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Conduct disorder
Classification and external resources
ICD-10 F91.
ICD-9 312
MeSH D019955

Conduct disorder is a psychiatric category marked by a pattern of repetitive behavior wherein the rights of others or social norms are violated.

Symptoms include verbal and physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.[1]

Conduct disorder is a major public health problem because youth with conduct disorder not only inflict serious physical and psychological harm on others, but they are at greatly increased risk for incarceration, injury, depression, substance abuse, and death by homicide and suicide. The syndrome is not a single medical entity but encompasses various forms of "major misbehaviour". [2] After the age of 18, a conduct disorder may develop into antisocial personality disorder, which is related to psychopathy.[3] Depressive conduct disorder is a combination of conduct disorder with persistent and marked depression of mood with symptoms such as loss of interest, hopelessness, disturbances in sleep patterns and altered appetite[4]

Causation

At one time or another most children and adolescents act out or do things that are destructive or troublesome to themselves or others as coping. Every teenager has a coping method; only some of the methods are troublesome or destructive. Such behavior is indicative of conduct disorder only if it persists. This disorder is much more common among boys than girls. As many as 50% of parents of 4 to 6 year-old children report that their child has exhibited such behavior, but most of these children show a decrease in antisocial behavior within the next couple of years.

Those who persist in such behavior may be candidates for psychological help. It is estimated that 5% of children show serious conduct problems, being described as impulsive, overactive, aggressive and engaging in delinquent behavior. Motives for such behavior include genetic inheritance of a difficult temperament, ineffective parenting, and living in a neighborhood in which violence is common. Despite considerable efforts made to help children with conduct disorders, there is lack of consensus on which methods actually work.[5]

A closely linked behavior is juvenile delinquency. This term refers to an adolescent's tendency to break the law or to engage in illicit behavior, a broad concept that ranges from littering to murder. According to U.S. government statistics, eight of ten cases of juvenile delinquency involve males. However, in the last two decades there has been a greater increase in female than male delinquency. [6]

Juvenile delinquency has been found to vary among cultures. Delinquency rates among minority groups and lower-socioeconomic-status-youth are especially high in proportion to the overall population of these groups. Some suggested causes of delinquency are heredity, identity problems, community influences, and family experiences.

Although delinquency is less exclusively a phenomenon of lower socioeconomic status than it has been in the past, some characteristics of lower-socioeconomic-class cultures may promote delinquency. It is a complex problem, but psychologists have found factors which may predict whether a youth is likely to turn violent. Violent youths are overwhelmingly male and driven by feelings of powerlessness. Ill-directed drives for power often motivate youth especially toward acts of violence.[5]

Behavioral models

Conduct disorder is the most prevalent diagnosis of children and adolescents in both outpatient and hospital settings. [7]Behavioral models of conduct disorder focus on the function of early childhood conduct problems.[8] In essence, these models represent a microsocial model of the development of conduct disorder. Using a matching law model of reinforcement, these models have shown that moment to moment success with conflict tactics as being either prosocial or antisocial, predict future conduct problems and arrest rates [9]

Lack of empathy

Conduct disorder is closely linked to psychopathy, a personality disorder characterized by an abnormal lack of empathy combined with strongly amoral conduct but masked by an ability to appear outwardly normal.

Some scholars have proposed that lack of empathy and empathic concern (callous disregard for the welfare of others) is an important risk factor for conduct disorder.[10][11]

File:Decety Striatum.jpg

When youth with aggressive conduct disorder watch an individual intentionally hurting another (like closing a piano lid), regions of the brain that process painful information are activated, as are the amygdala and ventral striatum (part of the neural circuit involved in reward processing). (Decety, Michalska, Akitsuki & Lahey, 2009).

Developmental psychologists and social neuroscientists have hypothesized that empathy and sympathetic concern for others are essential factors inhibiting aggression toward others.[12][13]

The propensity for aggressive behavior has been hypothesized to reflect a blunted empathic response to the suffering of others.[14] Such lack of empathy in aggressive individuals may be a consequence of failure to be aroused by the distress of others.[15] Similarly, it has been suggested that aggressive behavior arises from abnormal processing of affective information, resulting in a deficiency in experiencing fear, empathy, and guilt, which in normally developing individuals inhibits the acting out of violent impulses.[16]

Recently, a functional magnetic resonance imaging (fMRI) study conducted by neuroscientist Jean Decety and colleagues at the University of Chicago reported that youth with aggressive conduct disorder (who have psychopathic tendencies) have a different hemodynamic brain response when confronted with empathy-eliciting stimuli.[17] In the study, researchers compared 16 to 18 year-old boys with aggressive conduct disorder to a control group of adolescent boys with no unusual signs of aggression. The youth with conduct disorder had exhibited disruptive behavior such as starting a fight, using a weapon and stealing after confronting a victim. They were tested with fMRI while looking at video clips in which people endured pain accidentally, such as when a heavy bowl was dropped on their hands, and intentionally, such as when a person stepped on another's foot. Results show that the aggressive youth activated the neural circuits underpinning pain processing to the same extent, and in some cases, even more so than the control participants without conduct disorder.[18] However, aggressive adolescents showed a specific and very strong activation of the amygdala and ventral striatum (an area that responds to feeling rewarded) when watching pain inflicted on others, which suggested that they enjoyed watching pain.

