What is Conduct Disorder?
Conduct disorder (CD) is part of a group of disorders known as disruptive behavior disorders, which also includes oppositional defiant disorder (ODD). Often, these disorders can occur alongside attention deficit hyperactivity disorder (ADHD). Interestingly, ADHD used to be classified under the same group of disorders, but it has since been moved to another category, Neurodevelopmental disorders according to the most recent guidelines. A person with ODD might evolve to have CD. CD involves a series of behaviors that show aggression and disregard for others over a period of time. It’s often found together with other mental health issues, like depression, ADHD, and learning disorders. As such, a comprehensive mental health assessment is needed to understand the disorder before deciding on the right treatment plan. These characterizations are according to the Diagnostic and Statistical Manual of Mental Disorders, both its fourth and fifth editions.
What Causes Conduct Disorder?
Conduct Disorder (CD) is a complex condition developed from a mixture of biological and societal factors.
Biologically
* Research suggests that a tendency for antisocial behavior, impulsivity, aggression and a lack of response to punishment may be inherited.
* There’s evidence to suggest low activity in the noradrenergic system within the body of those with CD, which is responsible for producing adrenaline.
* Low levels of a brain chemical called 5-Hydroxy Indole acetic acid (5-HIAA) in spinal fluid have been linked with aggression and violence during teens.
* High levels of testosterone are also connected with aggression.
Family and Home Environment
* A home lacking stability, proper supervision and consistent discipline, or where parents often argue, can lead to destructive behavior.
* Verbal and physical aggression toward children.
* Exposure to regular domestic violence.
* Families with a history of criminal behavior or substance-use disorders, especially alcohol addiction.
* Living in poor social and economic conditions, such as overcrowded neighborhoods or unemployment, can cause economic distress and insufficient parenting.
Neurological Factors
* Certain studies suggest a relationship between aggressive behavior in children and abnormal brain activity patterns at rest.
* Early damage to the brain can result in problems with language, memory, and decision-making skills, causing poor judgement and difficulty solving problems in crisis situations.
* Developmental delays can lead to poor social skills, learning disabilities, and below-average intelligence, resulting in learning and academic difficulties, low self-esteem, and disruptive behavior.
* Traumatic brain injuries, seizures, and other neurological damage can also contribute to aggressiveness.
School Environment
* Large class sizes, too few teachers, or lack of positive feedback from teachers.
* Lack of supportive staff or counseling to address problems children may face at home or in their community.
* Exposure to violent gangs in the community.
Protective Measures
* Having a positive role model in life.
* Receiving affection from parents.
* The ability to self-regulate emotions.
* Early intervention and proper parenting.
Associated Conditions
* Children with difficult temperaments that show poor adaptability and frequent negative emotions.
* Attention Deficit Hyperactivity Disorder (ADHD): About one-third of children with ADHD also show signs of Conduct Disorder.
* Trauma-related disorders such as Post Traumatic Stress Disorder (PTSD) which can develop due to repeated physical and sexual abuse.
* Mood disorders, including depression and bipolar disorder.
* Developmental disorders.
Risk Factors and Frequency for Conduct Disorder
Occasional disobedience and rebellion are common behaviors in kids and teenagers. However, Conduct Disorder (CD) is a bit different. CD is identified by a persistent pattern of aggression towards others, including animals, and a consistent disregard for rules and property. Boys are more likely to have CD than girls, the ratio being anywhere from 4:1 to 12:1. In the general population, CD could impact between 2 to 10% of individuals and it doesn’t vary much between different races or ethnic groups.
- Conduct Disorder (CD) involves a repeated pattern of aggression towards others and rule-breaking.
- Boys are more likely to have CD than girls, with ratios ranging from 4 to 12 boys for every girl.
- In the general population, between 2% and 10% people could have CD in their lifetimes.
- CD occurs across different racial and ethnic groups.
- Many children with CD may eventually be identified as having an antisocial personality different disorder when they become adults.
- Starting to show signs of CD at a young age can suggest a worse outcome for the condition.
- CD is more common in children and teenagers if they’re around various social issues, including parents with substance abuse disorders or criminal problems.
Testing for Conduct Disorder
To diagnose a behavioral issue, doctors often use the DSM-V criteria. This involves checking whether a person repeatedly behaves in ways that break societal rules and negatively affects others. Signs of such behavior might include being physically cruel to people or animals, stealing, lying frequently, damaging property on purpose, or violating important rules like staying out late, running away from home, or skipping school.
There are three types of conduct disorder (CD). The first one is the Childhood-Onset type, which starts before the age of ten, is generally seen more in boys, involves more physical aggression, and unfortunately has a worse prognosis. The Adolescent-Onset type doesn’t exhibit problems before ten years old, shows less physical aggression, and usually has a better prognosis. Finally, the third type is the Unspecified-Onset, where it’s unclear when the problems began.
The diagnostic evaluation for these disorders involves a full psychiatric assessment, checking for other mental health problems like attention deficit hyperactivity disorder (ADHD) and mood disorders. This should take place in various settings with accounts from teachers, caregivers, and family members to understand the child’s behavior from all perspectives.
The evaluation also includes an in-depth review of the child’s academic performance and possible learning disorders. A detailed study of the child’s behavior patterns and family dynamics is also essential for the diagnosis.
Treatment Options for Conduct Disorder
Basic lab tests, including a drug screening, are necessary to rule out any additional medical issues or potential substance abuse disorders. Treatment approaches that involve the patient’s family and community resources have been shown to improve patient outcomes.
Treatments Based on Scientific Evidence
* Training for parents to set and enforce consistent discipline rules, along with rewarding good behavior and promoting positive behaviors in children.
* Multisystemic therapy that focuses on improving family dynamics, school performance, and the child’s behavior across various systems and environments.
* Training to help manage and control anger.
* Individual therapy that helps develop problem-solving skills, strength relationships through solving interpersonal conflicts, and learning to reject negative influences in the community.
* Community-based treatment programs: These programs aim to establish therapeutic schools and residential treatment centers that can provide a structured program to reduce disruptive behaviors.
Medication Treatments
* Medications are used to treat any other psychiatric problems that may be present, such as ADHD, depression, aggression, mood instability, and bipolar disorder. These could include stimulants and non-stimulants for ADHD, antidepressants for depression, and mood stabilizers for aggression, mood instability, and bipolar disorder.
* Mood stabilizers could include conventional mood stabilizers such as antiepileptic drugs (AEDs), as well as second-generation antipsychotic medications.
What else can Conduct Disorder be?
Other conditions that could be mistaken for Conduct Disorder (CD) include the sudden onset of a mood disorder or a psychotic disorder. These can sometimes cause individuals to overly engage in negative behaviors and show hostility towards others. If these issues only occur during episodes of mood or psychotic disorders, it’s likely not Conduct Disorder.
In addition, untreated depression or Attention-Deficit/Hyperactivity Disorder (ADHD) can lead to substance abuse. This could be mistaken for Conduct Disorder, so it’s important to rule these out when looking for a diagnosis.
What to expect with Conduct Disorder
The outlook can vary and it heavily depends on several factors such as the existence of hidden mental health conditions and the timeliness of treatment.
A poor prognosis is often predicted by low intelligence capacities, unstable family surroundings and continuous criminal behaviour in parents. On the other hand, factors that lead to a better prognosis include proper ADHD treatment, suitable school environment with added academic support, higher verbal intelligence, and positive parenting.