Conduct Disorder

CONDUCT DISORDER

Conduct disorder (CD)-synopsis

Conduct disorder (CD) is an emotional and behavioural state that leads children and young people to act in a way that is disruptive and violent, and not follow rules.

Conduct disorder represents a group of behavioural problems where a child is aggressive, antisocial and defiant to a much greater degree than expected for your child's age.

Onset

The DSM-( Diagnostic and Statistical Manual of Mental Disorders. (5th Edition)

notes that Conduct Disorder can appear as early as the preschool years, with ODD (Oppositional Defiant Disorder) a common premorbid condition, which may progress to Conduct Disorder.

Middle childhood to middle adolescence is the time frame where Conduct Disorder symptoms are most apparent,and come to parental/educational/clinical attention. Rejection by more prosocial peers and association with delinquent peers with reinforcement of conduct disordered behaviours may occur (American Psychiatric Association, 2013).

Prevalence

It has been shown that 5% of all children between five and 16 years old diagnosed with Conduct disorder, more common in boys than girls, The proportion of children with conduct disorders increases with age, For example, 7% of boys and 3% of girls aged five to 10 years have conduct disorders; in children aged 11 to 16 years, the proportion rises to 8% of boys and 5% of girls.

Diagnosis

To confirm the diagnosis of conduct disorder, your child must have shown with at least one of the characteristics shown in the last six months, and at least three of the core symptoms over the past year,

Characteristics of conduct disorder include:

Fighting and physical cruelty
Destructiveness
Lying and stealing
Truancy and running away from home

Core Symptoms of conduct disorder are grouped into four areas:

1. Aggression to people and animals

2. Destruction of property

3. Deceitfulness, lying or stealing

4. Serious violations of rules

What causes conduct disorder?

There is no single cause, however multi factors can interact and explain the child’s disruptive behaviours including:

Individual factor
Genetic factor
Physical factor such as brain damage
Environmental such as family social adverse circumstances

How is conduct disorder treated?

Treatment depends on the type, nature and severity of symptoms your child has . Possible treatments intervention include:

Cognitive Behaviour therapy
Behaviour therapy
Individual psychotherapy
Family Therapy
Medication for associated symptoms such as depression or ADHD

*DSM-5 Category: Disruptive, Impulse-Control, and Conduct Disorders

DSM-5,Diagnostic criteria of Conduct Disorder, at least four of the following have to be present

Aggressive behaviour toward others and animals.
Frequent physical altercations with others.
Use of a weapon to harm others.
Deliberately physically cruel to other people.
Deliberately physically cruel to animals.
Involvement in confrontational economic order crime- e.g., mugging.
Has perpetrated a forcible sex act on another.
Property destruction by arson.
Property destruction by other means.
Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
Has engaged in non-confrontational retail theft, e.g., shoplifting.
Disregarded parent's curfew prior to age 13.
Has run away from home at least two times.
Has been truant before age 13.

The preceding criteria is accompanied by the following:

1. The behaviours cause significant impairment in functioning and

2. If the individual is over age 18 the criteria for APD is not met.

Further qualifiers are:

1. Child, Adolescent, or Unspecified onset.

2 Limited prosocial emotions, - lack of remorse or guilt, lack of empathy, callousness, unconcerned about performance, shallow or deficient affect

3. With mild, moderate, or severe levels of severity (American Psychiatric Association, 2013).

Dr. Akeel. A.Abdul Wahab

Fellow & Member of The Royal College of Psychiatrists (UK)

FRCPsych. (UK), MRCPsych. (UK), Board NeuroPsych. (London University ,UK), Dip.Psych. (London University, UK), MB.ChB.(Basra University , Iraq )

Formerly Senior Consultant Psychiatrist & Clinical professor

References

Rutter, M. & Taylor, E. (eds) (2008)'Rutter’s Child and Adolescent Psychiatry' (5th edn). London: Blackwell Publishing.
Stephen Scott (2008): An update on interventions for conduct disorder Advances in Psychiatric Treatment, 14:61-70.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.