Conduct disorder

Question 1

What developmental skills do school-age children develop?

Answer 1

Question 2

What developmental features define adolescence?

Answer 2

Question 3

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

Answer 3

School refusal - primary school issue; not wanting to go to school due to feat, somatisation and depression

Truency - later school; usually without parents knowledge; conduct disorder

Question 7

What is the management of truency?

Answer 7

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

Question 8

Why do children become conduct disordered?

Answer 8

Question 9

What is the management of school refusal?

Answer 9

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

Question 10

What is the trend in conduct disorder?

Answer 10

Question 11

What are the key features of conduct disorder?

Answer 11

• Repetitive & persistent pattern of defiant behaviour
• Frequency & severity beyond age appropriate norms

Oppositional Defiant Disorder prevalence (5-10 yr-olds): boys = 4.5%; girls = 2.4%.

Question 12

How does behavioural management deal with desired and undesired behaviours?

Answer 12

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

Question 13

What is the difference between ODD and CD?

Answer 13

Oppositional Defiant Disorder (ODD)

• younger children
• severe tantrums
• active defiance and refusal to comply with rules
• frequent anger

Conduct Disorder (CD)

• adolescents
• truanting
• stealing
• initiating physical fights / mugging / weapons
• destruction of property / arson

Question 15

What is the prognosis/complication with conduct disorder?

Answer 15

• 40% of 7-8 yr olds with Conduct disorder become recidivist delinquents as teenagers
  
  • >90% of recidivist juvenile delinquents had Conduct disorder as children.
• Predictor of antisocial PD in adulthood (~50%)
• Intergenerational transmission

Therefore prevention is essential.

Question 17

What is the management of conduct disorder?

Answer 17

1. Treat any psychiatric disorder eg. ADHD
2. Target major modifiable risk factors at an early age and involve multiple agencies e.g. Health, Education, Social services, Youth Offending Service, charities
3. Family education
   
   • Explain CD and how they may accidentally reinforce some behaviours
4. Parent management training
   
   • 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)
5. Psychological therapy
   
   • ​​CBT-based, talking about thoughts and feelings and how they affect behaviour and well-being
6. Family therapy
   
   • ​​Helps discuss current family problems and cooperative problem-solving
7. Mentoring/anger management for the child

Question 19

What is the NICE evidence for Parent Trainning in ODD?

Answer 19

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.