Conduct

Disorder
characterized by persistent antisocial
behavior in children and adolescents that
significantly impairs their ability to function
in social, academic, or occupational areas.
 Conduct Disorder
• Characterized by persistent
antisocial behavior that violates:
– The rights of others
– Age-appropriate social norms
• Includes:
– Aggression to people and animals
– Destruction of property
– Deceitfulness and theft
– Serious Violation of rules
 Students with
Conduct Disorder
• Differ from peers in
– Rate of noxious behaviors
– Persistence of such conduct
beyond age at which most
children have adopted less
aggressive behaviors
How Do These Students Do
in School?
• Teachers see these students as:
– Uninterested
– Unenthusiastic
– Careless
• Students with Conduct Disorder have:
– Poor interpersonal relations
– Rejected by their peers
– Poor social skills
• Students with Conduct Disorder are most likely to
be:
– Left behind in grades
– Show lower achievement levels
– End school sooner than same-age peers
 Conduct Disorder
• Is often comorbid with other disorders
• Is one of the most prevalent
psychopathological disorders
• Affects:
– 6 – 16% of males
– 2 – 9% of females
– 1.3 to 3.8 million children have conduct disorder
• It occurs three times more
• often in boys than in girls. As many as 30% to 50%
of these
• children are diagnosed with antisocial personality
disorder
• as adults.
CONDUCT DISORDER IN GENERAL
•frequently is associated with early
onset of sexual behavior,
•drinking, smoking, use of illegal
substances, and other
•reckless or risky behaviors.
Conduct Disorder
• Males exhibit:
– Fighting
– Stealing
– Vandalism
• Overly aggressive
• Females exhibit:
– Lying
– Truancy
– Running away
– Substance abuse
– Prostitution
• Less aggressive
Conduct Disorder
• May be classified by age of
onset
• Earlier onset usually predicts
more serious impairment
 Classified As:
• Mild (resulting in only minor harm to others)
• Moderate (The number of conduct problems
increases as does the amount of harm to
others)
• Severe (causing considerable harm to others)

Researchers generally accept that genetic vulnerability,

environmental adversity, and factors like poor coping
Interact to cause the disorder.

•
• A lack of reactivity of the autonomic nervous system has
been found in children with conduct disorder; this
nonresponsiveness is similar to adults with antisocial
personality disorder. The abnormality may cause more
aggression in social relationships as a result of decreased
normal avoidance or social inhibitions.
 
May be associated with
• Poor family functioning,
• marital discord,
• poor parenting,
• family history of substance abuse and psychiatric
problems
 TREATMENT
Treatment must be geared toward the client’s
developmental age; no one treatment is suitable for
all ages.

• Preschool programs, such as Head Start,

result in lower rates of delinquent behavior and
conduct disorder through use of parental education
about normal growth and development, stimulation
for the child, and parental support during crises.
• For school-aged children with conduct disorder, the child, family,
and school environment are the focus of treatment. Techniques
include parenting education, social skills training to improve peer
relationships, and attempts to improve academic performance
and increase the child’s ability to comply with demands from
authority figures.
•  
• Family therapy is considered to be essential for children in this
age group.
•  
• Adolescents rely less on their parents and more on peers, so
treatment for this age group includes individual therapy. The
most promising treatment approach includes keeping the client
in his or her environment with family and individual therapies.
HISTORY
Children with conduct disorder have a
history of disturbed relationships with peers,
aggression toward people or animals,
destruction of property, deceitfulness or
theft, and serious violation of rules (e.g.,
truancy, running away from home, and
staying out all night without permission).
The behaviors and problems may be mild to
severe.
General Appearance
and Motor Behavior

• Appearance, speech, and motor

behavior are typically normal for
the age group but may be
somewhat extreme (e.g., body
piercings, tattoos, hairstyle, and
clothing).
 Mood and Affect
• Clients may be quiet and reluctant to
talk or openly hostile and angry.
• Their attitude is likely to be
disrespectful toward parents, the
nurse, or anyone in a position of
authority.
• Irritability, frustration, and temper
outbursts are common.
Thought Process and
Content

• Thought processes are usually

intact—that is, clients are capable
of logical rational thinking.
• They perceive the world to be
aggressive and threatening, and
they respond in the same manner
 Sensorium and
Intellectual Processes
• Clients are alert and oriented with intact
memory and no sensory-perceptual
alterations.
• Intellectual capacity is not impaired, but
typically these clients have poor grades
because of academic underachievement,
behavioral problems in school, or failure to
attend class and to complete assignments
 Judgment and Insight
• Judgment and insight are limited for
developmental stage.
• Clients consistently break rules with
no regard for the consequences.
• Thrill-seeking or risky behavior is
common
 Self-Concept
• Although these clients generally try to
appear tough, their self-esteem is low.
• .
• Their identity is related to their behaviors
such as being cool if they have had many
sexual encounters or feeling important if
they have stolen expensive merchandise or
been expelled from school.
•  
 Roles and
Relationships
• Relationships with others, especially
those in authority, are disruptive and
may be violent. ‘
• Verbal and physical aggression is
common.
• Siblings may be a target for ridicule
or aggression.
 Physiologic and Self-
Care Considerations
• Clients are often at risk for
unplanned pregnancy and sexually
transmitted diseases because of
their early and frequent sexual
behavior.
• Use of drugs and alcohol is an
additional risk to health
NURSING DIAGNOSIS:

• • Risk for Other-Directed Violence

• • Noncompliance
• • Ineffective Coping
• • Impaired Social Interaction
• • Chronic Low Self-Esteem
 NURSING
INTERVENTIONS

•Decreasing violence and increasing compliance with

treatment
•Protect others from client’s aggression and manipulation
•Set limits for unacceptable behavior
•Provide consistency with client’s treatment plan
•Use behavioral contracts
•Institute time-out
•Provide a routine schedule of daily activities
• • Improvingcoping skills and self-esteem
• Show acceptance of the person, not
necessarily the
• behavior
• Encourage the client to keep a diary
• Teach and practice problem-solving skills
• • Promoting social interaction
• Teach age-appropriate social skills
• Role model and practice social skills
• Provide positive feedback for acceptable
behavior
FOR CLIENT and FAMILY EDUCATION:
•• Teach parents social and problem-solving skills
when needed
•• Encourage parents to seek treatment for their
own problems
•• Help parents to identify age-appropriate
activities and expectations
•• Assist parents with direct, clear communication
•• Help parents to avoid “rescuing” the client
•• Teach parents effective limit-setting techniques
•• Help parents identify appropriate discipline
strategies
 goals
• The client will not hurt others or damage property.
• The client will participate in treatment.
• The client will learn effective problem-solving and
coping skills.
• The client will use age-appropriate and acceptable
behaviors when interacting with others.
• The client will verbalize positive, age-appropriate
statements about self.