Conduct Disorder
Author: Deane G. Baldwin, M.D.

Conduct Disorder (CD) is largely associated with delinquent or criminal activity. The economic and social impact of CD makes it a high priority mental health problem because lives and property are often damaged or destroyed by those with the disorder. Individuals with CD are often incarcerated for their criminal activity and many pursue a chronic criminal life style. The loss of property and the expense of incarceration as well as the loss of personal income place the cost of the disorder at a staggering figure. The grief and unhappiness imposed on others because of this condition cannot be measured.

The behaviors exhibited by children with CD are associated with mental and/or physical harm to others, destruction or theft of property and repeated and serious violation of societal and family rules. These behaviors can be further classified as mild, moderate and severe.

In order to qualify for the diagnosis of CD, the behavior must significantly impair social, academic or occupational functioning and the individual with the disorder must be under 18 years of age. It is generally agreed that the earlier the age of onset the more likely it will be more serious and lasting. CD beginning in adolescence is often noted to be less problematic and more likely to resolve with time. Fortunately most children with CD learn to adapt and adjust their behavior to meet societal expectations. However, the problem remains a serious one for many children.

CD is usually preceded with a diagnosis of Oppositional Defiant Disorder. The latter is therefore a marker for the potential development of CD. Once CD is established the diagnosis of Oppositional Defiant Disorder is abandoned. When a child who is diagnosed with CD becomes an adult and continues with antisocial behaviors, the diagnosis is then designated Antisocial Personality Disorder.

CD is often associated with other coexisting mental disorders. Substance Use Disorder is frequently a coexisting condition. More recently, the disorder has been linked to verbal learning problems and Executive Function Disorder.

Until recently, CD and the criminal behavior associated with it had been mostly treated by punitive measures and while many individuals with the disorder may require these measures, it is now believed there is promising medical treatment for some.

One should often consider a disordered conduct that is the result of a problem of adjusting to situations that for some individuals are unbearable (for example, abuse and humiliation). Once the stressful situation is removed the disordered conduct will resolve with time.

Two conditions, one recently termed dysphoric conduct and the other Intermittent Explosive Disorder, may respond to mood stabilizers or antipsychotics. These may fall into a bipolar spectrum of disorders rather than true CD. The behaviors are associated with a disordered mood (angry, sad or both) in conjunction with disruptive behaviors. There may be slow or rapid cycling of abnormal and normal behavior. It is therefore important to recognize these conditions because of their treatment potential.

Some experts now agree that individuals with the classic CD may, in some cases, respond to mood stabilizers or antipsychotic medications as well. The impulsive activity of Attention Deficit Hyperactivity Disorder (ADHD) that often coincides with disordered conduct can be effectively treated with medications for the core symptoms of ADHD.

There is often a hereditary history or an environmental template for the disorder that might support an early diagnosis. The child or adolescent with a CD that is covert, calculated, predatory and without remorse remains a dilemma for remediation or habilitation. Every effort should be made to accurately identify and treat young children with CD.

Perhaps with continued research and early intervention, many children with CD will achieve a better and more fulfilling life style

References for this article include the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and other articles published in mental health literature.

See www.ABLEDEV.com Resource Room for Oppositional Defiant Disorder, Executive Function Disorder, Attention Deficit Hyperactivity Disorder and Adjustment Disorder.







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Dr. Deane G. Baldwin, M.D., FAAP, is a Board Certified Pediatrician in private practice for 39 years. Specializing in developmental disorders and school health. For more information go to www.ABLEDEV.com

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