WHAT’S THE DIFFERENCE BETWEEN SO-CALLED “CONDUCT DISORDER” AND SIMPLY BAD BEHAVIOR OR DISOBEDIENCE?
A child or teen who is recurrently displaying poor behaviors and decision-making and persistently disobedient may have Oppositional defiant disorder (ODD). These kids/teens often lose their tempers, argue, resist rules and discipline, defy people of authority, such as parents and teachers, refuse to comply with directions and in general have a low frustration tolerance.
Conduct disorder is used to describe a child or teenager who displays a pattern of violating the rights of others, uses intimidation or aggression toward people or animals, steals or deliberately destroys property. The DSM-5, a diagnostic handbook used by mental health professionals, describes these children/teens as having “a callous and unemotional interpersonal style.” They lack empathy and therefore, do not understand or care about how their behaviors and may physically or emotionally hurt others.
A key difference between ODD and conduct disorder lies in the role of “control.” Children who are oppositional or defiant will fight against being controlled. Children who have begun to move—or have already moved—into conduct disorder will fight not only against being controlled, but will attempt to control others as well.
They may “con” or manipulate others to do what they want, taking things that don’t belong to them, or use aggression or physical intimidation to control a situation. Parents of children who exhibit this type of behavior describe feeling afraid in their own home, whereas living with a child who is oppositional and defiant can leave a parent frustrated, angry, disheartened and sad. It doesn’t typically lead to fear.
HOW EARLY DO CHILDREN USALLY SHOW SIGNS OF THIS TYPE OF MENTAL DISORDER AND CAN IT BE PREVENTED FROM BECOMING A SERIOUS PROBLEM AS THEY GROW UP?
Conduct disorder can have an early onset early, before age 10, or in adolescence. Children who display early onset conduct disorder are at a greater risk to experience persistent difficulties, and they are more likely to have troubled peer relationships and academic problems.
Early treatment can often prevent future problems, but will depend on your child’s symptoms (severity) age, and general health.
WHAT’S THE DIFFERENCE BETWEEN A PSYCHOPATH OR SOCIOPATH?
Some researchers believe that psychopaths tend to be born, so it’s likely caused by a genetic predisposition, while sociopaths tend to be made by their environment.
Psychopaths are generally, more manipulative, can be seen by others as more charming, may appear to lead a normal life, and minimizes risk in criminal activities.
Sociopaths are typically, more erratic, rage-prone, and unable to lead as much of a normal life. When engaged in criminal activity, they tend to do so in a reckless manner without regard to consequences.
They both share common features of antisocial personality disorder, which is defined as someone who exhibits 3 of 7 symptoms of the following:
- Disregard for society’s laws
- Violation of the physical or emotional rights of others
- Lack of stability in job and home life
- Irritability and aggressiveness
- Lack of remorse
- Consistent irresponsibility
- Recklessness, impulsivity
- Deceitfulness, constantly lying
To meet criteria for antisocial personality disorder, evidence of a childhood diagnosis or symptoms consistent with conduct disorder are present.
WHAT ARE SOME OF THE CLUES TO A SOCIOPATH OR PSYCHOPATH IN CHILDHOOD?
There is an established link between conduct disorder and the diagnosis of antisocial personality disorder (a shared and common feature of psychopathy and sociopathy) as an adult. In fact, the diagnostic criteria for antisocial personality disorder requires a conduct disorder diagnosis before the age of 15.
In the DSM-5, a diagnostic handbook used by mental health professionals, conduct disorder is characterized by “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the above criteria in the past 12 months, with at least one criterion present in the past 6 months.”
Many symptoms seen in children with conduct disorder can also be observed in children/teens without this problem. However, in children with the disorder, these symptoms occur more often and are severe. They also interfere with learning, school adjustment, and sometimes with the child’s relationships.
Some clues to what may develop into a psychopath or sociopath in a child are seen in this disorder. Each child’s symptoms may vary. The 4 main groups of behaviors are:
- Aggressive conduct
- Intimidating behavior
- Physical fights
- Cruelty to others or animals
- Use of weapons to threat harm
- Forcing someone into sexual activity, rape, or molestation
- Destructive conduct
- Intentionally destroying property (vandalism)
- Violation of rules or age-appropriate norms
- Not going to school (truancy)
- Running away
- Very early sexual activity
These symptoms may look like other mental health problems, so it is important for a healthcare provider to establish the diagnosis and distinguish it from other medical and mental health issues.
WHAT IS THE MOST COMMON CAUSE FOR THIS DISORDER?
There are many factors that play a role in causing conduct disorder.
Past school failure
Some children/teens with conduct disorders seem to have a problem in the frontal lobe of the brain. This interferes with a child’s ability to organize, plan, think before acting, stay away from harm, and learn from negative experiences.
Research on conduct disorder has shown that a series of traumatic experiences occurs for a child to develop this disorder. These experiences can often lead to depressed moods, behavior problems, and involvement in a deviant peer groups.
WHAT PERCENTAGE OF THE U.S. POPULATION IS LIKELY LIVING WITH SOME TYPE OF ANTI-SOCIAL PERSONALITY DISORDER?
About three percent of men and about one percent of women have antisocial personality disorder. Much higher percentages exist among the prison population.
WHERE SHOULD A PARENT GO FOR HELP IF THEY ARE CONCERNED ABOUT THEIR CHILD’S BEHAVIOR AND/OR MENTAL STATE?
