Conduct Disorder Term Paper

Conduct disorders are the reality humans have to face for centuries – fighting, abuse, stealing, aggressive behavior and other antisocial acts were common in early stages of the modern society development. Nowadays the behavior mentioned above is inacceptable in the civilized society. If a person shows evidence of antisocial behavior on a regular basis, he or she might be diagnosed Anti-Social Personality Disorder (ASPD). If such person is under eighteen, he or she might be diagnosed conduct disorder.

The treatment of conduct disorders, especially those discovered in infancy, childhood and youth determined a lot of time and effort, and the careful evaluation of all steps taken towards the improvement of the patient’s condition and behavior. The improvement is often a result of combined efforts of the therapist, the parents (or caregivers), teachers and even trusted peers. Still, there is a need for greater attention and care for children with conduct disorders – they can be helped if treated properly, otherwise their lives and the normal lives of there relatives and even the local society may be significantly endangered or impaired.

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According to the DSM-IV-TR, the conduct disorder may be diagnosed in case there is a repetitive and persistent pattern of behavior in which major age-appropriate societal norms or rules and the basic rights of others or are violated. The cases may include aggression to people and animals, destruction of property, serious violations of rules or deceitfulness/theft (American Psychiatric Association, 2000). For the CD to be diagnosed according to DSM-IV-TR, three (or more) criteria stated should be present in the past year, with at least one criterion present in the half year (American Psychiatric Association, 2000).

The onset of at least one criterion characteristic of Conduct Disorder prior to age ten years determines the Childhood-Onset Type, otherwise (no evidence of Conduct Disorder prior to age ten years) the Adolescent-Onset Type is determined (American Psychiatric Association, 2000).

The case of CD may be mild (minor harm to others), moderate (intermediate harmfulness) or severe (considerable harm caused)(American Psychiatric Association, 2000).

The disturbance in behavior causes clinically significant impairment in social, academic, or work functioning.

The World Health Organization categorizes Conduct disorder under code F91 and defines them as disorders characterized by a repetitive and persistent pattern of aggressive, defiant or dissocial conduct (ICD-10, 2007). Major violations of age-appropriate social expectations serve as a basis for assessment. Conduct disorder is more severe than ordinary childish misbehavior or rebelliousness common for adolescents. And its symptoms should last at least half a year or longer.

A conduct disorder may be confined to the family context, socialized, unsocialized, oppositional defiant disorder, or unspecified. It is often linked with diverse comorbidities: attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, mood disorder (e.g. major depression, bipolar disorder) and substance abuse).

Conduct disorder was the strongest predictor of lifetime heroin and cocaine use as stated by Slesnick & Prestopnik (2005). The substance abuse for individuals with CD nay include alcohol, tobacco was next, marijuana, inhalants, crack and cocaine, and hallucinogens (Morihisa, Barroso & Scivoletto, 2005).

Burket & Myers (1995) conducted a study to investigate psychotic comorbidities usually found in both male and female adolescents diagnosed with conduct disorder. 14 young males and 11 young females were evaluated for mood and personality disorders, and the findings stated depressive disorders were common for sixty-four percent of respondents, while anxiety disorders constituted comorbidities for fifty-two percent of adolescents with conduct disorder. Attention-deficit hyperactivity disorder was found in twenty-eight percent of respondents, and the substance abuse was common for forty-eight percent. Borderline personality disorder was found in thirty-two percent of the adolescents (Burket & Myers, 1995). In school, a child with conduct disorder may reveal aggressive and destructive behavior, assaulting peers or teachers, fighting, carrying weapon or anything related, and stealing money from peers or taking drugs. School suspensions are extreme cases indicating a child with noticeable conduct disorder. Searight et al.(2001) provides illustrative cases for a school behavior for a child with CD: Sharon (15) has been suspended from school ten times during the past three years, the cases include fighting, carrying a knife to school, smoking marijuana and stealing money from other students’ lockers. Another illustrative case Searight et al. (2001) provide is a six-year-old Tim (who was suspended four times during kindergarten) frequently pulls the family dog around by its tail and once threw a can of soup at one of his older sisters. Such domestic behavior is common for children with CD. At home, a child having conduct disorder may become «uncontrollable» ruining possessions, furniture or dishes, throwing things into relatives, hurting home pets, and intentionally starting fire. A child with CD may leave the house for several days.

At the camp, with less supervision available, a child with conduct disorder might abuse other children or damage camp property. He or she will neglect the rules and the requests of the supervisors or even threaten and abuse them.

The behavior patterns are mainly different for each separate individual. There is a risk of taking isolated behaviors like fighting, shoplifting or experimentation with forbidden substances for conduct disorder, but antisocial acts occur in most young individuals. For the disorder to be diagnosed, much more evidence and reasons should be taken into account for proper assessment and evaluation.

