Conduct disorder and antisocial behavior in children – part 1

I’ll write a two piece article on conduct disorder and antisocial behavior in children here at HTCC. This should give you a great insight about how to understand the problem and the better way to deal with it. This first part presents the problem and teaches you how to detect that in your child. So let’s get to it, I hope you enjoy!

Certain behaviors such as lying and skipping class, can be observed in the course of normal development of children and adolescents. To differentiate normality and psychopathology, it is important to verify that these antisocial behavior in children occur sporadically and in isolation or are syndromes representing a deviation from the standard behavior expected for people their age and sex in a given culture.

What the world says about antisocial behavior in children

The international literature addresses the issue of antisocial behavior from different points of view, taking into account the legal aspects (criminology) and psychiatric disorders. From a legal standpoint, the crime involves behaviors that violate the law. However, as not all antisocial children and youth transgressed the laws, the term was restricted to minor delinquent offenders (legal definition). The antisocial acts related to psychiatric disorders are more comprehensive and relate to behavior condemned by society, with or without breaking the laws of the State.

Based on international diagnostic criteria, such as the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV2 – learn more about this here), notes that the persistent antisocial behavior is part of some psychiatric diagnoses. The conduct disorder and oppositional defiant disorder diagnostic categories are used to children and adolescents, whereas antisocial personality disorder applies to individuals of 18 years of age or more .

In this article, it’s presented the main features of conduct disorder, emphasizing diagnosis, progression and treatment. Highlighting the factors associated with antisocial behavior in childhood and adolescence in order to expand the vision of the mental health professional about the family and the community in which the child is inserted.

Conduct disorder

The conduct disorder is one of the most frequent psychiatric disorders in childhood and one of the biggest reasons for referral to a child psychiatrist. For example, disobedient children and adolescents with difficulty to accept rules and limits and defying the authority of parents or teachers often be referred to mental health services due to “conduct disorders”. However, young people with such disorders do not always meet the criteria for the diagnostic category of “conduct disorder”. Therefore, the term “conduct disorder” is not appropriate to represent psychiatric diagnoses.

In Canada, the conduct disorder affects 5.5% of the general population aged 4-16 years, with rates ranging from 2% (girls 4-11 years) to 10% (boys 12-16 years). The conduct disorder is more common in males, regardless of age, and more frequent in older children (12-16 years) compared to smaller (4-11 years), regardless of sex.

How to detect a child with conduct disorder

Considering that conduct disorder is a permanent tendency to display behaviors that annoy and disturb others, the involvement in dangerous and even illegal matters are not uncommon. These young people do not seem to have psychological distress or embarrassment with their own attitudes and do not mind hurting people’s feelings or disrespect their rights. Therefore, their behavior has more impact on others than on their selves. The antisocial behavior tend to persist, since they lack the ability to learn from the negative consequences of their own actions.

The clinical features of conduct disorder is characterized by persistent anti-social behavior in violation of social norms or individual rights. The diagnostic criteria of DSM-IV conduct disorder include 15 possibilities for antisocial behavior in children:

• often haunts, torments, threatens or intimidates others,
• often initiates physical fights,
• has already used weapons that can cause serious injury (wood, stone, broken glass, knife, gun),
• was cruel to people, injuring them physically,
• was cruel to animals, hurting them physically,
• stolen or assaulted, confronted the victim,
• underwent to force someone into sexual activity,
• fires started deliberately with the intention of causing serious harm,
• deliberately destroyed others’ property (not fire),
• breaking and entering house , building or car;
• lie and cheat for material gain or favors or to avoid obligations;
• stole valuables;
• frequently spent the night outside, despite the prohibition of the parents (onset before 13 years)
• ran away from home at least twice, spending the night outside, while living with parents or foster parents (or ran away from home once, absent for a long time)
• missing school without reason, often ditching classes (beginning before age 15).

The diagnostic criteria of DSM-IV conduct disorder apply to individuals under the age of 18 and require the presence of at least three of these behaviors in the last 12 months and at least one anti-social behavior in the last six months, bringing important limitations in terms of academic, social or occupational.

Differential diagnoses include disorders reactive to stress and antisocial behavior due to psychotic symptoms (eg, manic episode). Children victims of domestic violence may exhibit antisocial behavior as a reaction to stress and teenagers in a manic episode may steal, forge signatures on checks or pick fights with wrestling as a result of the exaltation of humor and not due to conduct disorder.

THE COURSE AND ITS PROGNOSIS

Symptoms of conduct disorder arise in the period between the early childhood and puberty and may persist until the age when adult. Beginning before age 10, is observed more frequently with the presence of disorder and attention deficit hyperactivity disorder (ADHD – check Wikipedia’s definition), aggressive behavior, intellectual impairment, seizures and central nervous system impairment due to exposure to alcohol / drugs during prenatal infections, medications, head injuries, etc.., and a positive family history for hyperactivity and anti-social behavior. Early onset indicates greater severity with greater tendency to persist throughout life.

The conduct disorder is often associated with ADHD (43% of cases) and disorders of emotion (anxiety, depression, obsessive-compulsive disorder, 33% of cases). The comorbidity with ADHD is more common in childhood, mainly involving boys while comorbidity with anxiety and depression is more common in adolescence, mainly involving girls after puberty.

Antisocial behavior more severe (eg, fights with use of weapons, burglary, assault) are generally preceded by milder behaviors (eg, lying, cheating, skipping classes, steal objects of little value), and over time , there is the abuse of alcohol / drugs, mainly male to anxiety and depression, especially in female.

The conduct disorder is often associated with poor school performance and peer relationship problems, bringing the academic and social individual limitations to a more frequent basis, raising the display of risk behaviors involving sexual activity, drug abuse and even suicide attempts. Involvement with drugs and gangs can initiate the young into crime. In adulthood, was realized that there are serious consequences that cause antisocial behavior in children, such as marital discord, job loss, crime, prison and early violent death.

The persistence of antisocial behavior during adolescence and adulthood is favored in certain circumstances: when the conduct disorder begins early, when various types of antisocial behaviors are present, including aggressive and violent ones, when antisocial behaviors are quite common, when they are observed in different environments (eg, family and school), and when conduct disorder is associated with TDAH.

Life events may favor the persistence of antisocial behavior in adolescence and adulthood. The school environment, depending on their characteristics, can encourage or discourage antisocial behavior. The lack of jobs is a stressful situation that stimulates it, while the harmonious marriage with a person with no changes in behavior tends to diminish it.

At the same time that children with antisocial behavior tend to remain anti-social in adulthood, antisocial adults tend to have children with antisocial behavior (parents serve as role models to children), establishing a cycle of difficult interruption.

Part two of this article is now live, don’t hesitate and check it out!