Notes: Conduct disorder



  Conduct disorder
  • Objectives
  • Define conduct disorder
  • List down subtypes
  • Explain the etiological factors
  • Describe the predisposing factors
  • List down the clinical manifestations
  • Explain the differential diagnosis
  • Describe the management
  • Conduct disorder is an enduring set of behaviours that evolves over time, usually characterized by aggression and violation of the rights of others.
  • Childhood onset type
  • Adolescent on set type
  • Oppositional defiant disorder
            The disorder is an enduring pattern of negativistic, hostile, and defiant behaviours in the absence of serious violations of social norms or the rights of others.
  • Parental factors
    • Chaotic home conditions
    • Divorce
    • Parental psychopathology, child abuse and negligence
    • Sociopathy, alcohol dependence, and substance abuse in the parents
  • Socio-cultural Factors
  • Socioeconomically deprived children in urban environments
  • Unemployed parents, lack of supportive social network, and lack of positive participation in community activities
  • Drugs and substance abuse increases the risk
  • Psychological factors
  • Neurologic Factors
  • Child abuse and maltreatment
Predisposing Factors
  • Biological influences
  • Genetics- Family history of conduct disorder in the family predisposes to conduct disorder
  • Temperament-Children with difficult temperament before age of 3 years have high chance of developing conduct disorder
  • Biochemical factors-Alterations in nor-epinephrine and serotonin were seen in cases with conduct disorder. Higher levels of testosterone is seen among boys with this disorder
  • Psychosocial influences
    • Peer relationship: Poor peer relationship and rejection in turn will lead to aggressive behaviour and conduct disorder
    • Family influences:
  • Parental rejection
  • Inconsistent management with harsh discipline
  • Early institutional living
  • Frequent shifting of parental figures
  • Large family size
Clinical features
  • Frequent lying
  • Stealing or robbery
  • Running away from home and school
  • Physical violence like rape, fire-setting, assault or break-in, use of weapons
  • Cruelty towards other people and animals
  • Secondary complications such as syphilis, HIV, suicidal and homicidal behaviours
Differential Diagnosis
  • Childhood psychiatric conditions
  • ADHD and substance abuse often associate with conduct disorder
  • Behavioural interventions
  • Social skill training
  • Family education and therapy
  • Individual psychotherapy
  • Pharmacologic interventions
    • Tb Lithium, Tb.Carbamazepine To treat aggressive behaviour
    • Antipsychotics- To treat psychotic symptoms
Nursing management Diagnoses
  • Risk for other directed violence related to characteristics of temperament, peer rejection, negative parental role models, and dysfunctional family dynamics.
  • Impaired social interaction related to negative parental role models, impaired peer relations leading to inappropriate social behaviour.
  • Defensive coping related to low self esteem and dysfunctional family system.
  • Low self esteem related lack of positive feedback and unsatisfactory parent/child relationship.
  • Observe the child carefully for high risk behaviour.
  • Redirect the violent behaviour to physical activities such as exercise or cleaning ward
  • Administer tranquilizing drugs as prescribed
  • Use mechanical restraints if needed.
  • Set limits on manipulative behaviour
  • Maintain a log book on behaviour
  • provide positive reinforcement for acceptable behaviour
  • Assist in practicing adaptive behaviour
  • Provide social skill training
  • Guidance and support of parents in managing the childs behaviour.



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item Notes: Conduct disorder
Notes: Conduct disorder
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