conduct disorder- The American Psychiatric Association's DSM-5 criteria require three persistent specific behaviors of 15 conduct disorder symptoms

children psychiatry- The American Psychiatric Association's DSM-5 criteria require three persistent specific behaviors of 15 conduct disorder symptoms listed, over the past 12 months, with at least one of them present in the past 6 months


Conduct disorder symptoms include bullying, threatening, or intimidating others, and staying out at night despite parental prohibition.

DSM-5 also specifies that when truancy from school is a symptom, it begins before 13 years of age.

The disorder may be diagnosed in a person older than 18 years only if the criteria for antisocial personality disorder are not met.
DSM-5 includes specifiers denoting the severity of the disorder
"mild" - few conduct problems in excess of those needed to make the diagnosis and behaviors cause only minor harm to others.
"moderate" - exceed the minimum; however, there is less confrontation that may cause harm to individuals than in "severe" cases.
"severe" level shows many conduct problems in excess of the minimal diagnostic criteria or conduct problems that cause considerable harm to others.
DSM-5 has also added the following specifier: "With limited prosocial emotions."
To qualify for this specifier, the individual must show a persistent interpersonal and emotional pattern that can be characterized by at least two of the following:
(1) Lack of remorse or guilt,
(2) callous lack of empathy,
(3) unconcerned about performance,
(4) shallow or deficient affect.

Those children who develop CD at an earlier age will often have a worse prognosis than those who develop such problems in adolescence
Epidemiological studies also show the relationship between childhood behavioural disorders and other mental health disorders including ADHD, depression and anxiety.
More than one-third of girls and almost one-half of boys with ODD or CD present with a comorbid non-antisocial disorder
The presence of ADHD is particularly found to influence the development, course and severity of CD.
Young people with CD and comorbid ADHD have a much earlier age of onset of disruptive behaviour than those with CD alone
Those children who develop CD at an earlier age will often have a worse prognosis than those who develop such problems in adolescence
Epidemiological studies also show the relationship between childhood behavioural disorders and other mental health disorders including ADHD, depression and anxiety.
More than one-third of girls and almost one-half of boys with ODD or CD present with a comorbid non-antisocial disorder
The presence of ADHD is particularly found to influence the development, course and severity of CD.
Young people with CD and comorbid ADHD have a much earlier age of onset of disruptive behaviour than those with CD alone
Those children who develop CD at an earlier age will often have a worse prognosis than those who develop such problems in adolescence
Epidemiological studies also show the relationship between childhood behavioural disorders and other mental health disorde

1. Conduct Disorder Dr. Noraine Zainal Abidin

2. Conduct Disorder Conduct disorder is an enduring set of behaviors in a child or adolescent that evolves over time, usually characterized by aggression and violation of the rights of others. Youth with conduct disorder often demonstrate behaviors in the following four categories: physical aggression or threats of harm to people,/ animals destruction of their own property or that of others, theft or acts of deceit frequent violation of age-appropriate rules .

3. The American Psychiatric Association's DSM-5 criteria require three persistent specific behaviors of 15 conduct disorder symptoms listed, over the past 12 months, with at least one of them present in the past 6 months Conduct disorder symptoms include bullying, threatening, or intimidating others, and staying out at night despite parental prohibition. DSM-5 also specifies that when truancy from school is a symptom, it begins before 13 years of age. The disorder may be diagnosed in a person older than 18 years only if the criteria for antisocial personality disorder are not met.

4. DSM-5 includes specifiers denoting the severity of the disorder " mild" - few conduct problems in excess of those needed to make the diagnosis and behaviors cause only minor harm to others. " moderate" - exceed the minimum; however, there is less confrontation that may cause harm to individuals than in "severe" cases. " severe" level shows many conduct problems in excess of the minimal diagnostic criteria or conduct problems that cause considerable harm to others. DSM-5 has also added the following specifier: "With limited prosocial emotions ." To qualify for this specifier, the individual must show a persistent interpersonal and emotional pattern that can be characterized by at least two of the following: (1) Lack of remorse or guilt, (2) callous lack of empathy, (3) unconcerned about performance, (4) shallow or deficient affect.

