This document discusses conduct disorder, which is a repetitive pattern of behavior in which a child or adolescent violates the rights of others or social norms. There are two subtypes based on age of onset - childhood onset before age 10 which is more common in boys and associated with aggression, and adolescent onset after age 10 which is less aggressive. Risk factors include genetic, biological, psychosocial, and environmental factors. Symptoms involve aggression, defiance, lying, cruelty, theft, and truancy. Treatment involves pharmacotherapy, psychotherapy, parental guidance, behavior modification, and potentially juvenile justice involvement. Nursing diagnoses related to conduct disorder include risk for violence, impaired social interactions, defensive coping, and low self-esteem.

1. CONDUCTCONDUCT
DISORDERDISORDER

2. CONDUCTCONDUCT
Conduct of the child is theConduct of the child is the
behavior of the total individual asbehavior of the total individual as
expressed in psychological asexpressed in psychological as
well as physical activitywell as physical activity

3. CONDUCT DISORDERCONDUCT DISORDER
Conduct disorder is a repetitiveConduct disorder is a repetitive
and persistent pattern of behaviorand persistent pattern of behavior
in which the basic rights of othersin which the basic rights of others
or major age-appropriate societalor major age-appropriate societal
norms or rules are violated (APA,norms or rules are violated (APA,
2000)2000)

4. Commonly seen on olderCommonly seen on older
children and adolescents.children and adolescents.
Onset is before 18 yearsOnset is before 18 years
before(puberty)before(puberty)
Common in boysCommon in boys

5. TYPETYPE
TheThe DSM-IV-TR divides this disorder into twoDSM-IV-TR divides this disorder into two
subtypes based on the age at onset:subtypes based on the age at onset:
 Childhood-Onset TypeChildhood-Onset Type. This subtype is. This subtype is
defineddefined by the onset of at least one criterionby the onset of at least one criterion
characteristic of conduct disorder prior to agecharacteristic of conduct disorder prior to age
10.10.
 Individuals with this subtype are usually boys,Individuals with this subtype are usually boys,
frequently display physical aggression, andfrequently display physical aggression, and
have disturbed peer relationships.have disturbed peer relationships.

6.  Adolescent-Onset Type.Adolescent-Onset Type. This subtype isThis subtype is
defineddefined by the absence of any criteriaby the absence of any criteria
characteristic of conduct disorder before age 10characteristic of conduct disorder before age 10
years.years.
 They are less aggressive and tend to have moreThey are less aggressive and tend to have more
normal peer relationships than those withnormal peer relationships than those with
childhood-onset type.childhood-onset type.
 They are also less likely to have persistentThey are also less likely to have persistent
conduct disorder or develop antisocial personalityconduct disorder or develop antisocial personality
disorder than those with childhood- onset type.disorder than those with childhood- onset type.
The ratio of boys to girls is almost sameThe ratio of boys to girls is almost same

7. ETIOLOGYETIOLOGY
 GENETIC FACTORGENETIC FACTOR
 Monozygotic and dizygotic twinsMonozygotic and dizygotic twins
 Alcoholism and personality disorder of fatherAlcoholism and personality disorder of father
 Chromosomes 19 and 2 may contain genesChromosomes 19 and 2 may contain genes
conferring risk to conduct disorderconferring risk to conduct disorder
 Biochemical FactorsBiochemical Factors
 Alterations in the neurotransmitters nor epi-Alterations in the neurotransmitters nor epi-
nephrine and serotoninnephrine and serotonin
 Plasma Testosterone level is associated withPlasma Testosterone level is associated with
violence.violence.

