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Subject PSYCHOLOGY

Paper No and Title Paper No 15: Clinical Psychology

Module No and Title Module No 5: Conduct Disorder

Module Tag PSY_P15_M5

TABLE OF CONTENTS

1. Learning outcomes
2. Defining conduct Disorder
2.1: Clinical Picture, prevalence of Conduct Disaorder
2.2: DSM-IV-TR Criteria for conduct disorder
3. Etiology of Conduct Disorder
3.1 Genetic Factor
3.2 Neuropsychological Factor and the Autonomic Nervous system
3.3 Psychological factors and sociocultural factors
3.4 Peer influences
4. Treatment of conduct disorder
4.1 Family interventions
4.2Behavioral Techniques
5. Summary

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder
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1. Learning Outcomes
After studying this module, you shall be able to

 Know about, what is Conduct Disorder.

 Learn about the symptoms, prevalence and causes of conduct disorder.
 Evaluate the treatment of conduct disorder.

2. Defining conduct disorder

Conduct disorder is one of the psychological disorder which is a repetitive, persistent and
continuous violation of the recognised values and norms of society and disrespect for the rights of
others. The symptoms of conduct disorder are severe and intense including lying , stealing ,
excessive aggression , cruelty towards animals and children as well as damaging both private as
well as public property without any feelings of remorse which makes it a vicious cycle and further
grows into an anti-social personality disorder. This disorder is common among adolescents and
children.

2.1: Clinical Picture and prevalence of conduct disorder:

Conduct disorder is unacceptable conduct exhibited by the child both at school as well as at home
with both peers and parents. These children show a variety of other problems like alcohol abuse,
drug abuse, and deliquent behaviour who show deficits in social behaviour. They are not emtionally
attached to their family members and friends and exhibit an overtly aggressive , hostile, disobedient
and destructive behaviour. They generally display temper tantrums with stealing and lying being
common. At school, they bully others and often bunk school while being involved in activities like
vandalism, robbery and homicidal acts.
Children with conduct disorder generally suffer from anxiety, depression, substance abuse and
attention deficit hyperactivity disorder. Girls are at a higher risk of developing co-morbid disorders
like anxiety, substsance abuse as compared to boys. Conduct disorder is at its peak around the age
of 17 years , these children are often involved in law breaking , stealing and vandalism and drop
such behaviour when they grow older. Moffitt (1993) has concluded that some children show a
persistent pattern of anti-social behavior, conduct disorder starts at the age of 3 years and continues
to grow from stealing, mischief, lying to anti-social behaviour when they reach adulthood. He
proposed that conduct disorder is more common among boys than in girls. He concluded that
children whose behavior becomes more aggressive and anti-social as they reach adulhood, have
other problems like absenteeism from school, and are often underr-achievers or under performers.
They are involved in more violent activities as they grow old with a high dependency on drugs.
They are impulsive and commit crimes. However , some of them become better as they reach their
late twenties and early thirties.

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder
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2.2: DSM-IV-TR: Criteria for conduct disorder

A. This disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or
societal norms or rules are violated, as manifested by the presence of three or more of the following
criteria in the past 6 months.

They show aggression to people and Animals.

(1) They bullies, threatens others.

(2) They are involved in physical fights

(3) They keep dangerous weapons with them and harm others.

(4) They are usually cruel to others

(5) They are cruel to animals.

(6) They steal others property

(7) They force others to sexually involve with them.

Destruction of Property

(8) They are involved in causing damage to others property

(9) They destroy other’s property

Deceitfulness or Theft

(10) They jump into someone else’s house, building, or car without permission

(11) They often lies to obtain goods or favors or to avoid obligations

(12) They has stolen items of nontrivial value without confronting a victim.

Serious violation of Rules

(13) They often stays out at night despite parental prohibitions, beginning before age 13 years.

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder
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B The disturbance in behavior causes clinically significant impairment in social, academic, or

occupational functioning.

C If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

The severity of the disorder should be specified as follows:

Mild: when conduct problem causes minor harm to others.

Moderate: when the severity of conduct problem is more than mild and less than severe, it come under
the moderate category.