5. Conduct disorder has been divided into three subtypes, based on the age of onset of the disorder. Childhood-onset type , in which at least one symptom has emerged repeatedly before age 10 years; Adolescent-onset type , in which no characteristic persistent symptoms were seen until after age 10 years; and Unspecified onset , in which age of onset is unknown

6. Epidemiology In 1975 Rutter et al. compared the rates of child mental health disorders in different settings within the UK, showing a prevalence rate for CD of 4% for rural populations , increasing to 9% in urban centres. Many studies have shown CD to be more common in boys than in girls. In more recent UK-based community surveys, conduct disorders occur in 6.9% of primary school-aged boys and 2.8% of girls , whilst in secondary school-aged children these prevalences rise to 8.1% and 5.1% respectively

7. There is also evidence of a clear increase in the prevalence of CD with age, with boys showing a linear rise from an early age throughout childhood, whilst girls show a different pattern, with rates increasing in adolescence.

8. Childhood behavioural disorders often appear to show some longevity of symptoms , with 40% of 7–8-year-olds with CD becoming young offenders in later life

9. Those children who develop CD at an earlier age will often have a worse prognosis than those who develop such problems in adolescence Epidemiological studies also show the relationship between childhood behavioural disorders and other mental health disorders including ADHD, depression and anxiety. More than one-third of girls and almost one-half of boys with ODD or CD present with a comorbid non-antisocial disorder The presence of ADHD is particularly found to influence the development, course and severity of CD. Young people with CD and comorbid ADHD have a much earlier age of onset of disruptive behaviour than those with CD alone

10. AETIOLOGY The development of childhood behavioural disorders incorporates a broad and complex range of biological and psychosocial risk factors Biological factors, including genetics , have long been implicated in the development of childhood behavioural disorders, although much of the research has focused upon aggressive rather than other antisocial behaviours. Studies in the past decade show that the genetic effects appear to vary according to subtype. Children with callous-unemotional traits show much stronger heritability for antisocial behaviour than children without such traits

11. In addition, more aggressive children who offend early have an increased heritability to do so . Other biological risk factors include prenatal or perinatal exposure to toxins and early physical damage to the frontal lobe and other regions of the brain.

12. Young people with aggressive behaviours have been shown to experience general autonomic underarousal ( less sensitive to social cues, have a decreased fear response, or experience diminished emotional reactivity) , as demonstrated by lower heart rates and skin conductance, indicating an associated lack of inhibitory anxiety , which may protect against antisocial behaviours

13. Innate temperament , which may be apparent in very early childhood, has been shown to be predictive of future behavioural disorders. Children with vulnerable temperamental characteristics are more likely to be subject to poor parenting styles. challenging behaviors that trigger frustration or stress in caregivers, leading to harsher discipline or less nurturing responses. the interaction contribute to the persistence or escalation of behavioral problems.

14. Although cognitive and reading impairments are often thought to be related to behavioural disorders in children, - lead to frustration, low self-esteem, and behavioral problems, Other factors including i mpulsivity and social withdrawal have been shown to be associated with antisocial behaviours , as have social skills deficits such as failing to notice relevant social cues, whilst misattributing hostile intent to others

15. Children from socially disadvantaged areas have higher levels of conduct disorders . However, much of this effect is thought to be mediated by intrafamilial social processes associated with poor parenting and parental psychopathology, including mental illness, and alcohol and substance misuse . Certain parenting styles have been consistently shown to link to behavioural disorders in children, including lack of parental involvement, harsh and inconsistent discipline, and poor monitoring and conflict management. Children who have been exposed to sexual or physical abuse have a significantly increased risk of developing CD. Peer relationships and community factors such as drug availability and crime rate may also influence the development of behavioural problems in children

