F90-F99 : BEHAVIOURAL &

EMOTIONAL DISORDERS WITH

ONSET USUALLY OCCURRING IN
CHILDHOOD & ADOLESCENT
• F91 - CONDUCT DISORDERS
F91.0 CONDUCT DISORDER CONFINED TO THE FAMILY CONTEXT
F91.1 UNSOCIALIZED CONDUCT DISORDER
F91.2 SOCIALIZED CONDUCT DISORDER
F91.3 OPPOSITIONAL DEFIANT DISORDER
F90.8 OTHER CONDUCT DISORDERS
F90.9 CONDUCT DISORDER, UNSPECIFIED
CONTENTS
• INTRODUCTION
• CLASSIFICATION
• DIAGNOSTIC CRITERIA
• PREVALENCE
• CO-MORBIDITY
• DD
• ETIOLOGY
• RISK FACTORS
• PROGNOSIS
• MANAGEMENT
CLASSIFICATION
OPPOSITIONAL DEFENSE DISORDER CONDUCT DISORDER (CD)
(ODD)
• RECURRENT PATTERN OF NEGATIVISTIC, DEFIANT, DISOBEDIENT &
HOSTILE BEHAVIOR TOWARDS AUTHORITY FIGURES
* PERSITENT PATERN OF ANTISOCIAL BEHAVIOR IN WHICH THE
INDIVIDUAL REPEATEDLY BREAKS SOCIAL RULES & CARRIES OUT
AGGRESSIVE ACTS
• MAJORITY DO NOT PROGRESS INTO MORE SERIOUS
PSYCHOPATHOLOGY OR PSYCHOPATHOLOGY
DIAGNOSTIC CRITERIA OF
CONDUCT DISORDER
• (A) A REPETITIVE AND PERSISTENT PATTERN OF BEHAVIOR
• IN WHICH THE BASIC RIGHTS OF OTHERS OR SOCIETAL NORMS OR
RULES ARE VIOLATED
• (B) AT LEAST 3 OF THE FOLLOWING CRITERIA HAVE BEEN PRESENT IN
THE LAST 12 MONTHS, WITH AT LEAST 1 PRESENT IN THE LAST 6
MONTHS
DIAGNOSTIC CRITERIA OF
CONDUCT DISORDER
• 1. AGGRESSION TO PEOPLE AND ANIMAL • OFTEN BULLIES,
THREATENS OR INTIMIDATES OTHERS • OFTEN INITIATED PHYSICAL
FIGHTS • HAS USED A WEAPON • HAS BEEN PHYSICALLY CRUEL TO
PEOPLE • HAS BEEN PHYSICALLY CRUEL TO ANIMALS • HAS STOLEN
WHILE CONFRONTING A VICTIM • HAS FORCED SOMEONE INTO
SEXUAL ACTIVITY
• 2. DESTRUCTION OF PROPERTY AND/OR THREAT • HAS DELIBERATELY
ENGAGED IN FIRE SETTING • HAS DELIBERATELY DESTROYED
OTHER'S PROPERTY • HAS BROKEN INTO SOMEONE ELSE'S PROPERTY •
OFTEN LIES TO OBTAIN GOODS OR AVOID OBLIGATIONS • HAS STOLEN
ITEMS OF NON-TRIVIAL VALUE
DIAGNOSTIC CRITERIA OF
CONDUCT DISORDER
• 3. SERIOUS VIOLATION OF RULES • OFTEN STAYS OUT AT NIGHT
DESPITE PARENTAL PROHIBITIONS • HAS RUN AWAY FROM HOME
OVERNIGHT • IS OFTEN TRUANT FROM SCHOOL, BEGINNING BEFORE
13 YEARS
• (C) THE DISTURBANCE IN BEHAVIOUR CAUSES CLINICALLY
SIGNIFICANT IMPAIRMENT IN SOCIAL, ACADEMIC, OR OCCUPATIONAL
FUNCTIONING
• ( D) ID OVER 18 YEARS, CRITERIA ARE NOT MET FOR ANTISOCIAL
PERSONALITY DISORDER
PREVALENCE
• ODD • 3 -16% UNDER 16S
• CONDUCT DISORDER • 3-16% UNDER 16S
• ODD- USUALLY OCCUR BEFORE 8 YEARS, NO LATER THAN
ADOLESCENCE • CD - DIAGNOSED FROM 10-15 YEARS
• PREVALENCE HIGHER IN LOWER SOCIOECONOMIC GROUPS
CO-MORBIDITY
• ADHD • LEARNING DISABILITIES • SUBSTANCE ABUSE • PTSD •
ANXIETY DISORDERS • DEPRESSION • PSYCHOSIS
DD
ADHD
- HYPERACTIVITY, INATTENTION, IMPULSIVITY
- - ADHD DO NOT SHOW ANY A THE SPECIFIC BEHAVIOURS
ASSOCIATED WITH ODD AND CD
MOOD DISORDERS
- DEPRESSION CAN OCCUR WITH IRRITABILITY & OPPOSITIONAL
BEHAVIOR IN CHILDREN
AUTISTIC SPECTRUM DISORDERS LEARNING DISORDERS OR SPECIFIC
DEVELOPMENTAL DISORDERS DISOCIAL/ANTISOCIAL PERSONALITY
DISORDER PSYCHOSIS
AETIOLOGY
• GENETICS –
• 50%, POSITIVE FAMILY HX, (MAO LEADS FOR THIS AGGRESSIVE
BEHAVIOR)
• PSYCHOLOGICAL RISKS –
• EARLY EXPERIENCES - NEGLECT, ABUSE, POOR PARENTING,
EXPOSURE TO VIOLENCE • OVER PUNISHING CHILDREN •
I\)/EICI_I,SOYCLE WHICH NEGATIVELY REINFORCES THE CHILD'S
• ENVIRONMENTAL FACTORS –
• POVERTY HIGH NEIGHBOURHOOD, HIGH
RISK FACTORS FOR DISRUPTIVE
BEHAVIOURAL DISORDERS
• BIOLOGICAL
• GENETICS FAMILY HX OF CD/ODD AND TWIN STUDIES
• BYSREGULATION OF NEUROTRANSMITTORS
• LOW IQ • LANGUAGE DISORDERS OR DEFICITS
• MINOR PHYSICAL ANOMALIES
• LOW BIRTH WEIGHT
• BRAIN INJURY OR DISEASE
• LOW RESTING HEART RATE
RISK FACTORS FOR DISRUPTIVE
BEHAVIOURAL DISORDERS
• PSYCHOLOGICAL
• IRRITABLE TEMPERAMENT AS A BABY
• INSTITUTIONAL CARE
• POOR-PARENT-CHILD RELATIONSHIP
• ATTACHMENT DIFFICULTIES
• POOR PARENTING; INCONSISTENTENT RULE SETTING, CRITICISM OR HOSTILITY
• LOW PARENTAL INVOLVEMENT WITH CHILD
• PHYSICAL, SEXUAL, OR EMOTIONAL ABUSE
• NEGLECT
• LOW SELF-ESTEEM
• 'UNEMOTIONAL' PERSONALITY TRAIT
RISK FACTORS FOR DISRUPTIVE
BEHAVIOURAL DISORDERS
• SOCIAL AND ENVIRONMENT
• MATERNAL SMOKING IN PREGNANCY
• LOW SOCIO-ECONOMIC CLASS
• POOR DIET WITH LACK OF VITAMINS & MINERALS
• BAD NEIGHBOURHOOD
• CRIME IN THE FAMILY
• PARENTAL MENTAL ILLNESS OR SUBSTANCE ABUSE
• PEER INFLUENCES ; ASSOCIATES WITH OTHER CHILDREN WITH
ODD/CD
COUSE AND PROGNOSIS
• ONCE ODD AND CD ESTABLISHED
• USUALLY STABLE THROUGHOUT THE REST OF CHILDHOOD

