CAMHS 2 - Conduct Disorder Flashcards
What is conduct disorder?
A repetitive and persistent pattern of behaviour in which the basic rights of others or major age appropriate norms/rules are violated
What is conduct disorder sometimes called in younger children?
Oppositional Defiant Disorder (ODD)
What is conduct disorder classified as?
A behaviour disorder = second most common group of mental health disorders in children and teens (5%)
What is needed to diagnose conduct disorder?
Presence of three or more of the criteria in the past 12 months with at least one of the criteria in the past 6 months
What are the diagnostic criteria for conduct disorder?
Aggression to people or animals
Destruction of property
Deceitfulness or theft
Serious violation of rules
What are some types of aggression found in conduct disorder?
Often threatens, bullies or intimidates others
Has been physically cruel to other people or animals
Often initiates fights
Has used a weapon that can cause serious harm
Has stolen while confronting a victim
Has forced someone into sexual activity
What is classed as destruction of property when diagnosing conduct disorder?
Deliberately destroyed other people’s property or has engaged in fire-setting
What are some ways deceitfulness and theft may manifest?
Has broken into someone’s home, building or car
Lies to obtain goods or favours or to avoid obligations
What is the consequence of conduct disorder?
Serious impairment in social, academic or occupational function
What are some areas affected in someone’s life by conduct disorder?
School and family
Criminality and mental health co-morbidity
Health, Social or Criminal justice system involvement
What are the types of conduct disorder?
Mild, moderate and severe
Severe may be unsocialised or socialised
Where is mild to moderate conduct disorder restricted to?
The family environment
What does unsocialised severe conduct disorder present as?
Predominantly violent behaviour and more likely to be dealt with in the criminal justice system
How does socialised severe conduct disorder present?
More covert antisocial acts or have better ability at avoiding the involvement of the criminal justice system
What are some co-morbidities of conduct disorder?
Attachment difficulties (RAD), ADHD, depression, substance misuse, deviant sexual behaviour, reading and other learning difficulties (30%)
What difficulties make up the triad that characterises ADHD?
Inattention, hyperactivity and impulsivity
What are the impairing symptoms of ADHD that relate to self-regulation?
Developmentally inappropriate, impaired functioning, pervasive across setting, longstanding from age 5
What causes ADHD?
Multifactorial = involves genetic and environmental factors
How does ADHD run in families?
Shows familial clustering both in and across generations
60% increased risk in children with parents with ADHD
15% increased risk in siblings of children with ADHD
Hyperactivity tends to aggregate in families
Why is it possible to misdiagnose ADHD in children with conduct disorder?
The conditions present the similarly and are also highly co-morbid
How are simple ADHD and ADHD with co-morbid conduct disorder different?
Distinct subtypes = both have same short term response to stimulant medication but children with ADHD and CD have higher rates of antisocial personality as adults
What causes conduct disorder?
Genetics = some evidence as per twin studies Brain injury (intrauterine or post natal) Environmental
What are some environmental causes of conduct disorder?
Individual child problem = difficult temperament, clash of parental and child temperament
Parental and family circumstances are strong predictors
What is the link between brain injury and antisocial behaviour?
Antisocial behaviour is more common in children with neurological conditions
What is the responsibility of the family when raising a child?
Role of the family is to rear and socialise a child so that it develops normally
Why may families struggle to meet the need of a child to socialise?
Parents with mental illness or intellectual difficulties
Drug/alcohol problems or domestic violence
Single parent families
What are some intra-familiar predictors of antisocial behaviour?
Lack of house rules (no set routine) and supervision
Lack of clarity as to how children should behave
Lack of effective contingencies
Lack of techniques to deal with crises/resolve conflict
What is a lack of effective contingencies in a family setting?
Inconsistent responses to undesired behaviour with failure to follow through on consequences or rewards
Why is anger common in children with conduct disorder?
Protective response to painful feelings (easier to be angry)
Can give adolescents a sense of identity
Why are things like stealing and destructive behaviour a natural progression from anger?
Anger cause adrenaline rush in brain in body that makes young people feel powerful and alive = more serious aggressive behaviour has the same response
How are children with conduct disorder that have no co-morbid disorders treated?
Parent/Foster training = children under age 11
Child focused programmes = children aged 9-14
Multimodal interventions = young people aged 11-17
What are child focused programmes?
Social and cognitive problem solving programmes
What are multimodal interventions?
Multisystemic therapy providing intensive support to the young person and their family
How is medication used to treat conduct disorder?
Not first line = may help with impulsivity and aggressive behaviour in extreme cases
What are some medications used to treat co-morbid conditions of conduct disorder?
ADHD = stimulant medication Depression = SSRIs
What is an example of a medication used to treat conduct disorder?
Risperidone = atypical antipsychotic
