Conduct disorder (A complete guide)

Conduct Disorders include conditions involving problems in the self-control of emotions and behavior in children and teens.

A child with this disorder usually display pattern of disruptive and violent behaviors and have problems following commands and rules.

What are Common Symptoms of conduct disorder? 

1. Often bullies, threatens, or intimidates others.

2. Often initiates physical fights

3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle).

4. Has been physically cruel to people and animals
5. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

6. Has deliberately engaged in fire setting with the intention of causing serious damage.

7. Has deliberately destroyed others’ property (other than by fire setting). 

8. Has broken into someone else’s house, building, or car.

9. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).

10. Has stolen items of nontrivial value without confronting a victim e.g., shoplifting, but without breaking and entering; forgery)

11. Often stays out at night despite parental prohibitions, beginning before age 13 years.

12. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.

13. Is often truant from school, beginning before age 13 years.

Here are the Risk Factors of Conduct disorder

• Being a male

• Having other psychiatric disorders
• Poor nutrition
• Poverty
• Having history of parental psychopathology
• Poor parenting / lack of parental involvement
• Lack of adequate discipline
• Exposure to violence
• Having been subjected to physical, sexual, and/or emotional abuse

Management Plan for Conduct Disorder 

Many approaches to manage conduct disorder have been tried with varying success, they are as follows:

Medication

Stimulants such as Ritalin, Dexedrine and Cylert to reduce impulsivity and aggressive behavior.

Ritalin is the most frequently prescribed stimulant medication used for this purpose. 

Lithium can help reduce mood fluctuations, irritability, restlessness, hostility, and explosiveness. 

Contingency Management Programs

Many adolescents with CD come from families in which they have not been exposed to a consistent and contingent environment- a poor socialization experience that plays a major role in their deficient ability to modulate behavior. 

The basic structure of contingency management programs is deceptively simple. These programs involve:

1) Establishing clear behavioral goals that gradually shape a child’s behavior in areas of specific concern, 

2) Developing a system to monitor whether the child is reaching these goals, 

3) Having a system to reinforce appropriate steps toward reaching these goals, and 

4) Providing consequences for inappropriate behavior. 

Cognitive Behavioral Therapy 

CBT teach adolescent and parents both to identify and address faulty beliefs that make conflict more likely and to help demolish and debunk those beliefs.

Help adolescents develop several important cognitive skills, including:

•  cognitive reframing of stressful events (e.g., helping adolescents to generate alternative, more peaceful ways of thinking about the meaning of stressful situations so that anger is not an automatic consequence). 
• Anger management training, which generally involves teaching people to better manage frustration feelings by learning to recognize and defuse anger sensations with reframing 
• Relaxation techniques such as muscle relaxation or deep breathing. 

Behavioral Interventions

Psychoeducation

Psych education is providing information about basic behaviors and Conduct disorder concepts, such as reinforcement, punishment, and rule violation. 

Monitoring targeted behavior 

Target problem behaviors are identified and parents are asked to monitor the occurrence of these behaviors at home setting.

This monitoring helps the therapist in further designing therapeutic plan. 

Reinforcement 

Parents learn how to implement reinforcement techniques to focus the child’s attention away from antisocial behavior and direct it to desirable behaviors.

Reinforcement could be in the form of verbal appreciation, smiles, stars, favorite edibles, tokens (to be exchanged with money) and playing any favorite game. 

Time-out technique 

Correct use of time out could be very effective in managing undesirable and inappropriate behaviors.

Time-out consists of removal of child from the reinforcing situation and placement in a situation that is free of reinforcement.

Time-out should occur for a discrete period of time.

For example, if the child is throwing tantrums, T.V should be turned off and time period of time-out be extended for 3 to 4 minutes. 

Effective Communication Strategies

Parents first learn communication strategies and reflective listening to avoid power struggle with their kid.

Therapist assists parents through role playing and modeling to learn ways to communicate effectively. 

Nondirective Play

Parents are taught to play with their child in a non-directive way.

This is accomplished by teaching the parents to watch the child play as opposed to encouraging a certain type of play by the child.

When the parent is engaged by the child, the parent behaves in the manner suggested by the child.

Parents allow the child to lead the interaction and ignore the minor inappropriate behaviors.

Reinforcement of Prosocial Behavior

As in Paterson model the parents learn to identify and reward the child’s prosocial behavior.

The preferred and long-term effective reinforcers are praise and attention.

Simple effective commands

Parents are taught to state commands simply, and one at a time.

This is accomplished by the parent being in proximity to the child and having a stern facial expression, (e.g.; laughing or shouting from. another room are discouraged).

The parent then says the child’s name and maintains eye contact to ensure that the child’s attention is focused on the parent.

Finally, the parent gives the command in simple and clear language. Angry, demanding, or irritated tone of voice is discouraged.

Based on the child’s compliance or noncompliance with the command the child receives attention or time-out.

Enhancing Social Skills

There is some evidence of positive results from social skills training programs.

Most socially oriented cognitive behavioral approaches attempt to teach the child social behavior, based on a hypothesized social-skill deficit.

These programs coach children play skills, friendship and conversational skills, academic skills, and behavior control strategies. 

For example, children are taught to question others for information, classification, and invitation, they learn to help by giving support and suggestions, they are encouraged to cooperate and they are reinforced for sharing.

Therapeutic activities include cooperative projects, games, constructive activities with books and clay and play.

Anger Management

Several anger management programs have shown promise in the treatment of Conduct disorder children.

Muscle relaxation exercise

Progressive muscle relaxation exercise (16 PMR) stretches and relaxes 16 muscles of your body to release tension.

It is coupled with slow deep breathing with repetition of phrases that relaxes you for example, “Relax”, “Take it easy”, “You will feel better”.

The A -B -C model

This technique teaches children that each conflict situation has three stages:

a. Trigger (Antecedent): What led up to it? What caused the problem?

b. Response (Behaviour): How did the child react to the problem?

c. Consequences: What were the results of the conflict situation and the child’s behaviour?

Children give examples of A-B-C in various situations.

By learning the A-B-C of their own anger behaviour, children may begin to understand, anticipate and control it.

Identifying the warning signs of anger 

So as to manage anger we should first identify the warning signs that is, the physical and behavioral responses to anger.

With insight about causes of anger, the management techniques would function better.

Becoming aware of your personal anger signs helps you to take steps to keep your anger under control.

Positive coping statements 

Children are taught positive self-statements to increase control in pressure situations (e.g. slow down, chill out.

Frequently Asked Questions (FAQ)

Recommended resources 

A conceptual framework for preventing aggression in elementary schools

How to Teach Good Behavior: Tip for Parents

Improving the Classroom Behavior of Students with Emotional and Behavioral 

Center for the Study and Prevention of Violence (CSPV)

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