Conduct Disorder2018-02-21T23:50:38+00:00

Conduct Disorder

Conduct Disorder

Conduct Disorder

The essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior by a child or teenager in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviors fall into four main groupings: aggressive conduct that causes or threatens physical harm to other people or animals, non aggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules time and time again.

Symptoms of Conduct Disorder:

Conduct Disorder is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6_months:

Aggression to people and animals

  • Often bullies, threatens, or intimidates others
  • Often initiates physical fights
  • Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  • Has been physically cruel to people
  • Has been physically cruel to animals
  • Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
  • Has forced someone into sexual activity

Destruction of property

  • Has deliberately engaged in fire setting with the intention of causing serious damage
  • Has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

  • Has broken into someone else’s house, building, or car
  • Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  • Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

  • Often stays out at night despite parental prohibitions, beginning before age 13 years
  • Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  • Is often truant from school, beginning before age 13 years

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Types of Conduct Disorder:

Two subtypes of Conduct Disorder are provided based on the age at onset of the disorder (i.e., Childhood-Onset Type and Adolescent-Onset Type). The subtypes differ in regard to the characteristic nature of the presenting conduct problems, developmental course and prognosis, and gender ratio. Both subtypes can occur in a mild, moderate, or severe form. In assessing the age at onset, information should preferably be obtained from the youth and from caregiver(s). Because many of the behaviors may be concealed, caregivers may underreport symptoms and overestimate the age at onset.

Childhood-Onset Type

This subtype is defined by the onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years.

Individuals with Childhood-Onset Type are usually male, frequently display physical aggression toward others, have disturbed peer relationships, may have had Oppositional Defiant Disorder during early childhood, and usually have symptoms that meet full criteria for Conduct Disorder prior to puberty. These individuals are more likely to have persistent Conduct Disorder and to develop adult Antisocial Personality Disorder than are those with Adolescent-Onset Type.

Adolescent-Onset Type

This subtype is defined by the absence of any criteria characteristic of Conduct Disorder prior to age 10 years.

Compared with those with the Childhood-Onset Type, these individuals are less likely to display aggressive behaviors and tend to have more normative peer relationships (although they often display conduct problems in the company of others). These individuals are less likely to have persistent Conduct Disorder or to develop adult Antisocial Personality Disorder. The ratio of males to females with Conduct Disorder is lower for the Adolescent-Onset Type than for the Childhood-Onset Type.

Treatment for Conduct Disorder:

Behavior Therapy

Behavior therapy is a series of techniques meant to improve parenting skills and a child’s behavior; it fills in the behavior gaps that medication can’t address. It gives kids positive alternative behaviors to replace defiant ones. The American Psychological Association recommends this as the first line of treatment for children diagnosed with ADhD before the age of 5. In fact, it works best when it is started early in a child’s life, when parent-child interactions aren’t ingrained and are easier to change.

Successfully implementing behavior therapy at home is hard work. It means changing the way you and your child interact, and maintaining those changes over time. Improvements may not be apparent for weeks or months. But, it will be worth it when a child’s behavior changes for the long term.

All behavior programs operate on the same premise: Parents and other adults in the child’s life set clear expectations for their child’s behavior. They praise and reward positive behavior and discourage negative behavior. This establishes predictability and routines, and increases the positive attention directed at your child. A behavior therapy regimen can be developed by a pediatrician, school psychologist, or another mental health worker.

Family and Parent Training Programs

Parent- and family-training programs are based on the premise that bad behavior results when children realize they can get what they want by behaving badly. Say your child throws a fit when you ask him to turn off the video game; if you give in even some of the time, he learns that he will sometimes succeed. The goal of parent training is to break this cycle and help parents discipline children more effectively.

Parents are taught to change their reactions to a child’s behavior – good and bad. They learn to show their child what they expect, and then give well-defined rewards and praise when their child behaves accordingly – or consistent consequences when they don’t. Therapists will also work with a parent and child together to solve specific challenges. Sometimes this involves ignoring minor bad behavior. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create rewards systems.

