Behavior Advisor
Conduct Disorder The material on this web page was originally in an e-mail sent to members of the “B-list”. To sign up, go to: of "Conduct Disorder"?(from the Diagnostic & Statistical Manual,?DSM-IVtr?of the American Psychiatric Association, AND the International Classification of Diseases -?ICD 10):?When the leader of the orchestra directs the musicians to play Beetoven’s 9thth?symphony to the beat of?Macarena?using only piccolos and cowbells. Oh wait… that’s Conductor?Disorder!?? ? ? I hear that it's being considered for inclusion in the 12th editions of DSM and ICD. If you’d like to know about the history of the DSM, the holy book of mental health professionals, its present version, and the changes to be found in the upcoming DSM-5, view my rather irreverent?video podcast?on the topic.Fellow B-Lister:?Does the delivery of this weekly newsletter seem like a cruel and callous act aimed directly at you???If so, either I have a Conduct Disorder or you suffer from Paranoid Schizophrenia. Let's assume the former.??(It's not paranoia when they really ARE after you.)Conduct Disorder (CD) is one the most pronounced and intervention-resistant of the school-age diagnoses in the manual of mental illnesses. ?It is expressed inmajor violations of age-appropriate social expectations? ?I have a great deal of direct experience in self-contained classrooms chock-full of youngsters with this label.In my early experience, I remember being anxiously alert even during CD’s inactive stage when kids were on-task and cooperative; Often I could sense an odd, tense, undefined psychological undertone… a harbinger of what was to come.? It was like having your ear to the train tracks... ?You know something’s coming, but you don’t know from which direction.Then you realize the express train is upon you!In its active state, Conduct Disorder is one of the most frightening of disorders with which to be confronted… filled with deceit and/or terrible negative chi (energy).? Indeed, “confront” might be the operational word here.? When it presents itself in its full-force, you better be on top of your professional game..Fear not! ??You can reach that point with the strategies and materials found on and other fine sites/books.?First though, let’s wrap our brain around this psychological malstrom.? Last week, we addressed?ODD, Oppositional Defiant Disorder.? These youngsters exhibit a persistent pattern of disobedient, argumentative, defiant and hostile actions.? These youngsters are at great risk for transforming into someone with a more severe condition: Conduct Disorder.? Generally, kids with ODD do not demonstrate the mean, cruel behavior found in the diagnostic criteria for Conduct Disorder.?.The CD diagnosis is made when the youngster presents a prolonged pattern of antisocial behaviour such as serious violation of laws, social norms and rules. ?Our students with Conduct Disorder are the irritable, non-empathetic, angry kids who bully and threaten others,?solve their disputes with fearless??violent physicality?, destroy property, steal, lie, engage in drugs and alcohol,?disobey regulations in the home, stay out past curfew or run away (among other things).? They break the rules, regulations, and juvenile codes of society,??and violate the basic rights of others, sometimes cruelly.In DSM 5?,?the soon-to-be released new edition of the Diagnostic and Statistical Manual, the diagnostic criteria will remain about the same. ?However, it will reportedly contain a “specifier” regarding the Conduct Disorder diagnosis that is intended to differentiate between impulsive acts of rage due to emotional overload in the youngster, and those acts that are planned in a calculated manner before engagement. ?The latter type will be identified by an “Unemotional and Callous Traits” clause.It is hoped?(by the American Psychological Association)?that the qualification will separate “cold blooded” versus “hot blooded” behavior;?ruthlessness?versus?rage;?emotionalversus?evil. ?McCauley Caulkin’s character in the film titled “The good son.”??shows this latter behavioral pattern at its cinematic extreme.? He is removed, unemotional and callous.? You can view some film clips at : Search for “The good son tribute”?&??“The good son and car crash”.?(I can't place the links here... it attaches questionable adverts)For a less dramatic, more realistic depiction, take a look at this two-part video created by a graduate student in my behavior disorders teacher-training program.? Gabrielle does a wonderful job of describing the earlier and present life of a 10 year old boy with “childhood onset”?(versus "adolescent onset" which is more commonly due to troubled youngsters befriending other troubled adolescents)?Conduct Disorder.? His oppositional and peer relationship problems exacerbate into violent behavior.? This action pattern is connected to the diagnostic criteria before Gabby presents approaches and practices to help these youngsters fit better into society.?(Thanks, Gabrielle!)Here are the links: Conduct Disorder?(part 1):? Disorder?(part 2):? did they come to be this way?While the jury is still out regarding the etiology, for the most part, the source for this aberrant behavior, distorted value system, and negative character is believed to emanate in the home.? Conduct Disorder is frequently associated with the following factors that increase risk for the disorder:Smoking & alchohol use during pregnancyAbusive child-raising practicesInadequate supervisionInconsistent disciplinary measuresParental drug abuse and alcohol addictionHomes filled with familial conflictSingle parent householdYoung age of motherLarge family sizeDivorce in the familyLiving in areas of long-term, ingrained poverty*!?It is important to remember that the vast majority of kids who grow up in these circumstances do NOT develop Conduct Disorder.? However, these factors, especially in combination, do increase the risk of development.There might also be a biological component, as Attention Deficit Hyperactivity Disorder (ADHD) increases risk for CD, and an as-of-yet unidentified genetic component is also possible. ?Indeed, one study found children adopted from parents with anti-social personality disorder?