Conduct Disorder

Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rules are violated; to a lesser degree, it is called Oppositional Defiant Disorder (ODD) in younger children

Aetiology

Bio-psycho-social influences

• Some evidence in twin studies

• Intrauterine or post-natal CNS trauma

• Antisocial behaviour in general is more common in children with neurological conditions

• Individual child problem - difficult temperament

• Family circumstances
• Families with parents with mental illness and intellectual difficulties
• Drug and alcohol problems
• Domestic violence
• Single parent families

• Parenting style
• Lack of house rules - no set routine
• Lack of clarity as to how children are to behave
• Inconsistent responses to undersired behaviour with failure to follow through on consequences or with rewards
• Lack of techniques to deal with crises or resolve conflict within the family
• Lack of supervision

Pathophysiology

Types

• Mild-moderate - restricted to family environment

• Severe
• Unsocialised - predominantly violent behaviour and more likely to be dealt within the criminal justice system
• Socialised - more coverty antisocial acts or better ability to avoid getting involved with the criminal justice system

Co-morbitidies

• ADHD characterised by inattention, hyperactivity, and impulsivity

• Frequently co-occurs with difficulty in self-regulation

• Symptoms of ADHD are developmentally inappropriate, impair function, pervasive across settings, and longstanding from age 5

• It is possible to misdiagnose ADHD in children with HD as they present similarly but also are highly co-morbid

• However, ADHD (on its own) and ADHD with CD appear to be subtypes

• While the short-term response to stimulant medication is the same in these two groups, children with ADHD and CD have higher rates of antisocial personality as adults

• RAD

• Reading and other learning difficulties

• Depression

• Dubstance misuse

• Deviant sexual behaviour

Clinical presentation

• Aggression to people or animals

• Destruction of property

• Decietfulness or theft

• Serious violation of rules

Management

Children with no co-morbidities

• Parent/foster training when child is under 11

• Child-focused programmes where child is aged between 9 and 14

• Multimodel interventions for young people aged between 11 and 17 years

Pharmacological management

• Medication is not main line but in extreme cases can help with impulsivity and aggressive behaviour - in these cases risperidone (atypical antipsychotic) is the drug of choice

• Stimulant medication for co-existing ADHD

• SSRIs for co-existing depression