Severe: when the child causes a considerable harm to other people or their property it comes under severe
category.

Source: Adapted with permission from the diagnostic and statistical manual of mental disorders, Fourth
Edition, Text Revision (Copyright 2000) American psychiatric Association.

3: Causal Factors in conduct disorder

There are several factors which contribute to the development of conduct disorder.

3.1: A self –Perpetuating cycle: Research suggest that a genetic predisposition leads to the development
of the disorder along with neuropsychological problems, their temperament, insecure attachment to parent
and low intelligence. They have less control over their actions and behavior which maybe one of the
prime reasons for the disorder itself. Their parents find it difficult to provide them a secure attachment
because of their tough temperament. Mild neuropsychological deficits are also found in these children
who are unable to make plans or monitor themselves which accompanies their aggressive and impulsive
behavior bringing in long- term difficulties later in life.

Research studies conducted in the United-states, Sweden and Denmark regarding the hereditability of
criminal behavior rather than conduct disorder has found that both genetic and environmental factors play
an important role in the development of conduct disorder. Although the prevalence rate of occurrence is
different for boys and girls but genetic and hereditability component of is the same in both boys and girls.
Both twin and adoption studies concerning anti-social behavior indicated that 40% to 50% of anti-social
behavior is heritable. Aggressive behavior like fighting, cruelty and destroying property is truly heritable
whereas delinquent behavior such as truancy, stealing may not be heritable.

3.2: Neuropsychological factors and Autonomic Nervous system: Neuropsychological factors which
lead to the development of conduct disorder cause problems relating to memory , planning , difficulty
with executive functioning and problem-solving . These problems have been found to be common among
children with conduct disorder who at an early stage experience low IQ which is though not related to
school failure or their low socio-economic status.

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder
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Research studies also indicate that abnormalities in the autonomic nervous system are found in children
with conduct disorder. They have low arousal levels as compared to children without conduct disorder.
Adolescents with anti-social behavior were also found to have low arousal levels and lower levels of
resting heart rate than adolescents not exhibiting such anti-social behavior. Adolescents who show anti-
social behavior do not show fear of punishment as compared to children without anti-social behavior.
They do not show fear while doing such anti-social activities and have no fear of punishment even if they
are caught while doing so.

3.3: Psychological and socio-cultural factors: In our society, children refrain from doing anti-social
activities not because they are illegal, but because they are following the established norms of good
conduct in the society and are filled with guilt and remorse if they violate these established values and
norms. Child development thus involves a moral awareness of what is right and wrong. Children without
conduct disorder have the ability to follow the rules and norms of the society. However, children with
conduct disorder seems to be deficient in this moral awareness as they violate these rules and regulations
of the society without any feelings of guilt or remorse.

Behaviorists feel that modeling and conditioning play an important role in the maintenance and
development of conduct disorder. Children who face child abuse are likely to become aggressive as they
grow as they imitate others doing such aggressive acts. This behavior is likely to be maintained. They
learn from the peers who are engaged in anti-social acts and enjoying high-status possessions. Parental
bringing up with a lack of discipline or inadequate parenting are often associated with conduct disorder.
Children who are not punished for wrongful acts such as stealing, lying, damaging private or public
property become more and more aggressive which leads to them developing serious conduct problems.
Research studies suggest that ineffective parenting like parental neglect, rejection and lack of monitoring
is also associated with conduct disorder. If the parents have a disturbed emotional status, their children
also become anti-social and develop serious conduct problems. Low socio-economic status, parental
depression, parents have unstable marital relationships and stress all increase the probability of conduct
disorder.

Kenneth Dodge gave a social information processing theory of child behavior, as to how children process
social information and its impact on their behavior. He says that aggressive children have a bias in their
cognitive processes. Who then interpreted ambiguous acts such as bumped in line as exhibiting hostile
intent of others which makes them retaliate aggressively even if such actions had not been intended to
invoke such behavior by the other person. This creates a vicious cycle where others may react more
aggressively towards such children fueling even more aggressive responses from the latter. Therefore,
these deficits in the social information processing predicts anti-social behavior among adolescents.