Three types of parent and family training programs are:

  • Parent-Child Interaction Therapy (PCIT) – This helps parents become better at managing their child’s behavior with real-time coaching. It is most effective for children ages two to seven. The family interacts while listening to advice from therapists behind a one-way mirror, so the child associates the parenting skills with her parent, not the therapist.
  • Collaborative Problem Solving (CPS) – A program for defiant teens who are too big and strong to be put in a time out. The program focuses on giving kids problem-solving skills they lack rather than a reward-and-punishment system.
  • Vive – An intensive family therapy program for parents of older kids with behavioral problems. It uses two separate therapists: a “mentor” for the struggling teen, and a “coach” for the parents. The program can help kids become more reflective about problems, and help families recognize patters in ways of reacting to each other.
    Some children benefit from social skills training that allows them to interact more effectively with peers so that school becomes less of a battle ground.

Alternative Treatments for ODD

Parent-management training – in which parents learn to change the way they react to their child’s behavior — is highly effective in treating ODD. Between weekly sessions, the parents practice what they’ve learned from the therapist and report back on progress. Parents set up a system for giving praise and rewards when a child cooperates, and clear consequences when he misbehaves. Strategies include the following:

  • Always build on positives: Give the child praise and positive reinforcement when he shows flexibility or cooperation. Recognize the “little victories” with enthusiasm.
  • Learn to control yourself: Take a time-out or break if you are about to make the conflict with your child worse, not better.
  • Pick your battles: Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do.
  • Provide structure: Bad behavior is more apt to occur when kids have unsupervised free time. A daily routine can let them know what to expect.
  • Position behavioral issues as problems to solve: Explain to your child that ignoring an alarm clock doesn’t help her get to school on time, and ask what she can do to get ready without being tardy.
  • Set up reasonable, age-appropriate limits and enforce consequences consistently: Resist the temptation to rescue the child from naturally occurring consequences.
  • Don’t go it alone: Work with and get support from the other adults (teachers, coaches, and spouse) who deal with your child. Look for area support groups and/or parenting classes for parents of difficult children.
  • Avoid burnout: Maintain interests other than your child with ODD, so that managing your child doesn’t take all your time and energy. Manage your own stress with exercise and relaxation.

Use respite care as needed.

Additionally, supplements may improve certain symptoms of ODD. Be sure to consult with a physician before trying any of the alternative therapies below.

  • Omega-3 Fatty Acids to regulate mood and emotions
  • Vitamin E to help absorb Omega-3s
  • Melatonin to help normalize sleep patterns
  • Zinc to help neutralize brain chemicals that can lead to hyperactivity and impulsivity

Symptoms of Conduct Disorder:

Conduct Disorder is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6_months:

Aggression to people and animals

  • Often bullies, threatens, or intimidates others
  • Often initiates physical fights
  • Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  • Has been physically cruel to people
  • Has been physically cruel to animals
  • Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
  • Has forced someone into sexual activity

Destruction of property

  • Has deliberately engaged in fire setting with the intention of causing serious damage
  • Has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

  • Has broken into someone else’s house, building, or car
  • Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  • Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

  • Often stays out at night despite parental prohibitions, beginning before age 13 years
  • Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  • Is often truant from school, beginning before age 13 years

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Types of Conduct Disorder:

Two subtypes of Conduct Disorder are provided based on the age at onset of the disorder (i.e., Childhood-Onset Type and Adolescent-Onset Type). The subtypes differ in regard to the characteristic nature of the presenting conduct problems, developmental course and prognosis, and gender ratio. Both subtypes can occur in a mild, moderate, or severe form. In assessing the age at onset, information should preferably be obtained from the youth and from caregiver(s). Because many of the behaviors may be concealed, caregivers may underreport symptoms and overestimate the age at onset.

Childhood-Onset Type

This subtype is defined by the onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years.

Individuals with Childhood-Onset Type are usually male, frequently display physical aggression toward others, have disturbed peer relationships, may have had Oppositional Defiant Disorder during early childhood, and usually have symptoms that meet full criteria for Conduct Disorder prior to puberty. These individuals are more likely to have persistent Conduct Disorder and to develop adult Antisocial Personality Disorder than are those with Adolescent-Onset Type.

Adolescent-Onset Type

This subtype is defined by the absence of any criteria characteristic of Conduct Disorder prior to age 10 years.

Compared with those with the Childhood-Onset Type, these individuals are less likely to display aggressive behaviors and tend to have more normative peer relationships (although they often display conduct problems in the company of others). These individuals are less likely to have persistent Conduct Disorder or to develop adult Antisocial Personality Disorder. The ratio of males to females with Conduct Disorder is lower for the Adolescent-Onset Type than for the Childhood-Onset Type.

