Conduct Problems in Children and Youth

Definitions

Conduct refers to the way a person acts or behaves.

A child’s conduct is influenced by various environmental factors and internal processes (e.g., self-regulation skills, belief systems, established sets of values).

Conduct can also be an expression of feelings. For example:

• Frustration may lead to an outburst.
• Anger may lead to temper tantrums.
• Loneliness may lead to risky activities with others, such as substance use or abuse, in order to feel included.

Problems with conduct are often identified when the child has begun engaging in risky behaviors like these:

• Lying : saying things that are not true or leaving out important information when telling a story.
• Stealing : taking something that does not belong to you.
• Vandalizing : damaging, defacing, or destroying property that is not yours.
• Setting fires (arson): intentionally burning a person’s property or belongings or having a fascination with fire.
• Running away : leaving home for long periods of time (typically a day or more) or leaving without approval from a guardian.

Always be aware of issues related to the safety of the child, yourself, and the family.

Try to understand the underlying causes and motivation for the youth acting out with these behaviors (i.e., why he did what he did). This is called "the function of the behavior."

Most children will act out or test limits at some point in time. These behaviors can be isolated events and may not be repeated or become patterns of behavior. Children’s behaviors are greatly influenced by environmental factors such as inconsistent and unpredictable implementation of rules and expectations, poor self-regulation by adults, and established unhealthy moral and value systems.

Let parents know that consistent, predictable, andsupervisionis one of the most important things they can provide for their children. Work with the child to identify her family and cultural values. Support the child in developing skills of respect for herself and others.

Trytorespond to the child's behaviors neutrally and work to identify issues that contribute to the behavior.

• Both overreacting and under-reacting can have negative effects.
• Respond to the child's behavior in a manner that is consistent, predictable, and equal to the severity of the incident.
• If hearing what a client did in your community makes you feel angry or frustrated, consult with your clinical supervisor. Take time to consult with your supervisor to process your feelings. See Chapter C-5: Working with Difficult Clients.

An unstable childhood or home environment may lead a child to develop conduct problems. Early intervention is very important when these behaviors are repeated or turning into a pattern. See Chapter D-26: Conduct Disorder.

Lying

Children lie for a number of different reasons and, in many cases, lying is a normal part of development. Young children often do not understand that lying is wrong and dishonest, and it is normal for young children tell tall tales or make up stories. As they get older, possible reasons children lie include:

• To get out of doing things they do not want to do, or "non-preferred activities."
• To keep family secrets.
• Because they have seen someone else do it.
• To avoid punishment.
• To impress others.
• To boost their self-esteem.
• To get something they want.

Stealing

It is normal for young children to take things that excites their interest. As children get older, some reasons for stealing include:

• A misguided attempt to receive more attention.
• To express anger at someone or to “get even” with him.
• To meet basic needs, such as food or money.
• Out of jealousy.
• As a show of bravery.
• To give presents to family or friends.
• Being afraid of having to rely on others to provide for them.
• To finance substance use or abuse habits.

Vandalism

• Youth sometimes vandalize things to express anger at someone or to “get even."
• Vandalism can be the result of an attempt to break into a person’s property to steal belongings.
• Youth may not understand that graffiti is vandalism, but graffiti is considered vandalism if it involves someone else’s property.
• Vandalism can be linked to:
  • Substance abuse.
  • Attempts to locate drugs, alcohol, or valuables that can be used to purchase them.
  • Peer pressure.

Running away

Youth who run away often feel alienated from the people and things around them. The decision to run away is often fueled by ongoing conflict in the home and the child feeling that there is no other solution. A young person who runs away may believe that:

• She will not find the support she needs at home.
• Her friends or other people will give her the security and comfort she needs.
• She will get back at her parents by worrying them or making them angry.

Youth may use running away as a way to:

• Push parents’ buttons.
• Feel in control.
• Have more power.
• Feel safe.

Setting fires

• Children can accidentally set fires out of curiosity.
• Youth may set fires out of anger, frustration, retaliation, or to destroy someone’s property.
• A child or youth who deliberately sets fire to objects, or property, especially after being told not to do so, need professional help. Based on your organization's policies and procedures, consider developing a safety plan to manage fire-setting behaviors.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history, including information about problems at school or work, community conflicts, reports of illegal activities, arrests, or other interactions with the law.

Treatment Plan, if one exists.

Personal history

• Has aggressive conduct that threatens physical harm to other people or animals
• Has non-aggressive conduct that causes property loss or damage
• Steals
• Has a history of abuse or neglect
• Violates family or community rules
• Has run away from home

Personality

• Lies or makes up stories that are untrue
• Lacks empathy for others
• Has poor impulse control
• Is withdrawn from others
• Appears hyperactive
• Has a lot of energy and can't manage it in healthy ways
• Inadequate communication skills
• Uses of threats or intimidation to control others

Family history or environment

• Lacks adequate supervision
• Has family dysfunction
• Inadequate supervision by parents or guardians
• Has dysfunctional family dynamics, e.g., threats or intimidation are used to control others, family members use verbal and physical aggression, or there is inconsistent and unpredictable implementation of family rules and expectations

[Questions for caregivers]

Conduct problems

• Has she been acting different than she normally does?
• Does she lie more often?
• Does she leave out important information when telling a story?
• Is she stealing personal items or money from you?
• Do you see her with things you know are not hers, that you did not purchase for her, and that were not a gift?
• Does she damage or deface property that is not hers?
• Has she run away from home? If so, when was the last time? How many times total?

[Questions for client]

Conduct problems

• Have you accidentally set fire to anything (yours or not)?
• Have you had any run-ins with the police? If yes, what were the circumstances?
• Have you been in physical fights? If yes, what were the circumstance?
• Do you smoke, drink alcohol, or use other drugs, including inhalants (huffing)? If yes:
  • Which drug(s)?
  • How often do you use it?
• How long have these behaviors been going on?

Personality

• How do you describe yourself?
• How would others describe you?
• Do you get along with others?
  • Who do you usually get along with well?
  • Who do you have trouble getting along with?
• Have you ever hurt someone on purpose?
• Are there certain people that you want to hurt or hope will be hurt?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, you may consider individual counseling to help the client:

• Learn to identify safe adults.
• Learn coping skills.
• Develop his ability to express himself in a healthy, appropriate way.
• Create a behavior contract to establish appropriate behavioral expectations and consequences.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.