Pediatrics Book

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Conduct Disorder

Aka: Conduct Disorder, Conduct Behavior Disorder, Disturbed Conduct
  1. Epidemiology
    1. Lifetime Prevalence: 9.5% (12% for males, 7.1% for females)
  2. Risk Factors
    1. Male gender
    2. Childhood poverty
    3. Maternal Tobacco abuse during pregnancy
    4. Parental conditions (e.g. Substance Abuse, criminality)
    5. Exposure to physical or sexual abuse in childhood (or witness to Intimate Partner Violence)
    6. Lower cognitive ability
    7. Family Instability
    8. Peers with behavior problems (Substance Abuse, Truancy, criminality)
    9. Parents who Exercise severe Discipline or practice a cruel attitude
  3. History
    1. Skipped school (when and why)?
    2. School suspensions or expulsions?
    3. Physical fights (when and why) at school or elsewhere?
    4. Police trouble (negative interactions, arrests, charges filed)?
    5. Stealing?
    6. Do you use Alcohol, drugs?
    7. Are you sexually active?
    8. Stay out late past family curfew?
  4. Symptoms: Aggression
    1. Intimidates, bullies or threatens others
    2. Starts physical fights
    3. Weapon use that could cause serious physical harm to others (e.g. knife or gun, broken bottle or bat)
    4. Physically cruel to people
    5. Physically cruel to animals
    6. Stealing while confronting a victim (e.g. Mugging, Extortion, or armed robbery)
    7. Forced sexual activity
  5. Symptoms: Property destruction
    1. Arson with intent of causing serious damage
    2. Deliberate property destruction (property that does not belong to them)
  6. Symptoms: Lying or Theft
    1. Broken into another person's car or building
    2. Lies to obtain goods or favors or to avoid obligations (e.g. Con-Artist)
    3. Theft without confronting the owner (e.g. shoplifting or forgery)
  7. Symptoms: Rule violation
    1. Disregards curfews before age 13 years
    2. Truant from school before age 13 years
    3. Run away from home overnight
      1. Once if gone for prolonged period
      2. Twice for other cases
  8. Diagnosis: DSM-5 (based on 4 symptom criteria as above)
    1. Repetitive and persistent violation of other's basic rights or major age appropriate social norms or rules
    2. Three or more of symptom criteria in last 12 months (from 15 possible in any of the 4 symptom categories)
    3. At least one of symptom criteria in last 6 months
    4. Impaired social, school or work functioning
    5. Criteria not met for Antisocial Personality disorder
      1. Applies only to patients over age 18 years
    6. Specifiers
      1. Onset
        1. Childhood onset (one or more characteristic symptoms before age 10 years old)
        2. Adult onset (No characteristic symptoms before age 10 years old)
        3. Unspecified onset
      2. Limited prosocial emotions (2 or more characteristics in multiple settings, relationships for 12 months)
        1. Lack of remorse or guilt
        2. Callous or lack of empathy (cold and uncaring)
        3. Unconcerned with performance at school, work or important activities
        4. Shallow or deficient affect
    7. Severity
      1. Mild (minimal criteria met for diagnosis or relatively minor harm to others)
      2. Moderate
      3. Severe (many criteria met beyond diagnosis or significant harm to others)
    8. References
      1. (2013) DSM-5, APA, Washington DC, p. 469-71
  9. Diagnosis: Scales
    1. Child Behavior Checklist
    2. Disruptive Behavior Disorders Rating Scale
    3. Vanderbilt Assessment Scale
      1. Typically used for ADHD evaluation, but does have questions related to ODD and Conduct Disorder
      2. Test Sensitivity for Conduct Disorder is only 67%
      3. Becker (2012) J Dev Behav Pediatr 33(3): 221-8 [PubMed]
  10. Differential Diagnosis
    1. Oppositional Defiant Disorder
    2. Attention Deficit Hyperactivity Disorder
