Treatment of Conduct Disorder

Treating conduct disorder requires an approach that addresses both the child and his environment. Behavioral therapy and psychotherapy can help a child with Conduct Disorder to control his anger and develop new coping skills. Family group therapy may also be effective in some cases. Parents should be counseled on how to set appropriate limits with their child and be consistent and realistic when disciplining. If an abusive home life is at the root of the conduct problem, every effort should be made to move the child into a more supportive environment. Parent training programs are increasing in number.

For children with coexisting ADHD, substance abuse, depression, or learning disorders, treating these conditions first is preferred, and may result in a significant improvement to the Conduct Disorder condition. In all cases of Conduct Disorder, treatment should begin when symptoms first appear. Recent studies have shown Ritalin to be a useful drug for both ADHD and Conduct Disorder.

When aggressive behavior is severe, mood stabilizing medication, including lithium (Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate, Lithotabs), carbamazepine (Tegretol, Atretol), and propranolol (Inderal), may be an appropriate option for treating the aggressive symptoms. However, placing the child into a structured setting or treatment program such as a psychiatric hospital may be just as beneficial for easing aggression as medication.

Wilderness Programs, Boot Camps for Conduct Disorder

Many "behavioral modification" schools, "wilderness programs," and "boot camps" are sold to parents as solutions for conduct disorder. These may use a form of "attack therapy" or "confrontation" that can actually be harmful. There is no research support for such techniques. Research suggests that treating children at home, along with their families, is more effective.

If you are considering an inpatient program, be sure to thoroughly check it out. There have been serious injuries and deaths associated with some of them, and in many states they are not regulated.

Prognosis

The prognosis for children with Conduct Disorder is not bright. Follow-up studies of conduct disordered children have shown a high incidence of antisocial personality disorder, affective illnesses, and chronic criminal behavior later in life. However, proper treatment of co-existing disorders, early identification and intervention, and long-term support may improve the outlook significantly.

Complications

Children with conduct disorder may go on to develop personality disorders as adults, particularly antisocial personality disorder. As their behaviors worsen, these individuals may also develop significant drug and legal problems.

Prevention

A supportive, nurturing, and structured home environment is believed to be the best defense against Conduct Disorder. Children with learning disabilities and/or difficulties in school should get immediate and appropriate academic assistance. Addressing these problems when they first appear helps to prevent the frustration and low self-esteem that may lead to Conduct Disorder later on.

Resources:

Books:

• Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 2000.
• Maxmen, Jerrold S., and Nicholas G. Ward. "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence." In Essential Psychopathology and Its Treatment. 2nd ed. New York: W. W. Norton, 1995.
• Sholevar, Pirooz. Conduct Disorders in Childhood and Adolescence. Washington, DC: American Psychiatric Press, Inc., 1995.

Periodicals:

• Brodkin, Adele M., and Melba Coleman. "He's Trouble with a Capital T: What Can You Do for a Child with Conduct Disorder?" Instructor, Apr. 1996: 18-9.
• Thompson, L. L., et al. "Contribution of ADHD Symptoms to Substance Problems and Delinquency in Conduct-Disordered Adolescents." Journal of Abnormal Child Psychology 24, no. 3 (June 1996): 325-47.

Organizations:

• American Academy of Child and Adolescent Psychiatry (AACAP). 3615 Wisconsin Ave. NW, Washington, DC 20016. (202) 966-7300. http://www.aacap.org

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Reviewed: 04/2006