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Campbell Systematic Reviews - 2021 - Littell - Multisystemic Therapy for social emotional and behavioural problems in

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Treatment Summary: Children that exhibit Conduct Disorder (CD) tend to be callous, display unemotional traits, conduct problems, and difficulty with emotional processing resulting in levels of antisocial behavior. The age and degree of maladjustment reported through observation greatly depends on the resources available.

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ICD-11 for Mortality and Morbidity Statistics

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ICD-11 Browser contains the ICD-11 (International Classification of Diseases 11th Revision)

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Overview

What is conduct disorder?

Conduct disorder (CD) is a mental health condition that affects children and teens that's characterized by a consistent pattern of aggressive behaviors and actions that harm the well-being of others. Children with conduct disorder also often violate rules and societal norms.

Conduct disorder lies on a spectrum of disruptive behavioral disorders, which also includes oppositional defiant disorder (ODD). In some cases, ODD leads to CD.

Conduct disorder often occurs alongside other psychiatric conditions, including:

What is the difference between conduct disorder and personality disorders?

A personality disorder is a mental health condition that involves long-lasting, disruptive patterns of thinking, behavior, mood and relating to others. Most personality disorders begin in the teen years when personality further develops and matures. As a result, almost all people diagnosed with personality disorders are above the age of 18.

One exception to this is antisocial personality disorder (ASPD) - approximately 80% of people with this disorder will have started to show symptoms by the age of 11.

There's not much difference between conduct disorder (CD) and ASPD, but CD is typically diagnosed in children. If an adult meets the criteria for both conditions, then a mental health professional would give them a diagnosis of ASPD instead of CD.

Who does conduct disorder affect?

Conduct disorder affects children and adolescents. It can have early onset before age 10, but commonly develops in adolescence (between ages 10 years to 19 years).

The condition is more common in children assigned male at birth (AMAB) than children assigned female at birth (AFAB). The average age of presentation is 10 years to 12 years in children AMAB and 14 years to 16 years in children AFAB.

How common is conduct disorder?

Conduct disorder affects anywhere between 2% and 10% of children and adolescents in the United States.

Symptoms and Causes

What are the signs and symptoms of conduct disorder?

Characteristic behaviors of conduct disorder develop gradually over time. Children with conduct disorder tend to be impulsive and difficult to manage. They don't seem to be concerned about the feelings of other people.

The four core behaviors of conduct disorder include:

Aggression toward people and animals and/or violating others' basic rights.

Destruction of property.

Deceiving, lying and/or stealing.

Serious violations of rules.

Signs of aggressive behavior toward others include:

Bullying.

Physical violence (potentially with a weapon).

Verbal fights.

Threatening.

Forcing sexual activity.

Blaming others for their own behavior.

Hurting animals.

Signs of the destruction of property include:

Intentionally setting fires.

Vandalizing or destroying others' property.

Signs of deceiving, lying and stealing include:

Lying to get a favor or to avoid responsibilities.

Stealing from individual people or stores.

Breaking into houses or businesses.

Signs of violations of rules include:

Breaking rules without clear reason.

Not going to school (truancy).

Running away from home.

Frequently breaking any rules set by their parents.

Other common signs of conduct disorder include:

Heavy alcohol drinking and/or heavy substance use.

Engaging in frequent and risky sex.

Becoming easily frustrated.

Making no effort to hide their aggressive behaviors.

Not showing remorse for their actions.

Difficulty making and maintaining friendships.

It's important to note that occasional rebellious behavior is common during childhood and adolescence. The signs and symptoms that lead to the diagnosis of conduct disorder demonstrate a disruptive and repetitive pattern.

Signs of conduct disorder in adults

Adults who have conduct disorder may have difficulty keeping a job or maintaining relationships. They may be prone to illegal or dangerous behavior.

Symptoms of conduct disorder in an adult may be diagnosed as antisocial personality disorder.

What causes conduct disorder?

