DSM-IV : Diagnostic criteriaA. A repetitive and persistent pattern of behavior inwhich the basic rights of others or major age-appropriate societal norms or rules are violated, asmanifested by the presence of three (or more) of thefollowing criteria in the past 12 months, with atleast one criterion present in the past 6 months:
1. Aggression to people and animals• Often bullies, threatens, or intimidates others• Often initiates physical fights• Has used a weapon that can cause seriousphysical harm to others (e.g., a bat, brick, brokenbottle, knife, gun)• Has been physically cruel to people• Has been physically cruel to animals• Has stolen while confronting a victim (e.g.,mugging, purse snatching, extortion, armedrobbery)• Has forced someone into sexual activity
2. Destruction of propertyHas deliberately engaged in fire setting with theintention of causing serious damageHas deliberately destroyed others property (other thanby fire setting)3. Deceitfulness or thefta. Has broken into someone elses house, building,or carb. Often lies to obtain goods or favors or to avoidobligations (i.e., “cons” others)c. Has stolen items of nontrivial value withoutconfronting a victim (e.g., shoplifting, but withoutbreaking and entering; forgery)
4 Serious violations of rulesA. Often stays out at night despite parental prohibitions,beginning before age 13 years• Has run away from home overnight at least twice whileliving in parental or parental surrogate home (or oncewithout returning for a lengthy period)• Is often truant from school, beginning before age 13yearsB. The disturbance in behavior causes clinicallysignificant impairment in social, academic, oroccupational functioning.C. If the individual is age 18 years or older, criteria are notmet for antisocial personality disorder.• Specify type based on age at onset:
ICD- 10 diagnostic criteria and classificationDiagnostic criteria• G1. There is a repetitive and persistent pattern ofbehavior, in which either the basic rights of othersor major age-appropriate societal norms or rulesare violated, lasting at least 6 months, duringwhich some of the following symptoms arepresent.• Note: The symptoms in 11, 13, 15, 16, 20, 21, and23 need only have occurred once for the criterionto be fulfilled.
The individual:• Has unusually frequent or severe tempertantrums for his or her developmental level;• Often argues with adults;• Often actively refuses adults requests ordefies rules;• Often, apparently deliberately, does thingsthat annoy other people;• Often blames others for his or her ownmistakes or misbehavior;• Is often or easily annoyed by others;• Is often angry or resentful;
• Is often spiteful or vindictive;• Often lies or breaks promises to obtain goods orfavors or to avoid obligations;• Frequently initiates physical fights (this does notinclude fights with siblings);• Has used a weapon that can cause serious physicalharm to others (e.g., bat, brick, broken bottle,knife, gun);• Often stays out after dark despite parentalprohibition (beginning before 13 years of age);• Exhibits physical cruelty to other people (e.g., tiesup, cuts, or burns a victim);• Exhibits physical cruelty to animals;
• Deliberately destroys the property of others(other than by fire-setting);• Deliberately sets fires with a risk or intention ofcausing serious damage;• Steals objects of nontrivial value withoutconfronting the victim, either within the home oroutside (e.g., shoplifting, burglary, forgery);• Is frequently truant from school, beginningbefore 13 years of age;• Has run away from parental or parental surrogatehome at least twice or has run away once formore than a single night (this does not includeleaving to avoid physical or sexual abuse)
• Commits a crime involving confrontation withthe victim (including purse-snatching, extortion,mugging);• Forces another person into sexual activity;• Frequently bullies others (e.g., deliberateinfliction of pain or hurt, including persistentintimidation, tormenting, or molestation);• Breaks into someone elses house, building, orcar.
• G2. The disorder does not meet thecriteria for dissocial personalitydisorder, schizophrenia, manicepisode, depressive episode,pervasive developmental disorders,or hyperkinetic disorder. (if criteriafor emotional disorder are met, thediagnosis should be mixed disorderof conduct and emotions.)It is recommended that the age ofonset be specified.
Classification(F90-F98) Behavioral and emotional disorders with onsetusually occurring in childhood and adolescence• (F91.) Conduct disorders• (F91.0) Conduct disorder confined to the family context• (F91.1) Unsocialized conduct disorder• (F91.2) Socialized conduct disorder• (F91.3) Oppositional defiant disorder• (F91.8) Other conduct disorders• (F91.9) Conduct disorder, unspecified•
CLINICAL FEATURESEgo IntegrityFood/FluidHygieneNeurosensorySafetySexuality and substance useSocial InteractionsLegal
MANAGEMENTBehavior management techniques:•Develop consistent behavior expectations.•Communicate with parents so that strategies areconsistent at home and school.•Apply established consequences immediately,fairly and consistently.•Establish a quiet cooling off area.
• Teach self talk to relieve stress and anxiety.• Provide a positive and encouraging classroomenvironment.• These children are often lacking confidenceand have low self-esteem, promoting both willbe beneficial.• Give praise for appropriate behavior andalways provide timely feedback.• Provide a cooling down area / time out.• Avoid confrontation and power struggles.
PHARMACOLOGIC TREATMENTS:•No evidence exists to support the use ofmedication alone to treat conduct disorder.• Indicated medications for the treatment of any comorbid disorder that is present should be consideredand potentially offers improvement of conductdisorder symptoms.
OPPOSITIONAL DEFIANT DISORDEROppositional defiant disorder is a patternof disobedient, hostile, and defiant behaviourtoward authority figures.
INCIDENCEThis disorder is more common in boys than ingirls.Some studies have shown that it affects 20% ofschool-age children.However, most experts believe this figure is highdue to changing definitions of normal childhoodbehaviour, and possible racial, cultural, and genderbiases.This behaviour typically starts by age 8, but itmay start as early as the preschool years.
SYMPTOMSActively does not follow adults requestsAngry and resentful of othersArgues with adultsBlames others for own mistakesHas few or no friends or has lost friendsIs in constant trouble in schoolLoses temperSpiteful or seeks revengeTouchy or easily annoyed
TREATMENTThe best treatment for the child is to talk with amental health professional in individual andpossibly family therapy.The parents should also learn how to manage thechilds behaviour.Medications may also be helpful, especially if thebehaviours occur as part of another condition (suchas depression, childhood psychosis, or ADHD).
PSYCHOSOCIAL TREATMENT•One of the key factors in the development andmaintenance of the negative behaviours associatedwith ODD symptoms is reinforcement, whetherintentional or not, of the unwanted behaviours.•Behavioural therapy for children and adolescentsfocuses primarily on how to prevent problematicthoughts or behaviours from accidentally gettingreinforced unknowingly within a young personsenvironment.
• The most effective way of treating disruptivebehaviour disorders is behavioural therapies.• Positive reinforcement often unintentionallycontributes to an increase in the frequency ofODD behaviours.• Behaviour therapies can be applied to a widerange of psychological symptoms amongchildren, adolescents, and adults with ODD.
•Behaviour therapists encourage children andadolescents to try new behaviours and not to allowunwanted reinforcement to dictate the ways inwhich they act.•Family therapy may be used to help improvefamily interactions and communication amongfamily members.
•A specialized therapy technique called parentmanagement training (PMT) teaches parents waysto positively alter their childs behaviour.•Behaviour management plans also often involvedeveloping contracts between parent and child thatidentify rewards for positive behaviours andconsequences (punishments) for negativebehaviours.