Conduct disorder refers to a mental disorder that is mostly diagnosed in children and adolescents. Children or teens diagnosed with the condition demonstrate a persistent and repetitive pattern of violent and disruptive behavior, as well as problems with following rules. The behaviors that children with conduct behavior display are described as antisocial behaviors, which make the disorder to be often perceived as a sign of the antisocial personality disorder, which is diagnosed when one attains 18 years. Teens and children develop normal problems that are behavior-related in the course of their development. However, long-lasting behavior that violates the rights of others and disrupts the everyday life of the surrounding people by contradicting the acceptable norms is considered a conduct disorder. The key characteristics that define the disorder include property destruction, theft or deceit, severe violations of rules, and aggressive behavior towards animals and people, such as physical violence, bullying, cruelty towards people and animals. This paper explores the key causes and factors that contribute to the conduct disorder, the latest scientific developments in the diagnosis and management of the condition, as well as the key areas that require further study regarding the condition.
Behavioral and Biological Factors that Contribute to Conduct Disorder
Conduct disorder emanates from both the biological and environmental factors that influence the development of behavior in children. From the biological perspective, impulsiveness and aggression are linked with the structural anomalies that relate to the inhibition of behavior and thought processing. The major biological factors that contribute to conduct disorder are genetic, and they include deficits in such neurochemicals as norepinephrine and serotonin (Hicks, Foster, Iacono & McGue, 2013). The low expression of the serotonin transporter gene, the monoamine oxidase gene, and disparities in the dopamine and transporter receptor genes are associated with conduct disorder. Moreover, decreased performance of the autonomic nervous system, which regulates the bodily processes, contributes to chronic conduct problems. Particularly, low skin conductance and resting rate are common in individuals who demonstrate continual behavior problems. Gaysina et al. (2013) postulate that other biological factors associated with the conduct disorder include malnutrition and the exposure to such substances as alcohol, cocaine, and tobacco during the intrauterine development.
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On the other hand, observed behavior influences the development of conduct disorder in children. Children who witness parental violence or other forms of violence are at a high risk of using violence to resolve conflicts. Further, children who interact with delinquent peers are also highly likely to engage in criminal behavior. Such children demonstrate strong impulsiveness and low self-control, which may be enhanced by environmental and genetic factors; thus, making such children to feel rejected by the prosocial groups and attracted to the delinquent groups (Duncombe, Havighurst, Holland & Frankling, 2012). Moreover, child abuse, which may be in the form of early neglect, maternal rejection, inconsistent or severe discipline, interparental violence, physical and sexual abuse, is a key risk factor for the development of aggressive behavior in infancy.
Causes of Conduct Disorder
Social skills development is influenced by the interaction between the biological and the environmental factors. Hostile environments often catalyze the interaction between the environmental and biological factors, therefore increasing the risk of developing aggressive behavior. The key factors that influence the acquisition of social skills include deficits in the inter-hemispheric communication and the frontal lobe, verbal skills, and the aspect of socializing with both parents and peers (Regier, Kuhl & Kupfer, 2013). Antisocial and aggressive individuals tend to act on impulse and therefore demonstrate challenges in resolving interpersonal cognitive problems and have minimal empathy. Environments tend to reward certain behaviors while eliminating others; hence, since environmental factors interact with biological factors to create aggressive behavior, children who are biologically at a high risk of antisocial and aggressive behavior are likely to acquire conduct disorder through learning when exposed to a stimulating environment.
Some of the factors that are associated with causing conduct disorder include poor parental supervision, child abuse, low academic achievement, poverty, delinquent peers, trauma, and antisocial parents. The causes are categorized into three categories including genetic causes, environmental causes, and physical causes. Regarding genetic causes, children with mentally ill family members are at an increased risk of developing conduct disorder since the condition is partially inherited (Regier, Kuhl & Kupfer, 2013). On the other hand, physical causes pertain to the improper functioning of the neural circuits in the regions of the brain that are associated with regulating impulse control, behavior, and emotion. In addition, life experiences and the environment where a person grows contribute to conduct disorder, particularly in relation to such aspects as neglect, parental violence, rejection by peers, and physical abuse among other factors. The key factors that increase a child’s risk for conduct disorder include family history of mental illnesses, poverty, and drug abuse by parents, suffering from other mental disorders, family history of conduct disorder, living in urban areas, being male, a dysfunctional home, child abuse, and trauma.
