Conduct disorder

What is Conduct Disorder?

The American Academy of Child and Adolescent Psychiatry defines “Conduct Disorder” as a group of behavioural and emotional problems in youngsters. Those with this disorder find it really difficult to follow rules and behave in a socially acceptable way. Others often view children with conduct disorder as bad or delinquent, rather than mentally ill.
Many factors contribute to a child developing conduct disorder. Some of them include:-

• Brain damage
  
• Child abuse
  
• Genetic vulnerability
  
• School failure
  
• Traumatic life experiences

What are the symptoms?

Children or adolescents with conduct disorder may indulge in or exhibit some of the following behaviours:

• Aggression to people and animals- Those suffering from conduct disorder generally bullies, threatens or intimidates others, often initiates physical fights with other children, use weapons that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or etc), are physically cruel to people or animals and may force someone into sexual activity.
  
• Destruction of property- Such children deliberately engage in setting fire with the intention to cause damage and deliberately destroy other's property.
  
• Deceitfulness, lying, or stealing- Children with this condition generally lies to obtain goods, or favours and also steal items without confronting a victim (e.g. shoplifting, but without breaking and entering)
  
• Serious violations of rules- Those suffering from this disorder often stay out at night despite parental objections, run away from home and often bunk the school.

How can it be diagnosed?

The primary diagnostic features of conduct disorder are aggression, theft, vandalism, and violations of rules and/or lying. For a diagnosis, these behaviours must occur for at least a six-month period. The doctor takes into consideration biological, psychosocial and familial factors before confirming a case of conduct disorder. The differential diagnosis of the condition includes oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), mood disorder and intermittent explosive disorder. Family physicians may provide brief, behaviourally focused parent counseling, pharmacotherapy and referral for more intensive family and individual psychotherapy.

Which medical & behavioural conditions accompany conduct disorder?

Many children with a conduct disorder may have coexisting conditions such as mood disorders, anxiety, post-traumatic stress disorder, substance abuse, attention deficit hyperactivity Disorder, learning problems, or thought disorders, all of which also requires treatment. Hence, a comprehensive evaluation of the child and his/her associated behavioural problems is required for treating conduct disorder.

How can conduct disorder be treated?

Treatment of children with conduct disorder can be complex and challenging. The mode of treatment depends on the severity of the behaviours. Some of the major challenges include child's uncooperative attitude, fear and distrust of adults. In developing a comprehensive treatment plan, a child and adolescent psychiatrist may use information from the child, family, teachers, and other medical specialties to understand the causes of the disorder. Behaviour therapy and psychotherapy are usually vital to help the child appropriately express and control anger. Special education may be required for those with learning disabilities. Parents often need expert assistance in carrying out special management and educational programmes in the home and at the school. Treatment may also include medication in some children and adolescents, particularly for those with difficulty paying attention, impulse problems, or those with depression.

Establishing new attitudes and behaviour patterns takes time. So, treatment for conduct disorder is rarely brief. However, early treatment offers a child a better chance for considerable improvement and hope for a more successful future.