Understanding Conduct Disorder

 

As we learned on the History portion on this site, Conduct Disorder has not always carried its name, but its definition has been around for centuries. Towards the mid-20th century, psychologists began with the term of Conduct Disorder to describe children who would violate the rights of others in aggressive ways, cause physical harm to themselves and others, cause destruction to property, lack of respect for personal boundaries, stealing, lying, running away, and many other forms of delinquent style behaviors. The DSM (Diagnostic and Statistical Manual of Mental Disorders) defines Conduct Disorder as 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 (or more) of the following criteria in the past 12 months, with at least one criterion present in the past six months"  (American Psychiatric Association DSM-5 Development, 2014).

 

Conduct Disorders involve a heterogeneous group of problems. (Klahr, A. M., & Burt, S. A., 2014). Meaning there is not one type or reason for a child posing Conduct Disorder type of behaviour, but in fact there are many ongoing factors. Some of which may not always be determined.  Another way diagnosing Conduct Disorder can be difficult, is that children are ever changing. Because of that, it is not always clear if a diagnoses of CD is warranted as it may not be persistent behavior, and could (in some cases) be due to a child dealing with chronic stress.

 

Researchers have found that there are two subtypes to CD. It has been determined that the first subtype is Childhood onset, and that the second subtype is Adolescent onset. (King, J. H., 2014).

 

In childhood onset, if left untreated, the child has a more difficult time ever overcoming their behavioural issues. Some signs of childhood onset CD are destruction to property, starting fires, deliberately breaking things, and hurting others persistently. With childhood onset, the conduct disorder will in most cases develop into adult anti-social behavior.

 

In adolescent onset, it can be more difficult to diagnose immediately if the teen has CD. Although many teens tend to experiment in drug or alcohol use, may at times shoplift, and due to their ever changing hormones can show undue signs of aggression or disruptive behavior, a practitioner will look at this diagnostic criteria to show if the problems are persistent, and not occasional.

 

According to a study performed by the Department of Pediatrics, University of Alberta, Edmonton, Alberta, that from 2002-2006 the amount of children who were taken to the ER across Alberta with mental or behavioral issues went up by 15%. As for the reasons as to why this is occurring, the reasons are not fully clear. ( Liu, MSC, Ali, MDCM, Rosychuk, PhD; Newton PhD, RN. Feb 18, 2014).

 

In Alberta, according to the Alberta Special Education Code, in the 2014/2015 school term, there were approxiamtely 8,339 students diagnosed with severe emotional/behavioural disabilities. (Alberta Education: By Special Education Code, 2015).
 

According to the DSM, there are a series of questions practitioners and educators must first ask in order to help make the right diagnosis of Conduct Disorder.

 

From the article Conduct Disorder: Diagnosis and Treatment in Primary Care, (Russell Searight,  PH.D., 2001). is an example of the DSM questionnaire for diagnostic criteria for Conduct Disorder.

 

DSM-IV Diagnostic Criteria for Conduct Disorder

A.

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 (or more) of the following criteria in the past 12 months, with at least one criterion present in the past six months:

Aggression to people and/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.

Destruction of property

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 the 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 a parental or parental surrogate home (or once without returning for a lengthy period).

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

B.

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

C.

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

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis, and conduct problems cause only minor harm to others.

Moderate: number of conduct problems and effect on others intermediate between “mild” and “severe.”

Severe: many conduct problems in excess of those required to make the diagnosis, or conduct problems cause considerable harm to others.

(Reprinted with permission from American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:90–1. Copyright 1994.)

 

According to the DSM-IV (American Psychiatric Association. 78–85, 1994).  there should be at least three specific CD behaviors present for at least six months to warrant a CD diagnosis. Some other important features to further help make the correct diagnoses of CD will also include the inability to respect the welfare of others, and to show little to no guilt or remorse about their violent actions towards others.

 

The causes of CD can be biological, genetic, psychological and environmental. Therefore, if a child/teen is diagnosed with CD after showing the persistent behavior, doctors may also choose to find out more about the child’s family medical history, and wish to run brain scans, blood work, and other physical medical tests to ensure other factors are not prevalent in the child’s health condition. Once every factor is accounted for, then the prescribing practitioners, along with parents and educators, can determine all the best options for treatment for each specific case.