Intensive interventions in conduct disorders

Conduct disorder in childhood includes excessive levels of fighting or bullying; cruelty to animals or other people; severe destructiveness to properties; fire setting, stealing, repeated lying; frequent and severe temper tantrums; defiant provocative behaviour and persistent severe disobedience; truanting from school; and running away from home. As the child grows, not only do problems escalate but the response to treatment is reduced. 1 2 Several well conducted longitudinal studies indicate that conduct disorder is relatively stable over time and predicts antisocial behaviour in adult life. There are increased rates of delinquency and antisocial personality disorders. Follow up studies suggest high rates not only for alcoholism, substance abuse, physical illness, suicide and accidental death, but also for widespread social dysfunction with poor work records and difficulties in all relationships, including marital relationships.3 The prediction of antisocial behaviour is stronger for men than for women. For girls, conduct disorder in childhood predicts adult depression and anxiety disorders more strongly than antisocial behaviours and substance abuse.4 In addition to antisocial behaviours, there may be coexisting attention deficit and hyperactivity, frequently including cognitive deficits and academic failure.5 This is associated with particularly poor outcome.6 Disruptive and antisocial children are often unpopular with other children and are excluded from groups of normally functioning children, associating only with other antisocial children and becoming part of a deviant subculture.7 They, therefore, lack prosocial models and do not learn how to negotiate and fit in with the prosocial mainstream cultural group. Similarly, antiauthority attitudes and an inability to settle in class lead to a lack of satisfaction with the school and increasing alienation, disaffection, and disruptive behaviour. Most parents of conduct disordered children engage in incompetent child management practices, which are associated with the inadvertent development and maintenance of aggressive and antisocial behaviour.8