When is conduct disorder diagnosed

Shallow or deficient affect: Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial e. Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others. Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others. Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others e.

Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others e. Other titles in this collection.

Recent Activity. Clear Turn Off Turn On. Support Center Support Center. External link. In behavior there are symptoms of argumentative attitude with the elders, refuses to comply with the rules, deliberately tries to start a fight, tries to blame for own actions on others, etc. Vindictive behavior in the last 6 months for at least twice. The diagnosis and its criteria also vary with age. If the patient is below the age of 5 years then these symptoms are expected to occur nearly every day whereas if the age of the patient is above 5 years then these symptoms must be present at least once a week or more.

The diagnosis of the conduct disorder is different because the disorder is quite different from oppositional defiant disorder. In conduct disorder, there are violations of the rights of other people and there is compulsion felt to break the rules. These are usually classified as the anti-socials and is considered as one of the precursors of anti-social personality disorder. It consists of activities like lying, stealing, physical violence, sexual abuse, running away from home, beating parents and other people, etc.

In addition, these family groups often experience financial distress, which may further complicate the situation. These children are also more susceptible to the rise in peer group influence that typically occurs in later elementary school. Several common childhood psychiatric conditions have features similar to those of conduct disorder, and comorbid conditions are also common. Specialized multimodal treatment, including group, individual and family therapies; medical detoxification and inpatient treatment.

Dysphoric, irritable mood; sleep and appetite disturbance; anhedonia; suicidal ideation. Pharmacotherapy anticonvulsants, clonidine, lithium, SSRIs , cognitive behavior therapy.

The growing public awareness of ADHD and its relative treatability with stimulant medication may contribute to its confusion with conduct disorder. ADHD's features of disinhibition, inattention and distractibility should be distinguished from lying, serious aggression and illegal behaviors. Have you had any run-ins with the police?

If yes, what were the circumstances? Do you smoke, drink alcohol or use other drugs? If yes, what is the frequency and duration of your use? Which drugs? Oppositional defiant disorder may be difficult to distinguish from conduct disorder.

Key features of oppositional defiant disorder include argumentativeness, noncompliance with rules and negativism. While these features partially overlap with those of conduct disorder, there are important distinctions. Children with oppositional defiant disorder, although argumentative, do not display significant physical aggression and are less likely to have a history of problems with the law.

Parents of children with oppositional defiant disorder are more likely to have mood disorders than the antisocial pattern common among parents of children who have conduct disorder. Oppositional defiant disorder may, with time, develop into conduct disorder. Significant acting out frequently occurs among children and adolescents with major depression and dysthymic disorder. Patients with early-onset bipolar disorder may exhibit impulsive violations of rules and aggression.

However, mood disorders typically include disturbances of sleep and appetite and pronounced affective symptoms, as well as significant alterations in energy and activity levels not found among children with conduct disorder. The coexistence of major depression with conduct disorder increases the risk of impulsive suicidal behavior.

Substance abuse may also overlap with the symptoms of conduct disorder. A key issue in assessing substance use in adolescents is the distinction between experimentation and abuse or dependence. The frequency and duration of substance use are helpful dimensions in this regard. Early i. Additionally, substance use is likely to further reduce impulse control and increase contact with deviant peers.

Intermittent explosive disorder, featuring unprovoked, sudden aggressive outbursts, can only be correctly diagnosed when the child's behavior does not meet the criteria for conduct disorder.

In children and adolescents with intermittent explosive disorder, these episodes are the only signs of behavior disturbance. Other than unplanned acts of aggression, patients with intermittent explosive disorder do not engage in repeated violations of other rules or in illegal behavior such as theft or running away from home.

Family physicians are often the first professionals who are consulted by families of children with conduct disorder. During these visits, physicians should emphasize the seriousness of the patient's behavior and the possibility of a poor long-term prognosis if there is no significant parental intervention. These parental disorders influence children's behavior problems associated with inconsistency, harsh discipline, impaired attachment and minimal supervision. Basic intervention guidelines for family physicians are summarized in Table 4.

Emphasize parental monitoring of children's activities where they are, who they are with. Encourage the enforcement of curfews. Encourage children's involvement in structured and supervised peer activities e. Consider pharmacotherapy for children who are highly aggressive or impulsive, or both, or those with mood disorder. Conduct disorder has varying degrees of severity. Parental abuse, onset of problem behavior in early childhood, financial hardship and lack of supervision are all associated with more severe conduct disorder.

