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Conduct Disorder In Children

Definition

Conduct disorder is a personality disorder seen in children or adolescents where there are repeated bouts of disruptive behavior. These children or adolescents frequently break rules and ignore the basic rights of other people. They also cause physical harm to others or animals, steal, lie, and show other unacceptable behaviors.

What is going on in the body?

More research needs to be done before experts fully understand the mechanisms at work in this disorder.

Risks

What are the causes and risks of the condition?

The causes of conduct disorders are unknown. Theories include:
  • chemical imbalance in the brain
  • physical causes
  • genetic or inherited traits
  • chaotic home environments with little structure or predictability
  • the child's temperament or the family's response to it
The major risk of conduct disorder in childhood is that the child may develop one of the following conditions as an adult:
  • antisocial personality disorder
  • mood or anxiety disorders
  • substance abuse disorder

Prevention

What can be done to prevent the condition?

A nurturing and stable home environment is the best prevention. Children from homes with a balance of love and discipline are less likely to develop this disorder than are children from abusive, overly permissive, or neglectful homes. Prevention focuses on skill development not only for the child but also for others involved with the child. This includes the family and the school.

Diagnosed

How is the condition diagnosed?

Most children have some problems related to conduct at some time. But a conduct disorder is diagnosed when those behaviors become:
  • persistent and impinge on the basic rights of others
  • major violations of accepted norms
  • significant enough to impair everyday life
At least three of these behaviors must have been present during the past year. Typically, a complete psychological and social history will be obtained, either by a healthcare or a mental health care professional. Also, a complete physical exam should be done. This is to find out if any medical conditions are causing the child to act out.

Long Term Effects

What are the long-term effects of the condition?

If left untreated, conduct disorder can lead to:
  • school failure
  • school suspension
  • legal problems
  • injuries due to fighting
  • accidents
  • sexually transmitted disease
  • teenage pregnancy
  • drug addiction
  • suicide
  • homicide

Other Risks

What are the risks to others?

Children with conduct disorder tend to have aggressive behavior. They can cause intentional or unintentional harm to others, to themselves, and to animals.

Treatments

What are the treatments for the condition?

Treatment of conduct disorder may include group, individual, or family therapy or a combination. Psychotherapy is aimed at helping the child learn methods to deal with his or her emotions and impulses in ways that work better in social settings.
Counseling is essential to help the child with self-esteem, mood, anger control, and interpersonal problems. Providing support and sensitive acceptance of the child is important. This will include helping the child understand the various sources of the problems. Counseling will also focus on developing appropriate behavior and coping skills.
A predictable and nurturing home environment is important as well. A balance in diet, rest, play, and study should be maintained. Solid discipline, coupled with nurturing, consistent, and fair expectations is important for children with a conduct disorder.
Special education services with a plan customized for the child may be developed at school. This plan will help arrange for additional services for the child. Parents need to work closely with the school and educational services team.
Sometimes medications are used, but if so, they are generally aimed at other contributing conditions rather than at the conduct disorder per se.

Side Effects

What are the side effects of the treatments?

There are no side effects of the behavioral treatments. Side effects may occur if medicines are used.

After Treatment

What happens after treatment for the condition?

Mild forms of conduct disorder tend to improve as the child ages. Those who receive adequate social and work adjustments show progress. For others, the behaviors continue into adulthood and may develop into antisocial personality disorder. A plan should be in place with the child, family, and therapist for what steps to take if signs of relapse appear. An agreement should be made to call the therapist when those symptoms occur.

Monitor

How is the condition monitored?

Conduct disorder is monitored by the family, the school, and the therapist. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Hales, Robert, Textbook of Psychiatry, 2nd edition:1994

The Merck Manual of Medical Information, Home edition, 1997

"Conduct Disorders", http://www.adhd.com.au/conduct.html.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), American Psychiatric Association, 1994

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