A child with the disorder often comes to the attention of professionals due to misbehavior at kindergarten, at school or at home: mainly due to troublesome relationships with parents, relatives, teachers or peers, unwillingness to follow the rules, destruction of property or theft.

Therefore, the most probable way of getting the attention of doctors is through having behavioral and social functioning problems, depression, anxiety, aggression, disruptive behavior, and family troubles.

Sometimes parents bring smaller kids for assessment because they find signs or traces of problems usually associated with conduct disorders or are simply willing to ensure whether there might be any risk of their kid having conduct disorder. The prevailing criteria for assessment are contained in the Diagnostic and Statistical Manual of the American Psychiatric Association-Fourth Edition-Text Revision. The presence of at least three symptoms for the last twelve months as specified in the DSM-IV is necessary to make the diagnosis. First of all, there must be clear evidence of clinically significant impairment in occupational, academic, or social functioning to make any assessment. Making a diagnosis based solely on a diagnostic checklist is inadequate – it should be based on the history and clinical observation reviewing the individual’s current and past life. Information (Reports and ratings of significant others - from parents (or caregivers), therapists or teachers and other school professionals) regarding core symptoms of conduct disorder in various settings should be available to the evaluation of the professional.

Direct observation of the child’s behavior in multiple settings (e.g., home and school) collected throughout a substantial period of time. Institutional Records (police and school records of misbehavior) should also be available to the attention of the specialist making assessment. Self report measures, if available, might also be beneficial for proper assessment. It is extremely important to start helping children with conduct problems as early as possible. For most conduct disorder no single treatment approach has been shown to be effective enough – only a combination of treatment proves to bring relief to patients with conduct disorders. The two major components in the medical care of children with conduct disorder are pharmaceutical and psychosocial treatments. A combination of therapy starts with comprehensive evaluation and usually includes some or all of the following tools: individual psychotherapy, parent/child/family or group therapy, Dyadic and social skills and parent management training and the use of medication (DCFS Clinical Pathways, 2007). Many researchers believe that treatment of Conduct Disorder should include efforts of improving parenting and family functioning. (Kazdin & Wassell, 2000)

Psychopharmacological treatment alone is not effective for treating conduct disorder, but it might be useful for treating aggression or comorbid disorders.

The treatment of conduct disorder sometimes involves stimulants, antidepressants, lithium, anticonvulsants and clonidine (Campbell, 1992). Still, their effectiveness should be studied more carefully.

The prognosis for child-onset type is very poor; the adolescent-onset type provides more information on future development of a person with CD. The lack of prognosis for child-onset type is probably due to the relative lack of survey-based information about children with CD conducted for a lengthy period of time. Moreover, the conduct disorder often goes unnoticed in children, and the parents do not turn to the specialists. The adults are under more attentive supervision because their behavior is often obviously anti-social and there is no chance to hide the symptoms of the conduct disorder. In fact, conduct disorder is one of the most difficult treatment challenges in child psychiatry, if left untreated, the disorder has strong links to adult psychiatric disorders (especially ASPD and substance abuse), most children become unable to adapt to the demands of adulthood and continue having problems with the legal system and maintaining a job, a family and having normal social life.

Conduct disorder may cause severe impairment in life functioning. Discovered in early childhood but left untreated, it may substantially influence the child’s mental growth and development. Early developmental lagging and absence of basic knowledge or understanding of proper and improper behavior lead to the consequences that are difficult to change in adulthood.

Parents of children with conduct disorder often exhibit antisocial personality traits, substance abuse and depression, and may cause children’s behavior problems associated with inconsistency and harsh discipline. That is why timely and proper counseling and information and psychological support from both the family and the therapist are of great importance. Chronic underachievement may also shape the future of children with conduct disorder. Conduct problems in childhood often precede the development of alcohol and drug abuse in youngsters. The adolescents that continue to exhibit antisocial behavior in high school often develop further substance problems.

Adolescent girls with conduct problems are more likely to become young mothers, to be single parents, and to have children who display early signs of psychosocial problems. (Donovan, 2000)

The family should consider finding an appropriate professional counselor that would perform proper evaluation of the child’s condition and the subsequent treatment. The support of children with conduct disorders is usually minimal at school where a child may find aggressive social surrounding that impairs his or her ability to lead normal social life among peers. Conduct disorder found in early childhood needs immediate intervention of professionals. Otherwise it would be much more difficult and costly to change the behavior patterns of a young individual.

There is a strong need for combined efforts of a therapist and other specialists, parents, teachers, peers, and the individual with conduct disorder to overcome the barriers for normal social behavior and communication.

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