Conduct Disorder Flashcards
What is the ICD-10 definition for conduct disorder?
Repetitive and persistent pattern of behaviour whereby either the basic rights of others or major age appropriate societal norms or rules are violated, lasting >/= 6 months, during which some criteria present (in other flashcard).
What are ICD-10 criteria for conduct disorder?
- Has unusually frequent or severe temper tantrums for their developmental level
- Often argues with adults
- Often actively refuses requests or defies rules
- Often, deliberately does things to annoy others
- Often blames others for own mistakes/misbehaviours
- Often touchy or easily annoyed by others
- Often angry, resentful, spiteful, vindictive
- Often lies/breaks promise for own personal gain
- Initiates physical fights/uses weapons
- Deliberately destroys property of others
- Sets fire/steals things/breaks in to places
- Truant from school/run away from home
- Forces others into sexual activities/bullies others
What are the 2 main types of conduct disorder?
- Oppositional defiant disorder (younger children/milder severity) - symptoms present at home but may not be present outside of home
- Conduct disorder
- Socialised - antisocial behaviour often with others
- Unsocial - poor peer relationships
What are the risks to self and others in conduct disorder?
To self: - Risk of developing mental disorder - Risk of retaliation from others - Substance misuse increasing vulnerability To others: - Aggressive behaviour to others
What are the symptoms of conduct disorder?
- Violent physical fights
- Steal or lie
- No remorse/guilt in committing wrong
- Break the law
- May stay out all night and play truant from school during day (by age 13)
- May take risks with health and safety e.g. illegal drugs, unprotected sex
- May feel worthless and that they cannot do anything right - common for them to show anger and blame others for their difficulties if they struggle to change for the better
What are risk factors of conduct disorder?
- Male
- Physical or sexual abuse
- Low IQ
- ADHD
- Parental FH
- Substance misuse
- The earlier problems start the higher risk for them to be involved in violence and criminal acts
What home based help can be done for conduct disorder?
- Parents ignore the child when they are good and pay attention when behaving badly
- Children prefer angry critical attention to being ignored - vicious cycle
- Can help if discipline is fair and consistent and for parents/carers to agree how to handle the child’s behaviour + offer praise and love
What school based help can be done for conduct disorder?
- School staff can help focus on positive behaviours and reinforce work taking place at home and in community
- Individual classroom support and assessment of learning difficulties
What community based help can be done for conduct disorder?
- Ask GP for advice
- Referral to CAMHS
- Treatment may include social skills groups, behavioural therapy and talking therapy - these can help the child to appropriately express themselves in different situations and manage their anger more effectively.
What is the potential management for conduct disorder?
- Refer for multisystemic therapy (MST) - 1st line
- Continue sessions with Youth Offenders Team (YOT) - work on victim empathy, encourage patient to join in pro-social activities, work on substance misuse
- Continue assessment of mental state should there be concerns about them developing co-morbid mental disorder - pharmacological therapies for this
What is multisystemic therapy?
- Parent/foster carer/guardian training programmes are used for young people aged 3-11
- Child focused programmes, social + cognitive problem solving programmes to children and young people between 9-14, diagnosed with conduct disorder or at risk of developing or those involved with criminal justice system.
What are the biological investigations for conduct disorder?
- Full physical examination including all observations
- Relevant blood tests based on the findings from the physical examination and include screening bloods such as FBC, U+E, LFT, Vit D and TFT
- Urine drug screen
What are the psychological investigations for conduct disorder?
- Full psychiatric history - information gathering and building rapport
- Think about ‘attachment’ and the lack of attachments patient has had
- Part of psychological investigation will be to see if patient will be able to tolerate any form of psychological treatment
What are the social investigations for conduct disorder?
Gather info from health visitors, GP, school, PRU, CAMHS, youth offending team, foster carers, social worker, staff at current care home.
What is Oppositional Defiant Disorder?
ODD is defined by at least 6 months of negative, hostile, disobedient and defiant behaviour without serious violations of societal norms or rights of others. These symptoms are present in the home for the vast majority of patients, especially with those the patient knows very well, but may not be present at school or with other adults or peers.