Researchers aren't sure what exactly causes conduct disorder (CD), but they think it's a complex combination of genetic/biological and environmental factors.

Genetic/biological factors:

Various studies show that certain characteristics of CD can be inherited, including antisocial behavior, impulsivity, temperament, aggression and insensitivity to punishment.

High testosterone levels are associated with aggression.

Traumatic brain injury, seizures and neurological damage can contribute to aggression.

Parental, familial and environmental factors:

Parents of adolescents with CD often have engaged in substance use and antisocial behaviors. They're also frequently diagnosed with ADHD, mood disorders, schizophrenia or antisocial personality disorder.

A home environment that lacks structure and 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 are more likely to develop CD.

Living in low social and economic environments with overcrowding and unemployment leads to economic and social stress with a lack of adequate parenting. CD affects more children living in low economic environments than not.

Availability of drugs and increased crime in a child's neighborhood increases their risk of developing CD.

It's important to note that conduct disorder can occur in children from high-functioning, healthy families.

Diagnosis and Tests

How is conduct disorder diagnosed?

A mental health professional diagnoses conduct disorder using criteria provided in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

They diagnose conduct disorder in children or adolescents who've demonstrated three or more of the following behaviors in the previous 12 months, in addition to at least one in the previous six months:

Aggression toward people and/or animals.

Destruction of property.

Deceiving, lying or stealing.

Serious violations of parental rules.

These behaviors must be significant enough to impair functioning in relationships, at home, at school and/or at work.

Your child will likely need to see a child and adolescent psychologist or psychiatrist if they're showing signs of conduct disorder. These mental health professionals use specially designed interview and assessment tools to evaluate a child for a mental health condition.

Psychologists and psychiatrists often rely on reports from the child's parents, siblings, friends and teachers to get a full understanding of the child's behavior.

Management and Treatment

How is conduct disorder treated?

The go-to treatment for conduct disorder (CD) is multiple forms of psychotherapy (talk therapy) for your child and family, as well as community-based treatment.

Therapies include:

Parent management training: The goal of this therapy is to train the child's parents to set consistent discipline with proper rewarding of positive behaviors.

Psychotherapy: "Psychotherapy" is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional can provide support, education and guidance to the person and their family. Psychotherapy for conduct disorder usually needs to target family life and school with a focus on improving family dynamics, academic functioning and improving your child's behavior in the context of various environments.

Anger management training: The goal of anger management is to reduce both your child's emotional feelings and the physiological arousal that anger causes. You can't get rid of or totally avoid the things or people that make them angry, so anger management training teaches your child how to control their reactions.

Individual psychotherapy, such as cognitive behavioral therapy: Individual therapy for a child with conduct disorder focuses on developing problem-solving skills, strengthening relationships by resolving conflicts and learning skills to decline negative influences in their environment.

Community-based treatment: This treatment involves therapeutic schools and residential treatment centers that can provide a structured program to reduce disruptive behaviors.

Healthcare providers typically don't use medication to directly treat conduct disorder, but as other mental health conditions often occur alongside conduct disorder, your child may benefit from medication to manage these conditions.

Prevention

Can conduct disorder be prevented?

At this time, there's no known way to prevent conduct disorder, as it's likely caused by a complex combination of factors, but many of the related problems might be lessened with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to your child's life, family and friendships.

Outlook / Prognosis

What is the prognosis (outlook) for conduct disorder?

The prognosis (outlook) for conduct disorder depends on how early the condition developed and if it was treated.

Usually, the disruptive behaviors of conduct stop during early adulthood, but in about one-third of cases, they continue. Many of these cases meet the criteria for antisocial personality disorder.

Early onset of the condition (before 10 years of age) is associated with a poorer prognosis and is strongly associated with a significant decline in school performance.

Some children and adolescents with conduct disorder develop other mental health conditions, including:

Depression and bipolar disorder may also develop in the teen years and early adulthood. Suicidal ideation can be a complication of these conditions. It's important to get your child immediate medical care if they're talking about or threatening suicide.

