- 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
- 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
- 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
- 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
- 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.