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Conduct Disorder

By HopeQure

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13 Nov 2018

Conduct disorder is a diagnosable psychological condition that includes problems in emotional and behavioural control1,2. It is diagnosed among children and adolescents. In this condition, children exhibit severe and persistent antisocial behavioural tendencies which cause harm to others.

Defining Features of Conduct Disorder

The Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5., American Psychiatric Association, 2013) lists a range of symptoms for this disorder. These symptoms are divided across four major categories:

  • Aggression towards people and animals: Includes physical cruelty towards animals and people, incidents of bullying and threatening, use of potentially threatening weapon, stealing, forcing someone into sexual activity, and often initiating physical fights
  • Destruction of Property: Deliberate engagement in fire setting with intent to cause serious damage and deliberate destruction of property
  • Deceitfulness of theft: Breaking into someone’s car, building or house, engagement in frequent lying for personal gain, stealing of non-trivial items without confronting a victim,
  • Serious Violations of rules: Staying out at night often (despite prohibitions, beginning before age 13 years), history of running from home, truancy from school (beginning before age 13 years).

The International Classification of Diseases-10 Classification of Mental and Behavioural Disorders (10th Revision) also lists a similar clinical picture. Additional symptoms included in ICD relate to frequent and severe temper issues and direct defying of adult requests or rules.

Assessment and Diagnosis

The assessment of conduct issues begins with a detailed clinical history. The personal history reveals valuable information related to behavioural and emotional issues characteristic of conduct disorders. Warning signs of conduct disorder can be noticed in children aged between 10 to 14 years. Examples of such behavioural signs include smoking, alcohol and drug use, and deviant sexual activity4.

Assessment measures may also be applied to bolster the diagnostic process. Broad Band Behaviour Rating Scales help a clinician in examining multiple behavioural domains and screen for issues in a time efficient manner6. Another method applied for assessment is the use of performance based test. These tests are designed to identify mechanisms that support conduct issues. Behavioural observation also serves as a means of screening and assessment.

A clinician considers all the information elicited from various sources. However, the final diagnosis is based on criteria set by DSM V or ICD 10.

Interventions for Conduct Disorder

1.Family based interventions: The Functional Family Therapy (FFT)5 is a specialized intervention which is conducted at the patient’s home and focuses on complete involvement of the family.

2.Contingency Management Programs: By establishing clear behavioural goals, these programs focus on gradual behavioural change. The Parent Management Training (PMT), teaches parents to develop contingency programs at home. The principles of this training address parent child interaction, enhancing responsible and pro social behaviour6.

3. Multisystemic Therapy (MST): This intervention consists of specific goals that bolster responsible behaviour. Multiple systems maintaining behaviour are included

4.Cognitive Behavioural Skills Training: This therapy aims at developing better ways to deal with social situations. It usually focuses on dealing with deficits in social cognition and teaching better problem solving skills7.

5. Pharmacological treatment: Clinician judgement become highly imperative when pharmacological intervention is included in the management of conduct disorder. Such an approach is used in cohesion with other.

Given the risk of harm to others and oneself, conduct disorders often demand monitoring and support from multiple professional. Intensive parental and school staff’s involvement is imperative to manage behavioural issues. Such involvement provides a strong support system to develop and sustain social skills.

References:

1. American Psychiatric Association. (2013). Disruptive, impulse control and conduct Disorders. In Diagnostic and statistical manual of mental disorder (5th ed.).Washington, DC: Author.

2. World Health Organization (1993). Behavioural and emotional disorders with onset usually occurring in childhood and adolescence. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author.

3. Searight, H.R., Rottnek, F., & Abby, S.L. (2001). Conduct disorder: Diagnosis and treatment in primary case. American Family Physician, 63(8), 1579-1588.

4. Scott S. (2012). Conduct disorders. In Rey JM (ed)., IACAPAP e-Textbook of Child and Adolescent Mental Health (p D.3). Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.

5. Frick, P. (2001). Effective interventions for children and adolescents with conduct disorder. Can J Psychiatry, 43, 597-608.

6. Barry, C., Golmaryami, F.N, Rivera-Hudson, N., & Frick, P. (2013). Evidence based assessment of conduct disorder: current considerations and preparation for DSM 5. Professional Psychology: Research and Practice, 44(1), 56-63.

Conduct Disorder

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