CONDUCT DISORDER IN CHILDREN

One of several childhood behavioral disturbances, Conduct Disorder refers to repeated patterns of conduct by a child that violate the basic rights of others or transgress age-appropriate societal rules. The behavior is socially disruptive and generally more serious in its consequences than typical childhood mischief. The duration of the behavior, its severity, and the kinds of actions involved distinguish conduct disorder from general misbehavior. Conduct disorder is the most common behavioral problem seen in child psychiatric settings in North America.

The behaviors that characterize this disorder include theft, vandalism, physical fights—sometimes with weapons—fire setting, running away from home, truancy, repetitive lying, forcing sexual activity on others, physical cruelty to animals and to people, and substance abuse. Legal involvement may ensue. Different children may manifest different combinations of these behaviors, and these in turn may change at different points of child development. Conduct disorder appears to be more common in boys than in girls.

The etiology of conduct disorder is considered multifactorial. Psychological and social factors believed to contribute to its development include the child's particular temperament, a family history of Antisocial Personality disorder or alcohol dependence (or both), poor parenting skills, a chaotic home environment, and lower socioeconomic status. Mild central nervous system abnormalities have been found in children with a history of violent behavior, and they are thought to contribute to the children's impulsivity. Attention-Deficit Hy-Peractivity Disorder and specific developmental disorders are common associated diagnoses. Children who display significant antisocial behavior have a poorer long-term prognosis with greater psychiatric impairment in adulthood (including antisocial personality disorder), poorer educational achievement, overt criminal behavior, higher rates of unemployment, impaired social functioning—and considerably higher rates of smoking and alcohol abuse, illicit drug use and dependence.

Treatment of conduct disorder in children and adolescents can include family therapy, parent management training, behavioral and cognitive therapies, residential treatment programs, and, less frequently, pharmacotherapy.

(See also: Crime and Drugs )

BIBLIOGRAPHY

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders-4th ed. (DSM-IV). Washington, DC: Author.

Beers, M. H., & Berkow, R. (Eds.) (1999). The Merck Manual of Diagnosis and Therapy, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories.

Cantwell, D. P. (1989). Conduct disorder. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry, 5th ed., Vol. 2. Baltimore, MD: Williams & Wilkins.

Chamberlain, C., & Steinhauer, P. D. (1983). Conduct disorders and delinquency. In P. D. Steinhauer &Q. R. Grant, (Eds.), Psychological problems of the child in the family, 2nd ed. rev. New York: Basic Books.

Connor, D. F., Barkley, R. A., & Davis, H. T. (2000). A pilot study of methylphenidate, clonidine, or the combination in ADHD comorbid with aggressive oppositional defiant or conduct disorder. Clinical Pediatrics (Philadelphia), 39, (1) 15-25.

Malone, R. P., et al. (2000). A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Archives of General Psychiatry, 57, (7) 649-654.

Office of the Surgeon General. (2000). Mental Health: A Report of the Surgeon General. Washington, DC: U. S. Government Printing Office.

Schubiner, H., et al. (2000). Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers. Journal of Clinical Psychiatry, 61, (4) 244-251.

Weinberg, N. Z., & Glantz, M. D. (1999). Child psychopathology risk factors for drug abuse: overview. Journal of Clinical Child Psychology, 28, (3) 290-297.

Zeitlin, H. (1999). Psychiatric comorbidity with substance misuse in children and teenagers. Drug and Alcohol Dependence, 55, (3) 225-234.

Myroslava Romach

Karen Parker

Revised by Rebecca J. Frey