Childhood Conduct Disorder

Of all the childhood disorders that exist, one of those that most worries parents and that appears in a large percentage of cases is childhood conduct disorder. This is the diagnosis that almost half of the patients who attend outpatient psychological or psychiatric treatment receive. What is it and why is it so worrisome?

According to the DSM (Diagnostic and Statistical Manual of Mental Disorders carried out by the APA (American Psychiatric Association), conduct disorder is a type of disorder that appears in children and adolescents under 18 years of age and is characterized by a pattern of behavior in the one in which the rights of others are violated and in which there is a difficulty in integrating the norms of society. The symptoms that children and adolescents present are mainly:

1. Recurrent attacks on people or animals. They can be threats, insults, fights , serious damage with weapons, robberies with intimidation, rapes …

2. Vandalism, destroys the property of others or steals it. It is common for them to start fires just to annoy or destroy something important to their owner alone to take revenge or harm.

3. They continually lie, cheat, or cheat.

4. Violation of family or school rules. It is common for these guys to stay on the street until late at night despite being prohibited. They may also deliberately skip class or run away from home in the middle of the night. Both parents and teachers are unable to make the child comply with the rules.

TYPES OF CONDUCT DISORDER

For it to be possible to say that the child has a conduct disorder, it must be under 18 years of age and it is characterized by two types depending on the age of onset of symptoms:

– Childhood-onset conduct disorder : some of the symptoms appear before 10 years of age. In these cases we say that conduct disorder arises as a consequence of a personality disorder, perhaps with a certain genetic predisposition and therefore difficult to treat.

– Adolescent-onset conduct disorder: there are no symptoms before the age of 10, they tend to appear recurrently after that age. They are generally less serious and respond better to treatment because the disorder may be more influenced by the environment in which it has grown and not so much because it has a genetic predisposition. It is common for many pubescent girls to start behaving like this when they enter adolescence, but it is easier to redirect them because they tend to end up recognizing that they were not like that before and that they have changed.

When the child with these symptoms is less than 10 years old, it is difficult to treat them because they are not aware that they have a problem , on the contrary, they believe that others have the problem with them and they continually justify their behavior by blaming others.

CAUSES AND EVOLUTION

For a conduct disorder to appear, certain environmental and genetic influences must be present. Studies with twins indicate that there is a certain genetic weight, however, for this disorder to awaken, there must be environmental stressors that surround the child, for example, having lived in a marginal environment where the child has not received sufficient affection and attention is a powerful risk factor. On the other hand, having been neglected in childhood does not matter so much as having been exposed to a home with an inconsistent pattern of discipline . Even so, the marginal or incoherent environment is still only a risk factor and would not explain the origin by itself, it is necessary that both things occur, genetic vulnerability and environmental stressors.

Other studies speak of certain abnormalities at the cortical nervous level , for example they speak that dissocial children and adolescents , as well as antisocial adults, need more powerful stimuli to be able to feel excitement, as well as fear.

Regarding its evolution, children who have a dissocial personality disorder (less than 10 years old) that is not treated can lead to an antisocial disorder in adults, more dangerous and complex to treat. Basically the criteria are similar but more serious, what happens is that it is not politically correct to put the label of “antisocial” to an adolescent child, but it is an extension of the same problem.

Finally, as time passes and the person grows, antisocial behaviors tend to decrease, around the age of 40.

TREATMENT OF CONDUCT DISORDER

Unfortunately, antisocial disorder treatment is not very effective because most people do not recognize that they have a problem and do not commit to change. They can lie to the family and the psychologist to achieve their goals and maintain the situation. The recommended treatment will always depend on the individual and the circumstances surrounding him.(family or social support, if you have any other associated disorder, etc). Something similar happens with conduct disorder in children and adolescents, if they do not get involved we cannot do much more than try to raise their awareness, which is complicated with young children because many are still in the process of brain maturation and it may take years for them to recognize who need therapy, the same happens with adolescents, few recognize that they are wrong. However, the sooner this problem is worked on

the more chances we have for the child to change.

Cognitive behavioral therapy is one of those used for this type of disorder, through it the psychologist tries to change the child’s perspective and his way of interpreting reality. They also try to awaken feelings of empathy and remorse, although when the conduct disorder was early onset (the genetic factor weighs more) it is more difficult to follow. Prosocial behaviors with peers are encouraged , social skills are trained , such as recognizing emotions and feelings …

However, the most important work should be with the child’s parents and caregivers. They are advised on how to follow a contingency program in which the child is rewarded with attention or certain privileges for performing empathetic and sensitive behaviors towards others and reducing those that are antisocial. They are also taught to learn to identify problems early in order to avoid complications during treatment.