Unemployment, poverty , delinquency , lack of access to educational facilities and a disturbed family life
are all contributory factors to conduct disorder . The combination of one or more of these factors
combined with an early anti-social behavior predicts a trend of criminal activities.

3.4: Peer influences: Research suggests that peer pressure instills aggressive and anti-social behavior in
children. Sometimes peers accept or reject such children who often have affiliations with deviant peers.
When peers reject such children, they become aggressive and many of them show attention deficit and
hyperactive disorder. Many studies indicate that rejection by peers is generally related to later aggressive
behavior. When children have associations with deviant peers, they also become delinquent in their

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder
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behavior. When the aggressive children rejected by peers, they are also unskilled and unable to adjust
socially, they exhibit their tendency towards anti-social behavior. These socially rejected children have a
tendency to become anti-social and delinquent. They grow into adults with anti-social behavior.

4: Treatment of conduct disorder:

In the treatment of conduct disorder children, their family members, peers, neighborhood and school are
all involved providing social support.

4.1: Family Interventions: Families and parents play a very important role in the treatment of children
suffering from conduct disorder. If they interfere in the early stage of conduct disorder, its impact is
visible. The parents are advised to reinforce and motivate their pro-social behavior. They should
consistently reward their positive behavior and discourage anti-social and aggressive behavior. Parents
are taught how they can modify the conduct of the children. Management training is given to the parents,
in which various techniques are taught to parents, as to how they can use reinforcement techniques like
privileges are given to them, if they display a positive behavior and withdrawal of incentives if they are
involved in anti-social and aggressive behavior. Parent’s management training programs prove to be more
effective, when they work in co-ordination with teachers of the school. Teachers observes the behavior of
the children at school and parents keep an eye on children at home. When teachers and parents work
together, it proves to be more effective and fruitful and has been shown to improve the behavior of
siblings also.

Research suggests that parents of children with conduct disorder are found to be inconsistent in their
behavior and often lacking in good parenting skills. Children learn to avoid their parents and copy their
aggressive behavior. Divorced, burdened parents have no time or money to learn parental training
programs because of which children suffering from conduct disorder are shifted from one place to
another, perceiving this as rejection not only by society but also by their parents . If the environment is
warm and healthy , it brings about positive changes in their behavior. However , these treatments have
been found to be only temporarily effective.

4.2: Behavioral Techniques: Behavioral techniques are found to be effective in treating children
suffering conduct disorder. Parents are taught control techniques how they can modify their anti-social
and aggressive behavior to normal socially acceptable behavior. Parents are taught they can manage the
behavior of the children like a therapist. They can reinforce the socially acceptable behavior and
discourage the anti-social behavior. Parents should be consistent in their behavior. The changes brought
about when parents consistently accept and reward their child’s positive behavior and stop focusing on
the negative behavior may finally change their perception of and feeling toward the child, leading to the
basic acceptance that the child has to badly needed.

Although effective techniques for behavioral management can be taught to parents, they often have
difficulty carrying out treatment plans. If this is the case, other techniques such as family therapy or
parental counseling, are used to ensure that the parents or person responsible for the child’ s discipline is
sufficiently assertive to follow through on the program.

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder
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5: Summary:

 Children with conduct disorder display persistent aggressive and anti-social activities. They show
a variety of problems like stealing, drug abuse and damaging both public as well as private
property without any feelings of guilt or remorse. As they grow into adulthood, conduct disorder
transforms itself into anti-social behavior.
 There are many factors which contribute to the development of conduct disorder such as a genetic
predisposition to develop conduct disorder, environmental factors such as poverty,
unemployment, dysfunctional interpersonal relationships, and inadequate development of moral
awareness of the norms and rules of the society or of what is right or wrong along with negative
peer influences play an important role in the maintenance and development of conduct disorder.
 The most feasible as well as promising method of treatment of conduct disorder is through a
multiple support system involving peers , parents , family members as well as teachers who work
together in enhancing a pro-social behavior among such children.

PSYCHOLOGY Paper No 15: Clinical Psychology

Module No 5: Conduct Disorder