Living With

How do I take care of my child with conduct disorder?

If your child has conduct disorder, aside from getting them professional care, you can help them and yourself in the following ways:

Learn more about conduct disorder, including recent research on effective treatment approaches.

Talk to a mental health professional, preferably one who's trained in diagnosing and treating conduct disorder.

Explore the treatment options available. Treatment must be individualized to meet the needs of your child and should be family-centered.

Find a family support group or organization in your community.

When should my child see their healthcare provider about conduct disorder?

If your child has been diagnosed with conduct disorder, and their behavior becomes more severe or further disrupts family or school life, talk to their mental health provider.

If your child displays behavior that harms or endangers others, such as other people or animals, or themselves, it's important to get them immediate medical care.
A note from Cleveland Clinic
Children and teens who are disobedient or aggressive can be very challenging for parents. While it's normal for young children and teens to show defiant behavior from time to time, frequent and disruptive aggressive behavior may indicate conduct disorder (CD).

Starting treatment early for conduct disorder is important, and the first step to treatment is to talk with a healthcare provider or a mental health provider. Don't be afraid to ask your provider questions. They're available to help.

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Conduct Disorder: What It Is, Symptoms & Treatment

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Conduct disorder is a psychiatric condition that affects children and teens that involves a consistent pattern of aggressive and disobedient behaviors.

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Continuing Education Activity

Conduct disorder (CD) lies on a spectrum of disruptive behavioral disorders, which also include oppositional defiant disorder (ODD). In some cases, ODD is a precursor to CD. CD is characterized by a pattern of behaviors that demonstrate aggression and violation of the rights of others and evolves over time. Conduct disorder often occurs comorbidly with other psychiatric conditions, including depression, attention deficit hyperactivity disorder (ADHD), and learning disorders. Thus, a thorough psychiatric evaluation is required before initiating an appropriate treatment plan. This activity examines the presentation, evaluation, and management of conduct disorder and the role of an interprofessional team approach to the care of affected patients.

Objectives:

Access free multiple choice questions on this topic.

Introduction

Conduct disorder (CD) is classified in the spectrum of disruptive behavior disorders, which also includes the diagnosis of oppositional defiant disorder (ODD). Disruptive behavior disorders (DBD) are frequently comorbid with attention deficit hyperactivity disorder (ADHD). It is to be noted that ADHD was previously listed in the DBDs spectrum in DSM-IV-TR, but DSM V has moved the diagnosis of ADHD to Neurodevelopmental disorders. ODD can be seen as a precursor to CD. CD is characterized by a pattern of behaviors that demonstrates aggression and violation of the rights of others and evolves over time. Conduct disorder is comorbid with many other psychiatric conditions, including depression, ADHD, learning disorders, and thus a thorough psychiatric evaluation is required to understand the psychopathology before initiating an appropriate treatment plan (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013; Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994).[1][2][3][4]

Etiology

The etiology of CD is complex and results from an interaction between multiple biological and psychosocial factors.

Biological

Parental and Family

A home environment that lacks structure and adequate supervision with frequent marital conflicts between parents, inconsistent discipline leads to maladaptive behavior.

Harsh parenting with verbal and physical aggression towards children

Children exposed to frequent domestic violence

The family history of criminality and disruptive behaviors in caregivers.

Substance abuse, particularly alcohol dependence in parents

Living in low social, economic conditions with overcrowding and unemployment leads to economic and social stress with lack of adequate parenting.

Neurological

School

School environment with large classroom size increased ratio of children to teachers, lack of positive feedback from teachers.

Lack of supportive staff and counseling to address socio-economic difficulties in children

Exposure to increased gang violence in the community

Protective

Comorbid Conditions

Children with a difficult temperament that demonstrate poor adaptability and frequent negative emotions.

Attention deficit hyperactivity disorder (ADHD): Almost one-third of children with ADHD have symptoms of conduct disorder and other central nervous system dysfunction or damage.