However, more serious, longstanding behavior involving aggression, illegal acts, substance abuse or other harmful acts should prompt referral to a mental health specialist. With comorbid substance abuse, the focus of initial treatment should be cessation of drug use and may include medical detoxification before rehabilitation. Monitoring of children's activities and whereabouts by adult caregivers is critical.

Compliance with the evening curfew is essential. For working parents, telephoning to check on the child or having another responsible adult ensure that the child is in an appropriate setting during nonschool hours is important. Monitoring becomes particularly important during early adolescence when peer group influences increase. Vulnerable youth are susceptible to peer influences such as smoking, sexual risk-taking, and alcohol or other substance abuse.

Organized, supervised activities, such as sports, Scouting, the arts or recreational programs provided by churches, schools or agency youth clubs often protect teenagers from negative peer influences. A reasonable initial intervention for family physicians is parental instruction in communication for achieving improved compliance. Maybe you could be useful and help with dinner. If the requested activity is not initiated within five seconds, a verbal reminder should follow.

Well, you're grounded for the rest of the year. While adverse consequences may be necessary periodically, parent-child interactions should also include rewards. Positive reinforcement for desirable behavior will reduce reliance on punishment. Parents of children with conduct disorder typically rely on inconsistent coercion, rather than reinforcement, in a family climate high in negative exchanges.

Because television, movies and video games are reinforcing to many children and adolescents, they are often used as rewards.

Children who are at risk for conduct disorder, however, may be more likely to exhibit aggressive behavior in response to viewing violence. In two-parent households or other family situations in which multiple adults set rules, consistency between caregivers is particularly important. In single-parent households, particularly those with multiple children, parental availability and energy may be limited. Physicians should inquire about the availability of other responsible adults to assist with carrying out rules under the parent's guidance.

A useful directive to improve the emotional climate in families with preteens and younger children is to set aside 15 minutes every day for parent and child to play together. The child chooses a cooperative activity each day e. Structuring such exchanges ensures regular reinforcing contact between parent and child.

Pharmacotherapy may be considered as an adjunct treatment for conduct disorder and comorbid conditions. While there are no formally approved medications for conduct disorder, pharmacotherapy may help specific symptoms. Further studies are needed to evaluate the role of pharmacotherapy for conduct disorder. Commonly used medications are summarized in Table 5. For children six years and older: 2. Anorexia, nervousness, sleep delay, restlessness, dysrhythmias, palpitations, tachycardia, anemia, leukopenia.

Periodic CBC with differential and platelet count, blood pressure, height, weight, heart rate Tolerance or dependence can occur. Drug holidays should be considered. Amphetamine therapy is not recommended for children younger than three years. Anorexia, dependence, hyperactivity, sleep delay, restlessness, talkativeness, palpitations, tachycardia. CNS activity, height, weight, blood pressure Tolerance or dependence can occur. Do not discontinue abruptly.

Fluoxetine Prozac. Anxiety, dizziness, drowsiness, fatigue, headache, insomnia, nervousness, tremor, anorexia, diarrhea, dyspepsia. Dizziness, psychiatric changes, slurred speech, gingival hyperplasia, constipation, nausea, vomiting. Serum concentrations, CBC with differential, liver enzymes Drug interactions. Drowsiness, sedation, constipation, diarrhea, heartburn, nausea, vomiting, rash. Children: 15 to 60 mg per kg per day in 3 to 4 divided doses Adolescents: to 1, mg per day in 3 to 4 divided doses.

Dizziness, drowsiness, fine hand tremor, headache, hypotension, anorexia, diarrhea, dry mouth, nausea, vomiting, polyurea. Drug interactions Serum lithium concentrations prior to next dose, monitor biweekly until stable then every 2 to 3 months; serum creatinine, CBC, urinalysis, serum electrolyte, fasting glucose, echocardiogram, TSH.

Blood pressure, heart rate Do not discontinue abruptly or withdrawal symptoms may occur. By improving attention and increasing inhibitory activity, medication may improve children's capacity to benefit from other psychosocial intervention. Conduct Disorder. Signs and Symptoms. Behaviors characteristic of conduct disorder include: Aggressive behavior that causes or threatens harm to other people or animals, such as bullying or intimidating others, often initiating physical fights, or being physically cruel to animals.

Serious rule violations, such as staying out at night when prohibited, running away from home overnight, or often being truant from school. Learn more about conduct disorder, including recent research on effective treatment approaches. Contact NMHA for additional resources on conduct disorder or other emotional or behavioral disorders of childhood. Explore the treatment options available. Treatment must be individualized to meet the needs of each child and should be family-centered and developmentally and culturally appropriate.