Conduct disorder Flashcards

1
Q

Define conduct disorder.

A

A repetitive and persistent pattern of behavior violating basic rights of others or major societal norms or rules present in childhood or adolescence.

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2
Q

What is the adult form of conduct disorder? What % of children with CD develop this?

A

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

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3
Q

How common is conduct disorder?

A

Affects 10% of 10 year olds

M>F 4:1

Increasing incidence

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4
Q

When is the usual onset of CD?

A

Middle childhood through middle adolescence but may occur as early as preschool

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5
Q

What are the risk factors for conduct disorder?

A

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
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6
Q

How is antisocial behaviour acquired in conduct disorder?

A

Often learned from parental or societa models, and may be rewarded (e.g. by increased attention) and thus reinforced

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7
Q

What is ‘socialised’ vs ‘unsocialised’ conduct disorder?

A

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

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8
Q

What are the key features of conduct disorder?

A
  • 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.
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9
Q

What are 3 differential diagnoses for conduct disorder?

A
  • Oppositional defiant disorder
  • ADHD
  • Depression
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10
Q

How may features of CD differ between girls and boys?

A

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.

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11
Q

What is the management of conduct disorder?

A
  1. Treat any psychiatric disorder eg. ADHD
  2. Target major modifiable risk factors
  3. Family education- to understand CD and recognise that they may reinforce problems
  4. Parent management training - to reward good behaviour and deal constructively with bad behaviour
  5. Psychological therapy (e.g. ​​CBT-based)
  6. Family therapy
    • ​​Helps discuss current family problems and cooperative problem-solving
  7. Educational support e.g.involve Health, Educational, Social services, Youth Offending Services, charities
  8. Anger management for the child
  9. Treat co-morbid problems e.g. ADHD
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12
Q

Why is parent management training an important part of CD management?

A

Research has suggested that parents of children with CD frequently lack several important parenting skills

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13
Q

What does parent management training involve in CD?

A

Teaches how to reward good behaviour and how to deal constructively with bad behaviour

Training: individual or groups (Webster Stratton)

Programmes generally teach:

  1. house rules to be clearly communicated,
  2. spend quality time with child,
  3. parents to model good behaviour,
  4. behavioural management skills (via conditioning)
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14
Q

How does behavioural management deal with desired and undesired behaviours?

A

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
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15
Q

What is the prognosis with conduct disorder?

A
  • 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.

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16
Q

What is the difference between ODD and CD?

A

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
17
Q

How common is ODD?

A

5-10 yr-olds:

  • boys = 4.5%
  • girls = 2.4%
18
Q

Why does NICE recommend parent training for ODD?

A

16 RCTs showed that Parent Training:

  1. Improves behaviour of children with ODD in short & long term AND
  2. Saves money for the education and NHS sectors.
19
Q

What is the management of truency?

A
  1. Effective boundary setting by parents / school
  2. Supporting needs at school
  3. Liaison with Education Welfare Officer (EWO)
20
Q

What are the differences between school refusal and truency including causes and features?

A

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

21
Q

What is the management of school refusal?

A
  1. Treat underlying psych disorder
  2. Anxiety management
  3. Early graduated school return
  4. Liaison with Education Welfare Officer (EWO)
22
Q

What developmental skills do school-age children develop?

A

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

23
Q

What developmental features define adolescence?

A

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