Trauma-related disorders, particularly repeated physical and sexual abuse with maltreatment in children, can lead to a diagnosis of post traumatic stress disorder (PTSD) and other anxiety disorders.

Mood disorders that include depression and bipolar disorder

Epidemiology

It is important to note that occasional rebellious behavior and tendency to be disrespectful and disobedient towards authority figures can present commonly during childhood and adolescent periods. The signs and symptoms that lead to the diagnosis of CD demonstrate a pervasive and repetitive pattern of aggression towards people, animals, with the destruction of property and violation of rules. Conduct disorder is more common in boys than girls, and the ratio could range from 4:1 as much as 12:1. The lifetime prevalence rate in the general population could range from anywhere between 2 to 10% and is consistent among different race and ethnic groups. Children with conduct disorder are often categorized as antisocial personality different disorder in adult life. Early-onset of conduct disorder in childhood years could lead to a worse prognosis of the condition. Multiple socioeconomic factors contribute to a higher incidence of CD in children and adolescents, which includes substance abuse disorders and criminal problems in parents of these children.

Evaluation

Diagnosis

DSM-V Criteria

Exhibits a pattern of behavior that violates the rights of others and disregards social norms

Dysfunction in the Following Areas

CD, Childhood-Onset Type

CD, Adolescent-Onset Type

CD, Unspecified-Onset Type

Diagnostic Evaluation

Treatment / Management

Basic laboratory investigation, including urine drug screen, is necessary to rule out any comorbid medical problems or substance abuse disorders. Multimodal treatments that target family and community resources have improved outcomes.[5][6][7][8]

Evidence-based Psychosocial Treatments

Parent management training with the goal to train parents to set consistent discipline with proper rewarding of positive behaviors and promote prosocial behaviors in children.

Multisystemic therapy that targets family, school, individual, with a focus on improving family dynamics, academic functioning, and improving the child's behavior in the context of multiple systems

Anger management training

Individual psychotherapy that targets developing problem-solving skills strengthens relationships by resolving interpersonal conflicts, learn assertive skills to decline negative influences in the community.

Community-based treatment: Targets development of therapeutic schools and residential treatment centers that can provide a structured program to reduce disruptive behaviors

Pharmacotherapy

Targets treating psychiatric comorbidities with appropriate medications such as stimulants and non-stimulants for the treatment of ADHD, antidepressants for the treatment of depression, mood stabilizers for the treatment of aggression, mood dysregulation, and bipolar disorder;

Mood stabilizers include conventional mood stabilizers like AEDs (antiepileptic drugs) and second-generation antipsychotics.

Differential Diagnosis

Differential diagnoses include new onset of a mood disorder or psychotic disorder that precipitate excessive indulgence in negative behaviors and hostility toward others. CD should be excluded if the problems occur only during episodes of mood or psychotic disorder.

Furthermore, untreated depressive disorder or ADHD leads to substance abuse and can be the precursor to CD.

Prognosis

Prognosis is variable and depends on the presence of subtle psychiatric comorbidities and the initiation of early interventions.

Low intelligence capacities and a dysfunctional family environment with persistent criminality in parents predict a poor prognosis. Adequate treatment of ADHD, proper school placements with assistance for difficulties in learning, higher verbal intelligence, and positive parenting contribute to a better prognosis.

Enhancing Healthcare Team Outcomes

While the definitive diagnosis of a conduct disorder is made by a mental health expert, the follow-up is usually done by the primary care provider and nurse practitioner. The management of these patients is difficult because of low compliance. A variety of treatments have been devised depending on the age of the patient and comorbidity, but relapse rates are high. Pharmacological therapy is often used to manage mood and aggression, but again these patients never remain compliant. Many get into trouble with the law and are then forced into treatment. [Level 5]

References

Disclosure: Leena Mohan declares no relevant financial relationships with ineligible companies.

Disclosure: Musa Yilanli declares no relevant financial relationships with ineligible companies.

