Conduct Disorder

Definitions

Conduct Disorder is a diagnosis given to children who have repetitive and persistent conduct problems and behave in a manner that demonstrates a lack of respect for self, others, and property.

This is a formal diagnosis that requires a minimum 12-month report of conduct problems, with at least one reported incident occurring within the previous six months. The categories for issues related to conductinclude:

• Aggression toward people or animals.
• Destruction of property.
• Deceitfulness (dishonesty) or theft.
• Serious violations of known rules.

The child may be diagnosed with a different disorder, such as one of the following, because the symptoms appear similar.

• Oppositional Defiant Disorder (ODD).
• Attention Deficit Hyperactivity Disorder ( ADHD ).
• A mood disorder, including major depression or Disruptive Mood Disregulation Disorder.
• Intermittent Explosive Disorder (IED).

Children with untreated Conduct Disorder may be diagnosed with Antisocial Personality Disorder as adults. Those with untreated Conduct or Antisocial Personality Disorder often end up in jail or experience early death due to engaging in high-risk behaviors. See the DSM-5 for additional information on disorders that may be associated with issues of conduct.

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

Consider why the person is engaging in these behaviors. Try to understand the underlying causes and motivations, and gather information about the person's history that may help to explain what led to the behaviors.

Support the development of skills of respect for the self and others.

A diagnosis of Conduct Disorder may become more apparent as the child grows into adolescence.

Some clients will need residential treatmentor prescribed medications to manage their behaviors.

An unstable childhood or home environment may influence the development of conduct problems. Early intervention is critical because Conduct Disorder increases the risk of problems related to violence, weapon use, teenage pregnancy, substance abuse, and dropping out of school.

Occasional minor rule violations are not uncommon in adolescence. These behaviors need to be taken seriously, but may or may not meet criteria for Conduct Disorder.

Individuals who have been bullied, isolated, neglected, or abused are at risk for developing conduct problems.

Some children experience issues related to neglect or homelessness, which can result in behaviors such as stealing food or resources related to survival. Individuals in this situationmay be sensitive to abandonment and not being supported by others.

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

• Experienced child abuse or neglect
• Has witnessed domestic violence
• Has run away from home
• Has engaged in substance use or abuse

Personality

• Lacks empathy for others
• Expresses feelings of abandonment
• Lacks an appropriate level of remorse for the damage, injury, or loss he has caused
• Has ongoing anger or distrust towards others

Conduct problems

• Legal charges or convictions
• Acts aggressively or threatens serious harm to people or animals
• Steals
• Sets fires
• Frequently fights with peers
• Intentionally damages or destroys property
• Repeatedly violates rules or laws in the household, school, workplace, or community
• Persistently lies in order to:
  • Avoid consequences.
  • Obtain tangible goods.
  • Gain privileges.

Family-related factors

• A parent or caregiver abuses substances
• A parent or family member has a severe mental illness
• Poor parental supervision

Conduct problems

• Have you ever:
  • Set fires?
  • Run away from home?
  • Intentionally destroyed property?
  • Vandalized someone’s property?
  • Been charged with or convicted of a crime?
  • Been in physical fights?
  • Been suspended or expelled from school?
  • Stolen someone else's property?
• Do you smoke, drink alcohol, or use other drugs, including inhalants (huffing)? If yes:
  • Which drugs?
  • How often do you use them?

Personality

• How do you describe yourself?
• How would others describe you?
• Do you get along with others?
• 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.

Clients can benefit from developing moral reasoning, empathy, and skills related to emotion processing and problem solving. Moral Recognition Therapy (MRT), Problem Solving Skills Training (PSST), Parent Management Training (PMT), and Multisystemic Therapy (MST) are evidence-based approaches for positive client outcomes. MRT reduces acting out behaviors by developing an ethical and compassionate understanding of self, others, and society. PSST centers on managing thoughts and feelings that lead to disruptive behaviors. For younger children, PMT is helpful and addresses problematic behaviors within the family system through teaching healthy ways of parent-child interactions related to anger, irritability, and aggression. For older children, MST aims improve academic performance, peer-to-peer interactions, and enhance boundaries and bonding with family.

Specifically, you may consider:

• Individual therapy focused on:
  • Learn to tolerate negative emotions.
  • Teach alternative responses to triggering situations.
  • Role-playing and modeling positive behaviors.
  • Develop a positive view of self and others.
  • Positively reinforce and affirm moral thoughts and behaviors.
  • Develop social skills.
  • Learn about and seek healthy peer relationships.
• Family therapy focused on:
  • Learn healthy parent-child communication skills.
  • Develop boundaries in the home through rule setting, consistent reiforcement and contingency management.
  • Build a bond with family members (e.g., empathize with one another, talk about emotions, listen to one another).

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.