CONDUCT DISORDER

HAMZA DAAR
CONDUCT DISORDER
Children and adolescents with this disorder
have great difficulty following rules and
behaving in a socially acceptable way. They
are often viewed by other children, adults and
social agencies as ‘bad’ or delinquent, rather
than mentally ill.
DSM IV Categories
Within DSM IV, Conduct Disorder is placed in the category of
Attention-Deficit and Disruptive Behavior Disorders.
 This category is defined in the DSM IV as a set of
externalizing negative behaviors that co-occur during childhood
Oppositional Defiant Disorder (ODD): is defined as “a recurrent
pattern of negativistic, defiant, disobedient, and hostile behavior
towards authority figures”.
Attention-Deficit/Hyperactivity Disorder (ADHD): is defined
as a “Persistent pattern of inattention and/or hyperactivity-
impulsivity that is more frequently displayed and is more severe
than is typically observed at comparable level of development.”
CONDUCT DISORDER
DEFINATION:
The essential features of Conduct Disorder (CD) involve “a repetitive
and persistent pattern of behavior in which the basic rights of others or
major age-appropriate societal norms or rules are violated”, resulting in
a clinically significant impairment in functioning. This includes
Aggressive behaviors,
Behaviors that result in property loss or damage,
Deceitfulness or theft,
Other serious rule violations (e.g., running away from home,
truancy).
DSM IV Conduct Disorder
Criteria
For 12 months or more has repeatedly
violated rules, age-appropriate societal
norms or the rights of others
Shown by 3 or more of the following,
with at least one of the following
occurring in the past 6 months:
Physical cruelty to people
Aggression against people or animals
Physical cruelty to animals
Frequently bullying or threatening
Theft with confrontation
Often starts fights
Forced sex upon someone
Used a weapon that could cause serious
injury
DSM IV Conduct Disorder Criteria
Property Destruction
Deliberately set fires to cause serious damage
Deliberately destroyed the property of others (except fire-setting)
Lying or theft
Broke into building, car or house belonging to someone else
Frequently lied or broke promises for gain or to avoid obligations
(“conning”)
Stole valuables without confrontation (burglary, forgery,
shoplifting)
DSM IV Conduct Disorder Criteria
Serious rule violation
Beginning by age twelve, frequently stayed out at night against parents’
wishes
Runaway from parents overnight twice or more (once if for an extended
period)
Frequent truancy before age 13

 These symptoms cause clinically important job, school or social

impairment.
 If older than age 18, the patient does not meet criteria for Antisocial
Personality Disorder.
DSM IV Conduct Disorder Criteria
Childhood-Onset Type: at least one problem with conduct before age
10
Adolescent-Onset Type: no problems with conduct before age 10
Severity:
Mild (both are required): There are few problems with conduct
more than are needed to make the diagnosis, and Problems cause little
harm to others.
Moderate: Number and effect of conduct problems is between Mild
and Severe.
Severe: Many more conduct symptoms than are needed to make the
diagnosis, or Symptoms cause other people considerable harm.
Distinctions between Disorders
Diagnosis of ODD and CD have tested and proven differences
Subjecting gathered data to multidimensional scaling techniques
resulted in some significant findings which has helped narrow the
focus of study regarding behaviors associated with CD
Oppositional defiant and aggressive characteristics were located on one
end of the dimension (overt symptoms).
Substance use and other non-aggressive conduct disorder symptoms
were located on the other (covert symptoms).
Behavior directed towards property or persons in a destructive way was
located on one of the dimension (destructive behavior).
Behavior on the opposite end were non-destructive such as substance abuse,
status offenses (non-destructive behavior).
Distinctions between Disorders
These findings provide general support for the distinction between
oppositional defiant and conduct disorder.
They also suggest that conduct problems may be more meaningfully
grouped into four, rather than two, general categories. These include:
Overt & nondestructive behaviors reflecting symptoms of ODD
Overt & destructive symptoms of aggression
Covert & destructive behaviors, such as lying and stealing
Covert & nondestructive behaviors such as truancy and running
away from home (status offenses)
Four Dimensions of Conduct
Disorder Behavior
1) OVERT/DETRUCTIVE
(Aggressive Behaviors)
Fights
Bullies
Assault
Spiteful
Four Dimensions of Conduct Disorder
Behavior
2) OVERT/NONDESTRUCTIVE
(Oppositional Features)
Annoys
Defies
Stubborn
Angry
Four Dimensions of Conduct Disorder
Behavior
3) COVERT/DESTRUCTIVE
(Property Violations)
Cruel to animals
Vandalism
Steals
Fire Setting
Four Dimensions of Conduct Disorder
Behavior
4) COVERT/NONDESTRUCTIVE
(Status Offenses)
Runaway
Truancy
Substance Use
Break Rules
Under the Umbrella of Conduct Disorder
However defined, the general term Conduct disorder refers
to a heterogeneous group of problem behaviors.
Some are aversive, disruptive and problematic for parents
and teachers.
Others involve aggression towards property or persons.
Others involve actual violations of the law which might
result in the child being labeled as delinquent if the behavior
were to come to the attention of legal authorities.
Delinquency: A Definition
Delinquency is a legal term rather than a psychological construct
It refers to a juvenile (usually under 18 years) who is brought to
the attention of the juvenile justice system for committing a
criminal act or displaying a variety of other behaviors not specified
under criminal law.
These “other behaviors”, are usually referred to as status offenses.
They include truancy, curfew violations, running away from home
and the use of alcohol.
These are only violations of the law as a result of the child’s age
and his/her status as a minor.
What Follows Conduct Disorder
Antisocial Personality Disorder
“Pervasive pattern of disregard for, and violations of, the rights of
others that begins in childhood or early adolescence and continues
into adulthood.”
For diagnosis, must have a history of some Conduct Disorder
symptoms before age 15.
Not actually diagnosed prior to age 18.
Etiological Factors in Childhood Conduct
Disorder
While the etiology of Conduct disorder is not fully understood it
has been shown to be related to a range of psychosocial factors
including:
Living in environments with high crime rates
Dysfunctional and rejecting family environments
Inconsistent and severe discipline
Physical and sexual abuse
Social learning experiences (e.g., the learning of problem behavior through
observation and/or its reinforcement by parents, siblings and others).
Etiological Factors in Childhood Conduct
Disorder
While a range if factors has been implicated in the development of
conduct disorders, no one factor has been determined to be “the
cause”.
Each of the factors listed here may contribute to conduct disordered
and delinquent behavior in some instances.
It’s likely that there are numerous possible combinations of
contributing variables that can result in the clinical manifestations of
these disorders.
Coercive Family Behavior and Conduct
Problems
Conduct problems has been strongly associated with
ongoing patterns of coercive parent-child interactions that
are characterized by:
Escalating parent and child demands,
Escalating negative consequences,
Where the person who dispenses the most negative consequence
“wins”,
Problems with “winning the battle” while “losing the war”.
Treatment of Conduct Disorder
Treatment of children and adolescents who have Conduct Disorder has
frequently been carried out in institutions or within community based
programs.
 Research suggests that treatment within context of standard institutional
programs is often unsuccessful, with a 70-80% rate of recidivism.
Use of multiple forms of treatment, using a combination of family-systems
therapy, child-focused therapy, and Multi-systemic therapy has had modest
success.
Research suggests that treatment within context of standard institutional
programs is often unsuccessful, with a 70-80% rate of recidivism
Conclusion
Treat your kids well and most likely you
won’t have child with Conduct Disorder.
Understanding Conduct Disorder and the
associated symptoms and causes will help you
if you ever want to have kids or work with
kids.
Questions and Discussion