Conduct Disorder: Types, Symptoms, Causes, Risks, Diagnosis, Treatment and Prevention

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boy with Conduct Disorder shouting on a girl

1Overview

It is just normal for children and teens to manifest some behavioral problems sometime in their growing years. However, there are some behaviors that are so severe; they could pose a threat to the children themselves or others.

However, when a certain behavior is violent, could pose a threat to others and lasts for a long time, it is already considered a conduct disorder. Conduct disorder is a severe behavioral and emotional disorder that manifests in childhood and adolescence. A person with this problem may have a problem with following certain rules and violates the rights of others. They may also display a pattern of violence and disruptive behavior.

If your child has a conduct disorder, he or she may appear confident, tough and strong. However, they are actually insecure, has a low self-esteem and they perceive other people to be aggressive toward them.

Across the globe, conduct disorder is more common among boys than girls. Some studies have shown that the rate among male children or teenagers ranges between 6 percent to 16 percent while among girls, the rate is just 2 percent to 9 percent. The disorder could start in a child as early as before ten years old.

2Types

Conduct disorder can be divided into three parts – childhood onset, adolescent onset and unspecified onset.

Childhood Onset

The childhood onset conduct disorder could start even before the age of 10. Kids might display disruptive behaviors toward their classmates, parents, teachers, and siblings.

Adolescent Onset

This type of conduct disorder appears during the teenage years. Teens with this behavior problem are more violent to others and display defiance from rules and policies in school and at home.

Unspecified Onset

This onset means the age when the disorder first appeared is not known.

3Symptoms

Children with conduct disorder are hard to diagnose because some of the signs and symptoms of this disorder are similar to other diseases such as oppositional defiance disorder or attention deficit hyperactivity disorder (ADHD).

There are four categories of conduct disorder – aggressive behavior, destructive behavior, deceitful behavior and violation of rules.

Aggressive Disorder

  • Being cruel to animals
  • Fighting with others
  •  Bullying
  • Intimidating others
  • Physically harming other people on purpose
  • Using a weapon
  • Committing rape

Destructive Behavior

  • Vandalism
  • Arson or putting a property on fire
  • Intentional destruction of property

Deceitful Behavior

  • Lying
  • Shoplifting
  • Breaking and trespassing
  • Stealing
  • Forgery

Violation of Rules

  • Truancy
  • Running away from home
  • Skipping school
  • Drug and alcohol use
  • Sexual behavior at an early age

4Causes

Until today, the exact cause of conduct disorder is still unclear. However, some health experts believe that a combination of factors could lead to the development of conduct disorder.

Genetic Causes

Like any other mental and behavioral conditions, conduct disorder can be passed down in families. Many children and teenagers with conduct disorder have family members with mental illness like anxiety disorders, substance abuse, personality disorders and mood disorders.

Biological Causes

Many studies had shown that when the brain suffered from defects or injuries, these could lead to behavior disorders. When particular brain regions affected are the ones responsible for regulating behavior, emotion and impulse control, this could lead to conduct disorder.

Environmental Causes

In some children and teens, there are factors in the environment that could have caused the conducting behavior. These factors could also trigger the manifestation of the behavior’s signs and symptoms. The environmental factors linked to conduct disorder include:

  • Child abuse
  • Parents who are substance or drug users
  • Poverty
  • A dysfunctional family

Psychological Causes

Some health experts believe the conduct disorders stem from the lack of moral awareness like showing remorse and guilt. This could also be caused by deficits in cognitive processing.

5Risk Factors

There are also risk factors that could increase a child’s risk of developing conduct disorder:

  • Being male
  • Living in the city opposed to living in the countryside
  • Poor nutrition
  • Having other mental disorders
  • Poverty
  • Family history of conduct disorder
  • Family history of mental disorders
  • A dysfunctional home environment
  • Being neglected or abused
  • Lack of appropriate methods of discipline
  • Exposure to violence
  • Experienced physical, sexual, or verbal abuse
  • Maternal psychopathology

6Diagnosis

Just like in adults, mental disorders in children are diagnosed depending on the signs and symptoms they manifest. If the symptoms of conduct disorder are present, the doctor or psychiatrist can evaluate further through a complete medical and psychiatric assessment and history taking.

