CONDUCT DISORDER

Management of patient with Conduct Disorder

1. PREPARED BY MRS. DIVYA PANCHOLI ASSISTANT PROFESSOR, SSRCN, VAPI Mrs. Divya Pancholi 1

2. INTRODUCTION Conduct disorder is characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas. Mrs. Divya Pancholi 2

3. DEFINITION A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social norms or rules are violated. Mrs. Divya Pancholi 3

4. INCIDENCE Conduct disorder affects 1 to 4 percent of 9- to 17-year-olds. More common in boys than in girls. More common in cities than in rural areas. The rate among boys in the general population ranges from 6% to 16% while the rate among girls ranges from 2% to 9%. Mrs. Divya Pancholi 4

5. TYPE Mrs. Divya Pancholi 5

6. ETIOLOGY Biological influences Genetics temperament Biochemical factors Mrs. Divya Pancholi 6

7. Psychosocial influences Parental rejection Inconsistent management with harsh discipline Frequent shifting of parental figures Large family size Absent father Mrs. Divya Pancholi 7

8. CONTI.. Parents with antisocial personality disorder or alcohol dependence Marital conflict & divorce in parents Associations with delinquent subgroups Inadequate communication pattern within family Mrs. Divya Pancholi 8

9. Mrs. Divya Pancholi 9

10. Aggression to people and animals Bullies, threatens, or intimidates others Physical fights Use of weapons Deliberate property destruction Mrs. Divya Pancholi 10

11. Forced sexual activity Cruelty to people or animals Fire setting Vandalism Mrs. Divya Pancholi 11

12. Deceitfulness and theft Lying Shoplifting Mrs. Divya Pancholi 12

13. Breaking into house, building, or car Cons others to avoid responsibility Serious violation of rules Mrs. Divya Pancholi 13

14. Stays out overnight without parental consent Runs away from home overnight Truancy from school Mrs. Divya Pancholi 14

15. The diagnostic criteria for Conduct Disorder (DSM-5) A. repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months , with at least one criterion present in the past 6 months. Aggression to people and animals Destruction of property Deceitfulness or theft Serious violations of rules Mrs. Divya Pancholi 15

16. CONTI.. 1. Aggression to people and animals a. Often bullies, threatens, or intimidates others. b. Often initiates physical fights. c. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) d. Has been physically cruel to people. e. Has been physically cruel to animals. f. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). g. Has forced someone into sexual activity. 2. Destruction of property a. Has deliberately engaged in fire setting with the intention of causing serious damage. b. Has deliberately destroyed others’ property (other than by fire setting). Mrs. Divya Pancholi 16

17. 3 . Deceitfulness or theft a. Has broken into someone else’s house, building, or car. b. Often lies to obtain goods or favours or to avoid obligations (i.e., “cons” others). c. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). 4. Serious violations of rules a. Often stays out at night despite parental prohibitions, beginning before age 13 years. b. Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period). c. Is often truant from school, beginning before age 13 years. Mrs. Divya Pancholi 17

18. CONTI.. B. The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.  C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder. Mrs. Divya Pancholi 18

19. NURSING DIAGNOSIS Risk for violence related to peer rejection and dysfunctional family dynamics.   Impaired social interaction related to impaired peer relations leading to inappropriate social behavior. Defensive coping related to low self esteem and dysfunctional family system. Low self esteem related to unsatisfactory parent/child relationship. Mrs. Divya Pancholi 19

20. PHARMACOLOGICAL INTERVENTIONS Commonly used when comorbidity exists (ADHD, mood disorders) Used in combination with other treatments Treats specific symptoms: Stimulants (aggression) Anti-convulsants (rage and temper outbursts) Lithium (aggression) Clonidine (over-arousal) Neuroleptics and Atypical Antipsychotics (severe CD) Mrs. Divya Pancholi 20

