Conduct Disorder
Samantha Nitcher
Pittsburg State University

Conduct Disorder
Description and Behaviors of the Disorder Conduct disorder is described as a child or adolescent who has experienced abuse in the past or is presently experiencing it and is starting to show one or all of the following behaviors: impetuous behavior, drug use, and criminal activity (A.D.A.M., 2011). Other behaviors that might start to show include: aggression to people and animals, destruction of property, deceitfulness, lying or stealing, and violation of rules (AACAP, 2012).
Diagnosing
As stated in the DSM-IV by the American Academy of Family Physicians, there are an abundant amount of things that could fit the criteria for conduct disorder. Some examples are a person who bullies people or animals, has a weapon that could seriously harm someone or something, has forced someone into sexual activity, has destroyed other people’s property, has shoplifted, stays out even though parents say not to, runs away from home, and many more (AAFP, 2001). Other forms of diagnosing include obtaining a detailed history of the child’s behavior which is provided by anyone who comes in contact with that child, just observing the child, or even conducting psychological tests (Hopkins).
There are two subtypes of conduct disorder. The first one is childhood onset and the second is adolescent onset. Between the two of these, the childhood onset is by far the worst one. Childhood onset is labeled as the child having at least one conduct disorder behavior before they reach the age of ten. In most cases these children are males, have concerning peer relationships, and meet full criteria of conduct disorder before they reach their puberty years. In these children these symptoms are more likely to persist throughout their adulthood, whereas many of them tend to develop antisocial personality disorder as adults. When the onset happens when they are in adolescent years, there is no sign of conduct disorder behaviors before the age of ten, their relationships with peers are fine, and they are much less aggressive than the childhood onset children. They are also less likely to develop antisocial personality disorder (Wellmont, 2011).
Symptoms
Knowing what the symptoms are is the first step in realizing that a child has conduct disorder. They may range from breaking the rules for no apparent reason to skipping school on a regular basis or even heavily drinking. These are some warning signs that a kid is acting out and could potentially have conduct disorder. Other symptoms include setting fires on purpose, lying in order to get things, behaving aggressively, running away from home or even vandalizing property. These have to occur for at least six months in order be diagnosed as conduct disorder. Many children go through the stages of not wanting to listen to their parents and act out. Knowing the differences between acting out and conduct disorder increases the chance of the child getting help sooner and getting better faster.
Prevalence
There is no specific age that this can occur at. However, rates of conduct disorder vary from 6 to 16 percent in males and 2 to 9 percent in females. Overall that’s about 1.5% to 3.4% of the child population (McCain, 2003). Males are more likely to be diagnosed with conduct disorder, and diagnosis is more common in males who live in urban rather than rural settings. Many boys act out through fighting, vandalism, stealing or other aggressive ways. Girls, on the other hand, show their anger through lying, running away, prostitution and absenteeism from school (Wellmont, 2011). Aggressive behavior is the most common reason as to why children are referred to the mental health services (Chw, 2013). Unfortunately, prevalence for conduct disorder has increased over the past couple of decades. Many children or adolescents who have conduct disorder also tend to have some other psychiatric issue as well. According to the book Conduct Disorders in Children and Adolescents (1995) by G. Pirooz Sholevar explains the percentages of what both males and females with conduct disorder tend to do:
…the rates of the following behaviors for boys and girls, respectively: burglary of occupied residence—10% and 2%, burglary of unoccupied residence—17% and 4%, theft—13%-34% and 5%-26%, early sexual intercourse—78% and 62%, sex for money—5% and 1%, carrying a weapon—34% and 17%, running away from home—16% (for both sexes), using hard drugs—15% and 19%, selling marijuana—35% and 20%, and school probation/suspension/expulsion—32% and 27%. (Achenbach 1982 and in King and Noshpitz 1991)
Of course this study was done some time ago and was only done in a mid-western high school, but the numbers would approximately be the same or slightly different if the area changed.
Etiology
Conduct disorder could be caused by many things. Some of it is caused by genetics, while other parts are caused by family and social issues within that person. The American Academy of Family Physicians says that “children who have conduct disorder may inherit decreased baseline autonomic nervous system activity, requiring greater stimulation to achieve optimal arousal. This hereditary factor may account for the high level of sensation-seeking activity associated with conduct disorder” (2001). This evidence gives us a partial explanation as to why children or adolescents tend to act out and not care who they hurt in the process. Family issues also have an effect on the child/teen. Some examples of “issues” are substance abuse, early maternal rejection, psychiatric illness, marital conflict, financial distress, large family size, poverty, early institutionalization, separation from parents without an adequate alternative caregiver, and child abuse. All of these problems lead to a bad relationship with their parents, which may lead to the kids rebelling and not listening to what their parents have to say. Many of these children also don’t know how to say “no” when they are in a peer pressuring situation. Another factor into why children develop conduct disorder goes back to prenatal complications. These complications can cause neuropsychological problems in children. Low birth rate, for example, may lead to children developing this disorder. Other studies have been done that show that mothers who smoke during pregnancy also have a greater chance of putting their baby at risk for developing conduct disorder (Scott, 2012).
