Conduct
problems
D R . R A J E K A FA R D O S H TA N Y
A S S O C I AT E P R O F E S S O R
Basic information
Conducts problems constitute a 3rd to a half of all clinical referrals. (Murrihy et al,
2010)
It is the most costly disorder of childhood & adolescence for 3 reason-
1) They are remarkably unresponsive to treatment. Positive outcome rates for
routine treatments range from 20-40%.
2) About 60% of children with conduct problems have a poor prognosis
3) For the high cost of conduct problems is the fact that they are inter
generationally transmitted.
Classification
Conduct problems must take account of the extraordinary variability that occurs
among youngsters with such difficulties (Barry et al,2013). Available research
suggests that variability in conduct problems occurs along the followings axes:
1) Severity
2) Chronicity
3) Pervasiveness
4) Age of onset of problems
5) The presence of callous unemotional traits
6) Peer influences on conduct problems
Outcome for adults identified as conduct
disordered during childhood or adolescence
compared group
1) Criminality
2) Mental health
3) Physical health
4) Educational attainment
5) Occupational adjustment
6) Marital adjustment
7) Social adjustment
8) Intergenerational transmission
Diagnosis according to DSM-5( lasting angry/irritable
mood/argumentative/defiant behavior or vindictiveness
lasting at least 6 months with at least 4 symptoms
total 8 criterion
area -3
Area
a) Angry /irritable mood
b) Argumentative /defiant behavior
c) Vindictiveness
a. Angry /irritable mood
1) Often looses temper
2) Is often touchy /or easily annoyed
3) Is often angry or resentful
b. Argumentative /defiant behavior
4. often argues with authority figures
5. often actively refuses requests from authority figures or rules
6. often deliberately annoys others
7. often blame others for his or her own mistakes
( for children under 5 years, behaviors occur most days in the past 6
months
For children over 5 years, the behaviors occur once a week for 6
months)
c. Vindictiveness
8. has been spiteful or vindictive at least twice with the past 6 months
the disturbance in behavior is associated with distress in the individual or others
in his or her immediate social context ( like family, peer group, work colleagues),
or it impacts negatively on social, educational, occupational or other functioning
areas.
The behaviors do not occur exclusively during the course of a psychotic,
substance use , depressive or bipolar disorder.
Diagnosis according to DSM-5( a repetitive and persistent pattern of
behavior against rules or norms, lasting at least 3 of the following 15 criteria
in the past 12 months and at least 1 criterion present in the past 6 months
area-4
criterion-15
d. Aggression to people and animals
e. Destruction of property
f. Deceitfulness or theft
g. Serious violation of rules
d. aggression to people and animals
1) Often bullies , threatens
2) Often initiates physical fighting
3) Has used a weapon like bat, brick, knife, gun, broken bottle
4) Has been physically cruel to people
5) Has been physically cruel to animal
6) Has stolen while confronting a victim
7) Has forced someone into sexual activity
e. Destruction of property
8. has deliberately engaged in fire setting with the intention of causing serious
damage
9. has deliberately destroyed other’s property
f. Deceitfulness or theft
10. has broken into someone’s house, car, building
11. Often lies to obtain goods or favors or to avoid obligations
12. has stolen items off nontrivial value without confronting a victim
g. Serious violation of rules
13. often stays out late at night despite parental prohibitions before 13 years age
14. has run away from home overnight at least twice while living in the parental
home or once without returning for a lengthy period
15. is often truant from school, beginning before age 13 years
The disturbance in behavior causes clinically significant impairment in social,
academic or occupational functioning
If the individual is age 18 years or older. Criteria are not met for antisocial
personality disorder
Clinical features of conduct
disorder
1) Cognitive
2) Affect behavior
3) Physical condition
4) Interpersonal adjustment
1. cognitive
Limited internalization of social rules or norms
Interprets ambiguous social situations as threating and responds with anti social
behavior
2. Affect behavior
Anger and irritability
Persistent broad pattern of anti social behavior
Defiance
Aggression
Destructiveness
Deceitfulness and theft
Cruelty
Running away
Coercive sex
Drug use
3. Physical condition
Physical problems associated with risk taking behavior such as
Fighting
Drug abuse
Casual unsafe sex
Reckless driving
4. Interpersonal adjustment
Problematic relationships with
Parents
Teachers
Peers
Police
Assessment of conduct disorder
Predisposin
g factors
Precipitating
factors
Conduc Personal protective
t factors
Personal maintaining proble
factors m
Assessment of conduct disorder
biological factors
Personal
predisposing
factors Psychological
factors
Predisposin
g factors
Parent child factor
in early life
Exposure to family
Contextual problems in early
predisposing factors life
Stresses in early life
Biological factors
Genetic vulnerability
Impaired neurobiological systems for fear conditioning, rewarded sensitivity,
emotion regulation and executive function
Psychological factors
Low IQ
Difficult temperament
Low self esteem
External locus of control
Co morbid ADHD or learning disorder
Early onset of aggressive behavior
Many frequent serious anti social acts in multiple setting
Parent child factors in early life
Attachment problems
Authoritarian parenting
Permissive parenting
Neglectful parenting
Inconsistent parenting
Exposure to family problems in early life
Parental psychological problems
Parental alcohol and substance misuse
Marital distress / domestic violence
Parental separation
Family disorganization
Large family size and middle born
Stresses in early life
oBereavements
oSeparations
oChild abuse
oSocial disadvantage
oProblematic Growing period
Precipitating factors
Acute life stress
Adolescence
Child abuse
Bullying
Changing school
Loss of peer friendships
Separation or divorce
Parental unemployment
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