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CONDUCT DISORDER
 



SYNOPSIS

Conduct Disorders F91 - ICD10 Description, World Health Organization

Disorders characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring pattern of behaviour (six months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be preferred.
Examples of the behaviours on which the diagnosis is based include excessive levels of fighting or bullying, cruelty to other people or animals, severe destructiveness to property, fire-setting, stealing, repeated lying, truancy from school and running away from home, unusually frequent and severe temper tantrums, and disobedience. Any one of these behaviours, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.
Conduct Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with conduct disorder needs to meet all of the following criteria:

  • A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

    • Aggression to People and Animals

    • Often bullies, threatens, or intimidates others.

    • Often initiates physical fights.

    • Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).

    • Has been physically cruel to people.

    • Has been physically cruel to animals.

    • Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).

    • Has forced someone into sexual activity.

    • Destruction of Property

    • Has deliberately engaged in fire setting with the intention of causing serious damage.

    • Has deliberately destroyed others' property (other than by fire setting).

    • Deceitfulness or Theft

    • Has broken into someone else's house, building, or car.

    • Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).

    • Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

    • Serious Violations of Rules

    • Often stays out at night despite parental prohibitions, beginning before age 13 years.

    • Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period.

    • Is often truant from school, beginning before age 13 years.

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

  • If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

The majority of children with oppositional defiant disorder grow out of it, but some progress into delinquency - i.e., conduct disorder. Children or adolescents with conduct disorder have the same behaviors as those with oppositional defiant disorder (i.e., defiance, disobedience, and disruptiveness). In addition, they add delinquent behaviors (e.g., physical violence, property destruction, law-breaking, reckless thrill-seeking) and antisocial behaviors (e.g., disrespect of others, irresponsibility, and dishonesty). At school, children or adolescents with conduct disorder are the bullies, thieves and vandals. Conduct disorder, to be diagnosed, must last 6 months or longer. Most children or adolescents with conduct disorder grow out of this disorder, but if this behavior persists past age 18, the diagnosis is changed to antisocial personality disorder. Thus oppositional defiant disorder, conduct disorder, and antisocial personality disorder are all part of the same dissocial spectrum. It appears that, by reason of nature/nurture, these individuals haven't learned compassion and cooperation; hence they disregard rules and the rights of others.

Effective Therapies

Fortunately, parent training is quite effective as a treatment for this disorder. At 5-6 year followup after parent training, two-thirds of the children no longer received the diagnosis of conduct disorder. It is essential that these individuals be given healthy, compassionate role models (e.g., Big Brothers, Scouts) and learn how to play by the rules and cooperate (e.g. structured sports programs). "Scared Straight" programs (showing delinquents what life in prison is like) may be effective.

Ineffective Therapies:

physical punishment and incarceration is seldom effective. Likewise medication is seldom effective against the core features of this disorder.

Description

  • Conduct Disorder - PubMed Health
  • Conduct Disorder - Wikipedia
  • The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder. This was a study of a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. When followed up as adults, less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder. Thus for children with conduct disorder there was a very high continuity with adult social difficulties.

Stories

Free Diagnosis Of This Disorder

Rating Scales

Treatment

  • Conduct Disorder Treatment Guidelines
  • Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training. The effects of parent training (teaching better parenting skills) have been extensively evaluated. This study assessed the effectiveness of parent training 5-6 years later. While all the children qualified for a diagnosis of ODD/CD before treatment, 5-6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up.
  • Progression from conduct disorder to antisocial personality disorder following treatment for adolescent substance abuse. This was a prospective longitudinal study of 137 substance-abusing adolescents (53 female and 84 male), whose average age was 15.9 years and who met the DSM-III-R criteria for conduct disorder. Consecutively admitted patients were recruited from two adolescent inpatient alcohol and drug treatment facilities. Participants were interviewed again 4 years after treatment. Four years after treatment, 61% of the study group met the DSM-III-R criteria for antisocial personality disorder. Results of a logistic regression analysis indicated that onset of deviant behavior at or before age 10, a greater diversity of deviant behavior, and more extensive pre-treatment drug use best predicted progression to antisocial personality disorder. At 4-year follow-up, the subjects with an antisocial personality disorder diagnosis exhibited more involvement with alcohol and drugs and poorer functioning across important life domains than the subjects without antisocial personality disorder.

Research

Other Web Pages

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