetic and environmental factors contribute to their development.

  • Childhood-Onset
    Children display at least one conduct disorder criterion characteristic before reaching ten years of age.

    Most often, children in this type have troubled relationships with their peers, frequently exhibit physical aggression toward others, may have previously been diagnosed with oppositional defiant disorder (ODD), and are typically male.

    Those in the childhood-onset category stand a higher chance of having persistent conduct disorder, as well as the potential to develop adult antisocial personality disorder.

  • Adolescent-Onset
    Children present conduct disorder criteria characteristics after reaching ten years of age.

    Individuals in this category have less tumultuous peer relationships and are less likely to develop adult antisocial personality disorder or to have persistent conduct disorder. The ratio for this category is not as overwhelmingly male as seen in the childhood-onset category.

Causes of Conduct Disorder:

One or more of the following could be a factor for a child diagnosed with conduct disorder:

  • Abuse, family violence, or conflict
  • Dysfunctional or disorganized home
  • Academic failure
  • Brain damage
  • Other mental health conditions such as anxiety disorder, posttraumatic stress disorder (PTSD), and attention-deficit
  • hyperactivity disorder (ADHD)
  • Poverty or disadvantaged upbringing
  • Parental addiction issues
  • Social issues
  • Substance abuse, including drugs or alcohol
  • Other trauma

There is also a connection between problems in the frontal lobe area of the brain and conduct disorder — frontal lobe issues will disrupt a child’s ability to learn from bad experiences or to take effective measures to stay out of harm.

Treatment for Conduct Disorder:

Behavior Therapy

Behavior therapy teaches children new behaviors to replace negative, harmful, and defiant ones, and it also enhances the parents’ disciplining skills to become more effective and fair.

Most behavior therapy includes a clear reward system, effective timeouts, giving praise, and delivering instruction with authority.

Choices include:

  • Vive – for parents of older children. Delivers intensive therapy using two therapists: a mentor for the child and a coach for the parents. The children develop the capacity to think more about their problems, and their families become more aware of their communication patterns in their family life.
  • Collaborative problem solving (CPS) – focuses on development of problem-solving skills rather than a reward / penalty currency. Used when the child is either too big, too strong, or too defiant for parents.
  • Parent-child interaction therapy (PCIT) – For children between the ages of two and seven. Helps parents improve at managing their kid’s behavior through coaching. Therapists are in an adjacent room watching through a one-way mirror and communicate advice to the parents as they observe structured interactions between the parent and child. This method creates an association in the child’s mind between the parenting skill and the parent instead of with the therapist.
  • Cognitive-behavioral therapy – deals with the root of the cruel or harmful behavior. Enables the child and the parents to spot and work on beliefs that lend toward conflict, and then set about taking that belief and thought process apart. Includes teaching the child the skills to reframe stressful events so that lashing out in anger is not the default response.
  • Family therapy and parent training – helps the parents establish more effective and consistent discipline. They learn how to:

    • change their reactions to both good and bad behaviors,
    • show the child what is expected,
    • give clear rewards and/or praise when behavior lines up with those expectations, and
    • follow a healthy consequence structure when the child’s behavior falls outside the expectations.

It might be necessary to ignore less significant bad behavior for a period in order to focus on larger adjustments. It is hard work to walk through the therapy with the child, and there could even be no initial visible progress for months, but it all pays off when the family is consistent and successfully on the other side of the therapy.

Outlook for Conduct Disorder:

  • Conduct disorder causes significant impairment in functioning at home, work, school, or social settings.
  • Children and adolescents with conduct disorder often have coexistent mental health problems such as attention deficit hyperactivity disorder.
  • Approximately 50 % of children with a diagnosis of conduct disorder develop serious mental health issues as adults, such as antisocial personality disorder. They are also at increased risk of incarceration and of developing addiction problems.
Sources PSYCH CENTRAL | MENTAL HELP – Conduct Disorder Treatment | HOPKINS MEDICINE – What is Conduct Disorder | HEALTHLINE – Conduct Disorder Symptoms | HEALTHLINE – Conduct Disorder Types and Symptoms