21. TREATMENT Limit Television Limit all media use to no more than 1 to 2 hours per day. Monitor their children's use of the media. Co view television with their children. Eliminate or reduce video and Computer games   Mrs. Divya Pancholi 21

22. CONTI………… School-Based Treatment Programs A safe community Family Therapy Social Skills Training Cognitive-Behavioral Therapy Mrs. Divya Pancholi 22

23. INTERVENTIONS FOR CONDUCT DISORDER Decreasing violence and increasing compliance with treatment Protect others from client’s aggression and manipulation. Set limits for unacceptable behavior. Provide consistency with client’s treatment plan. Use behavioral contracts. Institute time-out. Provide a routine schedule of daily activities. Improving coping skills and self-esteem Show acceptance of the person, not necessarily the behavior. Encourage the client to keep a diary. Teach and practice problem-solving skills. Promoting social interaction Teach age-appropriate social skills. Role-model and practice social skills. Provide positive feedback for acceptable behavior. Providing client and family education Mrs. Divya Pancholi 23

24. CLIENT/FAMILY TEACHING FOR CONDUCT DISORDER Teach parents social and problem-solving skills when needed. Encourage parents to seek treatment for their own problems. Help parents to identify age-appropriate activities and expectations. Assist parents with direct, clear communication. Help parents to avoid “rescuing” the client. Mrs. Divya Pancholi 24

25. Different Types of Treatment School-Based Intervention Strategies Specialized Programming: Classroom Level Specialized Programming: Comprehensive Strategies Mrs. Divya Pancholi 25

26. CONTI… Interventions to Promote Prosocial Skills Parent Management Training Contingency Management Programs Cognitive Problem-Solving Skills Training Functional Family Therapy Group Therapy Psychopharmacologic Interventions Multidimensional Interventions Multisystemic Therapy Families and Schools Together (FAST TRACK) Mrs. Divya Pancholi 26

27. WHAT SCHOOLS CAN DO With a 504 plan or a behavioral plan, accommodations can be made for students with CD Specialized Programming: Classroom Level Create a structured, predictable environment Instruction should be consistent and methodical Sufficiently staffed environment Material should be presented in: Consistent manner Systematic instructional routines Cumulative manner Mrs. Divya Pancholi 27

28. SPECIALIZED PROGRAMMING: COMPREHENSIVE STRATEGIES Student-Focused Approaches Teachers and mental health professionals address mental and social processes that affect behavior Examples of interventions: modeling, role-play, immediate positive reinforcement of target behaviors Parent-Focused Approaches Parents can recognize influences at home that are affecting the child’s behaviors Examples of interventions: coaching, prompting, feedback, graduated homework assignments Mrs. Divya Pancholi 28

29. School-Focused Approaches Through instruction, teachers need to create a balance in the classroom between the needs of specific children and the rest of the classroom Examples of interventions: smooth transitions, being consistent and direct with praise and redirection, clear classroom rules stated first day of class and emphasize throughout the year, social skills curriculum, teamwork curriculum Mrs. Divya Pancholi 29

30. Parent Management Training Parents are trained to use specific procedures in the home: 1. Improve parent-child interactions warmth and responsiveness 2. Promote pro-social behaviors reinforcement of desirable behaviors 3. Discourage negative behaviors structured home environment clear rules and expectations consistent discipline Mrs. Divya Pancholi 30

31. CONTI… Functional Family Therapy Focus on making changes within the family system Improve communication skills and family interactions Cognitive Problem-Solving Skills Training Focus on improving child’s social skills using problem-solving techniques Self-statements Multiple solutions Understanding others’ perspectives Group Therapy Focus on development of interpersonal skills Interaction with positive peer role models Mrs. Divya Pancholi 31

32. You can refer following link also https://youtu.be/XH46Nm1QOcg https://www.youtube.com/watch?v=gVILmwjLEAA https://www.youtube.com/watch?v=EUCIKfNINYU Mrs. Divya Pancholi 32

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