Monday, November 23, 2009

Conduct Disorder In Our Children and Youth

Children diagnosed with conduct disorder show a repetitive and persistent tendency to disrespect and violate the rights of others and to break normal societal rules and also laws. Conduct Disorder may be identified in children before 10 years and up to 18 years of age. It can be diagnosed in individuals older than 18 years, but only if they do not meet the criteria for Antisocial Personality Disorder which I will discuss in a later blog. Briefly, Antisocial Personality Disorder is a life-long disorder that is more severe than Conduct Disorder. The early appearance of Conduct Disorder in a child makes it more likely that the problem will continue into Antisocial Personality disorder in adulthood.

Conduct Disorder may be classified as mild, moderate or severe in nature. Frequently, children with mild cases of this disorder can be helped with therapeutic interventions and the problem may improve with maturity. Severe cases are more likely to continue into adulthood and form a long-term pattern of deeply ingrained antisocial behavior patterns that are highly resistant to change. The majority of our prison populations would be diagnosed as Antisocial Personality Disordered.

The list of actions shown by the children diagnosed with Conduct Disorder can be alarming. A partial list of such behaviors is as follows:

Recklessness and risk-taking
Curfew violations
Truancy from school
Running away from home overnight or longer
Lying, deceiving or “conning” others
Early sexual activity
Tobacco, drug and alcohol use
Bullying, threatening, intimidating and fighting
Using weapons (stones, clubs, knives, guns)
Breaking and entering homes, cars, or other buildings
Cruelty of people and/or animals
Property destruction (vandalism)
Robbery, extortion, mugging, purse snatching (while confronting the victim)
Assault and, rarely, murder

Conduct Disorder has increased in prevalence over several decades and rates are around 6% to 16% for males and 2% to 9% for females.

Suspected Causes

Many very bad childhood experiences appear to be tied to the development of Conduct Disorder. Parents who are drug involved, or have mental disorders of their own are more likely to have conduct disordered children. Research also suggests that the tendency to develop Conduct Disorder behavior patterns is genetically inheritable. Children so diagnosed frequently have experienced traumatic events, poverty, family disorganization, abuse, neglect, and abandonment. They have frequently lived in poverty and grown up around violent peers and adults. Children with a biological or adoptive parent with Anti-social Personality Disorder or a sibling with Conduct Disorder, are themselves at greater risk for developing a conduct disorder.

A Case Study

One 15 year old’s father was in prison for killing someone. The boy had visited his father in prison on numerous occasions and sometimes got phone calls from him. Despite his father’s pleadings to him to do good in school, follow the rules and stay out of trouble, the boy was failing in school, frequently suspended, and had been in a juvenile detention center for threatening and attacking other students. The boy’s mother had lived with several other men in the course of his short life-time and he had experienced drugs, violence, and the physical abuse of his mother and himself repeatedly. After frequently running away from home and being involved with older men and drug abuse, he was placed in a long-term adolescent treatment facility. The boys Conduct Disorder was severe in nature, with an early onset, and it was likely that his behavior patterns would continue into adulthood and then be diagnosed as Antisocial Personality Disorder.

We must find ways to save our infants and children from these incredibly damaging influences. The majority of these human tragedies can be prevented before their contagious effects spread throughout our population. Our current late remediation strategies are failing miserably and are doomed to fail by the very nature of this intractable psychological disability.

America must create bold preventive and very early interventions to avoid the continued escalation of the social havoc that we now experience due to our increasing rates of Conduct Disorders.

If you see the symptoms listed above in your own children, or a Friend or family member complains about them in their children, the best advice is to get professional help as soon as this behavior pattern begins to take shape. I recommend a conference with your family MD and if there are no health issues, an appointment with a psychologist with both counseling and behavior modification skills.

God Bless,

Dr. Tom

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