Treatment for Conduct Disorder:

Behavior Therapy

Behavior therapy is a series of techniques meant to improve parenting skills and a child’s behavior; it fills in the behavior gaps that medication can’t address. It gives kids positive alternative behaviors to replace defiant ones. The American Psychological Association recommends this as the first line of treatment for children diagnosed with ADhD before the age of 5. In fact, it works best when it is started early in a child’s life, when parent-child interactions aren’t ingrained and are easier to change.

Successfully implementing behavior therapy at home is hard work. It means changing the way you and your child interact, and maintaining those changes over time. Improvements may not be apparent for weeks or months. But, it will be worth it when a child’s behavior changes for the long term.

All behavior programs operate on the same premise: Parents and other adults in the child’s life set clear expectations for their child’s behavior. They praise and reward positive behavior and discourage negative behavior. This establishes predictability and routines, and increases the positive attention directed at your child. A behavior therapy regimen can be developed by a pediatrician, school psychologist, or another mental health worker.

Family and Parent Training Programs

Parent- and family-training programs are based on the premise that bad behavior results when children realize they can get what they want by behaving badly. Say your child throws a fit when you ask him to turn off the video game; if you give in even some of the time, he learns that he will sometimes succeed. The goal of parent training is to break this cycle and help parents discipline children more effectively.

Parents are taught to change their reactions to a child’s behavior – good and bad. They learn to show their child what they expect, and then give well-defined rewards and praise when their child behaves accordingly – or consistent consequences when they don’t. Therapists will also work with a parent and child together to solve specific challenges. Sometimes this involves ignoring minor bad behavior. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create rewards systems.

Three types of parent and family training programs are:

  • Parent-Child Interaction Therapy (PCIT) – This helps parents become better at managing their child’s behavior with real-time coaching. It is most effective for children ages two to seven. The family interacts while listening to advice from therapists behind a one-way mirror, so the child associates the parenting skills with her parent, not the therapist.
  • Collaborative Problem Solving (CPS) – A program for defiant teens who are too big and strong to be put in a time out. The program focuses on giving kids problem-solving skills they lack rather than a reward-and-punishment system.
  • Vive – An intensive family therapy program for parents of older kids with behavioral problems. It uses two separate therapists: a “mentor” for the struggling teen, and a “coach” for the parents. The program can help kids become more reflective about problems, and help families recognize patters in ways of reacting to each other.
    Some children benefit from social skills training that allows them to interact more effectively with peers so that school becomes less of a battle ground.

Alternative Treatments for ODD

Parent-management training – in which parents learn to change the way they react to their child’s behavior — is highly effective in treating ODD. Between weekly sessions, the parents practice what they’ve learned from the therapist and report back on progress. Parents set up a system for giving praise and rewards when a child cooperates, and clear consequences when he misbehaves. Strategies include the following:

  • Always build on positives: Give the child praise and positive reinforcement when he shows flexibility or cooperation. Recognize the “little victories” with enthusiasm.
  • Learn to control yourself: Take a time-out or break if you are about to make the conflict with your child worse, not better.
  • Pick your battles: Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do.
  • Provide structure: Bad behavior is more apt to occur when kids have unsupervised free time. A daily routine can let them know what to expect.
  • Position behavioral issues as problems to solve: Explain to your child that ignoring an alarm clock doesn’t help her get to school on time, and ask what she can do to get ready without being tardy.
  • Set up reasonable, age-appropriate limits and enforce consequences consistently: Resist the temptation to rescue the child from naturally occurring consequences.
  • Don’t go it alone: Work with and get support from the other adults (teachers, coaches, and spouse) who deal with your child. Look for area support groups and/or parenting classes for parents of difficult children.
  • Avoid burnout: Maintain interests other than your child with ODD, so that managing your child doesn’t take all your time and energy. Manage your own stress with exercise and relaxation.

Use respite care as needed.

Additionally, supplements may improve certain symptoms of ODD. Be sure to consult with a physician before trying any of the alternative therapies below.

  • Omega-3 Fatty Acids to regulate mood and emotions
  • Vitamin E to help absorb Omega-3s
  • Melatonin to help normalize sleep patterns
  • Zinc to help neutralize brain chemicals that can lead to hyperactivity and impulsivity