conduct disorder, antisocial personality disorder and/or one or more of the above . significant relationship between CD symptoms and maternal smoking during. Early interventions of conduct disorder can prevent a future of antisocial . According to the American Psychological Association, Antisocial Personality Disorder. answer to What is conduct disorder (CD)? Conduct disorder is a diagnosis that is given to children and young adult that has to do with antisocial behavior that.
Empirical studies do not suggest a level at which symptoms become qualitatively different, nor is there a single cut-off point at which they become impairing for the child or a clear problem for others.
Picking a particular level of antisocial behaviour to call conduct disorder or oppositional defiant disorder is therefore necessarily arbitrary Moffitt et al. For all children, the expression of any particular behaviour also varies with age; physical hitting, for example, is at its peak at around 2 years of age and declines to a low level over the ensuing years. Before deciding that the behaviour is atypical or a significant problem, a number of other clinical features have to be considered: It should be noted that the making of a diagnosis of a conduct disorder only means that at the time, the individual concerned has been behaving in a way that meets the specified criteria.
It is purely a phenomenological description and carries no implications about the cause in any particular case. The child may spontaneously change over time and so no longer meet criteria for a diagnosis. In some, the origins might be entirely outside the child, with the child reacting as any child might to a coercive, traumatic or abusive upbringing.
In others, it might be that the child had had a completely benign upbringing but was born with callous-unemotional traits that were displayed in all social encounters.
Thus the use of a diagnosis is fully consistent with a biopsychosocial approach to the understanding and treatment of the presenting phenomena.
In middle childhood, from 8 to 11 years, the above features are often present, but as the child grows older and stronger, and spends more time outside the home, other behaviours are seen.
In adolescence, from 12 to 17 years, more antisocial behaviours are often added: Not all children who start with the type of behaviours listed in early childhood progress on to the later, more severe forms. Only about half continue from those in early childhood to those in middle childhood; likewise, only about a further half of those with the behaviours in middle childhood progress to show the behaviours listed for adolescence Rowe et al.
However, the early onset group are important as they are far more likely to display the most severe symptoms in adolescence, and to persist in their antisocial tendencies into adulthood. Follow-back studies show that most children and young people with conduct disorders had prior oppositional defiant disorder and most if not all adults with antisocial personality disorder had prior conduct disorders.
In contrast, there is a large group who only start to be antisocial in adolescence, but whose behaviours are less extreme and who tend to become less severe by the time they are adults Moffitt, Gender Severe antisocial behaviour is less common in girls than in boys; they are less likely to be physically aggressive and engage in criminal behaviour, but more likely to show spitefulness and emotional bullying such as excluding children from groups and spreading rumours so others are rejected by their peersand engage in frequent unprotected sex which can lead to sexually transmitted disease and pregnancydrug abuse and running away from home.
Whether there should be specific criteria for diagnosing conduct disorder in girls is debated Moffitt et al. Pattern of behaviour and setting The severity of conduct disorder is not determined by the presence of any one symptom or any particular constellation, but is due to the overall volume of symptoms, determined by the frequency and intensity of antisocial behaviours, the variety of types, the number of settings in which they occur for example home, school, in public and their persistence.
For general populations of children, the correlation between parent and teacher ratings of conduct problems on the same measures is low only 0. However, for more severe antisocial behaviour there are usually manifestations both at home and at school.
Impact At home, the child or young person with a conduct disorder is often exposed to high levels of criticism and hostility, and sometimes made a scapegoat for a catalogue of family misfortunes.
Frequent punishments and physical abuse are not uncommon. The whole family atmosphere is often soured and siblings also affected. Maternal depression is often present, and families who are unable to cope may, as a last resort, give up the child to be cared for by the local authority. At school, teachers may take a range of measures to attempt to control the child or young person, bring order to the classroom and protect the other pupils, including sending the child or young person out of the class, which sometimes culminates in permanent exclusion from the school.
This may lead to reduced opportunity to learn subjects on the curriculum and poor examination results.
The child or young person typically has few, if any, friends, and any friends become annoyed by their aggressive behaviour. On leaving school, the lack of social skills, low level of qualifications and, possibly, a police record make it harder to gain employment. Examples of the behaviours on which the diagnosis is based include the following: Any one of these categories, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.