· OF THOSE WITH EARLY ONSET CD (BEFORE 8 YRS)

• 50'YO OF THEM WILL BE ANTISOCIAL PERSONALITY DISORDER IN
CHILDHOOD
ASSESSMENT AND
MANAGEMENT
• GENERAL MEASU RES
• PHARMACOTH ERAPY
• PSYCHOL OGICAL TREATMENTS
GENERAL MEASURES
• THE CHILD USUALLY DOES NOT F EEL THAT THEIR BEHAVIOR IS
UNREASONABLE, AND WI LL RESIST THE INTERVENTIONS

• PROVIDE WRITTEN AND SELF -HELP MATERIALS, BUT ONLY IF

THEY CAN READ
PSYCHOLOGICAL TREATMENT
• 1ST LINE TR EATMENT
• CHILDREN UNDER 12
• GOOD EF F ICIENCY OF PARENTAL TRAINING COURSES
• SKILL LEARNT INCLUDE
• PROMOT ING GOOD BEH AVIOR & A POSITIVE RELAT IONSHIP
• SETTING CLEAR RULES & COMMANDS
• REMAINING CLAM
• MANAGING DIF F ICULT SITUATIONS
• SYSTEMATIC FAMI LY THERAPY
• GOOD F OR OLDER CHILDREN
RISK FACTORS PREDICT ING A
POOR OUTCOME IN ODD AND CD
MALE GENDER
LOWERQ
PARENTAL ALCOHOLISM
LOW- INCOME FAMILY
POOR SCHOOLS, LOW ACHIEVEMENTS
SEVERE, FREQUENT ANTISOCIAL ACTS
CO-MORBID HYPERSENSITIVITY
PARENTAL CRIMINALITY
HARSH, INCONSISTENT PARENTING
TROUBLESOME NEIGHBOR HOOD
LACK OF PARENTAL INTEREST IN CHILD
EARLY ONSET