02/20/98

Conduct Disorders

Several parents have requested more information about Conduct Disorders. As this diagnosis is not one I encountered very often in working with elementary school children, I consulted with a colleague, Richard Engelhardt, LCSW (Licensed Clinical Social Worker) who has treated children, adolescents and adults with Conduct Disorders. He graciously agreed to share his knowledge and expertise with SNET Internet readers.

The 1994 Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the "bible" of the psychiatric world, defines a conduct disorder as, "A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated." Basically this means that a person does things that are against the rules and doesn't seem to care whether people get hurt or not. Behavior such as physical aggression, cruelty to persons or animals, destruction of property, lying, stealing, skipping school and running away can be involved. The disorder is divided into two types, depending on when it is identified, in childhood or in adolescence, and is rated as mild, moderate or severe. It is a serious diagnosis, and if untreated, can lead to a lifelong personality disorder in adulthood that is very difficult to treat and seriously impairs a person's ability to live, love and work in society.

A conduct disorder is a severe problem, and before assigning this diagnosis it is important to make sure there are not other issues in the child's life that are causing him or her to behave in ways that might be mistaken for symptoms of a conduct disorder. Family stressors such as divorce, frequent family arguments, poverty or poor health might upset children and lead to trouble with their behavior. Alcohol and/or drug use can produce some of the telltale behaviors. So can having a parent who drinks or uses drugs frequently, or who abuses a child physically, verbally or sexually. Children can be hyperactive and/or have a learning disability which is very frustrating and damaging to their self-esteem, and they don't know how else to cope. There can be other psychological problems, like untreated anxiety or depression, which show up like an emergency flare as behavior problems. A more transitory and treatable condition called Oppositional Defiant Disorder (ODD) might be a more accurate diagnosis in may cases.

A certain amount of rebellion is normal as children become adolescents and begin cutting the apron strings and identifying with their peer group. There can be pressure from other kids to "join in the fun" and do things that are reckless and against the rules. There are plenty of messages in the media that encourage this kind of behavior. The stresses on families and the demands on parents' time and resources seem to be getting more difficult to cope with, too. It is in fact increasingly more stressful to be an adolescent today (or to be the parent of one!) than it has ever been before, so it isn't surprising that a lot of children are showing signs of behavior problems these days.

If your child has a problem that might be a conduct disorder, he or she has probably already come to the attention of authorities in school or in the community. There is probably conflict with parents, as well. If you think you need help, you might turn first to the people in the community who already know your family, like a clergy person, your family doctor, or a school social worker, psychologist, or guidance counselor. These professionals can help you determine how serious a problem you are dealing with and refer you to therapists who can help if there is need.

If you and your family do need professional help, make sure the therapist you are referred to is covered by your child's health insurance. Many companies have lists of therapists whose services they will cover; if you don't use someone on the list they either pay a small part or not at all. And for conduct disorders, they may decide not to pay at all, because these are defined by some companies as "personality problems" or "problems in living," for which counseling may not be considered "medically necessary" and therefore not covered. But don't let insurance problems stop you from getting the help you need. Many therapists will take family financial circumstances into account when setting a fee.

In therapy for a condct disorder, you can expect that the therapist will want everyone in the family involved in treatment. If they don't ask for this, maybe you should ask why they don't, or seek the services of someone with training in family therapy. Teamwork between family members, and with the therapist, is the most effective type of therapy. Some of the therapy might involve the family learning how to develop a structure of rules and limits that everyone commits to and maintains. Sometimes the therapist might want to meet with the child individually to talk about feelings and other issues. People in the community, like teachers and school counselors, or even people from the courts or the police department might also get involved. Therapy can take anywhere from a few weeks to over a year.

If everybody does their part, treatment can be successful and children with conduct disorders can get back on track to lead happy and productive adult lives. -- Richard Englehardt, LCSW

Please send questions or comments to bbruno@snet.net.