Dr Ruwan M Jayatunge

Children with conduct disorder repeatedly violate the personal or property rights of others and age-appropriate social standards and rules. Conduct disorder has a multifactorial etiology that includes biological, psychosocial and familial factors. Associated features of conduct disorder include an inability to appreciate the importance of others’ welfare and little guilt or remorse about harming others. The etiology of conduct disorder involves an interaction of genetic/constitutional, familial and social factors.

ƒÆ’-¡ƒ”š‚ Children with Conduct Disorder often view the world as a hostile and threatening place and they have difficulty maintaining friendships. They often have low self-esteem and low frustration tolerance. Peers and family members become negative and irritated with their misbehavior which leads to a vicious cycle. The literature abounds with studies indicating the comorbid relationships between Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Learning Difficulties, Mood Disorders, Depressive symptoms, Anxiety Disorders and Communication Disorders.

ƒÆ’-¡ƒ”š‚ Conduct disorder is more common among boys than girls, with studies indicating that the rate among boys in the general population ranges from 6% to 16% while the rate among girls ranges from 2% to 9%. According to research cited in Phelps & McClintock (1994), 6% of children in the United States may have conduct disorder.

ƒÆ’-¡ƒ”š‚ The onset of conduct disorder may occur as early as age 5 or 6, but more usually occurs in late childhood or early adolescence Studies have found that neurological abnormalities are inconsistently correlated with conduct disorder. This disorder not only affects the individual, but his or her family and surrounding environment. Conduct disorder appears in various forms, and combinations of factors appear to contribute to its development and maintenance.

ƒÆ’-¡ƒ”š‚ Symptoms of conduct disorder

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Aggressive behavior that harms or threatens other people or animals;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Destructive behavior that damages or destroys property;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Vandalism

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Poor peer relationships

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Lying or theft

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Truancy or other serious violations of rules

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Early tobacco, alcohol, and substance use and abuse; and

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· running away from home

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Precocious sexual activity

ƒÆ’-¡ƒ”š‚ A diagnosis of conduct disorder is likely when symptoms continue for 6 months or longer. Children who exhibit these behaviors should receive a comprehensive evaluation.

ƒÆ’-¡ƒ”š‚ Risk Factors of the Development of Conduct Disorder

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Early maternal rejection

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· separation from parents, without an adequate alternative caregiver;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Early institutionalization;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Family neglect;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Abuse or violence;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Marital conflicts and unfavorable home atmosphere

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Parental substance abuse

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Parental mental illness;

ƒÆ’†’ƒ¢¢”š¬…¡ƒÆ’-¡ƒ”š‚· Poverty.

Illustrative Case 1

Master N is 15 year old boy from a leading school punished by the sectional head for destroying school property and assaulting a prefect. Previously he was caught while smoking a cigarette in a classroom by one of the teachers. His academic skills are deteriorating and Master N got low marks for the recent term test.

ƒÆ’-¡ƒ”š‚ According to his mother he is stubborn at home and does not listen to her. His behavior gradually changed after his father went to Italy one and half years ago. He associates friends who are older to him and spends time with them. Often he refuses to go to school. He became more isolated and hostile. On one occasion he ran away from home and stayed two nights at a friend s place.

ƒÆ’-¡ƒ”š‚ Illustrative Case 2

Master P who is an eleven year boy has following behavioral features.

ƒÆ’-¡ƒ”š‚ 1 He often bullies and intimidates his peers

2 frequently initiates physical fights and assaults school mates

3 He was warned by the class teacher for using bad words at the classroom

4 He is cruel to animals especially to the cat which lives in their house

5 Whenever he finds the opportunity he steals money from the father s wallet

6 He refuses to go to school and sometimes keeps away from lessons

7 He never does homework or does not show any interest in studies

Master P has mood swings and sometimes engages in age inappropriate behavior. Recently a parent complained that he tried to remove the trouser of another boy at the school. When he was questioned by the teacher he simply denied the accusation. His teacher finds that Master L is becoming intolerable at the classroom. His peers are afraid of him and they try to avoid him. At home when he gets angry he damages the house property. His father stated that a few weeks a go he dashed the TV.

Treatment for Conduct Disorder

Treatment of children with conduct disorder can be complex and challenging. Treatment can be provided in a variety of different settings depending on the severity of the behaviors. Childhood conduct disorder, left untreated, has a poorer prognosis. Therefore the treatment is essential. The research indicates that in about 40 percent of cases, childhood-onset conduct disorder develops into adult antisocial personality disorder.

The treatment consists of medication and psychotherapy. Medications may be useful for co-morbid disorders or for controlling impulsive behavior or irritability. Some doctors prescribe antidepressants, mood stabilizers and these medications may help specific symptoms. Also the medication may improve children’s capacity to benefit from other psychosocial interventions.

Cognitive-behavioral approaches especially CBT or Cognitive-Behavior Therapy are often used. CBT is to improve problem solving skills, communication skills, impulse control, and anger management skills. Behavior modification therapy acts positively with the conduct disorder. Positive reinforcement for desirable behavior will reduce reliance on punishment. The child s disrupted behavior can be modified and new skills can be taught. Hence the child gains an insight and gradually minimizes dissocial behavior.

Parental counseling and awareness of the illness is vital. Following parental counseling they find a way to deal with the child s problem. Family therapy often enhances the disrupted family communication. Family therapy is often focused on making changes within the family system and improving family interactions.

As a mode of psychotherapy some therapists prefer to use cyber therapy which reduces stress factors and diminish the free floating aggression in the child. As a stress breaker music therapy has shown its efficacy in conduct disorder.

Children with conduct disorder may have academic difficulties. Therefore educational therapy is needed to improve their underlying learning difficulties. Some therapists recommend concept developmental learning aid programs and strategies to improve reading skills.

Conduct disorder has a complex nature. In this condition not only the child even the parents, siblings, peers, and teachers are affected by the child s disturbed behavior. ItƒÆ’†’ƒ”š‚¢ƒÆ’‚¢ƒ¢-¡‚¬ƒ¢-¾‚¢s vital to understand that the illness is causing such disturbances and not the child him self. Therefore companionate approach would be needed to manage the Conduct disorder.