Careful Assessment Needed to Treat Conduct Disorders

Article excerpt

ALBUQUERQUE -- Conduct disorders represent a complex family of conditions, and effective treatment requires careful assessment of contributing variables and comorbid conditions, Dr. David J. Mullen reported at a psychiatric symposium sponsored by the University of New Mexico.

"Conduct disorders develop over time, as [the] payoff for antisocial behavior ... exceeds the payoff for social behavior," said Dr. Mullen of the department of psychiatry at the university in Albuqerque. "This antisocial behavior may fluctuate, but it is always there."

The DSM-IV defines conduct disorder as "a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social norms or rules are violated."

For a patient to be diagnosed with conduct disorder, at least three characteristic behaviors must have been manifested in the past year, with at least one behavior present in the past 6 months, according to the DSM-IV The four main groupings of the characteristic behaviors are aggression toward people and animals, destruction of property, deceitfulness or theft, and serious violations of rules.

"These adolescents often bully and intimidate others, get into physical fights, have a weapon that can cause physical harm, can be physically cruel to people and animals, and some have had forced sexual activity," Dr. Mullen said.

Other behaviors include arson or other serious property destruction, breaking and entering, and lying and conning. "These kids often stay out at night despite parental prohibition," and they "run away from home and are often truant," Dr. Mullen said.

Epidemiologic studies have shown that the incidence of conduct disorder ranges from 1.5% to 15% in children and adolescents. It is three to five times more common in boys than in girls, and there is some evidence that the incidence is increasing, especially in urban areas. In adolescents, however, there is a more even distribution among males and females, he noted. …