With a Conduct Disorder (CD), a youngster will show repetitive patterns of behavior in which they violate the basic rights of others or important age-appropriate societal norms and rules. The actions entail more serious issues than pranks and mischief normally occurring among teenagers. The prevalence of CD in children aged 4 – 18 years has increased over the past 30 years and currently ranges from 6% – 16% for boys and 2% to 9% for girls. Thus, in the US there are about 1.3 to 3.8 million cases.
The diagnosis of CD organizes the problem into four functional areas. There are: aggession toward people or animals, destruction of property, deceitfulness or theft, and serious rule violations.
Problem behaviors may be initially less severe and escalate. Boys exhibit confrontation in actions like violence, whereas girls use less confrontational patterns such as lying and stealng.
Youth with CD usually have difficulties at home, in the community, and in school. They often blame others for their problems and hold that they have been treated unfairly by authorty figures. They project a “tough” image with drinking, smoking, or substance abuse. They have a low frustration tolerance, can be very irritable, have temper outbursts, and frequently act recklessly and impulsively. Many are sexually active.
Acedemics are not of high priority to the children with CD.but issues of power and control are. They manipulate others to satisfy short-term needs, and are affective in choosing targets for manipulation.
Dealing with authority is approached as a “game” with a focus on “winning”. There is an apparant lack of conscience or empahy for those who suffer because of their actions. Immediate gratification is most important to them. They may also have a learning disablity, attention deficit/hyperactivity disorder, or depression.
According to Harvey P. Mandel in Conduct Disorder and Underachievement: Risk Factors, Assessment, Treatment, and Prevention. (1997). Wiley: NY.: researchers report that once the pattern of CD develops, if conditions sustain or enhance its existence, it is difficult to change its course, and doing so requires many resources. The further the progression has advanced toward anti-social activity, the less likely the reversal to a non-deviant lifestyle. The single best predictor of anti-social disorders by age 11 was the existence of behavior problems in the pre-school years.
Loeber and Dishim (1983) found the major predictors of delinquency were parents’ family management techniques, or the supervision and discipline of the child’s conduct problems, parental criminality, and the child’s poor acedemic performance.
IQ appears to play a positive or protective role on the development of delinquency. Studies have found that infants with difficult temperments, low IQs, and family difficulties tended to develop disruptive behavior problems, whereas infants with difficult temperments, high IQs, and family difficulties did not. High IQs also appear to prevent subsequent underachievement.
Academic success, which follows from high performance IQ, may mitigate againsst acting out behavior because of the result of personal benefit to the student. Also higher IQ may show greater capacity for problem solving.
With lower IQ children may not as readily see alternatives to problems. This may lead to increased frustration and deteriorization of behavior.
Negative expectations of those with CD have been shown to decrease the effort placed into adaptive behavior and increases the likelihood of choosing maladaptive solutions in problematic situations.
In finding a good therapist for your child with CD, one who will be effective, look for someone who will be accessible, has a clear sense of boundaries, is willling to be informal without losing professionalism, exhibits warmth and understanding toward your child’s situation and patterns, is willing to confront his/her behaviors in an innovative way, is able to help your child define alternative goals, is active and directive, can see through manipulations of your child, and is able to set and abide by clear and reasonable limits.
Onset of treatment should occur as early as possible to increase the probabllity of positive change. For the child with CD, the family processes will need restructuring. For the adolescent with CD, the aim will be to face the realities of the decrease of family control, the greater potential for negative peer influences, and expanded community temptations.
Individually, the therapist must work with the child/adolescent in examining the ambiguous social cues which lead them to perceive hostility in others. Therapists need to be active and directive, especially in early stages of treatment. Her goals should be focused, practical, and attainable. She may need to obtain information from sources other than yourself, family, and your child. She will need to work with you to ensure regular attendance, which is very important.
She will need to incorporate family, community, and peer group resources, which could also include addressing dysfunctional parenting skills, a depressed or anti-social parent, or delinquent gang influence. Interaction with school, mental health professionals, and community organizations improves the ability to address a range of issues and leads to a better outcome.
Sharing information across the “treatment team” enhances success, so the concept of confidentiality may need to be more flexible. Important information may come from school reports, court reports, and assessments or psychological reports also.
To know how well the treatment has progressed the therapist will need to collect data from your child, the family, teachers, and community sources. Follow-up should extend beyond the usualy 6-month to 1-year period.
Research is attempting to gain knowledge about how many clients with CD come into therapy, and how many of them drop-out of it or its follow-up process. Currently a high drop-out rate exists and there is little data on long-term follow-up. This limits the ability to test and develop effective treatments, as well as to train competent therapists.
LOCAL SERVICES FOR CHILDREN AND ADOLESCENTS:
To find help locally for your child or adolescent please consult the Michigan Mental Health Networker website mhweb.org. There you will find Child and Adolescent Services listed by County as well as a wealth of information on mental health, an alpha list of therapists and agencies, links, articles and a therapist registry.