Conduct disorder (CD) pertains to a set of emotional and behavioral problems in children or adolescents. These “youngsters” have a hard time following rules and behaving in a way that is acceptable to society. They are seen by adults and their peers as delinquent or “bad children” rather than as kids who have mental illnesses.
Types
A. Early onset CD – a condition wherein the patient manifests at least one symptom before age 10
B. Adolescent-onset CD - a condition wherein the patient exhibits none of the characteristics before age 10, which is more common.
Conduct disorder also has different degrees of severity. Mild CD patients cause only minor harm to other people and have just enough symptoms to warrant a CD diagnosis; moderate CD patients cause moderate harm to others and manifest several behavioral problems; severe CD patients cause great harm to others and exhibit a wide range of symptoms.
Prevalence
This condition affects more boys than girls (4:1) in the 9-17 age bracket and, according to the U.S. National Mental Health Association, occurs in 6% of all children. In the U.K., 5% of children 5-15 years old are affected. Over the past few decades, the incidence of CD has risen, and because of this, it accounts for 1/3 to ½ of the referrals made to healthcare providers in the field of child and adolescent mental health.
Causes
This condition is caused by a wide range of factors, including, but not limited to school failure, childhood trauma, parental personality disorder, child abuse, brain damage, and genetic predisposition. Temperament has been shown time and again in studies that it can be inherited. It has also been found that most CD patients come from dysfunctional and/or disadvantaged families. A link has also been found between CD and fetal nicotine exposure.
On the surface, adults know that a child’s need to exercise autonomy, to assert himself/herself, or to simply see how far he can go with misdemeanors are possible causes of conduct disorder . However, many kids misbehave because of deep-seated psychological problems. It may be that a child is experiencing sorrow, anger, or frustration and is using misconduct as an outlet.
Some children habitually cause distress to others due to their misbehavior, and these are outside of the scope of what is considered acceptable or normal for children their age or stage of development. It is also important to note that CD has an ‘associated feature’ – that is, children with CD are unable to give value to other people’s welfare, and they rarely feel remorse for the distress that they cause others.
Parents, guardians, and educators should pay close attention to deteriorating academic performance, depression, and unacceptable expression of anger.
Symptoms
This condition is said to be “multifactorial” – that is, there is a multitude of factors impacting the cause. Tests have shown that CD is linked to impairment in the brain’s frontal lobe, obstructing their capacity to avoid harm, plan, or learn from their errors. Due to the many symptoms of conduct disorder, it is convenient to group them into four classifications/areas.
Deceitfulness, cheating, stealing, and lying
- Tells lies to gain advantage for self, to avoid responsibility, or to obtain goods or favors
- Breaks into private property
- Engages in petty theft
Defiance of rules at home or in school
- Participating in or masterminding harmful pranks
- Ignores curfew set by parents or guardians
- Truancy
- Leaves home without permission or runs away
- Relatively early (and sometimes aberrant) sexual behavior
Vandalism
- Deliberately engages in the destruction of others’ property
- Organizes or joins activities intended to cause harm or damage to property, such as setting fire to a building
Aggression directed at people and animals
- Steals from and harms others
- Instigates fights or gang wars
- Bullies other people
- Has made use of a weapon that could cause others serious harm
Treatment
Patients need to be evaluated when suspected of having conduct disorder, as they could be suffering from other conditions which may affect medication for conduct disorder or which may need to be treated as well. Conditions that usually coexist with conduct disorder are ADHD, mood disorders, anxiety, substance abuse, PTSD, and learning disorders.
Without timely intervention, children with conduct disorder tend to have ongoing problems that could give them difficulties in adjusting to society later on. If left untreated, they could have problematic personal relationships, figure in crimes, or develop antisocial behavior. It is also possible for them to have difficulties holding down a job or adjusting to pressures of the workplace.
For children with conduct disorder, the solutions can be complicated. The child could be incredibly uncooperative and distrustful of people. Depending on the severity of the condition, intervention can be given in various settings. A GP would normally refer the case to a psychiatrist specializing in cases of children and adolescents, who would then interview the parents or guardians, siblings, teachers, counselors, and other people interacting with the child in order to draw conclusions regarding the underlying causes of the condition.
There are no ‘instant solutions’ for conduct disorder. It takes some time for an adult to gain the trust of a misbehaving child, and to establish new behaviors and change attitudes, but when treated early on, a patient may make an impressive turnaround and start to lead a life conforming to the society he lives in.
Determining what type of treatment should be offered would depend on the following factors:
- The severity of the condition
- The child’s medical history, age, health condition
- Tolerance for drugs and other therapies
- The caregiver’s preferences
- The expectations for the course of treatment
To help express and likewise control anger, a patient is treated with psychotherapy and cognitive-behavior therapy. This approach aims to improve the child’s skills in anger management, impulse control, problem solving, and communication. Those with learning disorders would benefit from special education, and parents on homeschooling need special training for assistance in a specialized type of management for this condition. Family therapy and peer group therapy are effective solutions for CD.
Pharmacotherapy for CD.
Although drugs are not the end-all and be-all of CD treatment, they help alleviate some of the symptoms of this condition. The American Academy of Family Physicians provides a table of recommended treatments for CD and its related conditions. This is important because treating related conditions may spell the difference between full recovery from CD and a lifetime of run-ins with the law.
For example, ADHD, diagnosed with CD in thousands of children, is managed with stimulants; depression and intermittent explosive disorder, with SSRIs; and bipolar mood disorder, with lithium and certain anticonvulsants.