Associated Disorders Among the possibility of having conduct disorder, there a few other things that a child might have. They could potentially have oppositional defiant disorder (ODD) which is a disorder that conduct disorder could be mistaken for. Oppositional defiant disorder is defined as the ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child’s day to day functioning. Mood disorder, anxiety disorder, post-traumatic stress disorder, substance abuse, attention-deficit/hyperactivity disorder, and learning disorder are other possible disorders that could be associated with conduct disorder (Hopkins). The symptoms are very similar, so the psychiatrist will have to be extra careful in determining the right diagnosis so that the right steps are properly taken in order to help the child.
Treatment
Treatments for this disorder can range depending on how severe the conduct disorder has progressed in the child. They consist of cognitive-behavior approaches which deal with the child’s capability to handle their anger, their communication skills, problem solving skills and their impulses. This is usually for the children that have less severe conduct disorder.
Another treatment is family therapy, and the goal for this treatment is to get the family to be able to start communicating more effectively without a huge fight erupting and causing the child to go into an angry stage and behave destructively. Peer group therapy can also be effective in helping the child start to be able to reach out to friends when they are upset with their parents or school. By doing this, they will start to learn how to make stable relationships and gain interpersonal skills. And finally, for the kids who are in too deep with everything and need immediate attention on handling their problems, pharmacotherapy, which is the use of medication to lessen the symptoms and the child’s behavior, can be very effective (Hopkins). Two major form of stimulants used for the medication treatment are Ritalin and Dexedrine. With both of these medications the child (six years of age or older) is to get a dose of 2.5 to 5.0 mg/ per dose given before breakfast and lunch. Even though the doses are the same, some of the side effects are different. For Ritalin the adverse side effects include anorexia, nervousness, sleep delay, restlessness, tremors, irregular heartbeat, anemia, and decrease in white blood cell count. The anorexia, tremors, irregular heartbeat and the sleep delay in Dexedrine are the same as Ritalin, while other effects include dependence, hyperactivity, restlessness, and talkativeness (AAFP, 2001). Besides those two stimulants, some antidepressants and anticonvulsants that might help the child as well are Wellbutrin, Prozac, Dilantin, Tegretol, and Depakene. Other forms of medication include Lithium and Catapres (AAFP, 2001). Although these medications might work, it might benefit the child more if they were to receive these medications as well as some of the talk therapy that was mentioned above. By utilizing both forms of treatment, the medication will require the child to pay attention more and be more actively present. This way they will want to participate in trying to get better rather than fighting everything and everyone.
Management
Living with a child who has conduct disorder can be very hard on a family or a single parent. There are some techniques that parents should use in order for the child to start to realize that they are not in control and that they need to listen. Some of the techniques are monitoring where the child is at all times by setting a curfew and asking who they are with, phone numbers to those people, and where they are going; encouraging the child to start being more involved in in-school activities or club activities, setting up clear communication rules stating that no cursing is allowed and that you only speak in a calmly manner if they were to get upset, setting up appropriate rewards or punishments depending on the compliance or non-compliance of the child, and finally setting time for one on one with the child and parents (Wellmont, 2011). By doing all of this the child will eventually learn that they need to use their words to tell people what is wrong with them rather than going out and destroying things because they don’t want to talk. When the parents set up these guidelines, it’ll provide the child with a clear and understanding of what is going to happen if they do not comply.
Reinforcement
Many parents tend to believe that punishing children is what is best to make their child behave better. Unfortunately, punishing children actually has an adverse effect. While some punishment may be necessary, reinforcement is also necessary. Parents should discuss with children the rewards of behaving properly and make the rewards concrete. Reinforcement with a child should be provided immediately after the child meets the criteria for the set rules that were made. For example, if the parent were to say “if you clean up the dishes after dinner every night for the rest of the week, then you get to choose the dinner we have and movie we watch on Saturday night”, that would be considered a positive reinforcement. In today’s society, electronics and video games are becoming increasingly more of a positive reinforcement. However, it is said that children with conduct disorder tend to become more aggressive when they watch violence or play violent video games. If one of the reinforcements is video games or movies, parental supervision may be necessary (AAFP, 2001).