(the adult version of Conduct Disorder)?having a higher incidence of aggression than children adopted from parents who did not have anti-social personality characteristics.It is common for kids with CD, especially those with early onset of the condition, to have impaired cognitive functions and intelligence. ?This may be the result of differences in brain anatomy and function, as youth with CD are more likely to have reduced responses in areas of the brain that are associated with antisocial actions(i.e., amygdala, insula, orbitofrontal cortex, and ventromedial prefrontal cortex.... whew, that's enough... my tongue gets dizzy trying to say those names).How many kids have CD?It is difficult to assess the prevalence of the disorder because of the varied interpretations of the criteria for the diagnosis?("defiant", "rule breaking"). ?Additionally, the more international ICD manual uses a slightly different categorization system. ? It's akin to art and pornography; difficult to define, but you know it when you see it… and some folks see it more so than others.Consider the “epidemic” proportions of children with autism.? The latest estimates are 1 in 120 children up to 1 in 90.? Then consider the most common estimate for the number of kids with conduct disorder: 1 in 7!?(Although estimates range from 1% to 10%)My intent is not to demean or downplay the need to address autism.? My intent is to show the unequal power of the parental/professional bases, and public perceptions of the two conditions.We also know that the diagnosis is more common among boys?(estimated to be about 9% of them), but girls?(estimated at 2% of that gender)?are certainly not immune. ?The lesser estimate for females is sometimes attributed, in part, to the diagnostic criteria that tends to focus more on acting out behaviors, more common in the male gender.There are racial differences in diagnosis, with kids whose ancestry is from sub-Saharan Africa at greatest risk for diagnosis. ?Kids of Asian ancestry appear to be at least risk.?(Although, again, they are not immune)___________________________________Let's Reclaim These Kids!?Here are some?quick tips?and approaches. ?You'll see some new ideas at the end of the lists, although most will be reiterations of last week's approaches and interventions for youngsters with ODD. ?That's to be expected though, as I used to be the director of the Department of Redundancy Department. ?(Have I told that joke before? ?If so, you now understand why... again.)Educators1. Don’t give directions.? Huh?!?(That's "Eh" for our Canadian readers)??Yes, I realize that adults in authority see it as their charge, but with these kids you’re charging into the same valley as the 600.? Unlike the Light Brigade, ours?IS?to reason why, and if doomed to failure, decide on another course of action.What then do we do???Ask questions!??It hard to refuse a direction if it isn’t given!? Here are some examples:“Atsa, where should your tush (Yiddish for "buttocks") be?” ("In the chair.") “Good thinking.”“Kialani, when is the time for outside voices?” (“Recess.”)? “What voice level do we use during partner work?” (“Our six inch voice.”)? Teacher nods."Ebony, when is the time for learning centers?""Wei, when the bell rings, where should students be?"Note that the questions?NEVER?use "Why". ?It sounds accusatory..2. Make use of strong, research-supported, positive interventions2a.?Differential reinforcement:?It's a twenty Peso/Yen/Deutchmark term for a one monetary unit idea, but the different variations of the DR procedure are highly effective with intervention resistant kids.2b.? HYPERLINK "" \t "_blank" Self monitoring:?Promote self-regulation of behaviour by having the student keep track of his/her behavior..3. Pick up additional?defiance-defusing tips.4. Teach?problem solving?skills?to devise alternative solutions to anger and rebellion.5.?Modify the character of the youngster?using the?Circle of Courage model of intervention.6.??Determine the?present level of readiness?to change behaviour, and move the youngster toward?greater levels of willingness to change?his /her behavior for the better.7.??Use?“The Behavior Survival Guide for Kids: How to make good choices and stay out of trouble” in your social skills/anger management programs, or place it in the class library.8. Implement?the?FREE?100+ lesson plans?that accompany?The Behavior Survival Guide?(or use them in isolation)9.?Engage the youngster in Multi-Systematic Training (MST:?)10.??For girls who tend to me more responsive to peer-influence and empathy-based interventions than boys, provide this intervention focus._____________________________________________________?Parents1. Develop a home-school?behavior change program?based on the monetary system.2.?Learn the principles of changing behaviour for the better, and effective strategies for?helping your child make better behavior choices.3.??Leave “The Behavior Survival Guide for Kids: How to make good choices and stay out of trouble” out on the coffee table for your child to pick up.4. Seek out family counseling.5. If your child is engaging in drug abuse, seek out drug-exit programs. ?One research study showed that 1/2 of drug users with conduct disorder no longer exhibited the disorder when free of illicit substances.6. For girls who tend to me more responsive to peer-influence and empathy-based interventions than boys, seek out this intervention focus.7. Acquire the comprehensive program designed specifically to help parents of children with Conduct Disorder/highly disobedient behavior change their child's behavior for the better. (Click on the Total Transformation box below)NEXT WEEK:?Childhood Depression?(sometimes associated with CD).Author: Tom McIntyre, Ph.D. DoctorMac@ ................
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