Conduct Disorders
Definition – repetitive persistent pattern of behavior in which the basic rights of others or societal norms or rules are violated; behavior is more serious than transient mischief of kids & teens.
Oppositional defiant d/o (ODD) – kids won’t do what their told; minor incidents
Attention deficit hyperactivity d/o (ADHD) – kids are impulsive & hyperactive; move around most of the time
Conduct d/o (CD) – juvenile delinquents; violating rules & regs, social norms or morals
- Kids can progress from ODD to CD
- ADHD can also develop into or w/CD
Symptoms of conduct d/o
- Aggression to people & animals
o Often bullies, threatens or intimidates others
o Often initiates physical fights
o Has used a weapon that can cause serious physical harm to others
o Has been physically cruel to people and/or animals
o Has stolen while confronting victim
o Has forced someone into sexual activity
- Destruction of property
o Has deliberately engaged in fire setting w/intention to cause serious damage
o Has deliberately destroyed others’ property
- Deceitfulness or theft
o Has broken into someone else’s house, building or car
o Often lied to obtain goods or favors or to avoid obligations
§ If lying to avoid abuse, doesn’t count as symptom
o Has stolen items w/o confronting victim
- Serious violations of rules
o Often stays out at night despite parental prohibitions
o Has run away from home overnight at least twice
o Is often truant from school
- Duration
o Pattern of behavior must last at least 6 mo
- Severity
o Mild – lying; truancy
o Moderate – stealing w/o confrontation; vandalism
o Severe – excessive symptoms; causing considerable harm to other people, such as physical aggression, cruelty, etc
Prevalence
- Depends upon criteria used for diagnosis & source of data
- 30-33% of outpt referrals to clinics are for antisocial, often aggressive behaviors
- Only a small percentage of arrested youths go on to become chronic offenders
Etiology – no single etiology for COs; consider intrinsic & extrinsic factors asso’d w/CO & interaction of them
- Intrinsic factors
o Genetic theories
§ XYY (‘super males’) – over-represented in prisons, but those individuals aren’t at any increased risk
§ Being male is biggest risk factor for developing violent behavior
§ Adoption studies
§ Twin studies
o Biochemical abnormalities
§ Neurotransmitters (5-HT) & aggression
§ Testosterone levels – no direct link to aggression
o Medical hxs & neurologic vulnerabilities
§ Normal finding & EEGs
o Psychiatric vulnerabilities
§ Psychodynamic theory – concept of superego lacunae
- Holes in superego that allows you to carry out antisocial behaviors
§ Long-standing hxs of maladaption – instability at home, school or in community
§ Comparison of incarcerated delinquents w/a matched sample of non-delinquents
§ Suicide – due to impulsivity & taking part in high-risk behaviors
§ Educational & intellectual factors – co-morbid w/ADHD
- Extrinsic factors
o Sociocultural factors
§ Socioeconomic factors – economically deprived environments
§ Family size – family size, risk for aggression
§ Lack of supervision
§ Prevalence of parental illness
§ Access to medical care
o Racial minorities
§ Bias? – plays more of an important role in how kids are managed
o Parental factors
§ Child-rearing practices – severe corporal punishment ® more aggressive behavior
§ Specific kinds of antisocial behaviors in succeeding generations
- Substance abuse
- Family hx of EtOH abuse
- Parental & physical violence – exposure to violence
§ Identification w/aggressor
§ Physical abuse, EtOH abuse & brain injury
§ Parental discord (witness abuse) & physical violence
§ Media exposure
- Effect on kids, predisposing them to violence/aggression
- Caretaker plays key role in exposure’s effect
- Toddlers (2-3) are especially sensitive to exposure to violence
Clinical features
- Runs away
- Stealing & lying
- Trouble at home & community
- Substance abuse
o While not diagnostic, kids usu start younger (~10-11)
o Exposure at home
- Low self-esteem
o Co-morbid w/depression
- Sexual activity – at earlier ages
- Impulsive behaviors
- Complicated clinical picture
- Average IQ/intelligence
Diagnosis & evaluation
- Diagnosis – of exclusion
- Prognosis
o Variable
o The younger the onset, the worst the prognosis
- Differential considerations
o Thought d/os
o Mood d/os – manic, bipolar d/o
o Organic impairment – endocrine imbalance
o Intellectual deficits
o Learning problems
- Evaluation
o Multiple vulnerabilities to risk factors – both intrinsic & extrinsic
o Problem list
o Multi-disciplinary – involve social worker, psychologist, etc
Tx
- Multi-modal – not just one tx
- Parenting – teach consistency
- Problem solving – to manage aggression & impulsivity
- Medications
o No single medication is effective
o Can be useful for certain target symptoms
- Ongoing support
o Parent surrogates
o Emotional/physical support
o Structure & consistency
Tags: ADHD, aggressive behaviors, antisocial, Destruction of property, hyperactive, impulsive, initiates physical fights, maladaption, mood disorders, ODD, Oppositional defiant disorder, physically cruel, Psychodynamic theory, suicide, Testosterone levels, violence effect
