Conduct

Disorder
Conduct Disorder

Conduct Disorder 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
significant impairment in functioning.
 This includes
 aggressive behaviors,
 behaviors that result in property
loss or damage,
 theft,
 other serious rule violations (e.g.,
running away from home, truancy).
 Onset occur much before 18 years of age.

 In CD-11 Classification it comes under

F91.

 Have great difficulty following rules and

behaving in a socially acceptable way.

 often viewed by other children, adults

and social agencies as "bad" or
delinquent, rather than mentally ill.
EPIDEMIOLOGY
 Prevalence
 Estimated 2%-6% for Children
suffer from Conduct Disorder

 Gender differences
 Antisocial behavior 3-4 times more
common in boys.
ETIOLOGY
BIOLOGICAL FACTOR
 Higher incidence with monozygotic
then dizygotic twins.

 Higher risk of transmission to siblings

of parents who have conduct disorder.
TEMPERAMENT
 The term temperament refers to
personality traits that become
evident very early in life and
may be present at birth.

 Difficult temperament at age 3

has significant links to conduct
disorder
BIOCHEMICAL FACTORS
 Alterations in the neurotransmitters
Nor epinephrine and serotonin[low].

 Higher levels of testosterone in

pubertal boys association with
violence

 Testosterone plays a role in certain

behaviours including aggression and
dominance. It also helps to spark
competitiveness and boost self-esteem
ORGANIC FACTOR
 Brain damage

 Epilepsy

 frontal lobe impairment interfere with

ability to plan , avoid harm , learn from
negative experience.
PSYCHOLOGICAL INFLUENCE
Factors related to family dynamics have
been contributors in the predisposition.
They include:
● Parental rejection
● harsh discipline
● Early institutional living
● Frequent shifting of parental figures
● Large family size
● Absent father
● Parents with antisocial personality
disorder and/or alcohol dependence
● Marital conflict and divorce
Other psychological influence includes:
 living in environments with high
crime rates.
 Physical and sexual abuse.
 social learning experiences (e.g.,
learning of problem behavior
through observation or is
reinforcement by parents, siblings
and others).
SIGN AND SYMPTOMS

 Aggression against people or

animals
 Frequent bullying [ dominate,
abuse ,use force] or threatening
 Often starts fights
 Used a weapon that could cause
serious injury
 Physical cruelty to people
 Physical cruelty to animals
 Theft
 Forced sex upon someone
 Property destruction
 Deliberately set fires to cause
serious damage
 Deliberately destroyed the
property of others.
 Lying or theft
 Broke into building, car or house
belonging to someone else.

 Frequently lied or broke promises

for gain .

 Stole valuables things.

 Serious rule violation

 Beginning by age twelve, frequently

stayed out at night against parents'
wishes.

 Runaway from parents overnight twice

or more.

 Frequent truancy before age 13

DIAGNOSIS
 History talking form parents and caretaker.
 Neurological examination if there is a
history of head trauma or seizures.
 Complete team approach including:
 medical and psychiatric evaluation
 Feedback from parents
 Teachers observation report
 Educational assessment to determine
if there are cognitive deficit, learning
deficit.

 Based on ICD 11 criteria.

 Based on ICD-11 classification
 destructiveness to property; fire-setting; stealing; repeated lying;
truancy from school and running away from home; unusually
frequent and severe temper tantrums;
 defiant behaviour[refusing to obey something or someone and
involve in fighting] :
 persistent severe disobedience.
 Any one of these categories, if marked, is sufficient for the
diagnosis

 Exclusion criteria include any other psychiatric disorder.

 This diagnosis is not recommended unless the duration of the

behaviour described above has been 6 months or longer.
MANAGEMENTA
 Drug is indicated in presence of
 Hyperactivity(CNS Depressant)
 Impulse control and aggression
(lithium, carbamazepine)
 Antipsychotic
 Placement in corrective institution.

 Behavioural, educational and

psychotherapeutic measures are use to
change behaviour,
 cognitive-behavioral therapy aims to
reshape the child's thinking to improve
problem solving skills, anger management.

 Family therapy may be used to help

improve family interactions and
communication with children.

 Parent management training (PMT)

teaches parents ways to positively alter their
child's behavior in the home.
 NURSING
MANAGEMENT
ASSESSMENT
 Complete history from parents and
caretaker
 Developmental milestone assessment
 Complete medical evaluation with emphasis
on neurological.
 Assess children behaviour in home and
school.(rules violating , misconduct)
 Assess intellectual ability, academic
achievement and learning disorder problem.
NURSING
DIAGNOSIS
 Risk for other-directed violence related to characteristics
of temperament, peer rejection, negative parent as
evidence by attempted harm to other.
● Impaired social interaction related to impaired peer
relations as evidenced by inappropriate social behaviors.
● Defensive coping related to peer and parental rejection as
evidenced by aggression and low self worth.
● Low self-esteem related to lack of positive feedback and
unsatisfactory parent/child relationship as evidence by
anxious behaviour.
 NURSING
INTERVENTION
NURSING DIAGNOSIS: RISK FOR
OTHER-DIRECTED VIOLENCE
 Observe client’s behavior frequently
through routine activities and interactions.

 Become aware of behaviors that indicate a

rise in agression.

 Redirect violent behavior with physical

outlets for suppressed anger and
frustration.
 Act as a role model for appropriate
expression behaviour.

 Administer medication if ordered or use

restraints or isolation room only if situation
cannot be controlled.
NURSING DIAGNOSIS: IMPAIRED
SOCIAL INTERACTION
 Develop a trusting relationship with the
client.
 Convey acceptance of the person separate
from the unacceptable behavior.
 Discuss with client which behaviors are
and are not acceptable.
 Describe the consequence of unacceptable
behavior.
 Provide group situations for client.
NURSING DIAGNOSIS: LOW SELF-
ESTEEM
 Ensure that goals are realistic.
 Plan activities that provide opportunities
for success.
 Convey unconditional acceptance and
positive regard.
 Offer positive reinforcement for
attempts made.
 Give immediate positive feedback for
acceptable behavior.
NURSING DIAGNOSIS: DEFENSIVE
COPING
 Provide immediate nonthreatening feedback
for unacceptable behaviors
 Help identify problem situations and
practice through role-play more appropriate
responses.
 Provide immediate positive feedback for
acceptable behaviors.
 Set limits on manipulative behaviour. Take
caution not to reinforce manipulative
behaviors by providing desired attention.
 NURSING
EVALUATION
THANK YOU