Conduct disorder and antisocial behavior in children – part 2

This is the second and final piece of my article about conduct disorder and antisocial behavior in children. If you haven’t read the first one, you should take a look clicking here. So, let’s get to it.

FACTORS ASSOCIATED WITH ANTISOCIAL BEHAVIOR IN CHILDREN

The antisocial behavior of children and adolescents has been attributed to constitutional and environmental factors. Historically, it was with the establishment of clinics linked to the juvenile court that mental health professionals were able to observe the development of antisocial behavior in childhood and adolescence.

When seen from the high frequency of family and social problems in the life history of juvenile delinquents, formulated the hypothesis of a reaction to adversity found both in the family environment as a community.

When children suffer emotional deprivation, manifested antisocial behavior at home or in a larger sphere. From a psychodynamic point of view, these behaviors show hope to get something good that was lost, and the absence of hope the basic characteristic of children who suffered deprivation.

The young person experiences an urge to seek the object of someone who can take charge of caring for him, hoping to rely on a stable environment, able to withstand the tension resulting from impulsive behavior.

The environment is repeatedly tested on their ability to withstand the assault, to tolerate the discomfort, prevent the destruction, preserving the object that is sought and found.

Factors associated with antisocial behavior in childhood: being male, receiving inadequate maternal and paternal care, live in the midst of marital discord, being created by aggressive and violent parents, having a mother with mental health problems, living in urban areas and have low socioeconomic status.

Some authors suggest that low income associated with the antisocial behavior of children is related to antisocial maternal personality and the negligence of the parents.

In fact, one can assume that antisocial mothers would have greater difficulty achieve higher levels of income, because it would keep jobs and would be less capable of maintaining a stable relationship with a husband or partner to contribute to family income.

Antisocial parents are also often irresponsible and negligent with their children, failing to adequately feed them or take them to the doctor when sick. In addition, adolescents living in poverty and under-valued by parents may seek recognition through personal and economic rise of delinquencies group activities.

As for marital discord and maternal mental health problems, was demonstrated that the conflict between the parents and maternal depression were associated with aggressive behavior and antisocial in school.

However, one must consider the child’s contribution to the quality of the relationship between parents and children, for children to deal with difficult, aggressive and disobedient favor the disruption of family environment and the imbalance of a marital relationship more fragile.

As for the aggressive and violent family environment, one can not fail to mention the influence of domestic violence and physical abuse on antisocial behavior in childhood.

High rate of antisocial behavior (21%) was observed in children (school age) of spanked women. In Khartoum, Sudan, children subjected to severe corporal punishment (rope or rod) had more behavior problems (40.2% ) against children punished with spanking (24.6%). Studies evaluating the effects of long-term physical abuse have shown that individuals who have suffered abuse or neglect in childhood were more likely to commit crimes. However, the vast majority of abused children (74%) or negligence (90%) did not become delinquent or committed violent crimes.

Neurophysiological and genetic factors may also be involved in the development of anti-social. A higher rate of criminality was reported in the biological parents than in adoptive parents of individuals with criminal records, making the hypothesis of a biological predisposition to antisocial behavior.

The genetic influence is most evident in cases accompanied by hyperactivity and may be responsible for the individual more vulnerable to life events and stress. However, the role of genetic factors in conduct disorder should be further clarified.

Finally, there is evidence of differences in risk factors for antisocial behavior in children according to gender.

In a population survey conducted in Canada, involving 1,651 individuals aged 16 to 24 years, it was found that besides the presence of antisocial behaviors before age 15, other factors were considered at risk for antisocial behavior in adolescence and early adulthood.

For men, risk factor was the fact that he lived as a child of parents with mental health problems (depression, mania, psychotic episodes), while for women, stood out sexual abuse in childhood and the fact that it was created by parents with antisocial behavior or abuse of drugs and alcohol.

HOW TO DEAL WITH THESE PROBLEMS

The treatment reported in the literature are quite varied, including interventions with the family and the school (eg, family and individual psychotherapy, parent guidance, therapeutic communities and training of parents and teachers in behavioral techniques).

Although neither is very effective, especially as isolated intervention, the earlier start and the younger the patient, the better the obtained results emphasize the importance of concurrent and complementary interventions in the long term.

At the age of three to eight years, some symptoms of oppositional defiant disorder (eg, annoyed easily, refuses to comply with rules or fulfill requests from adults, deliberately disturbs people) or conduct disorder (for example, hurt animals, steals) are usually identified and merit preventive actions with the child and their parents and teachers.

Often the focus of the problem is the conflict between parents and children. Other times, parents are too involved with personal problems and need support.

Some parents need help to set limits and choose the most appropriate methods to educate their children. Contact with the school may also be useful for resolving conflicts between teachers and students and help teachers find better ways to deal with the difficulties of the child.

The younger the patient and the less severe the symptoms, the more likely the individual will benefit from psychotherapy.

When there are adolescents who have committed crimes, there is greater resistance to psychotherapy can be useful to professionals involved with the management of antisocial youth through art workshops, music and sports.

In these workshops, the adolescent has the opportunity to establish bonding with the professionals responsible for the activities, taking them as a model, and find themselves able to create, which favors the development of self-esteem.

Whenever possible, the family of patients should be included in the therapeutic process, noting that parents often need psychiatric treatment (eg drug abuse).

Treatment with psychotropic drugs is necessary in some situations in which the target symptoms (eg paranoid ideas associated with aggression, convulsions) or other psychiatric disorders (eg, ADHD, depression) are present.

We recommend caution in the use of neuroleptics for the treatment of aggression, because the risks may outweigh the benefits.

Hospitalization is indicated in cases of imminent risk to the patient (eg, suicide, self harm) or others (eg, murder). Whenever possible, opt for less restrictive interventions (eg, hospital days).

In our environment, often do not have the resources needed to treat the child or adolescent antisocial behavior. When these features exist, not all families are able to attend the service at the recommended frequency.

The mental health professional can be helpful to establish priorities among the different possible therapeutic approaches to the patient and recommending that it deems most critical.

WHAT CAN WE LEARN FROM THIS?

Antisocial behaviors are often observed during adolescence as isolated symptoms and transient. However, these may arise in early childhood and persists throughout life, being difficult to treat psychiatric conditions.

Individual, social and family are implicated in the development and persistence of antisocial behavior, interacting in complex and poorly understood.

As the anti-social behavior becomes more stable and less changeable over time, 30 children and adolescents with conduct disorder need to be identified as soon as possible to have greater opportunity to benefit from therapeutic interventions and preventive actions.

The most effective treatment involves combining different behaviors with the child / adolescent, family and school. When you can not access to complementary interventions, the mental health professional must identify the therapeutic priority in each specific case.

I found a nice video on the subject, with an “experiment” made by Neighbourhood Policing team for Barton, Risinghurst and Sandhills:

One thought on “Conduct disorder and antisocial behavior in children – part 2

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