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Conduct disorder is a psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors." Indeed, the disorder is often seen as the precursor to antisocial personality disorder. DSM
According to the current DSM classification system , a diagnosis of conduct disorder is based on the following criteria: A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: Aggression to people and animals (1) often bullies, threatens, or intimidates others (2) often initiates physical fights (3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) (4) has been physically cruel to people (5) has been physically cruel to animals (6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) (7) has forced someone into sexual activity (is a rapist) Destruction of property (8) has deliberately engaged in fire setting with the intention of causing serious damage (9) has deliberately destroyed others' property (other than by fire setting) Deceitfulness or theft (10) has broken into someone else’s house, building, or car (11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others) (12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules (13) often stays out at night despite parental prohibitions, beginning before age 13 years
89 Conduct Disorder. Callous-Lack of Empathy: Disregards and is unconcerned about the feelings of others.g.g. work.82 Conduct Disorder. there are no proposed revisions for the main criteria of conduct disorder in the DSM-V. or in other important activities. Unspecified Onset: age at onset is not known Specify severity Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others (e. Lack of Remorse or Guilt: Does not feel bad or guilty when he/she does something wrong (except if expressing remorse when caught and/or facing punishment). Meet full DSM-IV criteria for conduct disorder B. Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years 312.g. Shallow or Deficient Affect: Does not express feelings or show emotions to others.81 Conduct Disorder. 2. If the individual is age 18 years or older. stealing while confronting a victim... C. For this specifier. truancy. academic. staying out after dark without permission) Moderate: number of conduct problems and effect on others intermediate between “mild” and “severe” (e. except in ways that seem shallow or superficial (e.(14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) (15) is often truant from school. rape. Unconcerned about Performance: Does not show concern about poor/problematic performance at school. 4. 1. emotions are not consistent with . stealing without confronting a victim. there is a recommendation by the work group to add an additional specifier for Callous and Unemotional Traits. the individual must: A. Show 2 or more of the following characteristics persistently over at least 12 months and in more than one relationship or setting. vandalism) Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others (e. Code type based on age at onset 312. criteria are not met for Antisocial Personality Disorder. or occupational functioning. physical cruelty. The disturbance in behavior causes clinically significant impairment in social. Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years 312. use of a weapon. 3. However. breaking and entering) Proposed Changes for the DSM-V Currently. lying.g... beginning before age 13 years B.
. social/peer relationships) onset . familial and peer influences... youth with early and adolescent onset of conduct disorder displayed reduced responses in brain regions associated with antisocial behavior (i. The clinician should consider multiple sources of information to determine the presence of these traits. Cognitive Factors In terms of cognitive function. Individuals with conduct disorder are characterized as having reduced serotonin and cortisol levels (e. Aside from the differences in neuroanatomy and activation patterns between youth with conduct disorder and controls. intelligence and cognitive deficits are common among youth with conduct disorder. Etiology While the etiology of conduct disorder is complicated by an intricate interplay of biological and environmental factors.g.g. such as whether the person self-reports them as being characteristic of him or herself and if they are reported by others (e. which may account for the fear conditioning deficits in this population.. This provides a neural explanation for why youth with conduct disorder may be more likely to repeat poor decision making patterns. This reduction has been linked to difficulty processing social emotional stimuli. These reductions are associated with the inability to . or shift between tasks. socioeconomic status (SES).. Lastly. Executive function difficulties may manifest in terms of one’s ability to plan and organize. and wider contextual factors . particularly for those with early-onset who have intelligence quotients (IQ) one standard deviation below the mean and severe deficits in verbal reasoning andexecutive function. reduced hypothalamic-pituitary-adrenal (HPA) axis).g. and orbitofrontal cortex). youth with conduct disorder display grey matter volume reduction in the amygdala.g. neurochemical profiles also vary between groups< . to manipulate or intimidate others). inhibit a prepotent response. intraindividual factors. youth with conduct disorder may also demonstrate differences in brain anatomy and function. It is important to note that IQ and executive function deficits are only one piece of the puzzle. regardless of the age of onset .g. parents. Compared to normal controls. These findings hold true even after taking into account other variables such as race. can turn emotions “on” or “off” quickly) or when they are used for gain (e.actions. youth with conduct disorder also demonstrated less responsiveness in the orbitofrontal regions of the brain during a stimulus-reinforcement and reward task. several domains have been implicated in the development of conduct disorder including cognitive variables.. amygdala. insula. peers) who have known the person for significant periods of time. Structural and Functional Brain Differences Beyond difficulties in executive function. ventromedial prefrontal cortex. other family members. and the magnitude of their influence on the development of conduct disorder is increased during transactional processes with environmental factors. Despite the complexities. In addition. identifying etiological mechanisms is crucial for obtaining accurate assessment and implementing effective treatment . neurodevelopmental basis) and adolescent (e. and education. with different variables related to early (e.e. teachers. as well as reduced autonomic nervous system (ANS) functioning. neurological factors. These mechanisms serve as the fundamental building blocks on which evidence-based treatments are developed. These factors may also vary based on the age of onset.