    3. Substance Abuse
    4. Major Depression
    5. Bipolar Disorder
    6. Disruptive mood dysregulation disorder
    7. Adjustment Disorder (with depressed mood or Disturbed Conduct)
    8. Intermittent Explosive Disorder (impulsive, but not predatory)
    9. Posttraumatic Stress Disorder
  11. Associated Conditions
    1. Attention Deficit Disorder (comorbid in up to 20% of Conduct Disorder)
    2. Oppositional Defiant Disorder (comorbid in 50-60% of Conduct Disorder)
    3. Substance Abuse (esp. Tobacco and Alcohol Abuse when ADHD is comorbid)
    4. Mood Disorder (Major Depression, Anxiety Disorder)
  12. Management: General Measures
    1. Parents should have their own physical and mental health conditions managed appropriately
    2. Model positive listening and communication behaviors
    3. Involve professionals that communicate with one another
      1. School social workers
      2. Subspecialty Consultation as needed
    4. Parents should monitor their child's activities
      1. Where and with whom their children are spending time
      2. Curfews should be enforced
      3. Encourage organized school activities (under the direction of coaches, teachers or parents)
      4. Encourage healthy activities (e.g. sports, school clubs, community groups)
      5. Planned daily family activities (e.g. dinner together, board games)
      6. Parents and children can review together their phone messaging and online social media
    5. Enforce well-defined and pre-defined behavior-based rewards and consequences
    6. Treat comorbid mental health conditions
      1. Attention Deficit Disorder
      2. Mood Disorder
      3. Substance Abuse
  13. Management: Medications
    1. Precautions
      1. When ADHD is present, its effective management will typically improve conduct behaviors
      2. Conduct Disorder behavior management (see above) is the primary management strategy
      3. Other medications (esp. Risperidone) are only indicated in refractory cases
    2. Attention Deficit Disorder (with or without ODD, Conduct Disorder)
      1. ADHD Stimulants
      2. Atomoxetine (Straterra)
      3. Guanfacine
    3. Oppositional behavior or Conduct Disorder
      1. Risperidone or Risperdal (high quality evidence)
      2. Other agents with low quality evidence
        1. Clonidine (low quality evidence)
        2. Valproate (low quality evidence)
    4. Medications to Avoid (ineffective or harmful)
      1. Avoid Quetiapine (Seroquel)
      2. Avoid Haloperidol
      3. Avoid Lithium
      4. Avoid Carbamazepine (Tegretol)
  14. Resources
    1. First Step To Success (Kindergarten)
      1. http://www.firststeptosuccess.org/
    2. Second Step (School-based program)
      1. https://www.secondstep.org/
    3. Coping Power (Ages 10-12 years old, Grades 4-6)
      1. http://www.copingpower.com/
    4. Incredible Years (ages 2 to 12 years)
      1. http://www.incredibleyears.com/
    5. Triple P (Positive Parenting Program)
      1. https://www.triplep-parenting.com/us/triple-p/
  15. Complications
    1. Antisocial Personality Disorder (esp. with early onset Alcohol Abuse)
      1. Develops in 45-70% of Conduct Disorder
      2. Borderline Personality Disorder is also more common
      3. Increased risk of violent crime and Substance Abuse
    2. Substance Abuse
      1. Alcohol Abuse (78% in men, 65% in women)
      2. Drug use (48% in men, 46% in women)
    3. Failure to Complete High School
    4. Criminality
  16. References
    1. (2013) DSM-5, APA, Washington DC, p. 469-71
    2. Lillig (2018) AM Fam Physician 98(10):584-92 [PubMed]
    3. Searight (2001) Am Fam Physician 63(8): 1579-88 [PubMed]

Conduct Disorder (C0149654)

Definition (NCI) A disorder diagnosed in childhood or adolescence age group characterized by aggressive behavior, deceitfulness, destruction of property or violation of rules that is persistent and repetitive, and within a one year period.
