Conduct Disorder

Conduct disorder (CD) is a group of behavioural problems where a child is aggressive, antisocial and defiant to a much greater degree than expected for your child’s age. Characteristics of conduct disorder include:

• fighting and physical cruelty
• destructiveness
• lying and stealing
• truancy (including running away from home).

To get a diagnosis of conduct disorder, your child must have shown at least three of these characteristics over the past year, with at least one of the characteristics shown in the last six months.

How is conduct disorder classified?

There are two types of conduct disorder:

• early onset where the child shows at least one characteristic before the age of 10 (this is often associated with ADHD)
• adolescent-onset type where the child doesn’t show any of the characteristics before the age of 10. This is the most common type. It is not specific to ADHD, but may occur with ADHD.

The severity depends on how many problems the child has and his effect on others.

• Mild: has just enough conduct problems to make the diagnosis, causes only minor harm to others.
• Moderate: several conduct problems, causes moderate harm to others.
• Severe: many conduct problems, causes considerable harm to others.

What are the symptoms of conduct disorder?

Symptoms are grouped into four areas.

1. Aggression to people and animals

• Often bullies, threatens or intimidates others.
• Often initiates physical fights.
• Has used a weapon that could cause serious physical harm to others (eg a bat, brick, broken bottle, knife or gun).
• Is physically cruel to people or animals.
• Steals from a victim while confronting them (eg assault, mugging, purse-snatching).
• Forces someone into sexual activity.

2. Destruction of property

• Deliberately engages in fire-setting with the intention to cause damage.
• Deliberately destroys someone else’s property (other than by arson).

3. Deceitfulness, lying or stealing

• Has broken into someone else’s building, house, or car.
• Lies to obtain goods or favours or to avoid obligations.
• Steals items without confronting a victim (eg shoplifting without breaking and entering, forgery).

4. Serious violations of rules

• Often stays out at night despite parental objections before the age of 13.
• Runs away from home – at least twice overnight or once for a longer period.
• Often truant from school before the age of 13.

How does it cause problems?

• Socially: affected children tend to overreact to situations and have outbursts of temper or defiance. This means he'll have few friends and will be socially awkward. As adults, he may have relationship and marital problems.
• At work and school: his behaviour is likely to break rules. This means he may be excluded from school, if he attends in the first place, and it could affect exams. At work such behaviour can lead to dismissal.
• Legally: stealing, assault and destroying properly can land your child in court.

Conduct disorder can make it hard for children to trust adults, which in turn makes it harder for them to go along with treatments such as behaviour therapy and psychotherapy.

How common is it?
According to the National Mental Health Association in the US, conduct disorder is roughly four times more common in boys than girls and affects around 6 per cent of all children.

A UK government report by the Office of National Statistics found 5 per cent of children aged 5 to 15 years had conduct disorder, and 1 per cent had hyperkinetic disorder.

What causes conduct disorder?

The British Association for Behavioural and Cognitive Psychotherapies says there’s no one cause. However, several factors can interact to result in conduct disorder, with the main ones listed below.

• Individual: your child’s temperament.
• Genetic: it’s more common in the children of adults who had conduct problems when they were young.
• Physical: problems in processing social information or social cues; brain damage.
• Environmental: family problems and social pressures, for example rejection by friends or living in a deprived area.

Why are children with ADHD more likely to have CD?

According to research by McCabe, children with ADHD are two and a half times more likely to have early onset of conduct disorder than those without ADHD.

Conduct disorder is particularly common in adolescents with ADHD who have received harsh and critical parenting.
Other research shows that conduct disorder in adolescents occurred almost exclusively in those who were still showing symptoms of ADHD.
In adults, men with ADHD are 14 times more likely to have conduct disorder. Women with ADHD are 40 times more likely to have conduct disorder.
There’s no evidence to explain why those with ADHD are more likely to have conduct disorder. But it could be the chemical imbalance affecting your child’s ability to ‘put on the brakes’ also affects the way he’s able to deal with events going on around him.
It could also be genetic or because of the pressure that dealing with ADHD puts on the family.

How is conduct disorder treated?

Treatment depends on the kind of symptoms your child has and how severe they are. Possible treatments include:

• behaviour therapy, including role play, rehearsal and practice
• psychotherapy, particularly to help your child with anger management
• educational support for learning disabilities
• counselling of parents, eg helping you manage at home
• medication for the ADHD and/or depression.

Original articles taken from:
Netdoctor at  http://www.netdoctor.co.uk/adhd/conductdisorder.htm