Conduct Disorder

Conduct disorder is a diagnosable psychological condition that includes problems in emotional and behavioral control. It is diagnosed among children and adolescents. In this condition, children exhibit severe and persistent anti-social behavioral tendencies which cause harm to others.

Defining Features of Conduct Disorder

The Diagnostic and Statistical Manual of Mental Disorders (5^th ed., DSM-5., American Psychiatric Association, 2013) lists a range of symptoms for this disorder.  These symptoms are divided into four major categories:

• Aggression towards people and animals: Includes physical cruelty towards animals and people, incidents of bullying and threatening, use of potentially threatening weapons, stealing, forcing someone into sexual activity, and often initiating physical fights
• Destruction of Property: Deliberate engagement in a fire setting with the intent to cause serious damage and deliberate destruction of property.
• Deceitfulness of theft: Breaking into someone’s car, building, or house, engaging in frequent lying for personal gain, stealing non-trivial items.
• Serious Violations of rules: Staying out at night often (despite prohibitions, beginning before age 13 years), history of running from home, truancy from school (beginning before age 13 years).

The International Classification of Diseases-10 Classification of Mental and Behavioural Disorders (10^th Revision) also lists a similar clinical picture. Additional symptoms included in ICD relate to frequent and severe temper issues and direct defying of adult requests or rules.

Assessment and Diagnosis

The assessment of conduct issues begins with a detailed clinical history. The personal history reveals valuable information about behavioral and emotional issues characteristic of conduct disorders. Warning signs of conduct disorder can be noticed in children aged between 10 to 14 years. Such behavioral signs include smoking, alcohol and drug use, and deviant sexual activity.

Assessment measures may also be applied to bolster the diagnostic process. Broad Band Behaviour Rating Scales help a clinician in examining multiple behavioral domains and screen for issues in a time-efficient manner. Another method applied for assessment is the use of a performance-based test. These tests are designed to identify mechanisms that support conduct issues. Behavioral observation also serves as a means of screening and assessment.

A therapist considers all the information elicited from various sources. However, the final diagnosis is based on criteria set by DSM V or ICD 10. 

Interventions for Conduct Disorder

1. Family-based interventions: Functional Family Therapy (FFT) is a specialized intervention that is conducted at the patient’s home and focuses on the complete involvement of the family.

2. Contingency Management Programs: By establishing clear behavioral goals, these programs focus on gradual behavioral change. Parent Management Training (PMT), teaches parents to develop contingency programs at home. The principles of this training address parent-child interaction, enhancing responsible and pro-social behavior.

3. Multisystemic Therapy (MST): This intervention has specific goals that bolster responsible behavior. Multiple systems maintaining behavior are included.

4. Cognitive Behavioural Skills Training: This therapy aims at developing better ways to deal with social situations. It usually focuses on dealing with deficits in social cognition and teaching better problem-solving skills.

5. Pharmacological treatment: The therapist s judgment becomes highly imperative when pharmacological intervention is included in the management of conduct disorder. Such an approach is used in cohesion with others.

Given the risk of harm to others and oneself, conduct disorders often demand monitoring and support from multiple professional and online psychologist. Intensive parental and school staff involvement is imperative to manage behavioral issues. Such involvement provides a strong support system to develop and sustain social skills.