Complications
Even though conduct disorder can be found based on the signs and symptoms and treated right away, there are a few complications that can go along with it if not caught early enough. For instance, “impairment in school performance, poor social and family relationships, problems with the legal system, poor work performance, physical injuries due to fighting or carelessness, sexually transmitted diseases, teenage pregnancy, drug problems, suicide, and homicide” (Wellmont, 2011). Some other things that could go wrong if a child is not treated properly and grows up with conduct disorder may also include the increase of marital break-up, a higher violent death rate, and financial dependency on others (Sholevar, 1995).
Prevention
The sooner the symptoms are noticed by an adult or therapist, the better the outcome for the child will be. If the signs are caught earlier, then treatment can be started right away. By doing this, the child may not have to go through as much medication or therapy and may be helpful in disrupting the development of the sequence of experiences that lead to more disruptive and aggressive behaviors (Hopkins).
Interview
On CBS one evening there was an interview with a family who had two children with conduct disorder. One was an 11 year old girl name Lana who at one point her mother told CBS that she killed some of the chickens on their farm just because she was angry at her parents. She also hits her sister Natasha and has sent her to the hospital multiple times with needing stitches or having a black eye and multiple bruises. Then there is the 15 year old boy Dima who learned in the orphanage to hit as a defense mechanism. He is violent at school, and at home with his sisters. He has put Lana’s head through a window, and eventually it got so bad that he started doing drugs and writing in his diary that he was going to kill people. This interview shows how people in real life handle kids like these. Dima ended up having to go to a school that was specifically for troubled kids. He is getting better but still just acts on his impulses rather than thinking things through. His therapists states that if he were to snap and get angry at one of his sisters then they are in potential danger of getting seriously hurt. However, he states that he’s less likely to do that now since he has been in the school, and will hopefully be able to control his anger more in a year from now. Unfortunately, after a year of adopting the children the parents (Leann and Richard) marriage ended because the “strain was too much, and Richard simply just moved out.” Leann states that she had no idea what happened the first 12 years of Dima’s life, or what his genetic makeup is. Eventually she found out that their birth mother was an abusive drunk, who was a prostitute who left Dima in charge to feed, diaper, and care for his little sisters while she just vanished for weeks at a time. The men that also came around also sexually abused them all too (CBS, 2012). Unfortunately this is a true story, which the abuse has left its mark on. These children may never fully be normal again, but after many years of extensive therapy they can eventually start to try and form their own bonds with other people and hopefully make it out in the world.
Art Therapy Art therapy is a newly developed kind of therapy that in 2007 was named one of the top ten hot jobs (ADEA, 2012). This type of therapy provides children, adolescents and even adults to express how they are feeling through the different kinds of art. By doing this, it’ll allow that person to relieve stress, manage their behaviors, improve self-esteem, and increase their awareness. As stated by the Art Therapy Blog, “it can be used for counseling by therapists, healing, treatment, rehabilitation, psychotherapy, and in the broad sense of the term, art therapy can be used to massage one’s inner-self in a way that may provide the individual with a deeper understanding of him or herself” (Yoen Media, 2008). This type of therapy can be extremely beneficial in children, seeing as they don’t use their words like adults to in order to tell what they are feeling. By having them go through the art therapy process, they are able to express what they are feeling in what they draw, color, make in pottery or even paint. It is also very effective in helping improve some symptoms of mental and physical disorders like reducing tension, reducing pain and also anxiety. Art therapists are able to tell you things about yourself that you see badly, but they turn it in a way that it’s a positive outlook on it.
Art therapists are able to work in many different settings, depending on where the patient is at. They can work in all of the following: hospitals and clinics (both medical and psychiatric), out-patient mental health agencies and day treatment facilities, residential treatment centers, domestic violence and homeless shelters, community agencies and non-profit settings, sheltered workshops, schools (including colleges, and smaller universities), correctional facilities, elder care facilities, art studios, and even private practices. This style of healing is used to help with many illnesses like anxiety/depression, substance abuse, relationship issues, abuse, social/emotional difficulties, PTSD, physical/cognitive/neurological problems, and psychosocial difficulties (ADEA, 2012). Conclusion There are a lot of children in the world who misbehave for a reason. That reason may be that they want attention or that they are just bored and want to get a rise out of people. Other children however, can’t help that they act out. They were just neglected as a child and are expressing themselves through aggression and rebellion. Every child should have the ability to grow up with the potential to live a long and happy life. For children with conduct disorder they may be able to grow up just fine, but living a happy life may be a little harder for them. With the right treatment and therapy for the child, they will learn to control their anger and hopefully learn how to make long and lasting relationships with people.

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