Conduct disorder is a diagnosable psychological condition that includes
problems in emotional and behavioral control. It is diagnosed among children
and adolescents. In this condition, children exhibit severe and persistent
anti-social behavioral 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 into four major categories:
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Aggression towards people and animals: Includes
physical cruelty towards animals and people, incidents of bullying and
threatening, use of potentially threatening weapons, stealing, forcing
someone into sexual activity, and often initiating physical fights
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Destruction of Property: Deliberate engagement in
a fire setting with the intent to cause serious damage and deliberate
destruction of property.
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Deceitfulness of theft: Breaking into
someone’s car, building, or house, engaging in frequent lying for
personal gain, stealing non-trivial items.
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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 about behavioral and emotional
issues characteristic of conduct disorders. Warning signs of conduct disorder
can be noticed in children aged between 10 to 14 years. Such behavioral signs
include smoking, alcohol and drug use, and deviant sexual activity.
Assessment measures may also be applied to bolster the diagnostic process.
Broad Band Behaviour Rating Scales help a clinician in examining multiple
behavioral domains and screen for issues in a time-efficient manner. Another
method applied for assessment is the use of a performance-based test. These
tests are designed to identify mechanisms that support conduct issues.
Behavioral observation also serves as a means of screening and assessment.
A therapist 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: Functional
Family Therapy
(FFT) is a specialized intervention that is conducted at the
patient’s home and focuses on the complete involvement of the family.
2. Contingency Management Programs: By establishing
clear behavioral goals, these programs focus on gradual behavioral change.
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 behavior.
3. Multisystemic Therapy (MST): This intervention has
specific goals that bolster responsible behavior. Multiple systems maintaining
behavior 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 skills.
5. Pharmacological treatment: The
Expert's judgment becomes highly imperative when pharmacological
intervention is included in the management of conduct disorder. Such an
approach is used in cohesion with others.
Given the risk of harm to others and oneself, conduct disorders often
demand monitoring and support from multiple professional and
online psychologist. Intensive
parental and school staff involvement is imperative to manage behavioral
issues. Such involvement provides a strong support system to develop and
sustain social skills.