Conduct disorder lecture.pptx

emotional problems in youngsters.
•Conduct disorder usually happens between the ages of 6 and 15.
•factors contributing to development of conduct disorder
•brain damage
•child abuse or neglect
•genetic vulnerability
• school failure
• traumatic life experiences.

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Changes from DSM-IV to DSM-V
•The chapter on “Disruptive, impulse-control, and conduct disorders” is new to DSM-5.
•It brings together disorders that were previously included in the chapter “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence”.

1. Conduct Disorder Introduction

2. What is conduct disorder ? Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Conduct disorder usually happens between the ages of 6 and 15. factors contributing to development of conduct disorder brain damage child abuse or neglect genetic vulnerability school failure traumatic life experiences.

3. Changes from DSM-IV to DSM-V The chapter on “Disruptive, impulse-control, and conduct disorders” is new to DSM-5. It brings together disorders that were previously included in the chapter “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence”.

4. What is normal behavior ? It’s normal for children and youth to act out from time to time. They may seem grumpy or angry and act out more than usual when they’re tired, upset or feeling a lot of stress. Preschool-aged children and teens in particular may seem keen to disobey or talk back. This is a normal part of growing up.

5. When does it become Conduct Disorder ? The signs of conduct disorder behaviors that go against rules or other people’s rights and: last for a long time happen often cause a lot of problems in the child or youth’s life With this disorder, a child or youth may often: be aggressive towards other people or animals. Involved in Bullying, starting fights, hurting others, using a weapon

6. harm someone’s property on purpose tell major lies - to get something or avoid responsibilities. steal - break into a house or car, or steal something that’s important to someone break serious rules - run away from home or skip school a lot.

7. World to them judge the world as an antagonistic and intimidating place. They may tattle on friends or blame others for the harm they have caused. They have few if any friends because of their limited interpersonal skills. They may be viewed as irritating by their peers and family members . They often have low self-esteem internally but externally they appear tough, cocky or self-assured.

8. DIAGNOSTIC CRITERIA

9. Diagnostic Features A). repetitive and persistent behavioral patterns in which violation of basic right of others or basic age appropriate social norms take place. CD can be diagnosed if the individual shows at least 3 symptoms from the past 12 months and 1 symptom from past 6 months from the following criteria

10. FOUR major categories of symptoms Aggression towards people and animal Destruction of property Deceitfulness or theft Serious violation of rules

11. a) Aggression toward people and animal 1.Often bullies, threatens or intimidates others 2.Often initiates physical fights

12. a)Aggression towards people and animals 3.Used weapons that cause serious harms to others(knife, gun etc.) 4.Physically cruel toward animals

13. a)Aggression towards people and animals 5.Physically cruel towards people 6.Stoling while confronting a victims such as armed robbery etc.

14. a) Aggression towards people and animals 7.Forced someone into sexual activity Destruction of property 8. Deliberately sets fire in other’s property to cause serious harm.

15. c) Deceitfulness or theft 9.Deliberately destruction of property other than fire setting 10.Broke the house’s window pane , car, building etc.

16. c)Deceitfulness of theft 11.Pattern of running away from home overnight. 12.Stolen the items of nontrivial value without confronting the victims.

17. d)Serious violation of rules(e.g.,school,parents,workplace) 13.Staying out late at night despite parental prohibition. 14.Pattern of running away from home overnight.

18. d) Serious violation of rules 15. Often truant from school before the age 13 year old. B) . Disturbance in behavior cause impairment in social, academic and occupational functioning. C).Diagnosis of conduct disorder can be made only for those individual who is below 18.

19. Types of conduct disorder on the basis of age at the onset of disorder. Childhood-onset type: Individuals show at least one symptom of conduct disorder prior to age 10 years. Mostly exist in males. frequently display physical aggression toward others. have disturbed peer relationships. may have had oppositional Many children with this subtype also have concurrent attention-deficit/hyperactivity disorder (ADHD) or other neurodevelopment difficulties.

20. Types of conduct disorder on the basis of age at the onset of disorder. Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years. In this period individual less likely to display aggressive behaviors tend to have more normative peer relationships (although they often display conduct problems in the company of others). The ratio of occurrence of conduct disorder in males and females is equal .

21. Types of conduct disorder on the basis of age at the onset of disorder. Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

22. DIFFERENTIAL DIAGNOSIS

23. Conduct disorder Vs. ADHD Impulsive and Disruptive Behavior Note: If the criteria for both disorders are met, then both diagnosis can be given.

24. Etiology of Conduct Disorder Conduct disorder is caused by genetic, psychological and social factors that interact in a complex way.

25. Assessment Tools

26. Assessment Tools Informal assessment Clinical Interview Mental Status Examination Behavioral Observation Parent/ child/ school teachers interviews Questioning according to DSM 5 criteria of CD

27. Treatment

28. Treatment Behavioral interventions Social learning family Intervention (FLFI) Patterson’s therapy approach (Patterson, 1982) Six steps Psychoeducation Observation and monitoring Reinforcement of prosocial behavior Discipline of unacceptable behavior Supervision monitoring Communication strategies

29. Cont….. Non directive play: Play with their children Reduce the frequency of competing verbal behaviors Ignore minor inappropriate behaviors Reinforcement of prosocial behaviors Parents learn to identify and reward, E.G…… Simple effective commands State commands simply and one at a time, E.G…… 4. Use of time-out noncompliance

30. 2) Psychotherapy It encompasses cognitive-behavioral interventions to treat three deficits; social relationships, problem solving and anger management. Social relationships/ social skills: Praise Response-cost component Specific social skills targeted ( e.g …..) These can be enhanced through…… Emphasize cognitive skills

31. Problem solving Reinforcement and response cost may be used in problem solving interventions.

32. Medication Narcoleptics Lithium Antidepressants

33. Oppositional Defiant Disorder Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.

34. Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is especially true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child’s relationships with others.

35. DSM-V Criteria A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms of the following categories, and exhibited during interaction with at least one individual who is not a sibling: Angry/Irritable Mood 1. Often loses temper 2.Is often touchy or easily annoyed 3. Is often angry and resentful

36. Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults 5. Often actively defies or refuses to comply with requests from authority figures or with rules 6. Often deliberately annoys others 7. Often blames others for his or her mistakes or misbehavior Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months.

37. Symptoms Having frequent temper tantrums Arguing a lot with adults Refusing to do what an adult asks Always questioning rules and refusing to follow rules Being easily annoyed by others Often having an angry attitude Speaking harshly or unkindly Seeking revenge or being vindictive

38. Two major Explanations Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years. Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors. That’s because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.

39. Management Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger. Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding. Peer group therapy. A child develops better social and interpersonal skills.