FREE ESSAY ON CONDUCT DISORDERS

CONDUCT DISORDERS

Conduct disorders are a complicated set of behavioral and emotional problems that afflict
between nine percent of male boys and two percent of female girls. Persistent aggression,
theft, lying, destruction, and vandalism characterize the disorder. Most of all the child
or adolescent violates societal norms and the basic rights of others (Appendix). The
etiology of the disorder is still in debate. Some theories relate the disorder to
inconsistent home lives, a predisposition to the disorder, modeling and operant
conditioning theory, and environmental factors. Treatment is centered on helping the
child control their anger, parent interaction training, cognitive problem solving skills,
and medications (mostly for the other diagnosed disorders that accompany conduct
disorder). Prognosis is poor for this type of disorder especially if it is Child-onset
type (having 1 criteria before the age of 10), rather than Adolescent-onset type (no
criteria before the age of 10) in which the prognosis is guarded. 
A Review of Conduct Disorder
Introduction and Symptoms 
Conduct disorder is a complicated group of behavioral and emotional problems in children
and adolescents. The major feature of conduct disorder is a repetitive and persistent
pattern in which the basic rights of others or major age-appropriate societal norms or
rules are violated (American Psychiatric Association [APA], 1994, p.85). Children and
adolescents diagnosed with this disorder display aggression towards peers and adults,
destroy property, engage in vandalism, theft and truancy. Studies indicate that conduct
disorders are the largest group of psychiatric illnesses in adolescents. Often beginning
before the teen years, conduct disorders afflict approximately nine percent of boys and
two percent of girls under the age of 18. Because the symptoms are closely related to
socially unacceptable, violent or criminal behavior, many people confuse the illness with
either juvenile delinquency or the turmoil of the teen years. Symptoms and criteria for
conduct disorder include intimidating others, initiating fights, using weapons while
confronting a victim, being physically cruel to people or animals, forcing sexual
activity. Other criteria include setting fires, destroying property, consistently lies,
breaking into homes or cars, truancy, and running away from home at lest twice or once if
for a length period. Three or more of these criteria must be present in the last 12
months, with at least one criterion present in the past six months. When making a
diagnosis of conduct disorder, one must also specify either childhood-onset
characteristic is present before the age of 10. Adolescent-onset type is given if absence
of any criterion prior to age 10. The severity of the disorder is also given; ranging
from mild to severe. Mild severity is stated if there were only just enough of the
criterion present to diagnose the disorder and the child's conduct only causes minor harm
to others. Moderate is given if several conduct problems exist and the effect on others
is between mild and severe. Severe severity should be given if many criterions are met
and they cause considerable harm to others (APA). 
Causes of Conduct Disorders
Researchers have not yet discovered what causes conduct disorder, but they continue to
investigate several psychological, sociological, and biological theories. Psychological
and psychoanalytical theories suggest that aggressive, antisocial behavior is a defense
against society, the result of maternal deprivation, or a failure to internalize
controls. While other psychological theories (behavioral) suggest children use modeling
and operant conditioning to develop and maintain this disorder. Sociological theories
suggest that conduct disorders result from a child's attempt to cope with a hostile
environment or to gain social status among friends. Other sociologists argue that
inconsistent home life contribute to the development of the disorder, whereas, biological
theories suggest some children have a predisposition to the disorder linked to their
parents (APA, 1992). Cadoret & Yates (1995) studied such a combination of the previous
mentioned theories. The researchers used multiple regression analysis to measure
separately genetic and environmental effects on 95 male and 102 female adoptee and their
adoptee parents. They found that (1) a biological background of antisocial personality
disorder predicted increased adolescent aggressiveness, conduct disorder, and adult
antisocial behaviors, and (2) adverse home environments (parents who had martial
problems, were divorced, separated, or had anxiety conditions, depression, and substance
abuse) independently predicted increased antisocial behavior. Other factors may lead to a
child developing conduct disorder, including brain damage, child abuse, defects in
growth, school failure and negative family and social experiences. The child's bad