Definition (MSH) A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviors include aggressive conduct that causes or threatens physical harm to other people or animals, nonaggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules. The onset is before age 18. (From DSM-IV, 1994)
Definition (PSY) Repetitive and persistent aggressive or nonaggressive behavior in which basic rights of others or social norms are violated. Self esteem is generally low, and an inability to develop social relationships and lack of concern for others may or may not be present.
Definition (CSP) mental disorder of childhood and adolescence characterized by repetitive and persistent patterns of conduct in which rights of others and age-appropriate societal rules are violated; the conduct is more serious than ordinary mischief and pranks.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D019955
ICD9 312.9
ICD10 F91.9, F91
SnomedCT 430909002, 154945001, 192104004, 192597006, 268785008, 192603009, 192106002, 268782006
DSM4 312.8
English Unspecified disturbance of conduct, Conduct Disorder, Disturbance of conduct NOS, Disturbance of conduct unspec., Conduct Disorders, Conduct disorder, unspecified, CONDUCT DIS, [X]Conduct disorders, conduct disorder (diagnosis), conduct disorder, Conduct disorder (disorder), Conduct disorder, Conduct disturbance NOS, Conduct disorders, Conduct disorder NOS, Conduct Disorder [Disease/Finding], Disorder;conduct, conduct disorders, Unspecified disturbance of conduct (disorder), [X]Conduct disorders (disorder), [X]Conduct disorder, unspecified, Disturbance of conduct NOS (disorder), Conduct behavior disorder, Conduct behaviour disorder
Dutch antisociale gedragsstoornis, agressieve gedragsstoornis, niet-gespecificeerde gedragsstoornis, Gedragsstoornis, niet gespecificeerd, Gedragsstoornissen, Gedragsstoornis
French Trouble de la conduite, Trouble du comportement non précisé, Trouble des conduites, Trouble de conduite
Italian Disturbo di comportamento, Alterazione del comportamento, Alterazione della condotta non specificata, Disturbo della condotta
Portuguese Perturbação da conduta, Perturbação comportamental de conduta, Perturbação NE da conduta, Transtorno de Conduta, Transtorno do Comportamento, Transtorno da Conduta
Spanish Alteración de conducta, Alteración no especificada de la conducta, Alteración conductual, trastorno de conducta (trastorno), trastorno de conducta, trastorno de la conducta, SAI, trastorno del comportamiento, SAI, [X]trastornos de la conducta, alteración de la conducta, SAI (trastorno), alteración de la conducta, SAI, trastorno de la conducta no especificado, trastorno de la conducta no especificado (trastorno), [X]trastornos de la conducta (trastorno), Trastorno de la Conducta, Trastorno del Comportamiento
German Verhaltensauffaelligkeit, unspezifische verhaltensbezogene Beeintraechtigung, Stoerung des Sozialverhaltens, nicht naeher bezeichnet, Stoerungen des Sozialverhaltens, Störung des Sozialverhaltens, Verhaltensstoerung
Swedish Avvikande beteende
Czech porucha chování, Poruchy chování, Porucha chování vedení, Blíže neurčená porucha chování, Narušené chování
Finnish Käytöshäiriö
Russian POVEDENIIA RASSTROISTVA, ПОВЕДЕНИЯ РАССТРОЙСТВА
Korean 행동 장애, 상세불명의 행동 장애
Polish Zespół zaburzonego zachowania, Zaburzenia zachowania CD, Zaburzenie zachowania typu przestępczego, Zaburzenie związane z zachowaniem niszczycielskim, Zaburzenie kontroli zachowania, Przemoc młodocianych, Zespół zaburzenia zachowania, Zaburzenie zachowania (CD), Zachowanie przestępcze młodocianych, Zaburzenia zachowania typu CD
Hungarian Életvezetési viselkedési zavar, Életvezetési zavar, Az életvezetés nem meghatározott zavara, Életviteli viselkedési zavar
Norwegian Atferdsforstyrrelse
Japanese ショウサイフメイノソコウショウガイ, ソコウショウガイ, 詳細不明の素行障害, コウイショウガイ, 素行障害, 行為障害
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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