The doctor may ask your child questions about their behavioral patterns for them to make a diagnosis. Moreover, the child should have a pattern of displaying at least three behaviors of conduct disorder. The child should also show at least one of the behaviors within the past six months.

The doctors may ask interview questions to assess conduct disorder:

  • Have you had any conflict with the police? If yes, for what reason?
  • Have you been suspended or expelled from school? If yes, for what reason?
  • Have you been in physical fights? If yes, because of what?
  • Did you ever run away from home? How many times? Did you stay overnight?
  • Are you sexually active?
  • Do you smoke, drink alcohol or use other drugs? What are the names of the drugs? How frequently do you do these actions?

Conduct disorders often occur along with other mental health issues like mood disorders, anxiety disorders, posttraumatic stress disorder, ADHD, learning disorders and substance abuse.

7Treatment

The treatment of conduct disorder will mostly depend on various factors like the child’s age, the child’s ability to participate in the treatment methods and the severity of the symptoms.

Other factors include the child’s overall health, how well the child can handle the treatments, medicines and therapies, the child’s condition and the parents’ opinion and preference.

Without treatment at an early age, your child may have a difficulty living as an adult. He or she may have a problem with staying in relationships and landing a job.

Psychotherapy

Treatment for conduct disorder is hard because of the negative attitudes of those with the disorder. The various therapies, including psychotherapy, is affected by this, which takes a long time before it could manifest its efficacy.

The earlier the condition is diagnosed, the more successful the therapy will be. In younger children, treating conduct disorder with psychotherapy is easier than in teenagers. In adolescents, therapy may target not just the family interactions but also the school authorities.

Cognitive-behavioral Therapy

The goal of cognitive-behavioral therapy is to improve impulse control, anger management skills, problem-solving and communication skills. For kids with conduct disorder, behavioral therapy is based on scientifically-derived learning theory.

Family Therapy

Usually, the strategies used during the treatment is to reduce blame among parents, increasing parenteral monitoring and guiding the parents on supervising the child’s behavior. Moreover, family therapy focuses on making some changes within the family to help manage the child’s behavior such as improving family interactions and communication skills.

Peer Group Therapy

This type of therapy aims to develop social and interpersonal skills.

Medications

The medications should be prescribed and recommended only by a licensed doctor. Though there are no prescribed medicines for conduct disorder, some drugs can be used to treat the symptoms of the brain disorder.

Medicines that are used include Methylphenidate (Ritalin), Dextroamphetamine (Dexedrine), and antidepressants such as Fluoxetine (Prozac), Bupropion (Wellbutrin), and some anticonvulsants.

Parent Therapy Programs

There are many programs that can help parents deal with their kids with conduct disorder. There are some evidence-based parent training programs to guide them in managing their children’s behavior. It could help improve the quality of family life and at the same time, allow the parents understand the situation of their children, without being judgmental and authoritative.

8Outlook (Prognosis)

The long-term prognosis for people with conduct disorder relies on the severity and frequency of their symptoms and behavioral problems. Kids who persistently shows extremely aggressive, destructive and deceitful behavior may have a poorer prognosis than others.

Without treatment, the child is at a higher risk of having ongoing problems until adulthood. In the long run, if these behaviors are not treated or managed, it could lead to defiance behavior, committing crimes, inability to stay in a job and relationship problems.

For those with long-term conduct disorder, the effects could take a toll on the lives of those affected. Untreated conduct disorder may lead to the following:

  • Incarceration
  • Legal problems
  • Poor educational achievement
  • Increased academic failure
  • Antisocial personality disorder
  • Injuries to self and others
  • Substance abuse and addiction
  • Suicidal ideation
  • Poor interpersonal relationships
  • Lack of job or inability to stay in a job for long-term

9Prevention

Early detection may help in the treatment and prognosis of the disease. Prognosis may be improved by prevention of conduct disorder before it becomes worst. Moreover, by dealing with children who are at a high risk of conduct disorder and managing these risks before they influence the development of conduct disorder, could prevent the disease from worsening or being triggered in the first place.

There are many ways to prevent conduct disorder:

  • Improving communication skills within families
  • Guidance of parents on their children
  • Spending quality time with the kids

Helping children deal with the various stress of life such as the family going through a divorce