References:
- Course Module
A disorder characterized by a persistent behavior that violates societal norms, rules, laws, and the rights of others. Significant impairment of social, academic, or occupational functioning occurs, with manifestations being categorized into four areas: aggression to people and animals, destruction of property, deceitfulness and theft, and serious violations of rules.
- Onset, Incidence, Etiology: These behaviors occur before the age of 10 primarily for boys, and onset afterwards occurs for both boys and girls. As many as 40% of these children will be diagnosed with antisocial personality disorder as adults. Genetic vulnerability, environmental adversity, and factors such as poor coping interact to cause this disorder.
- Risk Factors: poor parenting, child abuse, marital problems, lack of interest in treatment, low academic achievement, poor peer relationships, and low self-esteem.
Manifestations
- Children with conduct disorders often exhibit callous and unemotional traits, similar to adults with antisocial personality disorder. Empathy is minimal, there is lessened guilt or remorse, and shallow or superficial emotions.
- Performance at home, school, or work does not concern these individuals.
- Low self-esteem, poor frustration tolerance, and temper outbursts are displayed.
- Early sexual behavior, drinking, smoking, and the use of illegal substances among other risky behaviors are related with conduct behavior.
| Classification | Behavior | Examples |
|---|---|---|
| Mild | Some conduct problems that cause relatively minor harm to others. | Repeated lying, truancy, minor shoplifting, and staying out late without permission. |
| Moderate | Increased number of conduct problems and harm to others. | Vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. |
| Severe | Many conduct problems with considerable harm to others. | Forced sex, cruelty to others, physical fights, cruelty to peers, use of a weapon, burglary, robbery, and violation of previous parole or probation requirements. |
Clinical Course
Two subtypes of conduct disorder depend on onset, and both have varying clinical courses:
- Childhood-Onset Conduct Disorder: an onset before 10 years of age, including physical aggression and disturbed peer relationships. Persistent conduct disorder and development of antisocial personality disorder are more common in this subtype. Even without antisocial personality disorder, these individuals as adults may lead troubled lives with difficult interpersonal relationships, unhealthy lifestyles, and an inability to support themselves.
- Adolescent-Onset Conduct Disorder: an onset after 10 years of age, which feature less aggression, more normal peer relationships, and less persistent conduct disorder and development of antisocial personality disorder. Adequate social relationships and academic or occupational success may be achieved.
Etiology
Genetic vulnerability, environmental adversity, and factors such as poor coping interact to cause the disorder.
- Risk Factors: poor parenting, low academic achievement, poor peer relationships, low self-esteem
- Protective Factors: resilience, family support, positive peer relationships, and good health
- Genetic Risk: conduct disorder is more common in children who have a sibling with conduct disorder or a parent with antisocial personality disorder, substance abuse, mood disorder, schizophrenia, or ADHD.
- Biologic Risk: a lack of reactivity in the autonomic nervous system has been found in children with conduct disorder, which may cause more aggression in social relationships due to decreased inhibitions.
Treatment
Early intervention is important, and prevention is more effective than treatment.
- Dramatic interventions, such as “boot camp” or incarceration, have not proved effective and may even worsen the situation.
- Treatment should be based on developmental age. Education, parental support, parenting education, social skills training, and attempts to improve academic performance are techniques that can be used.
- Adolescents require individual therapy as they rely less on their parents and more on peers. Legal involvement as a result of criminal behavior and consequent restrictions on freedom may be an obstacle to treatment. Any treatment for adolescents should also address the use of alcohol and other drugs if present.
- Medications alone have little effect, but may be used in conjunction with treatment for specific symptoms.