Inform guide to conduct disorder

Conduct disorder

What is conduct disorder?

Conduct disorder is a diagnostic term used by psychiatrists and clinical psychologists to denote a number of problematic behavioural symptoms in children and young people.

The diagnosis, which can only be made by a qualified clinician, identifies several antisocial behaviour patterns which have become habitual or repetitive, and violate age-appropriate social norms and/or the rights of others. The term is used if three or more of the following have been evident over a year:

● Aggression to people or animals in the form of bullying, initiating fights and physical cruelty.

● Deliberate destruction of own or others’ property, such as arson.

● Habitual or chronic lying, “conning” others or stealing.

● Serious violations of rules: for example, frequent absconding from school or home.

With any such diagnosis it is important the clinician can differentiate these behavioural symptoms from other diagnostic ­cat­egories, such as oppositional defiant disorder, learning disabilities, psychotic illness or attention deficit and hyperactivity. It is also important to consider whether there could be a combination of co-existing problems.

Working with serious behaviour problems

Some studies suggest between 6% and 16% of boys and between 2% and 9% of girls could meet the criteria for the diagnosis. In general these types of behaviours present in young people where there is a complex picture of underlying causes and a range of issues affecting family relationships. These might include situations where the parent(s) have been unable to meet their children’s need for emotional security – where there is a highly chaotic family environment with no limits, routines or stability.

There may also be a history of neglect and/or emotional, physical or sexual abuse. For intervention to be effective it is vital to link it to the causes of the problem behaviours. Treatment usually involves a combination of family work and individual therapy.

Conduct Disorder and Education

Where detection and intervention have not been available, more persistent and severe behavioural problems inevitably affect the young person’s education.

Unless early diagnosis or a statement of special educational need has been established, the most likely outcome is exclusion.

If resources are available some young people may be given a place in a pupil referral unit. These units have a high ratio of staff to pupils, and with more specialised teaching skills and methods can sometimes provide a vital place of respite and educational input.

The challenge of helping young people

It is important to find ways of attuning support to the individual personality and concerns of the young person. It should be borne in mind that this young person’s ­earlier environment has seriously failed them. It is never too late to try to tune in to their individual hopes and aspirations.

Many children with these symptoms are often doing to others what they have had done to them. Many such children feel hopeless and suffer internal persecuting feelings which drive their behaviour. Working with them can be frustrating and slow – the vital element in practice can be the ability to withstand the depths of their hopelessness so they have an opportunity to feel less locked into one fixed way of thinking and behaving.

Linking their problem behaviour with their earlier experiences may help to understand their actions.

First steps

Local child and adolescent mental health services can have a reputation for being difficult to access, with long waiting lists.

It can be helpful to phone a psychiatrist’s or psychologist’s secretary saying that you are concerned about a young person and would value a brief conversation and perhaps some advice about their troubling behaviour. This might facilitate a subsequent referral. It can also be enormously helpful for practitioners to set up less formal meetings with those closely concerned with the child or young person to gain an understanding of the wider circumstances which may be maintaining or causing the behaviour difficulties.

Severe behavioural problems or conduct disorder often generate high levels of anxiety in the community around the young person and can mean they are difficult to approach and may be intimidating. This makes the work of a helping practitioner difficult and one can be forgiven for feeling out of one’s depth or not skilled enough. This underlines the importance of liaising and working together to find ways forward and to avoid being locked into only one view of the problem.

Peter Toolan is a consultant child and adolescent psychotherapist at Foster Care Associates.

➔ Inform is Community Care’s online information tool for social care professionals working with children and families, go to www.ccinform.co.uk or phone 0845 308 8800

Our monthly series of articles offering guidance on important issues in children’s social care continues with a look at how to diagnose conduct disorder and how to help those who have it