I’ve been wanting to write about what Conduct Disorder is because that is one of the disorders my youngest son has been diagnosed with. However, I don’t know if my problem finding the words is because I don’t agree with the diagnosis or if the material on this diagnosis is truly lacking. It seems like every where I look, every link I click on is pretty much just a carbon copy of each other. It’s not very helpful. I can’t even seem to find a digital copy of what the DSM-V actually has to say about it.
I did find one news article from this month showing that the brain grows and develops differently in males that have Conduct Disorder from those that do not have it. The onset of the disorder also plays a role in how the brain develops as well.
So once again, genes and environment (nature and nurture) are playing a role here. Why should this even be a surprise? Our genes provide the basic building blocks for our brains but our brains are constantly responding and adjusting to our environment – but they can only do so much with the genes they have. It makes sense to me and it should be a given by now, but we should always abide by the scientific method to be sure.
Hopefully we can stop blaming parents for being the cause. However, this shouldn’t give parents a free pass either because again the brain can learn and adapt with what it has. So it’s up to the parents to teach these children how to cope, learn, and adapt with this disorder.
So what exactly is Conduct Disorder?
I think this link may be the best I can find to the DSM-V diagnostic criteria:
You can read the full article but for the sake of simplicity I will list the diagnostic criteria here.
- Aggressive behavior toward others and animals.
- Frequent physical altercations with others.
- Use of a weapon to harm others.
- Deliberately physically cruel to other people.
- Deliberately physically cruel to animals.
- Involvement in confrontational economic order crime- e.g., mugging.
- Has perpetrated a forcible sex act on another.
- Property destruction by arson.
- Property destruction by other means.
- Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
- Has engaged in non-confrontational retail theft, e.g., shoplifting.
- Disregarded parent’s curfew prior to age 13.
- Has run away from home at least two times.
- Has been truant before age 13.
To get this diagnosis, the individual needs to have at least four of the behaviors present. This link doesn’t state a length of time, but other sources have stated the behaviors have to be present for at least 6 months if not a full year.
Additionally, the criteria must:
- The behaviors cause significant impairment in functioning and
- If the individual over age 18 the criteria for APD is not met.
Now if you ask me, some of the items on the list are a bit redundant, such as “Aggressive behavior toward others and animals” and “Frequent physical altercations with others” and “Deliberately physically cruel to other people”. I mean, if you are “Deliberately physically cruel to other people” wouldn’t that automatically mean that you have “Aggressive behavior toward others and animals” and “Frequent physical altercations with others”? So then you would need just one more item on the list to get this diagnosis. I’m sure there is a reason the specialists set it up this way that I can’t fathom and it’s probably due to how people perceive and describe behavior.
Now don’t get me wrong. Looking at this list, I can see why my 6 year old son got this diagnosis. However look at the end under the heading of “Differential Diagnosis” and you will see that professionals are cautioned to make sure to rule out a variety of disorders that include these behaviors that have to be treated and managed differently than Conduct Disorder. Bipolar Disorder is one of the disorders listed because these behaviors can be caused by mania. In fact, the so-called “Bipolar Rage” is pretty famous for it.
Mania is episodic due to the nature of Bipolar Disorder and needs to be regulated with mood stabilizers (therapy can help too). Conduct Disorder is not episodic and responds well to long-term behavioral therapy (not that it’s easy or a cake walk). Two different diagnoses, same behaviors, but very different treatment plans.