Magazine article National Association of School Psychologists. Communique

Conduct Disorder

Magazine article National Association of School Psychologists. Communique

Conduct Disorder

Article excerpt

Serious antisocial behavior in children and adolescents poses significant challenges within educational settings and is one of the most important concerns facing educators today (Van Acker, 2007). Students with conduct problems often display aggressive and antisocial behaviors that significantly disrupt classroom activities, negatively impact peers, increase rates of truancy, and often cost school systems a great deal by requiring additional levels of security or frequent repairs to destroyed school property (Kimonis, Ogg, & Fefer, 2014; Atkins, McKay, Talbott, & Arvanitis, 1996). Furthermore, many forms of community and school violence have been perpetrated by students with a history of social alienation and disengagement from school (Griffiths, Lilles, Furlong, & Sidhwa, 2012). The disorder of particular interest to the development of aggressive and antisocial behaviors in youth is conduct disorder (CD).

Conduct disorder is characterized by patterns of behaviors whereby societal norms or the rights of others are consistently violated. Individuals with CD often misperceive intentions of others as hostile and threatening, and are more likely to initiate aggressive behaviors and react aggressively than their typically developing peers. Prevalence estimates of CD range from 2% to 10% (APA, 2013a). The age of onset is a key variable to understanding the course of the disorder. Onset of CD can occur as early as the preschool years; however, prevalence rates rise from childhood through adolescence. Onset after age 16 years old is fairly rare, although CD can be diagnosed in adulthood. In addition to developmental differences in prevalence, there are also gender differences-CD is more common in males than females.

While the course of the disorder varies, with many individuals (particularly those with onset in adolescent and those with milder symptoms) functioning successfully in society, it is particularly concerning that very few youth who are identified with CD actually receive treatment. This diagnosis places individuals at risk for many deleterious outcomes. For example, individuals with this diagnosis are at increased risk for comorbid as well as later-onset mental health disorders (e.g., mood disorders, anxiety disorders, substance-related disorders). Of particular interest is the transition for youth from CD to antisocial personality disorder (ASPD) and the association that CD and ASPD have with criminal behaviors. Specifically in the educational context, CD-related behaviors frequently lead to school suspension or expulsion. Without treatment, symptoms and behaviors may intensify. That is, many youth may begin with less serious behaviors (e.g., lying or stealing), and eventually develop more severe behaviors (e.g., rape, violence against family members; APA, 2013a). Intervening with such children can be challenging when they vary widely in terms of causal and risk factors, developmental outcomes, and response to intervention; however, such intervention is crucial. Understanding the unique pathways and features of the disorder is critical to designing effective school-based interventions. Fortunately, school psychologists and other school-based mental health staff are in a unique position to assess a broad spectrum of problems associated with childhood- and adolescent-onset CD.

CHANGES FROM DSM-IV-TR, RATIONALE, AND POTENTIAL CONSEQUENCES OF CHANGES

Since the DSM-IV-TR (APA, 2000) was published, a notable amount of new research regarding CD has emerged. However, although there is a great deal of new and exciting research in a number of areas, very little of it has provided the precise sort of evidence base required to justify any major adjustments to the DSM-5 criteria (Moffitt et al., 2008). Therefore, the diagnostic criteria for CD has remained relatively unchanged. Nevertheless, there have been some important, yet minor, changes made.

First, CD is now included in a chapter new to the DSM-5: "Disruptive, Impulse-Control, and Conduct Disorders. …

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