Conduct Disorders
aggression is SYMPTOM, not disease in itself
by motivation
impulsive/affective/reactive
proactive/instrumental/appetitive
callous/unemotional
adolescent-onset/peer-facilitated
by behavioral features (destructive vs non-destructive, overt vs covert)
by longitudinal features
early age --> life course persistent more likely
starting in adolescence --> usu adolescence limited
oppositional behavior
all kids are oppositional from time to time
normal part of development for 2-3 year olds and early adolescents
becomes a concern when it's so frequent and consistent that it stands out compared to other kids of same age
ODD
behavior more frequent than typically observed in kids of comparable age/developmental level - needs to show up in multiple different locations
angry/irritable mood
argumentative/defiant behavior (deliberately annoying, blaming others for mistakes)
vindictiveness
5-10% of kids; often comorbid w/ ADHD/mood disorders
more likely to develop SUD as adult
serious temper tantrums involving threats of suicide/destruction of property when denied something they want --> ER eval
etiology
biology
poor affective modulation
deficits w/ executive cognitive skills
social
family w/ patterns of inconsistent behavior management
difficult limit setting
parents are argumentative and resistant to authority
tx
behavior interventions
parent training
coping skills for kid
meds (for comorbid ADHD): stimulants, alpha adrenergic - clonidine, guanfacine
Conduct disorder
repetitive, persistent pattern of behavior - violating basic rights of others or major social norms
behaviors
aggression to people and animals
deliberate destruction of property
deceitfulness/theft
serious violations of rules: truancy, running away from home
onset
childhood onset < 10 yo: M>F, physical aggression, disturbed relationships, more likely to have conduct disorder persist in adulthood
adolescent onset > 10: more balanced gender ratio, less likely to be physically aggressive, more normative peer relationships, less likely to have conduct disorder into adulthood
unspecific onset
specify if "limited prosocial emotions": lack of remorse/guilt/empathy, unconcerned about performance, shallow or deficient affect
typically angry/sullen in context of adult world: pressure to conform, stay in school, persist in dull activities/
usually happy around peers
seemingly tough but usu have feelings of self-doubt and worthlessness
etiology
heritability ~50%
biological
hormones: oxytocin, vasopression, cortisol
NT: decreased serotonin --> aggression; decreased dopamine --> impulsive
social
parent separation/divorce
poor parenting styles: inconsistent, abandonment
adopted children have higher rates
child abuse
treatment
behavioral interventions: preventive measures toward risk factors, parent training, multisystemic therapy (targets individual, family, peer, school, and neighborhood)
meds used for comorbid disorders or decrease impulsive aggression
ADHD: stimulants, alpha agonists
severe aggression/impulsive rage: antipsychotics - Risperdal - and lithium
ODD: 30% get --> conduct disorder: 40% get --> antisocial personality disorder
DMDD (disruptive mood dysregulation disorder)
irritable and angry most of the time, but don't have other s/s of ODD or depression
severe recurrent temper outbursts way out of proportion to situation; inconsistent w/ developmental level, 3+/week
no FDA approved tx or guidelines - individualized approach to account for other comorbidities