Conduct Disorder

1. Conduct Disorder Mrs. Marsh Psychology Period X

2. Conduct Disorder • A pattern of repetitive behavior where the rights of others or the social norms are violated. • May be diagnosed as mild, moderate, or severe

3. Associated Features • Inability to appreciate the importance of others’ welfare. • Little guilt or remorse for the harming of others. • Views others as threatening or malicious without an objective basis. • They may lash out preemptively with unprovoked aggression. • Red Flags among 10 to 14 year olds: • cigarette smoking • sexual activity • alcohol or drug use

4. Associated Features • DSM-IV-TR Criteria A. Presence of three or more of the following in past twelve months, with at least one present within the last six months: • Aggression to people and/or 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. 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

5. Associated Features • 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 the victim (e.g. shoplifting, but without breaking and entering; forgery) • Serious violations of rules. • Often stays out late at night despite parents’ prohibitions, beginning before age 13 years • Has run away from home overnight at least twice while living in a parental or parental surrogate home (or once without returning for a lengthy time) • Is often truant from school, beginning before age 13 years

6. Associated Features • DSM-IV-TR Criteria Continued B. The disturbance in behavior causes clinically significant impairment in social, academic, and occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

7. Associated Features • Subtypes • Childhood Onset (before age 10) • Poorer prognosis if left untreated • 40% of cases develop into adult antisocial personality disorder • Adolescent Onset • Adolescent conduct disorder should be considered in social context

8. Etiology • Biological • Children may inherit decreased baseline autonomic nervous system activity, requiring greater stimulation to achieve optimal arousal. • Current research focuses on defining neurotransmitters that affect aggression (serotonin strongly implicated). • Family and Social Environment • Parental substance abuse, psychiatric illness, marital conflict, child abuse, and neglect all increase risk. • Exposure to antisocial behavior of caregiver. • Inconsistent parent availability and discipline. • Lower socioeconomic groups.

9. Prevalence • Rates are difficult to determine & vary demographically. • Typically affects 1 - 12% • More prevalent in boys • Boys: 6 - 10% of boys • Girls: 2 - 9% of girls • Considered the most serious childhood psychiatric disorder.

10. Treatment • Psychotherapy - Family Therapy • Behavior management • Requires parental consistency and reduction in marital and intergenerational conflict. • Interventions: • Counseling Parents about Clear Communication • Reinforcement for Positive Behavior • Parent-child Play Time

11. Treatment • Pharmacotherapy • Medications to treat co morbidity: • Stimulants, Lithium, Anticonvulsants • To reduce aggression • Antidepressants • Clonidine • To reduce impulsivity and aggression • Antipsychotics (for extreme cases) • Serious side effects include weight gain, stiffness, restlessness, tremors, elevated cholesterol and triglycerides, diabetes, and TardiveDyskinesia.

12. Prognosis • 30% of children with Conduct Disorder continue with similar problems into adulthood. • More common for males. • However, co morbid problems often remain or get worse in the remaining 70%. • 40% develop Antisocial Personality Disorder

13. References Blagojevich, R. R. (2006). Conduct disorder. Retrieved Mar. 19, 2006, from DCFS Web Resource Web site: http://dcfswebresource.prairienet.org/resources/conductdisorder_guide.php. Chandler, J. (n.d.). Oppositional defiant disorder (odd) and conduct disorder (cd) in children and adolescents: diagnosis and treatment. Retrieved Mar. 12, 2006, from http://www.klis.com/chandler/pamphlet/oddcd/oddcdpamphlet.htm. Children's mental health facts: children and adolescents with conduct disorder. (2003). Retrieved Mar. 19, 2006, from Substance Abuse and Mental Health Services Administration's National Mental Health Information Center Web site: http://www.mentalhealth.samhsa.gov/publications/allpubs/CA-0010/default.asp. Conduct disorder. (n.d.). Retrieved Mar. 12, 2006, from Wikipedia Web site: http://en.wikipedia.org/wiki/Conduct_disorder. Disruptive behaviour disorders. (2005). Retrieved Mar. 19, 2006, from Behavioural Neurotherapy Clinic Web site: http://www.adhd.com.au/conduct.html. Halgin, R., & Whitbourne, S. (2005). Abnormal psychology: clinical perspectives on psychological disorders. 4th ed. New York: McGraw Hill. Kane, A. (2003). Oppositional defiant disorder. Retrieved Mar. 19, 2006, from Mental Health Matters Web site: http://www.mentalhealthmatters.com/articles/article.php?artID=603. Oppositional defiant disorder. (n.d.). Retrieved Mar. 12, 2006, from Wikipedia Web site: http://en.wikipedia.org/wiki/Oppositional_defiant_disorder. Searight, H. R., Rottnek, F., & Abby, S. L. (2001, April 15). Conduct disorder: diagnosis and treatment in primary care. American Academy of Family Physician, Retrieved Mar 12, 2006, from http://www.aafp.org/afp/20010415/1579.html. Summary of the practice parameters for the assessment and treatment of children and adolescents with conduct disorders. (1997). Retrieved Mar. 19, 2006, from American Academy of Child and Adolescent Psychiatry Web site: http://www.aacap.org/clinical/CONDCT~1.HTM.

14. Discussion • How do the principles of associative learning and observational learning apply to children who develop this disorder? • What kinds of things could be done to perhaps prevent such a disorder from occurring?