behavior causes a negative reaction from others, which makes the child behave even worse
(American Academy of Child and Adolescent Psychiatry [AACD], 1996). Most likely, an
inherited predisposition and environmental and parenting influences all play part in the
etiology of the disorder. 
Diagnosis of Conduct Disorders
Common practice in diagnosing conduct disorder is by use of diagnostics interviews and
the use of the DSM-IV. Not only must a practitioner evaluate the child by the criteria,
but also consider the context in which the behavior is occurring. The DSM IV cautions
practitioners to give the diagnosis only when the behavior in question is symptomatic of
an underlying dysfunction within the individual and not simply a reaction to the
immediate social context (APA, 1994, p. 88). The practitioner must also understand the
comorbidity of conduct disorders. It is not uncommon for the child to also satisfy other
Axis I diagnosis if they are diagnosed as conduct disorder. Burket and Myers (1995)
conducted a study to investigate psychotic comorbidity in male and female adolescents
with conduct disorder. Twenty-five adolescents (11 females, 14 males) with conduct
disorder were evaluated using structured diagnostic interviews for Axis I and personality
disorders. The most common Axis I comorbid diagnosis were depressive disorders, 64 %;
anxiety disorders, 52 %; substance abuse, 48 %; and attention-deficit hyperactivity
disorder, 28 %. The most common Axis II disorder was borderline personality disorder
found in 32 % of the children. Other studies have found that there were no significant
differences in the incidence comorbidity between younger (aged 10 to 13) and older (above
13) youth. Among youth who met criteria for conduct disorder, 52 % also met criteria for
a substance abuse disorder (Reebye, Moretti, & Lessard, 1995). 
Treatment and Conclusion
Research shows that the future of children diagnosed with conduct disorders are likely to
be very unhappy if they and their families do not receive early, ongoing and
comprehensive treatment. The prognosis for child-onset type is very poor, whereas
adolescent-onset type is usually guarded. Without treatment many children become unable
to adapt to the demands of adulthood and continue to have problems with the legal system
and maintaining a job. Even if treated, the children may go on to develop anti-social
personality disorder. Treatment of children with conduct disorder is difficult because
the causes of the illness are complex and each youngster is unique. Adding to the
challenge of treatment are the child's uncooperative attitude, fear, and distrust of
adults (AACAP, 1996). Davidson and Neale (1996) go on to say just as precious little in
the way of effective treatment has been fund for psychotherapy, so are there few ways to
reach young people who commit violent and antisocial acts with little remorse or
emotional involvement (p. 427). However, behavior therapies and psychotherapies are
usually necessary to help the child appropriately express and control anger. The
clinician might also concentrate on parent interactions strategies, and cognition problem
solving skills. Remedial education may be needed for children with learning disabilities.
Parents often need assistance in devising and carrying out special management and
educational programs in the home and at school. Treatment may also include medication in
some children, such as those with comorbid diagnosis like depression or ADHD (AACAP,
1996). Campbell, Kafantaris, and Cueva (1995) reviewed the use of Lithium Carbonate with
children diagnosed with conduct disorder. They found only a few double bind and
placebo-controlled studies that show a wide range of results. The authors conclude by
stating that differences in duration of treatment, subject status, and subject selection
may account for the effectiveness of Lithium's ability to reduce aggression. The
children, who evade help, often end up in the legal system and are constantly
incarcerated or shifted from psychiatric hospital to group home. Lewis and Lovely (1994)
comment that in group homes the children are exposed to more people who are not
criminals, and, since they had to take responsibility for their living instead of simply
following prison rules, they internalize some standards and develop some self-control.
Children who went to prison, the authors say, come out angry, ignorant, and unprepared
for the life on the outside. They conclude by saying these types of treatments (group
homes) often work better than just simply throwing the children in prison. In conclusion,
conduct disorder is difficult to diagnose properly and treatment is rarely brief since
establishing new attitudes and behavior patterns take time. However, treatment offers a
good chance for considerable improvement in the present and hope for a successful future.

Bibliography
References
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