F91 An enduring pattern of behaviour should be present, but no time frame is given and there is no impairment or impact criterion stated. The research criteria take a menu-driven approach whereby a certain number of symptoms have to be present.
Fifteen behaviours are listed to be considered for a diagnosis of conduct disorder, which usually but by no means exclusively apply to older children and young people.
The behaviours can be grouped into four classes: Aggression to people and animals: Serious violations of rules: To make a diagnosis, at least three behaviours from the 15 listed above have to be present, one for at least 6 months. There is no impairment criterion.
There are three subtypes: It is recommended that age of onset be specified, with childhood-onset type manifesting before 10 years and adolescent-onset type after 10 years. Severity should be categorised as mild, moderate or severe according to the number of symptoms or impact on others, for example causing severe physical injury, vandalism or theft. To make a diagnosis of the oppositional defiant type of conduct disorder, four symptoms from either this list or the conduct disorder item list must be present, but no more than two from the latter.
Unlike for the conduct disorder variant, there is an impairment criterion for the oppositional defiant type: Where there are sufficient symptoms of a comorbid disorder to meet diagnostic criteria, ICD discourages the application of a second diagnosis, and instead offers a single, combined category for the most common combinations. There are two major kinds: There is modest evidence to suggest these combined conditions may differ somewhat from their constituent elements.
The same 15 behaviours are given for the diagnosis of conduct disorder As in ICD, three symptoms need to be present for diagnosis. Severity and childhood or adolescent onset are also specified in the same way. Comorbidity in DSM-IV-TR is handled by giving as many separate diagnoses as necessary, rather than by having single, combined categories.
Diagnosis requires four from a list of eight behaviours, which are the same as ICD; but, unlike ICD, all four have to be from the oppositional list and none may come from the conduct disorder list. In older children it is debated whether oppositional defiant disorder is fundamentally different from conduct disorder in its essential phenomena or any associated characteristics, and the value of designating it as a separate disorder is arguable.
Most but not all recurrent juvenile offenders have conduct disorder. Differential diagnosis Making a diagnosis of conduct disorder is usually straightforward, but comorbid conditions are often missed.
Differential diagnosis may include: Hyperkinetic syndrome and attention deficit hyperactivity disorder. It is characterised by impulsivity, inattention and motor overactivity. Any of these three sets of symptoms can be misconstrued as antisocial, particularly impulsivity, which is also present in conduct disorders. However, none of the symptoms of conduct disorders are a part of hyperactivity so excluding conduct disorders should not be difficult. A frequently made error, however, is to miss comorbid hyperactivity when conduct disorder is definitely present.
Adjustment reaction to an external stressor. This can be diagnosed when onset occurs soon after exposure to an identifiable psychosocial stressor such as divorce, bereavement, trauma, abuse or adoption. Depression can present with irritability and oppositional symptoms, but, unlike typical conduct disorder, mood is usually clearly low and there are vegetative features difficulties with basic bodily processes, such as eating, sleeping and feeling pleasure ; also, more severe conduct problems are absent.
Early bipolar disorder can be harder to distinguish because there is often considerable defiance and irritability combined with disregard for rules, and behaviour that violates the rights of others.
Low self-esteem is the norm in conduct disorders, as is a lack of friends or constructive pastimes. Therefore it is easy to overlook more pronounced depressive symptoms. Systematic surveys reveal that around a third of children with a conduct disorder have depressive or other emotional symptoms severe enough to warrant a diagnosis.
These are often accompanied by marked tantrums or destructiveness, which may be the reason for seeking a referral. Enquiring about other symptoms of autistic spectrum disorders should reveal their presence.
Dissocial and antisocial personality disorder. In ICD it is suggested that a person should be 17 years or older before dissocial personality disorder can be considered.
Because from the age of 18 years most diagnoses specific to childhood and adolescence no longer apply, in practice there is seldom a difficulty in terms of formal diagnosis. In contrast to a formal diagnosis of dissocial or antisocial personality disorder, however, there has been an explosion of interest in the last decade in what have been termed psychopathic traits in childhood.
The characteristics of the adult psychopath include grandiosity, callousness, deceitfulness, shallow affect and lack of remorse. Certainly there are now instruments that reliably identify callous-unemotional traits such as lack of guilt, absence of empathy and shallow, constricted emotions in children Farrington, In longitudinal studies such children go on to be more aggressive and antisocial than others without such traits Moran et al.
