Conduct Disorders

Conduct Disorders Deal with Behavior

Conduct Disorders Found in Childhood    

    As the name implies, Conduct Disorders focus on problems associated with the behavior.  There are three primary groups.  The first one is seen in childhood and adolescence, and the second begins to show up in young adulthood and beyond, and the third is seen in both childhood and adulthood.

Group One Affects Children    

Group one includes two primary diagnoses, Conduct Disorder and Oppositional Defiant Disorder. Whereas all children argue at times, children with these disorders are aggressive.  The child demonstrates repetitive, disorderly behavior that does not respond to correction and shows little to no desire to comply with established rules. Family members, teachers, and others describe their behaviors as disruptive and hostile. 

 Schizophrenia is the Focus of Group Two

     The second group of Conduct Disorders falls under the area of Schizophrenia and Schizoaffective disorder. Schizophrenia is a severe mental health disorder characterized by hallucinations, delusions, and other behaviors not under their voluntary control. In most cases, medication is essential for the stabilization of symptoms. 

Group Three Covers Both Children and Adults

   We used to think that the third group was primarily seen in childhood. However, we know now that it’s just as popular among adults –ADHD Attention Deficit Hyperactivity Disorder or ADD Attention Deficit Disorder (without the hyperactivity).  Both ADD and ADHD are behavioral conditions that result from the brain’s inability to prioritize and manage thoughts and actions. 

Conduct Disorder

Teens with Oppositional defiant behavior are known to join gangs in parts of the US as part of their rebellious behaviors.
Teens with Oppositional defiant behavior are known to join gangs in parts of the US as part of their rebellious behaviors.

     A conduct disorder is a severe emotional and behavioral problem in a child or adolescent that usually shows up by age 16. If left untreated, the child often moves on to antisocial personality disorder as an adult. Children with conduct disorders frequently behave in extremely troubling, socially unacceptable, and often illegal ways. However, they feel justified in their actions and show little to no empathy for their victims.

     Treatment for conduct disorder depends on many factors, including the child’s age and the severity of symptoms. With early intervention, the chance of a successful therapy outcome improves; however, without a qualified doctor’s assistance, the risk of incarcerations, mood disorders, and the development of comorbidities such as substance abuse is significant. Children with conduct disorder are at risk of becoming school dropouts, drug addicts, criminals, bullies, acquiring sexually transmitted diseases, and committing suicide or school violence. 

https://www.psychologytoday.com/us/conditions/conduct-disorder

Symptoms of conduct disorder generally fall into four categories:

  • Aggressive behavior toward people and animals, including bullying, threatening, physical violence, use of a weapon, physical cruelty to people or animals, and forcing someone to perform a sexual act.
  • Property destruction, including setting fires and purposefully destroying property.
  • Deceit or theft, including lying, breaking into someone else’s property with the intent to steal, and shoplifting.
  • Serious violations of rules, including breaking family rules, running away from home, and frequently skipping school before the age of 13.

For a diagnosis of conduct disorder, at least three of these behaviors must have occurred within the past year, with at least one occurring within the past six months.

  • Aggressive Behavior
  • Property Destruction
  • Deceit or Lying
  • Serious Violation of Rules

The number of symptoms exhibited and the degree of injury or damage sustained determines whether it is a case of mild, moderate, or severe conduct disorder.

  • Psychotherapy aimed at helping the child learn to express and control anger in more appropriate ways.
  • Cognitive-behavioral therapy aims to reshape the child’s thinking (cognition) to improve problem-solving skills, anger management, moral reasoning skills, and impulse control.
  • Family therapy structured to help improve family interactions and communication among family members.
  • Parent management training (PMT), a specialized therapy technique, which teaches parents ways to alter their child’s behavior in the home positively.
  • Medication use is limited to the treatment of co-existing conditions designed to provide symptom relief.

https://www.webmd.com/mental-health/mental-health-conduct-disorder#3

https://www.psychologytoday.com/us/conditions/conduct-disorder

Symptoms of conduct disorder generally fall into four categories:

  • Aggressive behavior toward people and animals, including bullying, threatening, physical violence, use of a weapon, physical cruelty to people or animals, and forcing someone to perform a sexual act.
  • Property destruction, including setting fires and purposefully destroying property.
  • Deceit or theft, including lying, breaking into someone else’s property with the intent to steal, and shoplifting.
  • Serious violations of rules, including breaking family rules, running away from home, and frequently skipping school before the age of 13.

For a diagnosis of conduct disorder, at least three of these behaviors must have occurred within the past year, with at least one occurring within the past six months.

  • Aggressive Behavior
  • Property Destruction
  • Deceit or Lying
  • Serious Violation of Rules

The number of symptoms exhibited and the degree of injury or damage sustained determines whether it is a case of mild, moderate, or severe conduct disorder.