Latest Scientific Developments
Current studies have demonstrated that conduct disorder can be effectively managed with the appropriate care and suitable support systems. The most successful treatment for the disorder comprises of long-term behavior therapy and psychotherapy, which focuses on helping children to learn more acceptable and healthier ways of behaving and thinking (Matthys, Vanderschuren, Schutter & Lochman, 2012). However, medication is utilized in the management of conduct disorder and other co-existing mental conditions in some cases. In addition, training programs for parents are employed in the management of conduct disorder, since they focus on helping parents to learn new approaches of responding to children, facilitating better understanding of the conduct disorder, as well as helping in rebuilding parent-child relationships.
Further, studies have demonstrated that children who demonstrate conduct behavior should be comprehensively evaluated by mental health professionals since in most cases, such children possess co-existing mental disorders, including PTSD, learning problems, substance abuse, anxiety, mood disorders, and ADH, which are treatable conditions (Lindsay, Steptoe, McVicker, Haut & Robertson, 2017). Children who fail to receive the appropriate care tend to break laws in adulthood as well as demonstrate antisocial behavior that may make them unable to cope with the adulthood demands.
Reliability of Diagnosis and DSM Diagnostic Criteria
Diagnostic criteria help in enhancing the reliability of the diagnosis of mental disorders. The diagnostic criteria in the DSM-5 majorly aim at facilitating improved diagnostic consistency. Despite the fact that the diagnostic criteria for psychiatric disorders utilized diverse structured interviews during their development, unreliability in diagnosis procedures is still a serious problem (Regier et al., 2013). In psychiatric diagnosis, the factors that cause unreliability include the inconstancy of the clinician, the inconstancy of the patient, and nomenclature inadequacy.
Patients with psychiatric disorders have disorganized thoughts; thus limiting their capability to provide essential information following psychosis (Regier et al., 2013). In other cases, patients may omit crucial information due to denial, shame, avoidance of certain medications, or the fear of legal consequences among other factors. Further, clinicians face challenges when managing patients with personality disorders since they may tend to manipulate the clinicians. Under such circumstances, the clinician is unable to control the patient, since the clinician’s role is to obtain information from the patient, examine the information, and make a rational decision that is presented in form of psychiatric diagnosis.
Moreover, in cases where the persons who provide the proxy information, including family members and caretakers, may tend to exaggerate or minimize the patient’s history or fail to provide all the relevant information, thus complicating reliable diagnosis. Further, regarding the presentation of atypical psychiatric disorders, most clinicians utilize the ICD or DSM criteria in diagnosing psychiatric disorders; however, in cases where patients present depressive symptoms that are not described under the DSM or ICD criteria, the diagnosis is likely to be unreliable. According to Regier, Kuhl, and Kupfer (2013), the majority of psychiatric patients do not match the psychiatric diagnoses described under the DSM criteria; thus, clinicians are forced to choose the most appropriate diagnosis from the available categories, which increases the diagnosis unreliability.
The clinician’s experience, training and school of thought may increase the unreliability of psychiatric diagnosis since such factors influence the manner in which clinicians interpret a patient’s symptoms. On the other hand, relying on observation may increase diagnosis unreliability since such an approach is subject to systematic bias. Finally, psychiatric nomenclature is considered as the key source of diagnostic unreliability, whereby the lack of satisfaction with DSM-I and DSM-II has led to the publication of DSM-III, DSM-IV, and the current DSM-V (American Psychiatric Association, 2013). DSM-V was necessitated by the poor reliability of data, which failed to effectively distinguish between the different types of conduct disorder. DSM-V provides specifiers to distinguish between the conduct disorders variations (American Psychiatric Association, 2013). Hence, the DSM-V diagnostic criteria have played a crucial role in improving the reliability of conduct disorder diagnosis as well as other mental disorders. The DSM-V diagnosis criteria have helped in enhancing the reliability in the diagnosis of conduct behavior by supporting the inclusion of information pertaining to family psychiatric history in the diagnosis (Henggeler & Sheidow, 2012). Family history is essential in the diagnosis of conduct disorder since it provides the clinicians with crucial information pertaining to the parent’s environmental influences on the children’s behavior and the familial genetic loading.
