The conduct or behavioural disorders refer to a variety of disruptive behaviours of childhood and adolescence, which often give rise to social disapproval because of their antisocial qualities.
These behaviours are deemed antisocial because they are explicitly harmful or disturbing to others or in some way have an adverse affect on the environment.
The problems range from legally-defined delinquent acts like violence, theft, vandalism and arson to a variety of delinquent behaviour such as lying, bullying, stealing, destructiveness, disobedience, defiance, cruelty to animals and fire-setting.
The conduct disorders include a third set of behaviours namely the “acting out” behaviours , such as temper tantrums, provocative behaviour, being quarrelsome and generally being difficult to manage.
Antisocial activities tend to disrupt and hinder the acquisition of crucial adaptive skills. Their presence in childhood is predictive to a degree of problems of adjustment in later adolescence and adulthood. Because of this there is a pressing need to identify, at an early age, children who are presenting with conduct problems and to discover and develop methods for their modification.
MY FIRST BRUSH WITH CONDUCT DISORDER
A few years ago I had the rather disturbing experience of meeting a very troubled the young man. He displayed behaviour than I had not encountered prior to making his acquaintance. The young man was completely self absorbed, had no respect for the property of others, and even less respect for personal space. He lied pathologically, abused every kindness extended to him and basically took advantage of everybody who entered his circle. He could not hold down a job due to his irresponsible and later criminal behaviour where he became involved in theft, fraud, and bribery. Our association ended when one afternoon he took it upon himself to grab me by the throat in my home. He was twenty and a full blown antisocial personality disorder at the time.
He had been raised by his mother, who had spoiled him rotten and who had never set any boundaries where he was concerned. I was to later learn that, she had in fact, facilitated his dreadful behaviour from a very young age. For instance when he started smoking at the age of six or seven, his mother merrily went out and bought him the cigarettes he demanded. She did the same when he later moved on to more dangerous narcotics and even steroids which he continues to use to date.
After investigating his past behaviour and school history, I rapidly unearthed the fact that he had long been considered a problem child at the various schools he attended. His behaviour was so problematic that two of these schools had asked him to leave. He first began exhibiting problems in early primary school. He consistently underperformed academically. He was a bully, was cheeky, and had no respect for the teachers who were trying to educate him or the school authorities who tried to enforce a measure of discipline on him. He bunked school consistently being truant. In the end he left school before completing high school with a Grade 10 and very little hope of a future although he would never admit to this. He spent much of his time lying to the world, trying to con people into believing he was more than he would ever amount to.
Throughout his life the young boy’s mother had consistently modelled manipulative and anti-social behaviour for her son. She took no responsibility for her own reckless behaviour. She appeared, over the years, to have consistently made excuses for his behaviour. She repeatedly blamed the child’s poor conduct on his “absent” father. A man who she had isolated from the child, not allowing him to see the boy or at the very least making it very difficult for him maintain contact. She deliberately undermined any relationship the boy could have formed with his father and any positive influence his father might have had on him. She married again, and a few years later, had a second child, but, eventually her new husband committed suicide. There was a history of suicidal behaviour in the mother’s family as her brother also killed himself. Later on the young man would use threats of suicide in his many attempts to manipulate people including his father and me.
He consistently used violence or the threat of violence to achieve his own ends. At one point he physically attacked his father during an argument. To give you an example of his total lack of respect for other people and even his own property: – His father purchased a car for him and gave it to him on the understanding that he would pay back the money spent with no interest. He paid for exactly two months, accrued many speeding fines which other people had to pay, drove the car like a maniac, doing doughnuts and so forth until the vehicle was so badly damaged that it could no longer be driven . Then had the audacity to demand his father fix it. His father declined to do so, after which he received a call from the errant boy demanding that he pay for the storage of the vehicle. When this didn’t happen he sold the car, without even informing his father, telling the buyer to get the papers from his dad who after the many speeding fines had deregistered the vehicle.
I had worked with a few offenders with antisocial personality disorder and recognised the boy was a poster child for the disorder but this was the first opportunity I had had to seriously research conduct disorder in children. What I discovered about children with conduct disorder is very troubling and probably a lot more common than we think especially in troubled societies like South Africa where almost every citizen has experienced trauma in one form or another.
WHAT IS CONDUCT DISORDER
According to the DSM IV “conduct disorder is a repetitive and persistent pattern of behaviour by a child or teenager 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 following criteria in the past 12 months, with at least one criterion present in the past six months.” This behaviour typically falls into four categories or groupings. Aggressive conduct that may cause harm to people or animals, nonaggressive conduct that causes serious damage or loss to property, deceitfulness and theft, and repetitive serious violations of rules both at home and at school.
People with conduct disorder commonly display aggression directed at both people and animals. They are often bullies who threaten or intimidate others by initiating physical fights. A child with conduct disorder will commonly use a weapon (for example a brick, broken bottle, or gun) that can cause serious physical harm to others to resolve an argument and assert dominance. They are commonly physically cruel to people and to animals. They will have stolen goods or items while confronting the victim and frequently commit crimes such as, mugging, purse snatching, extortion and robbery.