Disclosure: Sagarika Ray declares no relevant financial relationships with ineligible companies.

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Conduct disorder (CD) is classified in the spectrum of disruptive behavior disorders, which also includes the diagnosis of oppositional defiant disorder (ODD). Disruptive behavior disorders (DBD) are frequently comorbid with attention deficit hyperactivity disorder (ADHD). It is to be noted that ADHD was previously listed in the DBDs spectrum in DSM-IV-TR, but DSM V has moved the diagnosis of ADHD to Neurodevelopmental disorders.

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Ο Τζέφρυ Ντάμερ και η ΔΔ

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Ο Τζέφρυ Ντάμερ και η ΔΔ

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Conduct Theory, Antisocial behavior and Jeffrey Dahmer

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CD Rating scale for parents (Waschbusch, D. A., & Elgar, F. J.)

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CD Rating scale for parents (Waschbusch, D. A., & Elgar, F. J.)

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ΟΛΟ ΤΟ ΒΙΒΛΙΟ Ψυχομετρία και ψυχολογική αξιολόγηση (e-book epub) (1)

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neural mechanisms of aggression (including CD)

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neural mechanisms of aggression (including CD)

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Evidence-Based Assessment of Conduct Disorder

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Evidence-Based Assessment of Conduct Disorder

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Background:

It is considered a public health priority to effectively manage the troublesome behaviour of disorderly adolescents and children. Conduct disorder (CD) is estimated to affect up to 5% of children between the ages of four and sixteen and is often linked to drug abuse, violence, and sexual victimization. Therefore it is important to have reliable and consistent measures of CD. However, many existing scales measure CD is ways which are not wholly consistent with the criteria set out in the DSM-IV. To address this shortcoming Waschbusch & Elgar (2007) developed the Conduct Disorder Rating Scale- for parents (CDRS-P).

Psychometrics:

The psychometric properties of the Conduct Disorder Rating Scale- for parents (CDRS-P) are discussed in Waschbusch & Elgar, (2007).

Author of Tool:

Waschbusch, D. A., & Elgar, F. J.

Key references:

Primary use / Purpose:

The purpose of the Conduct Disorder Rating Scale- For Parents (CDRS-P) is to allow for measurement of conduct disorder (CD). The CDRS-P is a Likert-type scale with scores ranging from 1-4 which measures CD in line with current conceptualizations as described in the DSM-IV. The fifteen symptom used in the scale are taken directly form the DSM-IV definition of CD.

INSTRUCTIONS: Listed below are items that describe children's behaviour. Read each item carefully and check the box that best describes this child's behavior for the past 12 months. You may put DK next to any item that you do not know or do not wish to answer.

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Conduct Disorder Rating Scale- For Parents (CDRS-P)

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It is considered a public health priority to effectively manage the troublesome behaviour of disorderly adolescents and children. Conduct disorder (CD) is

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Προγράμματα εκπαίδευσης γονέων παιδιών προσχολικής ηλικίας ως μέτρο πρόληψης ΔΔ

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Προγράμματα εκπαίδευσης γονέων παιδιών προσχολικής ηλικίας ως μέτρο πρόληψης ΔΔ

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Γιαννοπούλου & Τσομπανογλου

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What is ODD_ ODD meaning and Oppositional Defiant Disorder DSM 5  diagnosis

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Oppositional Defiant Disorder_ Raising a Child with ODD and ADHD

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8 Discipline Rules for Parents of Children with Oppositional Defiant Disorder

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Conduct disorders and psychopathy in children and adolescents

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Oppositional Defiant Disorder and Conduct Disorder in Childhood Matthys

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Conduct Disorders A Practitioners Guide to Comparative Treatments (Springer Series on Comparative Treatments for Psychological Disorders)

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Conduct and Oppositional Defiant Disorders Epidemiology, Risk Factors, and Treatment by Cecilia A. Essau

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Oppositional Defiant Disorder and Conduct Disorder

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Assessment and Diagnosis of Conduct Disorder