Conduct Disorder

DEFINATION: Conduct disorder is disorder of childhood characterized by aggressive and destructive activities causing serious disruptions at home, school, neighborhood.

EXPLANATION:

conduct disorder shows behaviour falling  into following four groups:

  1. aggressive conduct causing threatens physical harm to other people or animals,
  2. nonaggressive behavior that causes property loss or damage,
  3. deceitfulness or theft, and
  4. serious violations of rules.

Child with conduct disorder shows repetitive and persistent pattern of behaviours which violate societal norms and the rights of other people.

The frustrating behavior of youngsters with conduct disorder frequently leads to blaming, labeling, and other unproductive activities.

Youngsters with conduct disorder often exhibit aggressive behavior to other people (bullying, starting fights, etc.) or to animals. Their actions may cause damage to others’ property.

When presented before age 10 child frequently exhibit oppositional behavior and peer relationship problems.

Not all but Persistent conduct disorder in childhood left untreated develops into adult antisocial personality disorder , they should be distinguished from individuals who had no symptoms of conduct disorder before age 10.

These children function poorly in a variety of places. In fact, the behaviors of “conduct disorder” leads to  majority of clinical referrals, classroom detentions, and can be extremely difficult for parents to manage.

Those with this disorder have great difficulty following rules and behaving in a socially acceptable way.  They are often viewed by other children, adults as “bad” or delinquent, rather than mentally ill.

PREVALANCE:

SEX BIAS: Males are seen to be affected more.

AGE OF ONSET: any time before and after 10 years of age..

ETIOLOGY: Conduct disorder is caused by an interaction of genetic, familial, and

social factors.

  • A child with a neurological condition or genetic predisposition and familial or social deprivation can develop conduct disorder.

Genetic/Physical Factors

  • under-arousal
  • Brain damage to the pre-frontal cortex
  • Insensitivity to physical pain and punishment
  • Learning impairments
  • Neurological factors due to birth complications or
  • low birth weight

Familial Factors

  • Exposure to parental antisocial behavior is the most influential factor.
  • Parental substance abuse, psychiatric illness, marital conflict, child abuse, and neglect
  • Poverty
  • Parent absence
  • Inconsistent discipline and consequences

Social Factors

  • School failure
  • Traumatic life events
  • Early institutionalization
  • More susceptible to peer influence

other

One study with adopted children in the mid-1990s looked at the relationship between birth parents with antisocial personality disorder, and adverse adoptive home environments. When these two adverse conditions occurred, there was significantly increased aggressiveness and conduct disorder in the adopted children. That was not the case if there was no indication of antisocial personality disorder in the birth parents.

CLASSIFICATION:

 Childhood Onset: Childhood-onset type is one where child is  showing at least one of the behaviors in question before the age of 10.

Worse prognosis if left untreated.

Aggression, property destruction, & poor relationships are common features.

40% of childhood onset conduct disorder transitions into antisocial personality disorder

Adolescent Onset: Adolescent onset type is defined by the absence of any conduct disorder criteria before the age of 10.

Before labelling Social context should be taken into consideration like Gang culture & survival needs (e.g., stealing food)

Severity may be described as mild, moderate or severe, depending on the number of problems exhibited and their impact on other people.

  • Mild severity would mean there are few problems with conduct beyond those needed to make a diagnosis AND all of the problems cause little harm to other people.
  • Moderate severity means the number and effect of the conduct problems is between the extremes of mild and severe.
  • Severe is indicated if there are many more conduct symptoms than are needed to make the diagnosis (more than three in the previous twelve months or more than one in the previous six months), or, the behaviors cause other people considerable harm

 

SIGNS AND SYMPTOMS:

The Diagnostic and Statistical Manual of Mental Disorders (also known as the DSM-IV-TR ) indicates that for conduct disorder to be diagnosed,

The patient has repeatedly violated rules, age-appropriate social norms and the rights of others for a period of at least twelve months.

This is shown by three or more of the following behaviors, with at least one having taken place in the previous six months:

  1. aggression to people or animals,
  2. property destruction,
  3. lying or theft, and
  4. serious rule violations.

Aggression to people or animals includes:

  • engaging in frequent bullying or threatening
  • often starting fights
  • using a weapon that could cause serious injury (gun, knife, club, broken glass)
  • showing physical cruelty to people
  • showing physical cruelty to animals
  • engaging in theft with confrontation (armed robbery, extortion, mugging, purse snatching)
  • forcing sex upon someone

Property destruction includes:

  • deliberately setting fires to cause serious damage
  • deliberately destroying the property of others by means other than fire setting

Lying or theft includes:

  • breaking into building, car, or house belonging to someone else
  • frequently lying or breaking promises for gain or to avoid obligations
  • valuables without confrontation

Serious rule violations include:

  • beginning before age 13, frequently staying out at night against parents’ wishes
  • running away from parents overnight twice or more or once if for an extended period
  • engaging in frequent truancy beginning before the age of 13

ASSOCIATED PROBLEMS:

  • Oppositional Defiant Disorder
  • ADHD
  • Depression
  • Anxiety
  • Mood Disorders (i.e. bipolar & depression)
  • The childhood type is more highly associated with heightened aggression, male gender, oppositional defiant disorder , and a family history of antisocial behavior.
  • Substance Abuse

Child may experience

  • Higher rates of depression,
  • suicidal thoughts, suicide attempts, and suicide
  • Academic difficulties
  • Poor relationships with peers or adults
  • Sexually transmitted diseases
  • Difficulty staying in adoptive, foster, or group homes
  • Higher rates of injuries, school expulsions, and problems with the law

MYTHS:       

EARLY INTERVENTION:

PARENTS APPROACH TO DISORDER: The financial costs of crime and correction for repeated juvenile offenses by youth with conduct disorder are extensive. The social costs include citizens’ fear of such behavior, loss of a sense of safety, and disruptions in classrooms that interfere with other children’s opportunity to learn. The costs to the child and his or her family are enormous in terms of the emotional and other resources needed to address the consequences of the constellation of symptoms that define conduct disorder.

Such behaviors often result in the child’s eventual placement out of the home, in special education and/or the juvenile justice system. There is evidence that the rates of disruptive behavior disorders may be as high as 50% in youth in public sectors of care such as juvenile justice, alcohol and drug

Parents of such children are often blamed as poor disciplinarians or bad parents. As a result, parents of children with conduct disorder may be reluctant to engage with schools or other authorities.

At the same time, there is a strong correlation between children diagnosed with conduct disorder and a significant level of family dysfunction, poor parenting practices, an overemphasis on coercion and hostile communication patterns, verbal and physical aggression and a history of maltreatment.

There is a suggestion of an, as yet, unidentified genetic component to what has generally been viewed as a behavioral disorder.