CONDUCT DISORDER

Budi Pratiti, Dr. dr. SpKJ

Departemen Psikiatri

Is defined ,
A repetitive and persistent pattern of
behavior
 Disorders on child and adolescent
psychiatry

◼ Mental retardation
◼ Autistic disorder (pervasive devlp dis)
◼ Attention-defisit/hyperactivity disorder
◼ Conduct disorder and Oppositional
defiant disorder, Anstisocial behavior
◼ Anxiety disorder (panic, phobia,special
phobia, selective mutism, separation
Anxiety), depresion
◼ Learning disability
 Overview symptom of disorders on child
and adolescent
psychiatry
.
◼ Mental retardation : General Intellectual Functioning is
defined by
Intellegence Question (IQ) : IQ ? .. Less 70
◼ Autistic disorder (pervasive devlp dis), characterized
by : pervasive impairment in severe areas of development
: social interaction skills, communication skills,
stereotyped behavior, interest, and activities
◼ ADHD, the impairment must have present > 5-7 years:
inattentive, hyperactive, impulsive symptoms
 Overview …. count

◼ Separation anxiety disorder,

- separation from home or whom the person is
attached.
- with somatic symptoms ( ? )
◼ Learning disability :
reading, mathematics & disorder of written
expression
.

Conduct disorder
4 main grouping behavior on
conduct disorder

◼ Treatens physical harm to other people

or animal (agresive) A1-7
◼ Property damage/loss (non agresive)
A8-9

◼ Theft A10-12
◼ Serious violations A13-14
….

◼ Three ( or more ) characteristic behaviors

must have been present during the past
12 month

◼ present in the past 6 month

….
The disturbance behavior causes:
◼ Impairment in
- Social
- Academic
- Occupational fungtion
( B criterion )
 The behavior begining
Often, onset in 10 year old :
◼ Out late staying at night
◼ Running away from home over night
(didn’t return for lengthy day)
◼ Physical or sexual abuse
◼ Truent from school
◼ Being absent from school/work without good
reason
The behavior usually
present in
◼ Home
◼ School
◼ Community
◼ Peer group (?)
 Subtypes of conduct disorder
◼ Provided based on the age at onset of the
disorder :
- Chilhood Onset type
- Adolescent onset type
…….. > mild, moderate, severe
◼ Assessing the age of Onset :
informing should be preferably be obtained
from : Youth, caregiver.
 Childhood-Onset Type
◼ Prior, in 10 year old
◼ Usually male ;
- frequently physical agression
- disturbed peer relationship
◼ Many children also have concurrent Attention-
Defisit/hyperactivity Disorder
◼ More likely to have persistent conduct disorder
…….. to develop adult Antisocial Personality Disorder
the prior ….. (?)

◼ ACTIVE BEHAVIOR IN CHILHOOD (?)

◼ ADHD
◼ CONDUCT DISORDER
◼ ANTISOCIAL BEHAVIOR
 Adolescent Onset type… Continue.

◼ Prior in 10 year old (any criteria characteristic

of conduct disorder)
◼ Persistent conduct disorder
◼ To develop Adult Antisocial Personality
Disorder
Severity-specify

◼ Mild : relatively minor harm to others e.g.,

lying, truancy, staying out after dark without
permission
◼ Moderate : e.g., stealing, vandalism
◼ Severe : considerable harm to others e.g.,
forced sex, physical cruelty use of a weapon,
stealing while confronting a victim
Prevalence

◼ Increased on last decades (?)

