Conduct Problems

About one-third of children with childhood behaviour problems develop conduct problems, which is a pervasive and persistent pattern of disregard for rules and antisocial behaviours that extends beyond the family into the community (APA, 2013). Lack of self-regulation skills, problematic parenting practices, and extra factors such as high stress and low social support all contribute to maintaining conduct disorder. All of the disruptive behaviours (oppositional defiant disorder, conduct disorder, or child and adolescent anti-social disorder) are of concern because they may lead to co-morbid academic, emotional and relationship problems, and in the long term to adult adjustment difficulties. These conduct problems are relatively common.

The DSM 5 has added a category for Callous and Unemotional (CU) traits which apply to a subgroup of conduct disorder children and adolescents who display distinct emotional and behavioural traits showing no remorse and are less sensitive to punishment cues. Critics of this category maintain that there is yet little evidence to categorize younger children as psychopathic or having a stable diagnosis in this category.

Oppositional defiant disorder (ODD). ODD is the least severe of the three types of disruptive behavioural disorders. ODD is marked by a pattern of aggressive, negativistic, hostile and defiant behaviour (APA, 2013). There is a persistent pattern of actively refusing to follow requests, of over-reactions, losing one’s temper, blaming others, angry, resentful and vindictive actions. Children with ODD may deliberately annoy others, and are likely to be argumentative with adults. ODD is rarely seen in isolation, rather its behaviour is usually a symptom complex resulting from some other underlying disorder of the syndrome mix.

About 5-15% of school age children meet criteria for ODD. As infants or toddlers, the ODD child may display irritability, stubbornness, rigidity, aggression, intense reactions, and tantrums. Sometimes these reactions are worsened by inconsistent or excessively harsh parenting techniques, or by family stresses. By school age, symptoms spill over to affect teachers, peers and other adults. The behaviours of the ODD child lead to increasing rejection and attention seeking behaviour. Often the negative behaviours tend to improve with the treatment of the underlying problem.

There is evidence that oppositional defiant disorder embraces three subdivisional developmental trajectories of irritability (affect dysregulation), headstrong and hurtful behaviors which diverge from age 8 to 16. Aggressive acts in early childhood respond well to multimodal treatments and have good outcomes according to the literature. Dysregulated affect (irritability) with headstrong traits have higher risk when developmental trajectories are followed into adolescence.

Conduct disorder (CD) Children with CD are more frequently overly hostile and aggressive, law breaking, with a lack of remorse (APA, 2013). These children violate the rights of others, bully, threaten, and can display physical cruelty with people and animals (APA, 2013).

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

 

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