8.  Organic factorsOrganic factors
 Children with brain damage and epilepsy are more prone.Children with brain damage and epilepsy are more prone.
 Psychosocial factorsPsychosocial factors
 Poor Peer relationPoor Peer relation
 Peer rejection- aggressionPeer rejection- aggression
 Child abuseChild abuse
 Family influencesFamily influences
 Parental rejectionParental rejection
 Inconsistent management with harsh disciplineInconsistent management with harsh discipline
 Early institutional livingEarly institutional living Frequent shifting of parentalFrequent shifting of parental
figuresfigures
 Large family sizeLarge family size

9.  Absent fatherAbsent father
 Parents with antisocial personality disorder and/orParents with antisocial personality disorder and/or
alcohol dependencealcohol dependence
 Marital conflict and divorceMarital conflict and divorce
 Inadequate communication patternsInadequate communication patterns
 Parental permissivenessParental permissiveness
 Broken familyBroken family
 Social problemSocial problem
 PovertyPoverty
 OvercrowdingOvercrowding
 UnemploymentUnemployment
 Poor housingPoor housing

10. Clinical manifestationClinical manifestation
 Unusually frequent or severe temper tantrumsUnusually frequent or severe temper tantrums
for the child's developmental level.for the child's developmental level.
 Often argues with adults.Often argues with adults.
 Often actively defies or refuses adults' requestsOften actively defies or refuses adults' requests
or rules.or rules.
 Often, apparently deliberately, does things thatOften, apparently deliberately, does things that
annoy other people.annoy other people.
 Often blames others for one's own mistakes orOften blames others for one's own mistakes or
mis-behaviour.-mis-behaviour.-

11.  Often touchy or easily annoyed by others.Often touchy or easily annoyed by others.
 Often angry or resentful.Often angry or resentful.
 Often spiteful or vindictive.Often spiteful or vindictive.
 Frequent and marked lying (except to avoidFrequent and marked lying (except to avoid
abusive treatment).abusive treatment).
 Excessive fighting with other children, withExcessive fighting with other children, with
frequent initiation of fightsfrequent initiation of fights
 Uses a weapon that can cause serious physicalUses a weapon that can cause serious physical
harm to othersharm to others

12.  Often stays out after dark without permissionOften stays out after dark without permission
(beginning before 13 years of age).(beginning before 13 years of age).
 Physical cruelty to other people (e.g. ties up,Physical cruelty to other people (e.g. ties up,
cuts or burns a victim).cuts or burns a victim).
 Physical cruelty to animalsPhysical cruelty to animals
 Deliberate destruction of others' propertyDeliberate destruction of others' property
 Deliberate fire-setting with a risk or intentionDeliberate fire-setting with a risk or intention
of causing serious damage.of causing serious damage.
 Stealing of objects of valueStealing of objects of value

13.  Frequent truancy from school beginningFrequent truancy from school beginning
before 13 years of age.before 13 years of age.
 Running away from home (unless this was toRunning away from home (unless this was to
avoid physical or sexual abuse).avoid physical or sexual abuse).
 Any episode of crime involving confrontationAny episode of crime involving confrontation
with a victimwith a victim
 Forcing another person into sexual activityForcing another person into sexual activity
against their wishes.against their wishes.
 Frequent bullying or threatening of othersFrequent bullying or threatening of others
 Breaks into someone else's house, building orBreaks into someone else's house, building or
car.car.

14. TreatmentTreatment
 PharmacotherapyPharmacotherapy
 Psycho-stimulantPsycho-stimulant
AmphetamineAmphetamine
MethylphenidateMethylphenidate
 Mood stabilizerMood stabilizer
Lithium, valporic acid, carbamazepineLithium, valporic acid, carbamazepine
 Anti psychoticsAnti psychotics
Haloperidol and chlorpromazineHaloperidol and chlorpromazine
 Adrenergic agentAdrenergic agent
Propranolol, metaorolalPropranolol, metaorolal

15.  Psycho therapiesPsycho therapies
 Corrective institutionsCorrective institutions
 Parental guidanceParental guidance
 Parent management trainingParent management training
 Problem solving skill trainingProblem solving skill training
 General relationship therapyGeneral relationship therapy
 Behavior modification techniqueBehavior modification technique
 Special schoolSpecial school
 Cognitive therapyCognitive therapy
 Juvenile justice system if need.Juvenile justice system if need.

