MRS. MARSHPSYCHOLOGY

PERIOD X

Conduct Disorder

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

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

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.

1. Often bullies, threatens, or intimidates others2. Often initiates physical fights3. Has used a weapon that can cause serious physical harm to

others (e.g. bat, brick, broken bottle, knife, gun)4. Has been physically cruel to people5. Has been physically cruel to animals6. Has stolen while confronting a victim (e.g. mugging, purse

snatching, extortion, armed robbery)7. Has forced someone into sexual activity

Associated Features

Destruction of property.8. Has deliberately engaged in fire setting with the intention of

causing serious damage9. Has deliberately destroyed others’ property (other than by fire

setting)

Deceitfulness or theft.10. Has broken into someone else’s house, building, or car11. Often lies to obtain goods or favors or to avoid obligations (i.e.

“cons” others)12. Has stolen items of nontrivial value without confronting the

victim (e.g. shoplifting, but without breaking and entering; forgery)

Serious violations of rules.13. Often stays out late at night despite parents’ prohibitions,

beginning before age 13 years14. 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)

15. Is often truant from school, beginning before age 13 years

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.

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

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.

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.

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

Treatment

Pharmacotherapy Medications to treat co morbidity:

Stimulants, Lithium, AnticonvulsantsTo 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 Tardive Dyskinesia.

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

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.

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?