particularly peer rejection in childhood and association with deviant peers  . The first is known as the "childhoodonset type" and occurs when conduct disorder symptoms are present before the age of 10 years. but it is not simply the case that youth with aggressive tendencies reside in violent neighborhoods. and 2) a “facilitation” process whereby deviant peer networks bolster patterns of antisocial behavior. Intraindividual Factors Aside from findings related to neurological and neurochemical profiles of youth with conduct disorder. neighborhood safety and exposure to violence has been studied in conjunction with conduct disorder. Family functioning and parent-child interactions also play a substantial role in childhood aggression and conduct disorder. antisocial behavior suggestive of conduct disorder is associated with single parent status. However. parental divorce. intraindividual factors such as genetics may also be relevant. In a separate study by Bonin and colleagues. Hinshaw and Lee (2003) also explain that association with deviant peers has been thought to influence the development of conduct disorder in two ways: 1) a “selection” process whereby youth with aggressive characteristics choose deviant friends. This course is often linked to a more persistent life course and more pervasive behaviors. these factors are difficult to tease apart from other demographic variables that are known to be linked with conduct disorder. and decreased self-esteem . youth with conduct disorder also exhibit polymorphism in the monoamine oxidase A gene. Transactional models propose that youth may resort to violence more often as a result of exposure to community violence. but also a contributing factor for the continuity of the disorders over time. Taken together. Family and Peer Influences Elements of the family and social environment may also play a role in the development and maintenance of conduct disorder. it is important to note that these are not static factors.. children in this group have greater levels of ADHD .g. weakened signals of anxiety and fear. parenting programs were shown to positively affect child behavior and reduce costs to the public sector . these findings may account for some of the variance in the psychological and behavioral patterns of youth with conduct disorder. research has highlighted the importance of environment and context in youth with antisocial behavior. Developmental Course Currently. Peer influences have also been related to the development of antisocial behavior in youth. For instance. Having a sibling or parent with conduct disorder increases the likelihood of having the disorder. For instance. low resting heart rates. inadequate supervision.regulate mood and impulsive behaviors. with low levels of parental involvement. large family size. including poverty and low SES. but rather transactional in nature (e. and increased testosterone. Peer rejection is not only a marker of a number of externalizing disorders. there are thought to be two possible developmental courses to conduct disorder.53. Specifically. and young age of mothers . but their predisposition towards violence also contributes to neighborhood climate. However. individuals are influenced by and also influence their environment). Wider Contextual Factors In addition to the individual and social factors associated with conduct disorder. with a heritability rate of . There also tends to be a stronger genetic link for individuals with childhood-onset compared to adolescent onset. and unpredictable discipline practices reinforcing youth’s defiant behaviors. In addition.
and higher likelihood of aggression and violence. and most adults with antisocial personality disorder were previously diagnosed with conduct disorder. and thus labeling an individual may be inappropriate. It is also argued that some children may not in fact have conduct disorder.symptoms. It is concerning that a premature diagnosis may be made in young children. research has demonstrated continuity in the disorders such that conduct disorder is often diagnosed in children who have been previously diagnosed with oppositional defiant disorder. Moreover. suggesting that adolescent-onset conduct disorder is an exaggeration of developmental behaviors that are typically seen in adolescence. there appears to be a relationship among oppositional defiant disorder. this is not to say that this trajectory occurs in all individuals. In fact. such as rebellion against authority figures and rejection of conventional values . Nonetheless. conduct disorder and antisocial personality disorder. For example. Research has shown that there is a greater number of children with adolescent-onset conduct disorder than those with childhood-onset. In addition to these two courses that are recognized by the DSM-IV-TR. Epidemiology Prevalence & Incidence Prevalence estimates for conduct disorder range from 1-10%. However. some research has shown that 90% of children diagnosed with conduct disorder had a previous diagnosis of oppositional defiant disorder. In fact. but are engaging in developmentally appropriate disruptive behavior. only 25-40% of youths with conduct disorder will develop antisocial personality disorder. the current diagnostic criteria for antisocial personality disorder require a conduct disorder diagnosis before the age of 15 . At times. Correspondingly. Specifically. many of the individuals who do not meet full criteria for antisocial personality disorder still exhibit a pattern of social and personal impairments or antisocial behaviors. again. There is debate among professionals regarding the validity of diagnosing young children with conduct disorder. among incarcerated youth or youth in juvenile detention facilities. there is an established link between conduct disorder and the diagnosis of antisocial personality disorder as an adult. which have important implications for both research and treatment. neuropsychological deficits. this argument is not established and empirical research suggests that these subgroups are not as valid as once thought  . more academic problems.  However. both disorders share relevant risk factors and disruptive behaviors. rates of conduct disorder are between 23% and 87%. increased family dysfunction. Individuals with adolescent-onset conduct disorder exhibit less impairment than those with the childhood-onset type and are not characterized by similar psychopathology  . Gender Differences . suggesting that oppositional defiant disorder is a developmental precursor and milder variant of conduct disorder. The second developmental course is known as the "adolescent-onset type" and occurs when conduct disorder symptoms are present after the age of 10 years. The characteristics of the diagnosis are commonly seen in young children that are referred to mental health professionals  . However. These developmental trajectories suggest the existence of antisocial pathways in certain individuals . However. these individuals will remit in their deviant patterns before adulthood. only about 25% of children with oppositional defiant disorder will receive a later diagnosis of conduct disorder .
