Conduct Disorder

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Conduct Disorder - Rebel Yell Defined

  • Conduct Disorder (CD): A disruptive behavior disorder in children/adolescents.
  • Key: Persistent behavior violating others' rights or major societal norms/rules.
  • Manifests as:
    • Aggression (people/animals)
    • Property destruction
    • Deceitfulness/theft
    • Serious rule violations
  • ⭐ > Core feature: A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Conduct Disorder - Rulebook Rundown

  • DSM-5 Criteria: ≥3 of 15 criteria in past 12 months; ≥1 in past 6 months.
    • Categories (📌 TRAP):
      • Deceitfulness or theft
      • Serious violations of rules
      • Aggression to people/animals
      • Destruction of property
  • Subtypes (Onset):
    • Childhood-onset: At least one symptom before age 10.
    • Adolescent-onset: No symptoms before age 10.
    • Unspecified onset.
  • Specifier: With limited prosocial emotions (e.g., lack of remorse/guilt, callous-lack of empathy).

⭐ DSM-5 requires at least 3 of 15 criteria in the past 12 months, with at least one criterion present in the past 6 months.

Conduct Disorder - Why So Wild?

Multifactorial etiology:

  • Biological Factors:
    • Genetic predispositions
    • Neurobiological: Frontal lobe dysfunction, altered serotonin/cortisol levels
    • Difficult temperament
  • Psychosocial Risk Factors:
    • Parenting: Harsh, inconsistent, neglect, abuse
    • Family: Parental criminality, substance abuse
    • Peers: Rejection, deviant group affiliation
    • Environment: Low SES, neighborhood violence

⭐ Childhood-onset type (symptoms before age 10) is associated with a worse prognosis and higher risk of developing Antisocial Personality Disorder in adulthood.

Conduct Disorder - Who Else Is Who?

  • Common Comorbidities:
    • ADHD (very high), ODD, specific learning disorders
    • Anxiety disorders, depressive disorders, substance use disorders
  • Differential Diagnosis:
    • ODD: Less severe, no aggression, destruction, theft/deceit.
    • ADHD: Distinguish impulsivity from deliberate rule-breaking.
    • Mood Disorders: Irritability vs. pervasive aggression.
    • Intermittent Explosive Disorder, Adjustment Disorder.

⭐ Oppositional Defiant Disorder (ODD) often precedes childhood-onset Conduct Disorder; however, many children with ODD do not subsequently develop CD.

Conduct Disorder - Calming the Chaos

Multimodal treatment is key.

  • Psychosocial Interventions:
    • Parent Management Training (PMT)
    • Cognitive Behavioral Therapy (CBT): Problem-Solving Skills Training (PSST), anger management.
  • Family Therapy:
    • Functional Family Therapy (FFT)
    • Multisystemic Therapy (MST) for severe/complex cases.
  • Pharmacotherapy: (Not first-line for core CD symptoms)
    • For comorbidities: Stimulants (ADHD), SSRIs (depression/anxiety).
    • Severe aggression: Low-dose atypical antipsychotics (e.g., risperidone), short-term.
  • Prognosis: Variable.
    • Poorer outcomes: Childhood-onset, limited prosocial emotions, comorbid ADHD.
    • Risks: Antisocial Personality Disorder, substance abuse, criminal behavior in adulthood.

⭐ Parent Management Training (PMT) and Multisystemic Therapy (MST) are evidence-based psychosocial interventions with strong support for treating Conduct Disorder.

High‑Yield Points - ⚡ Biggest Takeaways

  • Persistent behavior violating rights of others or major societal norms.
  • Four key categories: aggression, property destruction, deceitfulness/theft, serious rule violations.
  • Onset: childhood-onset (<10 years, poorer prognosis) or adolescent-onset (≥10 years).
  • Specify if with Limited Prosocial Emotions (e.g., lack of remorse, callous).
  • Strong precursor to Antisocial Personality Disorder (ASPD) in adulthood.
  • Management focuses on psychosocial therapies (PMT, MST); medications for comorbidities.
  • Differentiated from ODD by severity, aggression, and law-breaking acts.

Practice Questions: Conduct Disorder

Test your understanding with these related questions

A 13-year-old boy is brought by his parents with history of frequent fighting at school, disciplinary problems, stealing money, assaulting his batchmates and being weak in studies. What is the most appropriate diagnosis for this child:

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Flashcards: Conduct Disorder

1/10

_____ is characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.) for > 6 months (duration)

TAP TO REVEAL ANSWER

_____ is characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.) for > 6 months (duration)

Attention-deficit hyperactivity disorder (ADHD)

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