16. PREVENTION AND TREATMENT There are many good reasons for trying to alleviate childhood behavioural disorders. As well as causing distress and damage to individual children and families, conduct disorders are known to have a considerable cost to the wider society. Scott et al. have shown that by the age of 28 years, costs for people with CD were 10 times higher than for those with no problems. These costs include crime, extra educational provision, foster and residential care, and state benefits as well as smaller costs to the health service

17. As parenting practices have been identified as relevant aetiological factors in the development and maintenance of childhood behavioural disorders, there has been considerable interest in the use of parenting programmes as a form of prevention and treatment. In 2006, the National Institute for Health and Clinical Excellence (NICE) and Social Care Institute for Excellence (SCIE) jointly commissioned a review of parenting programmes in the management of children aged 12 years or younger. They concluded that group-based parenting/education programmes are to be recommended in the management of children with conduct disorders . For those parents with whom it is difficult to engage or for whom problems are more complex, similar individual-based programmes can be used instead.

18. parenting programmes aim to improve the child’s behaviour by helping parents to change the ways in which they approach parenting and to improve their relationship with their children. Whilst most group-based programmes focus upon the actions of parents without the direct involvement of the child, some individual programmes include observation of parent–child interactions, allowing these to be modified as necessary. Most parenting programmes comprise behavioural management techniques based upon social learning theory . These teach parents how to increase desired behaviours through positive reinforcement, whilst decreasing unwanted behaviours by reducing social reinforcement, such as by ignoring behaviours or using Time Out techniques. Programmes will also usually include elements to help parents to understand their children’s feelings and behaviours and subsequently improve understanding and communication between parent and child

19. Analysis of relevant research studies indicates that such interventions are clinically effective at improving children’s behaviour , may lead to an improvement in maternal mental health, and are cost-effective ways of treating children with conduct disorders

20. There is now a wide variety of group-based parenting programmes devised to prevent the development of childhood behavioural disorders as well as to help treat those children who have already developed such problems. Examples of effective programmes include the Triple P (Positive Parenting Programme) and the Webster–Stratton Incredible Years Programme, with evidence that these effects continue over several years. Several long-term follow-up studies in the USA and Canada have shown a reduction in later criminal activity in those children exposed to a variety of early interventions, with huge cost benefits to society

21. In some circumstances parent training programmes may not be feasible or as effective as hoped . Some families may be unwilling to take part in such programmes or there may be additional risk factors in the child, such as callous and unemotional traits, which may reduce the potential effectiveness of this approach. In these cases, NICE recommends that alternative approaches such as individual cognitive problem solving skills training should be considered. Other theoretical models such as attachment theory, systems theory or cognitive attribution theory may also be helpful.

22. As children with conduct disorders often present with other comorbid child mental health disorders, these disorders may require treatment in their own right, which may in turn lead to a reduction in the behaviour problems. Studies have suggested that the treatment of ADHD with stimulants or atomoxetine may lead to an improvement in comorbid oppositional behaviour, whilst atypical antipsychotics have been shown to be effective for the treatment of acute and chronic aggression in young people with learning disabilities or pervasive developmental disorders

23. It is generally agreed within the scientific community that short-term interventions such as military-style boot camps , whilst often promoted within certain sections of the British media, are not effective in the long term. Frightening children with the aim of reducing aggressive behaviour but without offering them any other behavioural alternatives, has the opposite effect of that intended, perhaps as a result of an increased fear-aggression reaction or due to modelling of deviance

24. Conclusion Childhood behavioural disorders have always been and still remain a common problem and, given current epidemiological trends, are likely to continue to do so for the foreseeable future. These disorders lead to considerable damage, both in terms of the quality of life for young people, their families and their victims, and the wider economic cost to society as a whole Simple behavioural disorders can progress to much more serious personality disorders in adulthood.

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