Conduct Disorders PDF

CONDUCT DISORDERS Characteristics:  Hallmark: aggressive behavior  Child rarely performs at level predicted at by IQ or age. Causes:  Unknown  May have biological and psychosocial components in twins and adopted children. Risk factors:  Early maternal rejection...

CONDUCT DISORDERS Characteristics:  Hallmark: aggressive behavior  Child rarely performs at level predicted at by IQ or age. Causes:  Unknown  May have biological and psychosocial components in twins and adopted children. Risk factors:  Early maternal rejection  Separation with parents, with no alternative caregiver available  Early institutionalization.  Family neglect, abuse or violence.  Frequent verbal abuse from parents, teachers or other authority.  Large family size, crowding, and poverty.  Parental psychiatric illness, substance abuse, or marital discord. Signs and symptoms:  Aggressive behavior  Destruction of property  Deceitfulness of theft  Disregard to rules Treatment：  Psychotherapy (talk therapy)- variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors such as: *Parent management training *Anger management training *Cognitive behavioral therapy *Community-based treatment  Pharmacotherapy: Stimulants, anti-depressants, lithium, anticonvulsants and clonidine  Early identification of at - risk - children.  Juvenile justice system, if needed to provide structured rules and means for monitoring and controlling child's behavior. Nursing Intervention  Work to establish trusting relationship with child and family.  Provide clear behavioral guidelines.  Talk to him about making acceptable choices.  Teach him effective problem-solving skills.   Help him identify personal needs and best strategies for meeting them.  Teach him how to express anger.  Monitor him for anger as well as for signs that he's internalizing anger. Conduct disorder is a persistent pattern of behavior in which the rights of others are violated and societal norms or rules are disregarded. The behavior is usually abnormally aggressive and can frequently lead to destruction of property or physical injury. Persons with this disorder initiate physical fights and bully others, and they may steal or use a weapon to intimidate or hurt others. Coercion into activity against the will of others, including sexual activity, is characteristic of this disorder. These behaviors are enduring patterns and continue over a period of 6 months and beyond. It is one of the most frequently diagnosed disorders of childhood and adolescence. The people affected by this disorder may have a normal intelligence, but they tend to skip class or disrupt school so much that they fall behind and may be expelled or drop out. People with conduct disorder crave excitement and do not worry as much about consequences as others do. Though the literature tends to focus on children and adolescents with conduct disorder, it is quite a problem in adults as well. In adults, conduct disorder has similar characteristics of aggression, destruction of property, stealing, deceitfulness, and criminal behavior. Adults, like younger persons, have family problems based on self-interest and lack of engagement. Rule breaking takes such forms as parole violation, disregard for general laws such as speed limits, and employment problems such as frequent lateness or absence with unacceptable or unbelievable excuses. There are two subtypes of conduct disorder—child-onset and adolescent- onset—both of which can occur in mild, moderate, or severe forms. Childhood-onset conduct disorder occurs prior to age 10 years and is found mainly in males who are physically aggressive, have poor peer relationships, show little concern for others, and lack feelings of guilt or remorse. These children frequently misperceive others’ intentions as hostile and believe their aggressive responses are justified. Violent children also often display antisocial reasoning, such as “he deserved it,”when rationalizing aggressive behaviors (Farrell et al., 2008). Children with childhood-onset conduct disorder attempt to project a strong image, but they actually have a low self- esteem. Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment they may later develop antisocial personality disorder as adults. In adolescent-onset conduct disorder, no symptoms are present prior to age 10. Affected adolescents tend to act out misconduct with their peer group (e.g., early onset of sexual behavior, substance abuse, risk-taking behaviors). Males are more likely to fight,steal, vandalize, and have school discipline problems whereas girls tend to lie, be truant,run away, abuse substances, and engage in prostitution. The male-to-female ratio is not as high as for the childhood-onset type, indicating more girls become aggressive during this period of development. As previously stated, conduct disorder is one of the most frequently diagnosed disorder in children and adolescents and has an estimated rate of 5.4% in both inpatient and outpatient mental health facilities (Kessler et al., 2012). COMORBIDITY attention deficit hyperactivity disorder, substance use disorders, and learning disabilities. Children with bipolar disorder may often be confused with conduct disorder and may result in delayed detection and treatment (Kovacs & Pollock, 2009). ETIOLOGY *GENETIC Conduct disorders are more common in children and adolescents whose parents were similarly afflicted (Mental Health America, 2012). *NEUROBIOLOGICAL Adolescents with conduct disorder have been found to have significantly reduced gray matter bilaterally in the anterior insulate cortex and the left amygdala (Sterzer et al., 2007). The insulate cortex is believed to be involved in emotion and empathy, and the amygdala also helps to process emotional reactions. Researchers believe that this reduction may be related to aggressive behavior and have found a positive correlation between this deficit and empathy scores. That is, the less gray matter in these regions of the brain, the less likely adolescents are to feel remorse for their actions or victims. Fairchild and colleagues (2011) found that regardless of age of onset gray matter reductions crucial in brain regions for processing emotional stimuli contribute to this disorder. PARENTAL, FAMILIAL, AND ENVIRONMENTAL FACTORS  Parents who engaged in substance abuse and antisocial behaviors and diagnosed with ADHD, mood disorders, schizophrenia, or antisocial personality disorder.  A home environment that lacks adequate supervision with frequent conflicts between parents can lead to maladaptive behavior in children, which can lead to CD.  Children exposed to frequent domestic violence.  Living in low social and economic environments with overcrowding and unemployment leads to economic and social stress with a lack of adequate parenting.  Availability of drugs and increased crime in a child’s neighborhood. ASSESSMENT TOOLS conduct disorder in young people can be examined more carefully with the use of questions. They are subsets of an ADHD scale created by Wolraich (1998). For both scales individually, scores of 2 to 3 are considered to be indicative of a problem.