16. Nursing diagnosisNursing diagnosis
 Risk for other-directed violence related to characteristicsRisk for other-directed violence related to characteristics
of temperament, peer rejection, negative parental roleof temperament, peer rejection, negative parental role
models, dysfunctional family dynamicsmodels, dysfunctional family dynamics
 Impaired social interaction related to negative parentalImpaired social interaction related to negative parental
role models, impaired peer relationships leading torole models, impaired peer relationships leading to
inappropriate social behaviorsinappropriate social behaviors
 Defensive coping related to low self-esteem andDefensive coping related to low self-esteem and
dysfunctional family systemdysfunctional family system
 Low self-esteem related to lack of positive feedbackLow self-esteem related to lack of positive feedback
 and unsatisfactory parent–child relaand unsatisfactory parent–child relationshiptionship

17.  RISK FOR OTHER-DIRECTEDRISK FOR OTHER-DIRECTED
VIOLENCEVIOLENCE
 Observe client’s behavior frequently through routineObserve client’s behavior frequently through routine
activities and interactions. Become aware of behaviorsactivities and interactions. Become aware of behaviors
that indicate a rise in agitation.that indicate a rise in agitation.
 Redirect violent behavior with physical outlets forRedirect violent behavior with physical outlets for
suppressed anger and frustration.suppressed anger and frustration.
 3. Encourage client to express anger and act as a role3. Encourage client to express anger and act as a role
model for appropriate expression of anger.model for appropriate expression of anger.
 4. Ensure that a sufficient number of staff is available to4. Ensure that a sufficient number of staff is available to
indicate a show of strength if necessary.indicate a show of strength if necessary.
 5. Administer tranquilizing medication5. Administer tranquilizing medication

18.  IMPAIRED SOCIAL INTERACTIONIMPAIRED SOCIAL INTERACTION
 Develop a trusting relationship with the client.Develop a trusting relationship with the client.
 Convey acceptance of the person separate fromConvey acceptance of the person separate from
the unacceptable behavior.the unacceptable behavior.
 Discuss with client which behaviors are and areDiscuss with client which behaviors are and are
not acceptable.not acceptable.
 Describe in matter-of-fact manner theDescribe in matter-of-fact manner the
consequence of unacceptable behavior. Followconsequence of unacceptable behavior. Follow
through.through.
 Provide group situations for client.Provide group situations for client.

19.  DEFENSIVE COPINGDEFENSIVE COPING
 Explain to client the correlation between feelings ofExplain to client the correlation between feelings of
inadequacy and the need for acceptance from othersinadequacy and the need for acceptance from others
and how these feelings provoke defensive behaviors,and how these feelings provoke defensive behaviors,
such as blaming others for own behaviors.such as blaming others for own behaviors.
 Provide immediate, matter-of-fact, nonthreateningProvide immediate, matter-of-fact, nonthreatening
feedback for unacceptable behaviors.feedback for unacceptable behaviors.
 Help identify situations that provoke defensivenessHelp identify situations that provoke defensiveness
and practice through role-play more appropriateand practice through role-play more appropriate
responses.responses.
 4. Provide immediate positive feedback for4. Provide immediate positive feedback for
acceptable behaviorsacceptable behaviors

20.  LOW SELF-ESTEEMLOW SELF-ESTEEM
 Ensure that goals are realistic.Ensure that goals are realistic.
 Plan activities that provide opportunities for success.Plan activities that provide opportunities for success.
 Convey unconditional acceptance and positive regard.Convey unconditional acceptance and positive regard.
 Set limits on manipulative behavior. Take caution not toSet limits on manipulative behavior. Take caution not to
reinforce manipulative behaviors by providing desiredreinforce manipulative behaviors by providing desired
attention. Identify the consequences of manipulation.attention. Identify the consequences of manipulation.
administer consequences matter-of-factly whenadminister consequences matter-of-factly when
manipulation occurs.manipulation occurs.
 Help client understand that he or she uses this behaviorHelp client understand that he or she uses this behavior
in order to try to increase own self-esteem.in order to try to increase own self-esteem.
 Interventions should reflect other actions to accomplishInterventions should reflect other actions to accomplish
this goalthis goal