Unlike the control group, the youth with conduct disorder did not activate the areas of the brain involved in understanding social interaction and moral reasoning (i.e., the paracingulate cortex and temporoparietal junction).[19]

Psychosocial treatments

One of the key factors in the development and maintenance of the negative behaviors associated with conduct disorder results is reinforcement, whether intentional or not, of the unwanted behaviors. The most effective way of treating disruptive behavior disorders is behavioral therapies [20] Behavioral therapy for children and adolescents focuses primarily on how problematic thoughts or behaviors may accidentally get "rewarded" within a young person's environment. These rewards or reinforcements often contribute to an increase in the frequency of these thoughts and behaviors. Behavior therapies can be applied to a wide range of psychological symptoms among adults, adolescents, and children. In behavioral therapy, therapists encourage children and adolescents to try new behaviors and not to allow negative "rewards" to dictate the ways in which they act. Furthermore, therapists may work with parents to discontinue ways in which they are unintentionally reinforcing negative behaviors. More information and examples of behavioral therapy are available through the Society for Clinical Child and Adolescent Psychology.[1]

See also

  • Bullying
  • Challenging behavior
  • Child pyromaniac
  • Oppositional defiant disorder

References

  1. Loeber, R., Farrington, D.P., Stouthamer-Loeber, M., & Van Kammen, W.B. (1998). Antisocial behavior and mental health problems: Explanatory factors in childhood and adolescence. Mahwah, NJ: Lawrence Erlbaum Associates.
  2. Hales R., Yudofsky S., and Talbott J. 1999 Textbook of Psychiatry 3rd Ed. London: The american Psychiatric Press. p. 855
  3. Lahey, B.B., Loeber, R., Burke, J.D., & Applegate, B. (2005). Predicting future antisocial personality disorder in males from a clinical assessment in childhood. Journal of Consulting and Clinical Psychology, 73, 389-399.
  4. ICD-10
  5. 5.0 5.1 Santrock, J. W. (2008). A Topical Approach to Life-Span Development. Moral Development, Values, and Religion: Antisocial Behavior (pp. 491-495). Boston, Massachusetts: McGraw-Hill.
  6. Tong, S. (2010) Living Life to the Fullest: An Excerpt from Teenage Life" (pp. 149-150). Toronto, Ontario: Tree Leaf.
  7. Antai-Otong, D. Psychiatric Nursing: Biological and Behavioral Concepts. 2nd ed. Delmar: Canada
  8. Patterson (2002) Etiology and Treatment of Child and Adolescent Antisocial Behavior. The Behavior Analyst Today, 3 (2), 133 -145 BAO
  9. James Snyder, Mike Stoolmiller, Gerald R. Patterson, Lynn Schrepferman, Jessica Oeser, Kassy Johnson, and Dana Soetaert (2003): The Application of Response Allocation Matching to Understanding Risk Mechanisms in Development: The Case of Young Children’s Deviant Talk and Play, and Risk for Early-Onset Antisocial Behavior. The Behavior Analyst Today, 4 (4), 435 - 439 BAO
  10. Frick, P.J., Stickle, T.R., Dandreaux, D.M., Farrell, J.M., & Kimonis, E.R. (2005). Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. Journal of Abnormal Child Psychology, 33, 471-487.
  11. Lahey, B.B., & Waldman, I.D. (2003). A developmental propensity model of the origins of conduct problems during childhood and adolescence. In B.B. Lahey, T.E. Moffitt, & A. Caspi (Eds.), Causes of conduct disorder and juvenile delinquency (pp. 76-117). New York: Guilford Press.
  12. Eisenberg, N. (2005). Age changes in prosocial responding and moral reasoning in adolescence and early adulthood. Journal of Research on Adolescence, 15, 235-260.
  13. Decety, J., & Meyer, M. (2008). From emotion resonance to empathic understanding: A social developmental neuroscience account. Development and Psychopathology, 20, 1053-1080.
  14. Blair, R.J.R. (2005). Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations. Consciousness and Cognition, 14, 698-718.
  15. Raine, A., Venables, P., & Mednick, S. (1997). Low resting heart rate at age three years predisposes to aggression at age 11 years: Evidence from the Mauritius Child Health Project. Journal of the Academy of Child and Adolescent Psychiatry, 36, 1457-1464.
  16. Herpertz, S.C., & Sass, H. (2000). Emotional deficiency and psychopathy. Behavioral Science and Law, 18, 317-323.
  17. Decety, J., Michalska, K.J., Akitsuki, Y., & Lahey, B. (2009). Atypical empathic responses in adolescents with aggressive conduct disorder: a functional MRI investigation. Biological Psychology, 80, 203-211.
  18. Decety, J., Michalska, K.J., & Akitsuki, Y. (2008). Who caused the pain? A functional MRI investigation of empathy and intentionality in children. Neuropsychologia, 46, 2607-2614.
  19. Meneley, D. PhD (2010) Living Life to the Fullest: An Excerpt from Teenage Life" (pp. 149-150). Toronto, Ontario: Tree Leaf.
  20. Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008).

"The Good Son"

Further reading

  • Decety, J., & Moriguchi, Y. (2007). The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. BioPsychoSocial Medicine, 1, 22-65.
  • Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for child and adolescent with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37, 215-237
  • Lahey, B.B., Moffitt, T.E.,& Caspi, A. (Eds.). Causes of conduct disorder and juvenile delinquency. New York: Guilford Press.
  • Raine, A. (2002). Biosocial Studies of Antisocial and Violent Behavior in Children and Adults: A Review. Journal of Abnormal Child Psychology, 30, 311-326.
  • Van Goozen, S.H.M., & Fairchild, G. (2008). How can the study of biological processes help design new interventions for children with severe antisocial behavior? Development and Psychopathology, 20, 941-973.

External links

Template:Emotional and behavioral disorders

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