◼ In urban > rural
◼ 1 – 10 %
◼ Male > female
 Comorbidity

◼ ADHD
◼ Anxiety or mood disorder
◼ Internet addiction (?)
Internet addiction

◼ Internet addiction: It is the inability of the

individual to control the use of the internet.
using internet
◼ primarily for communication,
◼ entertainment and educational purposes
◼ bullying others,
◼ meeting new online contacts
◼ sending sexual messages
 using internet

◼ social support, even more helpful

than their families
◼ adolescents who used internet mainly for
chatting purposes also
◼ higher on both ADHD and CD
◼ frequently reported problems that
adolescents with ADHD
◼ deficient social skills and peer
rejection
 ADHD
(Attention Deficit/Hyperactivity Disorder)

◼ The impairment must have present > 7 years

old, > 5 years old
◼ Inattentive symptoms ?
◼ Hyperactive symptoms ?
◼ Impulsive symptoms ?
◼ One of DD, CD is ADHD
SUBTYPE OF ADHD

◼ Inattentive Type
◼ Hyperactive Type
◼ Impulsive Type

◼ Predominantly Hyperactive - Impulsive

◼ Combined type
 Symtoms of ADHD

Inattention
◼ Often fails or make careless mistakes in schoolwork,
work or other activity
◼ Often has difficulty in task or activity
◼ Often not seem to listen when spoken to directly
◼ Often does not follow on instruction
◼ Is often forgetfull in daily activity
(DSM IV – TR/DSM V)
 ADHD ….. Cont

Hyperactivity
◼ Often fidgets with hand or feet or squirms in seat
◼ Often leaves seat in classroom
◼ Often runs about or climbs exessively in situations in
which it is inapropriate
◼ Is often “on the go” as if ‘driven by motor’
Impulsivity
◼ Often blurt out answers before the question have
been completed, difficulty awaiting turn
 Conduct disorder

◼ ODD ADHD CD AS
◼ Milder symptoms achieve adequate ?
◼ Social and occupational adjustment as adult
◼ CD,comorbid with > mood disorder
> anxiety disorder
> somatoform
> substance abbuse
> internet addiction
Family Pattern
◼ Risk for conduct disorder in children with :
biological parent with ASP
sibling with CD
Alkohol dependence
mood disorder
parent ADHD / CD
Deferential diagnosis :
ADHD
Mood disoder in children/adolescents
Diagnostic criteria, Conduct disorder
DSM IV - TR

◼ A. A repetitive and persistent pattern of

behavior. Three (or more) of following
criteria in the past 12 months, with at
least one criteria present in the past 6
months :
Aggression to people and animal :
1. Often bullies,threatens,intimidates others
Continued A criteria

2. Often initiates physical fights

3. Has used a weapon that can cause serious
physical harm to others (e.g., a bat, brick,
broken, 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
Continued A criteria CD

◼ Destruction property
8. has deliberately engaged in fire
setting with the intention of causing
serious damage
9. has deliberately destroyed others’
property ( other than by fire setting)
 Continued A criteria CD

◼ Deceitfulness or theft
10.has broken into someone else’s house,
building, or car.
11. often lies to obtain goods or favors to
avoid obligations (i.e.,’cons’ others)
12. has stolen items of nontrivial value
without confronting a victim ( e.g., shoplifting,
but without breaking and entering; forgery )
 Continued A criteria CD

◼ Serious violations of rules

13. Often stays at night despite parental
prohibitions, beginning before age 13 years.
14. Has run away from home overnight at least
twice while living in parental surrogate home
(or once without returning for a lengthy
period )
15. Is often truant from school, beginning before
age 13 years
 Continued criteria CD

B. The disturbance in behavior causes

clinically significant in social,
academic or occupational unctioning.
C. If the individual is in 18 year old or
older, criteria are not met for
antisocial personality disorder.
Treatment

◼ Problem solving Sklills Training

◼ Family therapy (parents)
◼ Pear Relationship and School
◼ Pharmacotherapy: depend on
comorbidity (anxietas,
depression,psychotic symptom, drug
abuse)
Prevention
◼ Identifying children at neurodevelopment risk
and intervening earlier.
◼ Symtoms such as impaired on executive
function, poor impulsive control, decrease
academic achievement.
◼ Parent training- interventions
◼ School-base interventions with the parent,
teacher and child.
.
Reference:
- DSM-IV TR , 4 ed.
Pages 39-135
- DSM - V
- Child and Adolescent psychiatry
- PPDGJ - III
..