Conduct disorder Flashcards
Define conduct disorder.
A repetitive and persistent pattern of behavior violating basic rights of others or major societal norms or rules present in childhood or adolescence.
What is the adult form of conduct disorder? What % of children with CD develop this?
Antisocial personality disorder
The majority of children with conduct disorder do not develop adult ASPD, but ~25% of girls and 40% of boys with CD develop ASPD
How common is conduct disorder?
Affects 10% of 10 year olds
M>F 4:1
Increasing incidence
When is the usual onset of CD?
Middle childhood through middle adolescence but may occur as early as preschool
What are the risk factors for conduct disorder?
Bio:
- FH - runs in families but no genes identified
- ADHD
- Chronic illness, epilepsy
Psycho:
- Social/cognitive deficits
Social:
- Urban upbringing
- Deprivation
- Parental criminality/poor role models
- Harsh and inconsistent parenting/abuse
- Maternal depression
- FH of substance misuse
How is antisocial behaviour acquired in conduct disorder?
Often learned from parental or societa models, and may be rewarded (e.g. by increased attention) and thus reinforced
What is ‘socialised’ vs ‘unsocialised’ conduct disorder?
Socialised - child has a peer group, often sharing the antisocial behaviour
Unsocialised - child rejected by other children, which often makes them more isolated and hostile
What are the key features of conduct disorder?
- Persistent antisocial behaviour
- Violates the basic rights of others or of age-appropriate societal norms
-
>3 criteria present in the last 12 months:
- aggressive conduct threatening physical harm
- non-aggressive conduct that causes property damage
- deceitfulness or theft
- serious violations of rules
- Significant impairment in social, academic or occupational functioning.
What are 3 differential diagnoses for conduct disorder?
- Oppositional defiant disorder
- ADHD
- Depression
How may features of CD differ between girls and boys?
Boys diagnosed with CD tend to display more serious acts such as vandalism and theft. Whereas girls tend to display acts such as running away, truancy, and prostitution.
What is the management of conduct disorder?
- Treat any psychiatric disorder eg. ADHD
- Target major modifiable risk factors
- Family education- to understand CD and recognise that they may reinforce problems
- Parent management training - to reward good behaviour and deal constructively with bad behaviour
- Psychological therapy (e.g. CBT-based)
-
Family therapy
- Helps discuss current family problems and cooperative problem-solving
- Educational support e.g.involve Health, Educational, Social services, Youth Offending Services, charities
- Anger management for the child
- Treat co-morbid problems e.g. ADHD
Why is parent management training an important part of CD management?
Research has suggested that parents of children with CD frequently lack several important parenting skills
What does parent management training involve in CD?
Teaches how to reward good behaviour and how to deal constructively with bad behaviour
Training: individual or groups (Webster Stratton)
Programmes generally teach:
- house rules to be clearly communicated,
- spend quality time with child,
- parents to model good behaviour,
- behavioural management skills (via conditioning)
How does behavioural management deal with desired and undesired behaviours?
Increasing desired behaviour: Reinforce
- Clearly
- Immediately
- Consistently
- Contingently
- With attention, praise, stars…
Reducing undesired behaviour: Extinction
- Undesired acts ignored
- ‘Time-out’ from positive reinforcement
- Distraction
- Clear consequences if boundaries breached
What is the prognosis with conduct disorder?
- Up to 50% develop substance misuse problems
- Up to 50% develop antisocial personality disorder
- May pass it on to their children
Therefore prevention is essential.
What is the difference between ODD and CD?
Oppositional Defiant Disorder (ODD)
- milder form of CD
- children <10yrs
- severe tantrums, active defiance and refusal to comply with rules, frequent anger
- no extreme antisocial behaviour present
Conduct Disorder (CD)
-
persistently antisocial behaviour, not merely ‘rebellious’ e.g.
- truanting
- fire-setting
- cruelty to animals or people
- stealing
- initiating physical fights / mugging / weapons
How common is ODD?
5-10 yr-olds:
- boys = 4.5%
- girls = 2.4%
Why does NICE recommend parent training for ODD?
16 RCTs showed that Parent Training:
- Improves behaviour of children with ODD in short & long term AND
- Saves money for the education and NHS sectors.
What is the management of truency?
- Effective boundary setting by parents / school
- Supporting needs at school
- Liaison with Education Welfare Officer (EWO)
What are the differences between school refusal and truency including causes and features?
School refusal - primary school issue; not wanting to go to school due to fear, somatisation and depression
Truency - later school; usually without parents knowledge; conduct disorder
What is the management of school refusal?
- Treat underlying psych disorder
- Anxiety management
- Early graduated school return
- Liaison with Education Welfare Officer (EWO)
What developmental skills do school-age children develop?
Cognitive: general rules, school/learning
Social: group activities, gender-linked peer group identification
Emotional: fears of real dangers and loss
Moral: rigid notion of right and wrong; concept of personal property
What developmental features define adolescence?
Cognitive: formal operational/abstract thinking
Emotional: turmoil
Social: autonomy, criticism of established values, ambivalence, close friendships, sexual interest, experimenting with alcohol/substances
Moral: considering choices on moral issues
Physical: growth spurt, puberty
