Aggressive behavior is the hallmark of conduct disorder. A child with this disorder fights, bullies, intimidates, and assaults others physically or sexually, and is truant from school at an early age. Typically, the patient has poor relationships with peers and adults and violates others’rights and society’s rules. Conduct disorder evolves slowly over time until a consistent pattern of behavior is established.
Studies have suggested that the disorder has biological (including genetic) and psychosocial components. Roughly 30% to 50% of clinical populations with conduct disorder also have attention deficit hyperactivity disorder (ADHD). Social risk factors that may predispose a child to conduct disorder include socioeconomic deprivation; harsh, punitive parenting with verbal or physical aggression; separation from parents; early institutionalization; family neglect, abuse, or violence; frequent verbal abuse from parents, teachers, or other authority figures; parental psychiatric illness, substance abuse, or marital discord; large family size, crowding, and poverty; and divorce with persistent hostility between the parents. Other risk factors include child abuse and neglect, neurologic damage caused by low birth weight or birth complications, underarousal of the autonomic nervous system, learning impairments, insensitivity to physical pain and punishment, and impaired functioning of the nonadrenergic system.
The prevalence of conduct disorder among people ages 9 to 17 is approximately 1% to 4%. An estimated 6% to 16% of boys and 2% to 9% of girls younger than age 18 have the disorder. The prognosis is worse in children with an earlier onset; these children are more likely to develop antisocial personality disorder as adults.
Signs and symptoms of conduct disorder include:
❑ abusing others sexually
❑ cheating in school
❑ cruelty to animals
❑ engaging in precocious sexual activity
❑ fighting with family members and peers
❑ skipping classes
❑ smoking cigarettes
❑ speaking to others in a hostile manner
❑ stealing or shoplifting
❑ using drugs or alcohol
❑ vandalizing or destroying property.
Medical and psychiatric evaluations, feedback from parents, a school consultant’s recommendations, case manager plan, and probation officer reports can assist in a team approach to diagnosis. The diagnosis is made when the patient meets the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (See Diagnosing conduct disorder.)
Treatment focuses on coordinating the child’s psychological, physiologic, and educational needs. A structured living environment with consistent rules and consequences can help reduce many symptoms. Parents need to be taught how to deal with the child’s demands. Juvenile justice interventions may also be used. Medication can be useful as an adjunct to treatment. Overt aggression responds to many medications, such as antipsychotics, lithium, clonidine, and selective serotonin reuptake inhibitors. ADHD, if present, must also be addressed.
❑ Work to establish a trusting relationship with the child.
❑ Provide clear behavioral guidelines, including consequences for disruptive and manipulative behavior.
❑ Teach the child effective coping skills, social skills, and problem-solving skills, and have him demonstrate them in return.
❑ Teach the child to express anger appropriately through constructive methods to release negative feelings and frustrations.
❑ Help the child accept responsibility for behavior rather than blaming others, becoming defensive, and wanting revenge.
❑ Use role-playing to help the child practice handling stress and gain skill and confidence in managing difficult situations.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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