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  1. 1. DIAGNOSIS The essential feature of conduct disorder is a repetitive and persistent pattern of conduct in which either the basic rights of others or major age-appropriate societal norms or rules are violated.  The conduct is more serious than the ordinary mischief and pranks of children and adolescents. 
  2. 2. EPIDEMIOLOGY Conduct disorder is fairly common during childhood and adolescence. It is estimated that approximately 9 percent of boys and 2 percent of girls under the age of 18 years have the disorder.  The disorder is more common among boys than among girls and the ratio ranges from 4 to 1 to 12 to 1.  Conduct disorder is more common in children of parents with antisocial personality and alcohol dependence than it is in the general population.  The prevalence of conduct disorder and antisocial behavior is significantly related to socioeconomic factors. 
  3. 3. ETIOLOGY  No single factor can account for children’s antisocial behavior and conduct disorder.  Rather, a variety of bio-psychosocial factors contribute to their development.
  4. 4. PARENTAL FACTORS It has long been recognized that some parental attitudes and faulty child-rearing practices influence the development of children’s maladaptive behaviors.  Chaotic home conditions are associated with conduct disorder and delinquency. However, broken homes per se are not causatively significant it is the strife between the parents that contributes to conduct disorder.  Parental psychopathology, child abuse and negligence often contribute to conduct disorder. 
  5. 5.  Sociopathy, alcoholism and substance abuse in parents are associated with conduct disorder in their children.  Recent studies suggest that many parents of conduct disorder children suffer from serious psychopathology, including psychoses.  Psychodynamic hypotheses suggest that children with conduct disorder unconsciously act out their parents antisocial wishes.
  6. 6. SOCIOCULTURAL FACTORS  Current theories suggest that socioeconomically deprived children, unable to achieve status and obtain material goods through legitimate routes, are forced to resort to socially unacceptable means to reach those goals and that such behavior is normal and acceptable under circumstances of socioeconomic deprivation, as the children are adhering to the values of their own subculture.
  7. 7. PSYCHOLOGICAL FACTORS Children brought up in chaotic, negligent conditions generally become angry, disruptive, demanding and unable to progressively develop the tolerance for frustration necessary for mature relationships.  As their role models are poor and often frequently changing, the basis for developing both an ego-ideal and a conscience is lacking.  The children are left with little motivation to follow societal norms and are relatively remorseless. 
  8. 8. NEUROBIOLOGICAL FACTORS  Neurobiological factors in conduct disorder have been little studied. However, ADHD research yields some important findings and conduct disorder and ADHD often coexist.
  9. 9. OTHER FACTORS ADHD, central nervous system (CNS) dysfunction or damage and early extremes of temperament can predispose a child to conduct disorder.  Propensity to violence correlates with CNS dysfunction and signs of severe psychopathology, such as paranoid tendencies.  Longitudinal temperament studies suggest that many behavioral deviations are initially a straightforward response to a poor fit between, on the one hand, a child’s temperament and emotional needs and on the other hand, parental attitudes and child-rearing practices. 
  10. 10. CLINICAL FEATURES  Children with the solitary aggressive type of conduct disorder commit solitary, rather than group acts of aggression.  The aggressive antisocial behavior may take the form of bullying, physical aggression and cruel behavior toward peers.  The children may be hostile, verbally abusive, impudent, defiant and negativistic toward adults.  Persistent lying, frequent truancy and vandalism are common. In severe cases there is often destructiveness, stealing and physical violence.
  11. 11. TREATMENT    Multimodality treatment is often necessary and can include individual psychotherapy, family therapy, special schooling, Pharmacotherapy, homemaking services and residential placement. Treatment is difficult, given the child’s and the family’s pathology. Both the child and the family can undermine therapy and frequently the conductdisordered child proceeds to delinquency in adolescence and to antisocial behavior in adulthood. Medications are generally used in the conductdisordered child to quell aggressive, Assaultive behavior. Once under control the child may be able to learn more in school and may be more amenable to psychotherapy.
  12. 12. CLINICAL FEATURES     The DSM-III-R criteria for the group type of conduct disorder list the predominant feature as conduct problems occurring mainly as a group activity in the company of friends who have similar problems and to whom the child is loyal. Physical aggression may be included in this condition. The group antisocial behavior invariably occurs outside the home. It includes repeated truancy, vandalism and serious physical aggression or assault against others, such as mugging, gang fighting and beating. The important and constant dynamic features in this condition are the significant influence of the peer group on such youngsters’ behavior and their extreme dependency needs to maintain membership in the gang.
  13. 13. COURSE AND PROGNOSIS Very few youngsters with the group type of conduct disorder remain delinquent beyond adolescence; they may even given it up during adolescence.  They may relinquish their delinquent behavior in response to fortuitous positive happenings, such as academic or athletic success, romantic attachment and role modeling of an interested adult.  Other youngsters may be dissuaded from the repetitive pattern through the unpleasantness of arrest and appearance in juvenile court. Such occurrences may also awaken the family to their responsibilities toward the child. 
  14. 14. TREATMENT Traditional individual psychotherapy alone has proved to be relatively ineffective, party because of adolescent’s common resistance to this type of therapy.  Some delinquent youngsters respond better to the accepting, permissive, and dynamically oriented counseling approach.  The relatively high success rate in treating delinquent youngsters with the group oriented approach is explained by the group conduct disordered youngsters natural tendency to turn to peers for advice and emotional support. 
  15. 15. Occasionally, such youngsters need to be separated from their previous peer group and to be transplanted to an entirely new environment, as in training schools, Outward Bound and therapeutic camping programs.  Therapeutic optimism is very much warranted in this group of youngsters. Any approach that alters the attitudes of the entire group or that separates the youngsters from their delinquent peer group and offers them contact with strong adult leaders and less delinquent peer is likely to improve the group’s antisocial or criminal behavior. 
  16. 16. A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:
  17. 17. AGGRESSION TO PEOPLE AND ANIMALS (1) often bullies, threatens, or intimidates others (2) often initiates physical fights (3) has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun) (4) has been physically cruel to people (5) has been physically cruel to animals (6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) (7) has forced someone into sexual activity
  18. 18. DESTRUCTION OF PROPERTY (8) has deliberately engaged in fire setting with the intention of causing serious damage (9) has deliberately destroyed others' property (other than by fire setting)
  19. 19. DECEITFULNESS OR THEFT (10) has broken into someone else's house, building, or car (11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) (12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)
  20. 20. SERIOUS VIOLATIONS OF RULES (13) often stays out at night despite parental prohibitions, beginning before age 13 years (14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) (15) is often truant from school, beginning before age 13 years
  21. 21. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.