Conduct Disorder in Children - A Look at Treatments

Conduct Disorder in Children - A Look at Treatments
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What is Conduct Disorder?

Conduct Disorder is earmarked by repetitive behavior problems. According to the American Psychological Association (1994), conduct disorder is the “repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.” Additionally, there are certain criteria that are used in determining if an adolescent has conduct disorder. The following list of behaviors is published in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV):

  • Aggression to people and/or animals

    • bullies, threatens or intimidates others
    • initiates physical fights
    • has used a weapon that can cause serious physical harm to others
    • has been physically cruel to people
    • has been physically cruel to animals
    • has stolen while confronting a victim
    • has forced someone into sexual activity

  • Destruction of property

    • Has deliberately engaged in fire setting with the intention of causing serious damage
    • Has deliberately destroyed others’ property

  • Deceitfulness or theft

    • Has broken into someone else’s house, building or car
    • Often lies to obtain goods or favors or to avoid obligations
    • Has stolen items of nontrivial value without confronting the victim

  • Serious violations of rules

    • Often stays out at night despite parental prohibitions, beginning before age 13 years
    • Has run away from home overnight at least twice while living in a parental or parental surrogate home
    • Is often truant from school, beginning before age 13 years

In order for an adolescent to be diagnosed with conduct disorder, at least three of the above behaviors must be present for the past 12 months, with one of these behaviors being present in the last six months (DSM-IV). Conduct disorder is more prevalent among boys than girls.

Treatment

There are several ways of treating conduct disorder in children which include medication, parent management training, cognitive problem-solving skills training, functional family therapy, and multisystemic therapy. Treatment can be very successful. Consistency will be a major part of the treatment.

Medication

Currently, there are no approved medications specifically for conduct disorder in children. However, there are certain medications that have been used and have been shown to improve behavior. The stimulants Dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) are most commonly used in the treatment of conduct disorder. These medications work by reducing an individual’s aggression and impulsivity.

Antidepressants such as bupropion (Well-butrin), fluoxetine (Prozac), and selective serotonin reuptake inhibitors (SSRIs) can also be useful when treating conduct disorder; especially when comorbid disorders such as ADD or depression are present. Finally, Lithium and anticonvulsants can also be used to treat conduct disorder. Lithium acts as an “anti-aggressive” agent (American Family Physician, 2001), and needs to be closely monitored. Anticonvulsants like clonidine have greatly reduced aggression and impulsive behaviors. Like lithium, it needs to be monitored.

Therapy

Parent management training is essential in the treatment of conduct disorder. By providing the proper tools to parents, therapists can play an intricate part in the training. Often times, parents can become frustrated and feel helpless when dealing with this disorder. But with the proper training, they can learn how to correct bad behaviors and set boundaries.

Cognitive problem-solving skills training can teach both parent and child how to deal with a problem in a healthy, productive way. This training can be very empowering to the child as it teaches them to approach problems in a new mindset. Being able to do this is a very important part of therapy for the child. To adults, is equally as important because it teaches the parent to use skill rather than anger or frustration to solve the problem.

Functional family therapy is beneficial for the entire family. It involves not just the child with conduct disorder, but parents and siblings. It reinforces boundaries, relationship building, and the basic tools needed to function as a family.

Multisystemic therapy steps outside the family unit in order to explore other relationships that may contribute to conduct disorder. The child is encouraged to sever relationships with his/her peers who are deemed to having a negative effect on the child. Likewise, relationships the child has within his home environment and neighborhood are also examined.

Outlook

The treatment of conduct disorder is extremely hopeful. Typically, the child and parent can learn to handle deviant behaviors and ultimately correct them. However, it does require patience and diligence from both parties. Without these two components, treatment will most likely fail.

References

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:90–1

Searight, H. R., Rottnek, F., Pharm, S. L. A., (2001, April 15). Conduct Disorder: Diagnosis and Treatment in Primary Care. American Family Physician. Retrieved September 7, 2010, from https://www.aafp.org/afp/2001/0415/p1579.html