Description about conduct disorder on basis of ICD 11.

1. Conduct Disorder
By,
Dr. Tesita Sherry

2. Contents
• Introduction
• Diagnostic criteria
• Prevalence
• Co-morbidity
• DD
• Etiology
• Prognosis
• Management

3. Introduction
• The essential features of Conduct Disorder
(CD) involve "a repetitive and persistent pattern
of behavior in which the basic rights of others or
major age-appropriate societal norms or rules
are violated“, resulting in a clinically significant
impairment in functioning.
• This includes
▫ Aggressive behaviors,
▫ Behaviors that result in property loss or
damage,
▫ Deceitfulness or theft,
▫ Other serious rule violations (e.g., running
away from home, truancy).

4. ICD-11 Diagnostic criteria
(6C91) Conduct-dissocial disorder
➢6C91.0 Conduct-dissocial disorder, childhood
onset
➢6C91.1 Conduct-dissocial disorder, adolescent
onset

5. Conduct-dissocial disorder
1. Aggression towards people or animals; destruction of
property; deceitfulness or theft; and serious violations
of rules.
2. The behaviour pattern is of sufficient severity to result
in significant impairment in personal, family, social,
educational, occupational or other important areas of
functioning.
3. To be diagnosed, the behaviour pattern must be
enduring over a significant period of time (e.g., 12
months or more).
4. Isolated dissocial or criminal acts are thus not in
themselves grounds for the diagnosis.

6. Conduct-dissocial disorder
• Conduct-dissocial disorder, childhood onset :-
Features of the disorder must be present during
childhood prior to adolescence (e.g., before 10
years of age) and the behaviour pattern must be
enduring over a significant period of time (e.g.,
12 months or more).

7. Conduct-dissocial disorder
• Conduct-dissocial disorder, adolescent onset:-
No features of the disorder are present during
childhood prior to adolescence (e.g., before 10
years of age). To be diagnosed, the behaviour
pattern must be enduring over a significant
period of time (e.g., 12 months or more).

8. Prevalence
• Most often diagnosed in boys but may be as
prevalent in girls
▫ Boys
 4 to 16%
▫ Girls
 1.2 to 9%
• Prevalence higher in lower socioeconomic
groups.

9. Co-morbidity
• ADHD
• Learning disabilities
• Substance abuse
• Anxiety
• Depression
• Psychosis

10. Differential diagnosis:
• ADHD:- Hyperactivity, inattention, impulsivity
ADHD do not show any of the specific
…………..behaviors with CD
• Mood Disorder:- Depression can occur with
………………………..irritability.
• Oppositional Defiant disorder(ODD) behaviors do not
meet criteria for CD (especially extreme physical
aggressiveness) but child displays pattern of defiant
behavior
▫ Argumentative, loses temper, lack of compliance, deliberately
aggravates others, hostile, vindictive, spiteful, or touchy,
blames others for own problems

11. Etiology
• Genetic factors
▫ 50%. Positive family history
• Parental factors
▫ Harsh and inconsistent parenting
▫ Lack of parental monitoring
▫ Substance abuse in parents
▫ Modeling and reinforcement of aggressive behavior

12. Etiology
• Psychological factors
▫ Deficient moral development, especially lack of
remorse
▫ Poor emotion regulation.
• Socio-cultural factors
▫ Poverty
▫ High crime neighborhood
▫ High unemployment
• Child Abuse and Maltreatment.

13. Prognosis
• In general, the literature suggests that
▫ Children who develop conduct disordered behavior
later in childhood have a somewhat better prognosis.
▫ The severity and variety of early antisocial behavior is
a powerful predictor of serious antisocial behavior in
adulthood.
▫ The prognosis may be worse for those who also have
co-morbid disorders.

14. Prognosis
• Robins, et al. (1991) found that 71% of children
who displayed severe conduct disorder (eight or
more symptoms) at age 6 showed evidence of
antisocial personality disorder in adulthood.
• 53 % of children whose symptoms began
between the ages of 6 and 12 displayed
antisocial personality disorder in adulthood.
• 48 % of those who developed symptoms after
age 12 showed evidence of this disorder as
adults.

15. What is Antisocial Personality Disorder?
• “Pervasive pattern of disregard for, and violation
of, the rights of others that begins in childhood
or early adolescence and continues into
adulthood.”
• For diagnosis, must have a history of some
Conduct Disorder symptoms before age 15.
• Not actually diagnosed prior to age 18.

16. Management
• Psychosocial Interventions:-
• 1st line of treatment.
• Fast track preventive intervention:- 10yr
preventive program
• Problem solving skills training:- 12 weeks
program.
• Multisystemic therapy:-

17. Psychopharmacological Interventions
• Anti-Psychotics:
▫ Haloperidol, Risperidone, Quetiapine,
Olanzapine, Aripiprazole for aggressive behaviour.
• SSRI’s:
▫ Fluoxetine, sertraline etc for impulsivity,
irritability and mood lability.
• Co-existing condition must be addressed.

18. Thank you