They regularly partake in destructive behaviours such as the destruction of property. They may be deliberately engaged in fire setting with the intention of causing serious damage to property. This is not only attained through this setting off fires however, and they may employ many other methods to destroy the property of others such as the breaking of windows with rocks or breaking the headlights of vehicles or smashing windscreens with a cricket bat.
They are highly deceitful and consistently and pathologically lie in order to achieve their goals, garner favour and avoid obligations. They are commonly involved in many “cons” and have no qualms about their behaviour. There are regularly involved in theft and shoplifting which may escalate to more serious crime such as housebreaking or breaking into businesses if not addressed. With the right skills they will commit crimes such as hacking, fraud and forgery, for instance signing their parents signature on a poor report card.
The have little regard for rules and repetitively engage in behaviour which serious violates the rules of both in the parental home as well as school rules. They will often stay up late at night despite parental prohibitions and this will commonly begin before thirteen years of age. They run away from home when they do not get their own way. In order to meet the diagnostic criteria the child must have run away from home overnight at least twice while living in parental or parental surrogate home or once without returning for a lengthy period of time. They are often truant from school and this too regularly begins before they are thirteen years old.
In order to diagnose conduct disorder the disturbance in behaviour must cause clinically significant impairment in social, academic or occupational functioning.
Conduct disorder can be diagnosed in individuals over eighteen years of age if the criteria are not met for antisocial personality disorder but the person meets the criteria for conduct disorder as described or outlined above. In order to be diagnosed with anti-social personality disorder the person should have been diagnosed with conduct disorder before reaching the age of fifteen.
TYPES AND SEVERITY OF CONDUCT DISORDER
There are essentially two types of conduct disorder which differ with reference to the characteristic nature of the presenting conduct problems, and the developmental course and prognosis and gender ratio. Both subtypes can occur in a mild moderate or severe form. When assessing the age at onset, information can be obtained from the child himself, from caregivers and from the child’s teachers. It must always be kept in mind that many of the behaviours can be concealed or hidden and because of this, caretakers may under report problems at times and often overestimate the age at onset.
The first is the Childhood-Onset Type ÔÇô where the onset of at least one criterion characteristic of conduct disorder is exhibited prior to the age of ten years old. Persons with Childhood-Onset Type are typically male, commonly exhibit physical aggression towards others, have disturbed peer relationships, might have had oppositional defiant disorder at some stage in early childhood, and as a rule have symptoms that meet the full criteria for conduct disorder preceding puberty. These individuals are more prone to have persistent conduct disorder and to later develop adult antisocial personality disorder than those with Adolescent-Onset Type
The second is Adolescent-Onset type ÔÇô where there is an absence of any criteria characteristic of conduct disorder prior to age ten years in other words the symptoms manifests only after the child has reached the age of ten. When compared with the first type, people with this type of conduct disorder are less likely to display aggressive behaviours and tend to have more normal peer relationships. However they commonly display conduct problems when they are in the company of their peers. These individuals are less likely to have persistent conduct disorder or to develop adult antisocial personality disorder so the prognosis for them is much better.
The severity of conduct disorder has been classified by the DSM IV as mild, moderate or severe. Mild: -when few if any conduct problems in excess of those required in order to make the diagnosis exist and the conduct problems have caused only minor harm to others. Moderate: -when a number of conduct problems exist and the effect on others intermediate between “mild” and “severe”. Severe: – when many conduct problems are exhibited by the individual, these will often exceed the number of criteria required to make the diagnosis of conduct disorder. Additionally these problems will have caused considerable harm to others.
TREATMENT AND PROGNOSIS
In order for treatment of conduct Disorder to be successful, it must be diagnosed and started early . It is critical for the child’s parents to be involved in the treatment program as parents can learn techniques that will enable them to manage their child’s problem behavior. Research suggests that treating children at home, along with their families, is more effective, improving the long term prognosis.
In cases where the child has suffered abuse in the home, the child should ideally be removed from the family home and placed in a less chaotic home when treatment is initiated. Treatment with medicines may be effective in managing co-morbid conditions like bi-polar disorder or depression and talk therapy may be used for depression and assisting the child with working through his problems.
Ideally therapy should be sought with a psychologist or psychiatrist in order to improve the prognosis. Children who have severe or frequent symptoms and who are not able to complete treatment (which could take years and tends to be expensive) tend to have the poorest outlook. The good news is that children who are diagnosed and treated early usually overcome their behavioral problems.
If treatment is not sought, children diagnosed with conduct disorder could go on to develop personality disorders as adults, predominantly antisocial personality disorder. As their behaviors get worse, these individuals commonly develop problems with drug abuse and the law.
Depression and bipolar disorder may develop in the teen years and early adulthood. Suicide and violence toward others are also possible complications.
If the case study or the symptoms described above are ringing alarm bells for you. Please seek help for your child, niece, nephew or student as quickly as you can. Make an early diagnosis and save a child from a lifetime of misery.
Expert Profiling contactable on Tel: 390 9957 email – [email protected] or [email protected] or on Twitter @LauriePieters which is ideally placed to assist.