The parental history pertaining to antisocial behavior helps in informing treatment for children with conduct disorder. For instance, children whose parents demonstrate antisocial behavior are often exposed to domestic violence, physical abuse, and maternal hostility and such parents are most likely to terminate treatment for the children before the desired results are achieved (Matthys, Vanderschuren, Schutter & Lochman, 2012).
Efficacy of Treatment
Current research on conduct disorder has enhanced better understanding of the factors that influence aggressive behavior as well as the causes of conduct disorder. Several current literature reviews have established different effective treatment approaches for children and adolescents, thus preventing the advancement of the disorder into adulthood. The most effective treatment interventions are those administered early, those that address the diverse contexts under which children display problem behavior, including the community, school, and family, and those that are intensive and structured (Henggeler & Sheidow, 2012). Some of the most successful treatment interventions include cognitive-behavioral therapy and the functional family therapy, which focuses on equipping affected children and adolescents such skills as anger management.
Gaps in Current Knowledge and need for Further Research and Studies
The current literature on conduct disorder demonstrates several knowledge gaps that need to be filled through studies and further research. The key areas that require further study include family psychiatric history, neuroimaging biomarkers, genotypic biomarkers, and physiological biomarkers as they relate to conduct disorder. Information on psychiatric family history demonstrates great potential in improving predictions in research settings; thus, studies are required to further assess the specificity and the sensitivity with which information regarding family history helps in predicting conduct disorder (Frick, 2012). Further, research is required to estimate the number of false-positive conduct disorder diagnoses that would emanate from utilizing family history in diagnosing the disorder. Moreover, research is required to establish how clinicians can employ family psychiatric history effectively in diagnosing conduct disorder in the treatment settings. Additionally, there is a need to conduct research to establish the family members that should be assessed during the diagnosis of the disorder as well as to identify whether the history helps in predicting treatment response as well as the long-term prognosis.
On the other hand, there is need to replicate the original findings of the neuroimaging biomarkers through research to allow for the standardization of the imaging paradigms so as to ensure meaningful interpretation and replication of the findings related to conduct disorder. Further, there is need to assess neuroimaging biomarkers for their specificity and sensitivity to conduct disorder through studies (Frick, 2012). For instance, assessing the potential effects of sex, race, and age differences on the markers is crucial in enhancing better management of the condition. Moreover, pertaining to genotypic biomarkers of conduct disorder, epidemiological studies are required determine the basic information pertaining to the genetic biomarkers that are connected to conduct disorder before evaluating their likely clinical utility. Finally, further research is needed to establish the role of the physiological biomarkers in conduct disorder, since the markers may be essential in boosting the understanding the etiology of conduct disorder.
Conclusion
Conduct disorder is synonymous with children and adolescents and it is manifested through a repetitive pattern of problems with following rules as well as disruptive and aggressive behaviorSome of the genetic factors that contribute to the disorder include deficiencies in such neurochemicals as serotonin and norepinephrine, which are responsible for regulating bodily processes. Although the management of the disorder failed to achieve the desired levels of success in the past, current scientific knowledge has demonstrated great improvements in the treatment and diagnosis of the disorder. For instance, the implementation of the DSM-V diagnosis criteria has enhanced the reliability of the diagnosis procedure by including the assessment of the family psychiatric history, which plays a crucial role in informing clinicians about the causes of the disorder and the most effective treatment plan to utilize.
References
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