About Conduct Disorder (page 4)
The child with a Conduct Disorder does not respect authority, has little regard for the basic rights of others and breaks major societal rules; he or she demonstrates aggressive conduct that threatens physical harm or property damage, deceitfulness, theft, truancy or running away from home. The child with a Conduct Disorder is often vengeful, irascible, and has a chip on his shoulder. The cause of Conduct Disorder is believed to be a combination of genetic vulnerability and environmental factors. Treatment plans might include behavior therapy with the child and parents and pharmacotherapy.
Real Life Stories
Brandon's teachers in the daycare center report that he is the "terrorist of the 4- year-olds." He punches or bites children and pushes them off the swings in the playground without provocation. He swings the class pet rabbit by the tail in spite of being told how it hurts the animal. His parents report that he has been difficult to manage since he was an infant.
Eleven-year-old Paul, known as The Prankster in his family, was suspended from school after leaving half-eaten candy bars in all the girls' lockers. He had previously been suspended for leaving poison pills for the frogs in the biology class lab.
Robin, l6: "When I was 13, that summer was a blast. One time we picked up some older guys in a bar and tried a new kind of speed. We got really wild and we smashed in some car windows and somebody called the police. My mother freaked out and tried to punish me by locking me in my room, but I would just skip out on her through the window."
What are the symptoms?
A child or adolescent who has a Conduct Disorder behaves in a manner that violates the basic rights of others and/or major age-appropriate societal rules. These behaviors fall into four main groupings:
- aggressive conduct that causes or threatens physical harm to other people or animals. Examples of such behaviors are bullying or intimidating behavior, physical fights or cruelty, use of a weapon, forcing someone into sexual activity
- conduct that causes property loss or damage, such as firesetting, vandalism
- deceitfulness or theft, such as breaking into stores or homes, shoplifting
- serious violations of rules, such as truancy or repeated running away overnight
The behavioral disturbances can cause deficits in social, academic or occupational functioning. The behavior usually occurs in a variety of settings, such as home, school and community.
Other manifestations of Conduct Disorder:
- Oppositional Defiant Disorder (ODD) - a recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward authority figures that persists for at least six months. To warrant a diagnosis of ODD, the child must show frequent occurrence of at least four behaviors such as losing temper, arguing with and defying adults, deliberately doing things that will annoy other people. Children and adolescents with ODD are usually angry and resentful and quick to blame others for their misbehaviors.
Who is likely to have it?
The age of onset of CD is critical. The earlier the age of onset the worse the prognosis.
Early onset CD, which occurs before adolescence, is the most common.
Late-onset CD occurs after early adolescence. The prevalence of CD has increased over recent decades and is higher in urban than in rural settings. It is estimated that six percent of all children have CD, with a male-female ratio of four to one. Aggressive children comprise one-third to one-half of the referrals to child and adolescent clinics.
Why does it happen?
Certain children have a genetic vulnerability to this disorder, the nature of which is unclear. When that vulnerability is combined with certain high-risk environmental factors, such as poverty, parental neglect, marital discord, parental illness, parental alcoholism, and having a parent with antisocial personality disorder, chances of CD increase.
Adolescents with CD have been found to have impairment in the frontal lobe of the brain, an area that affects the ability to plan, to avoid harm, and to learn from negative consequences.
How is it treated?
Early treatment and identification of children with early-onset CD is vital. Intelligence is another significant factor; a child with a high IQ is easier to work with in treatment. Many children with CD have learning disabilities and lower than average verbal skills.
Various forms of treatment, including medication and family approaches, have been utilized with varying degrees of success. There is no one medication or treatment of choice. A treatment plan might include some or all of the following:
Behavior therapy attempts to set up contingencies that make desirable behavior more likely and attempts to eliminate undesirable behaviors. It provides a high level of structure which is generally needed by children with CD. Behavior therapy helps the child make crucial cause and effect connections that he or she has not been able to do previously, either through lack of experience or inherent lack of capability. Behavioral plans should be coordinated between school and home for maximum effectiveness.
Treatment is often conducted in the context of the family. Therefore the family may require assistance, ranging from education about basic parenting skills to management strategies for the disturbed child.
Questions & answers
I have a hard time disciplining my child. Does that mean he will develop a conduct disorder?
All children misbehave at some time. Only those children and adolescents who have more serious and consistent behavioral problems may develop a Conduct Disorder.
If an 8-year-old defies her parents and refuses to do what they ask her to do does that mean she has a Conduct Disorder?
CD is manifested in different ways at different ages. Preschoolers may be aggressive, oppositional , defiant and have tantrums. School-aged children may challenge classroom and adult authority, lie and steal. Adolescents may violate the law and community authority; they fight, steal, vandalize, are accident-prone and commit crimes against persons and property. An eight-year-old who has tantrums is not displaying age-appropriate behavior, and consultation with a professional would help pinpoint ways to help her change her behavior.
My adolescent son stays out late and doesn't tell us where he is. We don't like the friends he chooses, and his school work is beginning to suffer. Is that part of a Conduct Disorder?
It might be. A Conduct Disorder can cause problems in the academic and social life of adolescents. It's important to remember that the behavior usually occurs in a variety of settings, such as home, school and in the community.
My 10-year-old can be mean or bullying with his friends, and then he won't agree to say he's sorry. He usually says the argument was started by somebody else. I'm afraid that he's just like his father who never accepts responsibility for what he does. Are kids with Conduct Disorder like that?
Children and adolescents with Conduct Disorder may have little empathy and little concern for the feelings and well-being of others. They may misperceive the intentions of others as more hostile and threatening than is the case and respond with aggression that they then feel is reasonable and justified. They may lack appropriate feelings of guilt or remorse.
My 12-year old acts like a big shot after he's done something obnoxious, like hitting our dog. Does that mean he has good self-esteem?
Although a child with CD may have an air of bravado, his self-esteem is usually low, and he has little tolerance for frustration; irritability, temper outbursts and recklessness are frequent.
About the Author
Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.
About the NYU Child Study Center
The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at http://www.aboutourkids.org/.
Reprinted with the permission of the NYU Child Study Center. © NYU Child Study Center.
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