Some young people are antisocial and commit crimes but are not particularly aggressive or defiant. They are well-adjusted within a deviant peer culture that approves of recreational drug use, shoplifting and so on.
In some areas, one third or more of young males fit this description and would meet ICD diagnostic guidelines for socialised conduct disorder.
Some clinicians are unhappy to label such a large proportion of the population with a psychiatric disorder. Using DSM-IV-TR criteria would preclude the diagnosis for most young people like this due to the requirement for significant impairment.
In both systems Axis 1 is used for psychiatric disorders that have been discussed above. The last three axes in both systems cover general medical conditions, psychosocial problems and level of social functioning; these topics will be discussed in Section 2.
Both specific and general learning disabilities are essential to assess in children and young people with a conduct disorder. While this may in part be due to lack of adequate schooling, there is good evidence that the cognitive deficits often precede the behavioural problems.
General learning disability is often missed in children and young people with a conduct disorder unless IQ testing is carried out. The rate of conduct disorder increases several-fold in those with an IQ below This chapter describes the general pattern of behaviour that comprises conduct disorder and alternative diagnoses.
A modest rise in diagnosable conduct disorder over the second half of the twentieth century has also been observed when comparing assessments of three successive birth cohorts in Britain Collishaw et al. In terms of class, there is a marked social class gradient with conduct disorders more prevalent in social classes D and E compared with social class A Green et al.
Gender differences in prevalence The gender ratio is approximately 2. On balance, research suggests that the causes of conduct problems are the same for both genders, but males have more conduct disorders because they experience more of its individual-level risk factors for example hyperactivity and neurodevelopmental delays.
Thus, the genes that dispose the mother to SDP may also dispose the child to CD following mitotic transmission. Indeed, Rice et al. Thus, the distinction between causality and correlation is an important consideration. These findings hold true even after taking into account other variables such as socioeconomic status SESand education. However, IQ and executive function deficits are only one piece of the puzzle, and the magnitude of their influence is increased during transactional processes with environmental factors.
Compared to normal controls, youths with early and adolescent onset of conduct disorder displayed reduced responses in brain regions associated with social behavior i. Lastly, youths with conduct disorder display a reduction in grey matter volume in the amygdala, which may account for the fear conditioning deficits.
These reductions are associated with the inability to regulate mood and impulsive behaviors, weakened signals of anxiety and fear, and decreased self-esteem.
Intra-individual factors[ edit ] Aside from findings related to neurological and neurochemical profiles of youth with conduct disorder, intraindividual factors such as genetics may also be relevant.
Having a sibling or parent with conduct disorder increases the likelihood of having the disorder, with a heritability rate of. For instance, antisocial behavior suggestive of conduct disorder is associated with single parent status, parental divorce, large family size, and young age of mothers.
Family functioning and parent-child interactions also play a substantial role in childhood aggression and conduct disorder, with low levels of parental involvement, inadequate supervision, and unpredictable discipline practices reinforcing youth's defiant behaviors. Peer influences have also been related to the development of antisocial behavior in youth, particularly peer rejection in childhood and association with deviant peers.
Conduct disorder - Wikipedia
Hinshaw and Lee  also explain that association with deviant peers has been thought to influence the development of conduct disorder in two ways: In a separate study by Bonin and colleagues, parenting programs were shown to positively affect child behavior and reduce costs to the public sector.
For instance, neighborhood safety and exposure to violence has been studied in conjunction with conduct disorder, but it is not simply the case that youth with aggressive tendencies reside in violent neighborhoods. Transactional models propose that youth may resort to violence more often as a result of exposure to community violence, but their predisposition towards violence also contributes to neighborhood climate.
Similar criteria are used in those over the age of 18 for the diagnosis of antisocial personality disorder. Therefore, it is important to exclude a substance-induced cause and instead address the substance use disorder prior to making a psychiatric diagnosis of conduct disorder. Additionally, treatment should also seek to address familial conflict such as marital discord or maternal depression. For those that do not develop ASPD, most still exhibit social dysfunction in adult life.
Females are more likely to be characterized by covert behaviors, such as stealing or running away. Moreover, conduct disorder in females is linked to several negative outcomes, such as antisocial personality disorder and early pregnancy,  suggesting that sex differences in disruptive behaviors need to be more fully understood.