The young rebel without a cause
Adolescence - Juvenile disorder - (applicable to anti - social disorder in later life)
Conduct disorder is something that develops during childhood into adolescence.
In its earlier stages (age 10 or below) or in very young children with very mild symptoms it is known as Oppositional defiant disorder however if those symptoms and defiant behaviours persist or increase in severity it becomes conduct disorder.
It is typically diagnosed before the age of 15, however if the individual is age 18 years or older with similar deviant behaviours, but does not meet the criteria for anti-social personality disorder they may get a referred diagnosis of conduct disorder.
Symptoms of behaviour have to be persistent and reoccurring over a prolonged span of time. Initially to be observed over 3 - 6 months. The behaviour either staying at an average rate of occurrence (weekly basis) or becoming more frequent and progressively worse in nature, before a child can be diagnosed with this.
The severity can vary from child to child some with very extreme behaviours that put them and others at significant risk, others with frequent but milder deviant behaviours that impact their lives and the lives of others negatively, preventing a child from being productive and leaving them unable to function within the norms of society.
The DSM-5 defines Conduct disorder as being characterised by behaviour "that violates either the rights of others or major societal norms. These symptoms must be present for at least three months with one symptom having been present in the past six months. To be diagnosed with conduct disorder, the symptoms must cause significant impairment in social, academic or occupational functioning." (DSM-5, 2013)
The Severity Indicator
There are 3 different stages of classification based on the types of behaviour the young person will display over a number of social settings.
The severity indicator (Mild, Moderate, Severe) allows for Psychiatrists to treat the disorder effectively. This avoids a shoe fits all approach when considering what would be needed to help the child learn to function as normally as possible, whilst also teaching them tools to help them cope day to day. Thus allowing for a treatment program that is designed more around the individuals specific needs rather than around a set criteria.
Mild - This would be a child who meets the most basic criteria for this diagnosis.
Requiring 1 symptom to be consistently present for at least 6 months along with at least 1 or more symptoms that occur on a frequent (weekly/bi-weekly) basis.
Examples of behaviours that would qualify as mild Conduct disorder would be things such as; answering back/ argumentative; ignoring curfews; lying; disregard of rules or authority in general.
Moderate - This meets somewhere in the middle where regular behavioural problems (weekly/bi-weekly) will occur of a serious nature along with some of the milder behaviours. The more serious behaviours in this category would include things such as robbery without victim confrontation or destruction of property. Some of the milder type symptoms would include things like lying, truancy or a general disregard for rules/social expectations.
Severe - Excessive behavioural problems that are present on a daily basis that have been present at least 3-6 months.
The child will have multiple symptom criteria, these behaviours are extreme, defiant, destructive and manipulative. They put the child and others at significant risk of danger or harm.
Behaviour examples of a severe case would be assault, sexual deviancy, destruction of property, brandishing weapons, aggravated robbery, harming animals, breaking and entering.
The severe category of this disorder is also characterised by the childs reactive and emotional responses to their behaviours, for example they display little or no remorse for the things they do. They have no urgency in trying to understand the feelings of others and will show no compassion in their daily life.
"applies to those individuals with a more serious pattern of behavior characterized by a callous and unemotional interpersonal style across multiple settings and relationships.
The specifier goes beyond the presence of negative behavior and reflects an individual’s typical patterns in emotional and interpersonal functioning." (2013) DSM -5
The Criteria
The criteria to be met in order to get a diagnosis of conduct disorder consists of 3 sections A, B & C.
A - regarding the specifics of the behaviour which is broken down into 3 subsets - Aggression to People and Animals; Destruction of Property and Serious Violations of Rules.
B - Evidence that the disorder in behaviour is significantly impairing social, academic, or occupational functioning of the individual, preventing them from being able to function well in society and meet expected norms of behaviour. This could be things like a criminal record of petty crimes such as vandalism or theft, problems applying themselves in school resulting in exclusion, being aggressive and argumentative at home.
C - In regard to age the child is typically diagnosed before the age of 15 up to the age of 18, unless the individual is age 18 years or older, and does not meet the criteria for antisocial personality disorder.
Behaviour criteria set out in section A is listed below.
At least three of the following 15 behaviour criteria must be present for a span of at least 12 months from any of the categories below.
One of those 3 must of been frequently (weekly/bi-weekly) observed as continually present behaviours over the span of 6 months:
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., a bat, 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.
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). 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).
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 the parental or parental surrogate home, or once without returning for a lengthy period.
15. Is often truant from school, beginning before age 13 years.
The emotional implications
Those who have conduct disorder do not regulate their emotions in the same way a person without conduct disorder could. This is another good indicator when considering a diagnosis.
Someone with conduct disorder would have a number of undesirable emotional and communicative traits that go alongside their physical behaviours such as lack of remorse, callousness, and verbal or emotional manipulation. They can come across as uncaring, shallow, self centred or emotionless.
They are seemingly able to switch their emotions on and off especially if it is for personal gain.
The motivations and drives to succeed will also be affected, they won't be focused on achieving set goals at school, bad grades won't bother them. They have no motivation to apply themselves and won't follow instructions well to complete tasks. They will put in little effort regardless of the expectation put onto them.
They won't be held accountable for their actions and will often deny responsibility for the things they do. Generally blaming others for their choices, or using others behaviours as a reason why they had to act the way they did.
Long term implications
Those with this disorder can find ways of managing their behaviours long term effectively, with the help of good support systems at home, school and with the help of mental health professionals.
This is done using a variety of therapeutic and counselling techniques which are put in place based on the individuals needs.
These could be things like attending sessions for cognitive behavioural therapy, taking anger management sessions, talking to a counsellor about everyday tasks and finding coping strategies.
Research has shown that the earlier these problems start, the higher the risk is for the young person to be involved with violence and criminal acts later on in life. Dealing with these issues sooner rather than later can really help a person to manage themselves and be aware how their actions impact others.
Many children who suffer with this disorder will be seen to others including their peers as a problem child, naughty, bad etc this can impact their self esteem and confidence greatly, they can become more socially withdrawn, and have great difficulty in making and maintaining social friendships (outside of their family) therefore it is important that the child feels supported and stable while they learn to manage their behaviours. It is vital that they feel understood and listened to, this will keep them encouraged to engage in things like therapy and behaviour management.
As they go onto to become a young adult their chances of being able to live a normal life will increase with the right support and treatment in place, helping them to go on to live a relatively normal life.
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
Conduct Disorder.American Academy of Children and Adolescent Psychiatry. No 33. Updated June 2018.
Royal College of Psychiatrists. (2020). Behavioural problems and conduct disorder for parents carers and anyone who works with young people - https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/behavioural-problems-and-conduct-disorder-for-parents-carers-and-anyone-who-works-with-young-people
Hopkins, J. (2018).Conduct Disorder in Children.Johns Hopkins Medicine.
Loeber, R., & Stouthamer-Loeber, M. (1998). Development of juvenile aggression and violence: Some common misconceptions and controversies. American Psychologist, 53(2), 242–259. https://doi.org/10.1037/0003-066X.53.2.242
Benjamin B. Lahey, Ph.D. et al.(1994) DSM-IV Field Trials for Oppositional Defiant Disorder and Conduct Disorder in Children and Adolescents. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.458.9053&rep=rep1&type=pdf
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