good coping skills. leading to increased overall risk for these youth. While it is unlikely that ADHD alone is a risk factor for developing conduct disorder. Moreover. risk factors associated with conduct disorder and the effects of conduct disorder symptomatololgy on a child’s psychosocial context have been linked to overlap with other psychological disorders.The majority of research on conduct disorder suggests that there are a significantly greater number of males than females with the diagnosis. Risk & Protective Factors It is important to note that the development of conduct disorder is not immutable or predetermined. while Asian youth are about one-third as likely to develop conduct disorder when compared to Caucasian youth. There are a number of interactive risk and protective factors that can influence and change outcomes. In addition to the risk factors identified under etiology. Females are more likely to be characterized by covert behaviors. suggesting that sex differences in disruptive behaviors need to be more fully understood. In this way. such that aggressive behaviors increase substance use. which leads to increased aggressive behavior. and supportive family and community relationships . as compared to their peers. Comorbidity Children with conduct disorder have a high risk of developing other adjustment problems. However. Use Disorders Conduct disorder is also highly associated with both substance use and abuse. such as aggression and fighting. with approximately 25-30% of boys and 50-55% of girls with conduct disorder having a comorbid ADHD diagnosis  . which are more often exhibited by males. this difference may be somewhat biased by the diagnostic criteria which focus on more overt behaviors. there seems to be reciprocal effects of comorbidity with certain disorders. conduct disorder in females is linked to several negative outcomes. . Protective factors have also been identified. and also tend to use multiple substances . children with comorbid conduct disorder and ADHD show more severe aggression Substance  . and in most cases conduct disorder develops due to an interaction and gradual accumulation of risk factors . Children with conduct disorder have an earlier onset ofsubstance use. including child physical abuse  and prenatal alcohol abuse and maternal smoking during pregnancy. Racial/Ethnic Differences Research on racial or cultural differences on the prevalence or presentation of conduct disorder is limited. with some reports demonstrating a three-to-four fold difference in prevalence . such as antisocial personality disorder and early pregnancy. As mentioned above. such as stealing or running away. and most notably include high IQ. being female. However. Attention-Deficit/Hyperactivity Disorder ADHD is the condition most commonly associated with conduct disorders. it appears that African-American youth are more often diagnosed with conduct disorder. several other variables place youth at increased risk for developing the disorder. children who exhibit hyperactivity and impulsivity along with aggression is associated with the early onset of conduct problems . positive social orientations. Moreover. it seems that there is a transactional relationship between substance use and conduct problems. Specifically.
There were no serious adverse effects. In a study of preschoolers. Matthys. Treating the unmanageable adolescent: A guide to oppositional defiant and conduct disorder. However. approximately 20-25% of youth with conduct disorder have some type of learning disability. and Treating Conduct Disorder at School (Developmental Psychopathology at School). Riseperidone is one of the most commonly studied medications used in treating children and adolescents with conduct disorder. K. T. Hughes. Identifying. (2010). (2008). it seems as if learning disabilities result from a combination of ADHD. J. and the tolerability of the drug was good. (2006). New York: Springer. and long-standing socialization difficulties with family and peers  . New York: Jason Aronson. N. Treatment There are poor outcomes associated with the diagnosis of conduct disorder in children and adolescents. or neurodevelopmental delay also need to be considered in this relationship. such as language deficits.Learning Disabilities While language impairments are most common. SES disadvantage. researchers treated the patients with Risperidone for 8 weeks and assessed the efficacy of the drug  . confounding variables.. Youth with conduct disorder: In trouble with the world. Oppositional defiant disorder and conduct disorder in children. & Livingston. MO: Compact Clinicals. MA: Wiley-Blackwell. Inc. Eddy. Results of this study concluded that Risperidone may in fact be an effective antipsychotic for the treatment of CD. Although the relationship between the disorders is complex. Kansas City. Resources Bernstein.). (2000). New York: Mason Crest Publishers. P. a history of academic difficulty and failure. Conduct disorders: The latest assessment and treatment strategies (4th Edition ed. as they could help explain some of the association between conduct disorder and learning problems . (2010). Malden. McIntosh. Assessing. W. See also Drift Hypothesis Bullying Challenging behavior Child pyromaniac Oppositional defiant disorder .
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