  • Psychotherapy aimed at helping the child learn to express and control anger in more appropriate ways.
  • Cognitive-behavioral therapy aims to reshape the child’s thinking (cognition) to improve problem-solving skills, anger management, moral reasoning skills, and impulse control.
  • Family therapy structured to help improve family interactions and communication among family members.
  • Parent management training (PMT), a specialized therapy technique, which teaches parents ways to alter their child’s behavior in the home positively.
  • Medication use is limited to the treatment of co-existing conditions designed to provide symptom relief.
https://www.webmd.com/mental-health/mental-health-conductdisorder#3

 

https://www.psychologytoday.com/us/conditions/conduct-disorder
Children who have Conduct Disorders frequently get into fights.
Children who have Conduct Disorders frequently get into fights.

Conduct Disorder: Oppositional Defiant Disorder

Introduction:

     When a child’s behavior rises above the point of being strong-willed and challenging, the action may fall under the Conduct Disorder category of Oppositional Defiant Disorder. With this behavioral disorder, the child or teenager demonstrates a persistent and frequent anger pattern, irritability, arguing, defiance, or vindictiveness toward the parent or other authority figures. Signs often begin to show in pre-school but are almost always present before early teens. The behaviors cause significant family, social activity, school, and work disruptions.

https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

Schizophrenia

Schizophrenia is a conduct disorder exhibiting conflicting behaviors that can become aggressive or bazaar. Often the person feels unable to control his emotions or behaviors as if someone else has his power.
Schizophrenia is a conduct disorder exhibiting conflicting behaviors that can become aggressive or bazaar. Often the person feels unable to control his emotions or behaviors as if someone else has his power.

Schizophrenia is a chronic and severe Conduct Disorder. As a mental health disorder it affects how a person thinks, feels, and behaves. Although it is not as common as other mental disorders, the symptoms are often worse because the individual has a difficult time knowing the difference between what is real and what is not. They frequently see and hear things that are not there, but the images and sounds are so real to them that you cannot convince them that they are imaging they exist. can be very disabling. People with schizophrenia may seem like they have lost touch with reality.  Therefore, it becomes very challenging for the caregiver to provide care and to establish or maintain trust with them.

Along with medication, psychotherapy and coordinated specialty care is recommended to help the individual learn how to cope in the external environment where coping skills will be essential.

Along with medication, psychotherapy and coordinated specialty care is recommended to help the individual learn how to cope in the external environment where coping skills will be essential.

Along with medication, psychotherapy and coordinated specialty care is recommended to help the individual learn how to cope in the external environment where coping skills will be essential.

https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Symptoms of schizophrenia usually start between ages 16 and 30 but rarely, may occur in children. The symptoms of schizophrenia include the following:

  • Hallucinations (seeing or hearing things not there) or Delusions (believing in things not real)
  • Thought disorders (unusual or dysfunctional ways of thinking) such as A+ B doesn’t = C it equals China.
  • Movement disorders (agitated body movements)
  • A “flat affect” (reduced expression of emotions – monotone voice; blank face)
  • Reduced feelings of pleasure in everyday life
  • Difficulty beginning and sustaining activities
  • Reduced speaking
  • There may be a decrease or change in memory function; it could be subtle or significant
  • Poor “executive functioning” (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with “working memory” (the ability to use the information immediately after learning it)

Treatment for Schizophrenia often focuses on medication management, especially the use of Antipsychotic medications.  Some of these medications have potential side effects that caregivers should learn to recognize and inform the doctor promptly if they occur. Talk to your doctor or pharmacist about them if you are not clear on what they may be. 

https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Hyperactive child with attention deficit disorder.
Hyperactive child with attention deficit disorder.

Attention Deficit Hyperactivity Disorder (ADHD)

Introduction:

     Unlike the other three Conduct Disorder Conditions, ADHD is not characterized by potentially aggressive actions. Attention Deficit Hyperactivity Disorder is a problem of not being able to focus (inattentiveness), being overactive (hyperactivity), not being able to control behavior (impulsivity), or a combination of these beyond the normal age-ability of the individual. It affects both children and adults and is on the increase.

      Treatment includes several options and often involves a combination of medication and therapy. Three primary therapies are available: behavioral, cognitive/behavioral, and family/marital.

     The National Resource Center on ADHD, a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD®) supported by the Centers for Disease Control and Prevention (CDC), has information and many resources. You can reach this center online or by phone at 1-866-200-8098.

