1.
Conduct Disorder
K. Kavindya M. Fernando
JMJ 1

2.
F90-F99 : Behavioural & emotional
disorders with onset usually
occurring in childhood & adolescent
• F91 – Conduct disorders
JMJ 2
F91.0 Conduct disorder confined to the family
context
F91.1 Unsocialized conduct disorder
F91.2 Socialized conduct disorder
F91.3 Oppositional defiant disorder
F90.8 Other conduct disorders
F90.9 Conduct disorder, unspecified

3.
Contents
• Introduction
• Classification
• Diagnostic criteria
• Prevalence
• Co-morbidity
• DD
• Etiology
• Risk factors
• Prognosis
• Management
JMJ 3

4.
Classification
Distruptive
behavioural
disorder
Oppositional
defense
disorder (ODD)
Conduct
disorder (CD)
JMJ 4

5.
Classification
Oppositional defense disorder
(ODD)
Conduct disorder (CD)
• Recurrent pattern of
negativistic, defiant,
disobedient & hostile behavior
towards authority figures
* Persitent patern of antisocial
behavior in which the individual
repeatedly breaks social rules &
carries out aggressive acts
• Majority do not progress into
more serious psychopathology or
psychopathology
JMJ 5

6.
Diagnostic criteria of ODD
Criterion Examples
A pattern of negativistic, hostile
and defiant behavior for at least 6
months:
including at least 4 of the
following behavioural
• Often loses temper
• Often argues with adults
• Often defies or refuses to
comply with rules or requests
• Deliberately annoys people
• Blames others for their own
behavior
• Is easily annoyed or ‘touchy’
• Is angry and resentful
• Often spiteful and vindictive
JMJ 6

7.
Diagnostic Criteria of ODD
Criterion Examples
The behavior causes significant
impairment in functioning :
• Home , school, work
None of the following are present 1. Behaviour only occurring during
an episode of depression or
psychosis
2. Criteria are met for conduct
disorder
3. Criteria are met for antisocial
personality disorder (>18 years
only)
JMJ 7

8.
Diagnostic Criteria of
Conduct disorder
JMJ 8
• (A) a repetitive and persistent pattern of
behaviour
• In which the basic rights of others or
societal norms or rules are violated
• (B) at least 3 of the following criteria have
been present in the last 12 months, with at
least 1 present in the last 6 months

9.
Diagnostic Criteria of
Conduct disorder
JMJ 9
• 1. aggression to people and animal
• Often bullies, threatens or intimidates others
• Often initiated physical fights
• Has used a weapon
• Has been physically cruel to people
• Has been physically cruel to animals
• Has stolen while confronting a victim
• Has forced someone into sexual activity

10.
Diagnostic Criteria of
Conduct disorder
JMJ 10
• 2. Destruction of property and/or threat
• Has deliberately engaged in fire setting
• Has deliberately destroyed other’s property
• Has broken into someone else’s property
• Often lies to obtain goods or avoid obligations
• Has stolen items of non-trivial value

11.
Diagnostic Criteria of
Conduct disorder
JMJ 11
• 3. Serious violation of rules
• Often stays out at night despite parental
prohibitions
• Has run away from home overnight
• Is often truant from school, beginning before 13
years

12.
Diagnostic Criteria of
Conduct disorder
JMJ 12
• (C) the disturbance in behaviour causes
clinically significant impairment in social,
academic, or occupational functioning
• ( D) id over 18 years, criteria are not met
for antisocial personality disorder

13.
Prevalence
• ODD
• 3 -16% under 16s
• Conduct disorder
• 3-16% under 16s
• ODD- usually occur before 8 years, no later
than adolescence
• CD – diagnosed from 10-15 years
• Prevalence higher in lower socioeconomic groups
JMJ 13

14.
Co-morbidity
• ADHD
• Learning disabilities
• Substance abuse
• PTSD
• Anxiety disorders
• Depression
• Psychosis
JMJ 14

15.
DD
ADHD - Hyperactivity, inattention, impulsivity
- ADHD do not show any of the specific
behaviours associated with ODD and CD
Mood disorders - Depression can occur with irritability &
oppositional behavior in children
Autistic spectrum
disorders
Learning disorders or
specific developmental
disorders
Disocial/antisocial
personality disorder
Psychosis
JMJ 15

16.
Aetiology
• Genetics –
• 50%, positive family Hx, (MAO leads for this
aggressive behavior)
• Psychological risks –
• Early experiences – neglect, abuse, poor parenting,
exposure to violence
• Over punishing children
• Vicious cycle which negatively reinforces the child’s
behavior
• Environmental factors –
• poverty, high crime neighbourhood, high
unemployment
JMJ 16

17.
Risk factors for disruptive
behavioural disorders
• Biological
• Genetics : family hx of CD/ODD and twin studies
• Dysregulation of neurotransmittors
• Low IQ
• Language disorders or deficits
• Minor physical anomalies
• Low birth weight
• Brain injury or disease
• Low resting heart rate
JMJ 17

18.
Risk factors for disruptive
behavioural disorders
• Psychological
• Irritable temperament as a baby
• Institutional care
• Poor-parent-child relationship
• Attachment difficulties
• Poor parenting; inconsistentent rule setting,
criticism or hostility
• Low parental involvement with child
• Physical, sexual, or emotional abuse
• Neglect
• Low self-esteem
• ‘unemotional’ personality trait
JMJ 18

19.
Risk factors for disruptive
behavioural disorders
• Social and Environment
• Maternal smoking in pregnancy
• Low socio-economic class
• Poor diet with lack of vitamins & minerals
• Bad neighbourhood
• Crime in the family
• Parental mental illness or substance abuse
• Peer influences ; associates with other children
with ODD/CD
JMJ 19

20.
Couse and prognosis
• Once ODD and CD established
• Usually stable throughout the rest of childhood
• Of those with early onset CD (before 8 yrs)
• 50% of them will be antisocial personality
disorder in childhood
JMJ 20

21.
Assessment and management
• General measures
• Pharmacotherapy
• Psychological treatments
JMJ 21

22.
General measures
• The child usually does not feel that their
behavior is unreasonable, and will resist the
interventions
• Provide written and self-help materials, but
only if they can read
JMJ 22

23.
Pharmacotherapy
• Medication should not be the 1st line Tx for
ODD and CD
• Use stimulants
• SSRI decreases symptoms in children with
co-morbid ADHD or depression
• Atypical antipsychotics can be used
• Compliance is a problem
JMJ 23

24.
Psychological treatment
• 1st line treatment
• Children under 12
• Good efficiency of parental training courses
• Skill learnt include
• Promoting good behavior & a positive relationship
• Setting clear rules & commands
• Remaining calm
• Managing difficult situations
• Systematic family therapy
• Good for older children
JMJ 24

25.
Risk factors predicting a
poor outcome in ODD and CD
• Male gender
• Lower IQ
• Parental alcoholism
• Low-income family
• Poor schools, low achievements
• Severe, frequent antisocial acts
• Co-morbid hypersensitivity
• Parental criminality
• Harsh, inconsistent parenting
• Troublesome neighbourhood
• Lack of parental interest in child
• Early onset
JMJ 25

26.
JMJ 26

27.
JMJ 27