If you are concerned your child’s behaviors, it is important to get appropriate care. I recommend the following:
- Talk to your child’s doctor, school nurse, or other health care provider about the behaviors or symptoms that concern you.
- Ask your child’s primary care physician if your child needs further evaluation by a specialist with experience in child behavioral problems
- Ask if your child’s specialist is experienced in treating the problems you are observing.
- Talk to your medical provider about any medication and treatment plans.
I also recommend starting a conversation with your child about his/her mental health. Try leading with these questions. I encourage you to communicate your concerns with your child’s doctor.
1) Can you tell me more about what is happening? How you are feeling?
2) Have you felt like this in the past?
3) Let’s talk about your feelings/emotions. I’m here to listen.
4) How can I help you feel better?
5) I’m worried about you. Have you ever had thoughts about harming yourself or others?
As a family unit, explore the treatment options available with your child’s doctor. Treatment should focus on the needs of each child and should be family-centered and developmentally and culturally appropriate. Locate a family support group or organizations that can help, in your community.
CAN THIS BE PREVENTED WITHOUT MEDICATION?
Although it may not be possible to prevent conduct disorder, recognizing and acting on symptoms when they appear can minimize distress to the child and family, and prevent many of the problems associated with the condition. Treatment outcomes can vary, but early intervention to getting appropriate help can reduce the risk for incarcerations, mood disorders, and the development of other comorbidities such as substance abuse and depression.
There are no medications that have been formally approved to manage conduct disorders. Medications are used as an adjuvant treatment for children and teens who are highly aggressive, impulsive or have mood-disorder symptoms. However, medications have been found to be useful at managing specific symptoms of other disorders associated with conduct disorder. Symptom control may help the child/teen participate in family or community interventions or treatments.
In addition, a consistent, nurturing and supportive, home environment with a balance of discipline and love can help reduce symptoms and prevent episodes of disturbing behaviors.
Promising treatment programs for conduct disorder focus on enhancing parenting skills and creating support networks for families. Since conduct problems are about social interaction, it is important work with families and communities, not just individual children and youth.
WILL SOME CHILDREN JUST GROW OUT OF THIS TYPE OF BEHAVIOR?
Research has shown that most children and teens with conduct disorder do not grow up as adults to have behavioral problems or problems with the law as adults. The majority of these youth do well as adults, both socially and occupationally.
HOW DO YOU CONVINCE SOMEONE THAT THEIR CHILD NEEDS HELP AND THE PARENT IS IN DENIAL?
For some parents, just trying to comprehend the disparity between their desires for their child and the possibility that their child may have a mental health disorder compounds their emotional and intellectual efforts to adjust to the situation and provide help for their child. They may feel grief, depression, fear or shame. Some may also feel that they are being punished for sins or bad acts of the past. So, for some, it is easier for their mind to go against this belief and denial sets in.
One in ten young people will experience a mental health problem which equates to three in every classroom. This is why it is imperative to break through this denial and encourage parents to seek help for their child.
As a loved one or friend of a parent whose child you are concerned about and depending on your relationship with their parent(s), here are some things to consider if you choose to discuss your concerns with them:
1) Let the parent know that you need to have an important conversation with them.
2) Pick a good time and place to talk that is comfortable for them.
3) Approach them with empathy. You might say something like “I know this is really hard for you, but I’m talking to you because I love you and your family. If I didn’t care, we wouldn’t be having this talk.”
4) Be prepared for the parent(s) to be upset – and try not to get defensive.
5) Use “I” statements, such as “I’m concerned about your child.”
6) Offer to pay for the appointment, if possible. A common excuse is that mental health appointments are too pricey.
7) Avoid using words like “crazy” or “abnormal.”
There is no perfect child, just like there is no perfect parent. Children should be loved unconditionally and our love should include the responsibility of tending to all of their needs and locating help, when needed. There are more resources now than ever and parents are not alone if this is about their child.
IS THERE A POSSIBLiITY WITH TAKING MEDICATION, THE PERSON WILL HAVE TO TAKE IT FOR THE REST OF THEIR LIFE?
There is no approved medications for conduct disorder. Medication treatment is used in cases there are other associated mental health disorders that occur with the child’s conduct disorder such as ADHD, depression and anxiety. Long term medication use can help provide symptom control and the length of treatment is determined with the assistance of an individual’s doctor.
Treatments for conduct disorder are designed to decrease or eliminate behavior problems in the short-run. They also work towards the long-term goal of preventing a child/teen’s behavioral problems from worsening over time (for instance, into a full-blown adult Antisocial Personality Disorder).
Treatment approaches need to intervene at many levels. and therefore, may lead to life-long treatment. Early interventions may influence the course and may prevent the need for “treatment” in the juvenile justice system. An ideal, comprehensive treatment plan integrates the individual, family, school and community. There are evidence-based treatment programs such as functional family therapy, multisystemic therapy and community organizations that are working at the various levels required to provide the best treatment plan for a child and their family.
WILL INSURANCE COVER THE TREATMENT COST?
Check the description of your healthcare plan benefits. Your plan should include information on behavioral health services or coverage for mental health and substance-use disorders. If you still aren’t sure, ask your human resources representative or contact your insurance company directly.
Your “Text Tom” Questions Answered on the next page.