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Inattentive Symptoms:
  • Fails to give close attention to details or makes careless mistakes in schoolwork at work, or during other activities
  • Has difficulty keeping focus during tasks or play, including conversations, lectures, or lengthy reading
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork or chores and tasks but quickly lose focus and get easily sidetracked
  • Has problems organizing tasks and activities such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
  • Avoids or dislikes tasks that require sustained mental effort such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
  • Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  • Is easily distracted by unrelated thoughts or stimuli
  • Is often forgetful in daily activities such as chores, errands, returning calls, and keeping appointments

Hyperactivity and Impulsivity Symptoms

  • Fidget and squirm in their seats
  • Leave their seats in situations when staying seated is expected, such as in the classroom or the office
  • Run or dash around or climb in cases where it is inappropriate or, in teens and adults, often feel restless
  • Be unable to play or engage in hobbies quietly
  • Be always in motion or “on the go,” or act as if “driven by a motor”
  • Talk nonstop
  • Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation
  • Have trouble waiting for his or her turn
  • Interrupt or intrude on others, for example in conversations, games, or activities

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Tips to Help ADHD Kids Stay Organized

For Kids:

Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:

  • Keeping a routine and a schedule. Keep the same times every day, from wake-up to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the plan on the refrigerator or bulletin board in the kitchen. Write changes on the bulletin board as far in advance as possible.
  • Organizing everyday items. Have a place for everything, (such as clothing, backpacks, and toys), and keep everything in its place.
  • Using homework and notebook organizers. Use organizers for school material and supplies — stress to your child the importance of writing down assignments and bringing home the necessary books.
  • Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
  • Giving praise or rewards when following rules. Children with ADHD often receive and expect criticism. Look for good behavior and praise it.

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Tips to Help ADHD Adults Stay Organized

For Adults

A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:

  • Keeping routines
  • Making lists for different tasks and activities
  • Using a calendar for scheduling events
  • Using reminder notes
  • Assigning a special place for keys, bills, and paperwork
  • Breaking down large tasks into more manageable, smaller steps so that completing each part of the job provides a sense of accomplishment.

https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Conduct Disorder: Oppositional Defiant Disorder Facts

Behaviors Include:
Angry and irritable mood:
  • Often and quickly loses temper
  • Is frequently touchy and easily annoyed by others
  • Is often angry and resentful
Argumentative and defiant behavior:
  • Often argues with adults or people in authority
  • Often actively defies or refuses to comply with adults’ requests or rules
  • Often deliberately annoys or upsets people
  • Often blames others for his or her mistakes or misbehavior
Vindictiveness:
  • Has shown spiteful or vindictive behavior at least twice in the past six months
ODD can vary in severity:
  • Mild – symptoms occur only in one setting, such as only at home, school, work, or with peers.
  • Moderate – Some symptoms occur in at least two settings.
  • Severe – Some symptoms occur in three or more settings.

https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

Oppositional Defiant Disorder Treatment

Treatment for oppositional defiant disorder primarily involves family-based interventions but may psychotherapy and training. Treatment often lasts several months or longer. It’s essential to treat any co-occurring problems, such as a learning disorder, because left untreated, they tend to get worse.

The cornerstones of treatment for ODD usually include:

  • Parent training.The development of parenting skills that are more consistent, positive, and less frustrating for you and your child. In some cases, your child may participate in this training with you, so everyone in your family develops shared goals for how to handle problems. Involving other authority figures, such as teachers, in training may be an essential part of treatment.
  • Parent-child interaction therapy (PCIT).During PCIT, a therapist coaches parents while they interact with their child. For example, one approach is the use of an “ear bug,” an audio device used by a therapist to guide parents through strategies that reinforce positive behavior in their child while the therapist observes out of view of the group.
  • Individual and family therapy.Individual therapy to help the child learn anger management and healthy ways to express feelings. Family therapy may also be encouraged to promoted improved communication skills and help family members learn how to work together to resolve family issues.
  • Cognitive problem-solving training.Therapy teaches the child how to identify and change destructive thought patterns that lead to behavior problems. Collaborative problem-solving brings the parent and child together to learn how to create solutions to problems as a team working work rather than against one another.
  • Social skills training.The training aimed to help the child develop social skills useful in establishing friendships and interacting positively and effectively with peers at school and in other social situations.

Parents learn how to manage a child’s behavior by:

  • Giving clear instructions and following through with appropriate consequences when needed
  • Recognizing and praising the child’s desired actions and positive characteristics for promoting desired behaviors

Although some parenting techniques may seem like common sense, learning to use them consistently in the face of opposition isn’t easy, especially if there are other stressors at home. Learning these skills requires practice and patience.  Repetition in the face of difficulty and disruptive interactions while a therapist is present to provide support, provides the parent with the resources necessary to develop consistency and to rebuild the ability to express unconditional love and acceptance to their child.