CONDUCT DISORDER

Conduct disorder (CD) is a psychiatric condition, characterized by a repetitive and persistent pattern of antisocial, aggressive or defiant behavior   in which a child persistently engages in acts that violate the basic rights of others and/or violate the norms of society

Two patterns of conduct disorder are described based on the age at onset.

Early onset conduct disorder

  • Onset before the age of 11 years
  • Associated with a particularly poor prognosis
  • it is rare to find an anti-social adult who did not report a history consistent with conduct disorder as a child

Adolescent onset conduct disorder

  • Most often self-limiting
  • Does not typically persist in adulthood

Studies reveal that the structural abnormalities in brain i.e. reduction of grey matter in the area that processes socio-emotional stimuli are associated with conduct disorder, regardless of age of onset.3

CAUSES:

Conduct disorder emerges as a result of amalgamation of underlying genetic vulnerability, subsequent exposure to coercive parenting and variety of psychosocial risk factors including low socioeconomic status, peer relationship difficulties, parental mental illness and child maltreatment neglect and abuse.

CLINICAL FEATURES  AND DIAGNOSTIC CRITERIA

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5)

The essential feature of conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviors fall into four main groupings:

Aggressive conduct that causes or threatens physical harm to other people or animals:

  1. Often bullies, threatens, or intimidates others.
  2. Often initiates physical fights.
  3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
  4. Has been physically cruel to people.
  5. Has been physically cruel to animals.
  6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
  7. Has forced someone into sexual activity.

 Nonaggressive conduct that causes property loss or damage:

  1. Has deliberately engaged in fire setting with the intention of causing serious damage.
  2. Has deliberately destroyed others’ property (other than by fire setting).

 Deceitfulness or theft:

  1. Has broken into someone else’s house, building, or car.
  2. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
  3. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery);

Serious violations of rules:

  1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
  2. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
  3. Is often truant from school, beginning before age 13 years.

Three or more characteristic behaviors must have been present during the past 12 months, with at least one behavior present in the past 6 months. And result in clinically significant impairment in social, academic, or occupational functioning.

TREATMENT

Prevention is the best approach. Conduct disorder can be prevented by interventions in childhood, particularly by using parenting programs.

Once it has established, the programmes that employ intensive interventions that involve children, parents and family have proved effective.

As far as pharmacological option is concerned, further research is required to prove its benefits.

References:

1 Richardson, Joanna, and Liabo, Kristin. Child and Adolescent Mental Health : Conduct Disorder and Offending Behaviour in Young People : Findings from Research. London, GB: Jessica Kingsley Publishers, 2007. ProQuest ebrary. Web. 12 March 2017.

2 Gabbard’s Treatments of Psychiatric Disorders, Fifth Edition Chapter 42. Conduct Disorder http://dx.doi.org/10.1176/appi.books.9781585625048.gg42

3 Graeme Fairchild, Ph.D., Luca Passamonti, M.D., Georgina Hurford, B.Sc., Cindy C. Hagan, Ph.D., Elisabeth A.H. von dem Hagen, Ph.D., Stephanie H.M. van Goozen, Ph.D., Ian M. Goodyer, M.D., and Andrew J. Calder, Ph.D. Brain Structure Abnormalities in Early-Onset and Adolescent-Onset Conduct Disorder, the American journal of psychiatry, Volume 168, Issue 6, June 2011, pp. 624-633

http://dx.doi.org/10.1176/appi.ajp.2010.10081184 

4. Oxford handbook of pediatrics 2nd

5 David P. Farrington 1998  Predictors, Causes, and Correlates of Male Youth Violence the university of Chicago press journals

6 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5)

  1. (Kellermann 1998, Reid, Webster-Stratton and Baydar 2004)