Conduct Disorder

Conduct DisorderKaren Elise ParkerEDU 214Anne Arundel Community College

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I hate you!I really want to hurt somebody!Callous Unemotional Traits2Opening Activity Hi! Let me introduce myself. I am Conduct Disorder! My teachers say I am hard to manage. Sometimes I feel hatred toward others around me, and I am antisocial. I yell mean things to people and lash out at others. I may tie up my best friend if she doesnt let me be the leader in a game we play. Or, I may beat up a guy just because he looks at me in a manner that I dont like. I am oppositional defiant disorder taken to the next level. In my teenage years, I will get locked up at least once for committing harm against someone with a weapon or stealing from the people I love. I hurt people and animals. I may even engage in an armed robbery of a bank or store. People dont understand me, and without medication, I have a difficult time focusing on my work in school and maintaining positive relationships with peers and my teachers. I am callous and unemotional, thats me. Conduct Disorder.

Using the introduction provided to you, write at least five things you think will be a criterion of a conduct disorder diagnosis. Criteria for the Diagnosis of Conduct disorder A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months.

Aggression to people and animals.

Destruction of property.

Deceitfulness or theft.

Serious violations of rules.

4Aggression to people and animalsOften bullies, threatens, or intimidates others.Often initiates physical fights.Has used a weapon that can cause serious physical harm to others (i.e., a bat, brick, broken bottle, knife, gun). Has been physically cruel to people.Has been physically cruel to animals. Has stolen while confronting a victim (i.e., mugging, purse snatching, extortion, armed robbery). Has forced someone into sexual activity.

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6Destruction of Property

Deliberately engaged in fires setting with the intention of causing serious damage. Deliberately destroys others property (other than by fire setting). 7

Deceitfulness or Theft

Has broken into someone elses house, building, or car.

Often lies to obtain goods or favors or to avoid obligations (i.e., cons).

Has stolen items of nontrivial value without confronting a victim (i.e., shoplifting; forgery).8

Serious violations of rulesOften stays out at night despite parental prohibitions, beginning before age 13 years.

Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).

Often truant from school, beginning before age 13 years. 9

other criterion needed in order to meet a diagnosis of conduct disorderThe disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code Type (based on age at onset):

312.81 Childhood-Onset Type: at least one criterion present prior to age 10 years.

312.82 Adolescent-Onset Type: absence of any criteria characteristic of conduct disorder prior to age 10 years.

312.89 Unspecified Onset: onset of Conduct Disorder is unknown.

10Levels of severity Mild: few if any conduct problems in excess of those required to make the diagnosis and that cause minor harm to others (i.e., lying, truancy, staying out after dark without permission).

Moderate: number or conduct problems and effect on others intermediate between mild and severe (i.e., stealing without confronting a victim, vandalism).

Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems that cause considerable harm to others (i.e., forced sex, physical cruelty, weapon use, breaking and entering, and stealing while confronting a victim). Reference:American Psychiatric Association. (2000). The diagnostic and statistical manual of mental disorders. (4th ed., text rev.) Washington, DC, Author. Treatments

Parent Management Training [PMT]Psychotherapy Family Therapy Medication Treatment School Based Interventions

Parent management TrainingFast Track Program Intervention targeted to prevent externalizing disorders. The use of parent behavior-management, child social cognitive skills, reading, home visiting, mentoring, and classroom curricula prevents lifetime prevalence of conduct disorder. Promoting play.Developing a positive parent-child relationship.Using praise and rewards to increase desirable social behavior.Giving clear directions and rules.Using consistent and calmly executed consequences for unwanted behavior.Reorganizing the childs day to prevent problems.

Measurement tool: Computerized Diagnostic Interview Schedule for parent and Child (CDISC) Incredible Years Treatment Program A multifaceted treatment approach for young children with conduct disorder. Effective in strengthening teacher and parent management skills, improving childrens social competence, emotion regulation, and school readiness, and reducing behavior problems.

Provides parents and teachers with strategies to build positive relationships, attachments, and to manage behaviors such as aggressiveness, ongoing tantrums, and acting out behavior such as swearing, whining, yelling, hitting and kicking, answering back, and refusing to follow rules. Reference: http://incredibleyears.com/about/incredible-years-series/

Psychotherapy

Cognitive-Behavioral and social skills training is used to target aggressive behavior, social interactions, self- evaluation, and emotional dysregulation. Most successfully used in children and adults, and more recently adapted for pre-school children.

Problem-Solving Skills Training [PSST]. Play Therapy.

Four common targets: To reduce childrens aggressive behavior (i.e., shouting, pushing, and arguing). To increase prosocial interactions (i.e., entering a group, asking questions politely, and listening to others). To correct cognitive deficiencies, distortions, and inaccurate self-evaluation. To reduce impulsivity, explosiveness, to enable self-control, and the ability to respond effectively in provoking situations.

Scott, Stephen (2008). Advances in Psychiatric Treatment. (14) 61-70.14Family Therapy Functional Family Therapy

Four Phases of Family Based Intervention:

EngagementMotivationBehavioral ChangeGeneralization

Medication Treatments

Psycho-stimulants Mood Stabilizers Anti-psychotics

School Based InterventionsFour Targets of Classroom Techniques:

Promoting positive behaviors (i.e., compliance and following classroom rules and procedures.

Preventing problem behavior (i.e., talking at inappropriate times).

Teaching social and emotional skills (i.e., conflict resolution and problem-solving skills).

De-escalation of angry behavior and acting-out behavior.

Classroom strategies: Make few rules (i.e., three to six rules).Negotiate rules with the children.State rules positively and behaviorally. Make a contract with the children to adhere to them. Post them on the classroom wall. Send a copy of the rules to the parents. 16ReferencesConduct Problems Prevention Research Group (2011). The effects of the fast track preventive on the development of conduct disorder across childhood. Child development, 82 (1), 331-345.

Frick, P. (2013). Developmental pathways to conduct disorder: implications for future directions in research, assessment, and treatment. Journal of Clinical Child & Adolescent Psychology. 41 (3), 378-389., DOI: 10.1080/15374416.2012.664815.

Pardini, D., and Frick, P. (2013). Multiple developmental pathways to conduct disorder: current conceptualizations and clinical implications. Journal of Canada Academy of Child Adolescent Psychiatry, 22 (1). 20-25.

Rhee, S.H., et. al., (2013). Early concern and disregard for others as predictors of antisocial behavior. Journal of Child Psychology Psychiatry 54 (2), 157-166.

Scott, S. (2002). Parent training programmes. Child and Adolescent Psychiatry (4th edition) (eds M. Rutter & E. Taylor), 949-967. Blackwell.

Scott, S. (2008). An update on interventions for conduct disorder. Advances in Psychiatric Treatment (14th edition), 61-70.