Conduct disorder – This book covers the entire syllabus of “Psychiatric Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate the latest information and topics. This book is an examination-friendly setup according to the teachers’ lectures and examination questions.
At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.
Conduct disorder
Conduct disorder is defined as persistent antisocial behavior of children and adolescents that significantly impairs their ability to function in the social, academic, or occupational area.
[Ref-MR Khan/4/314
Or
Conduct of a child is “the behaviour of the total individual as expressed in psychological as well as physical activity, behaviour conforms to the standards established by the person’s social group”,
[Ref: KP Neeraja/I/Vol-2/513)
Conduct disorder (CD) is a severe form of oppositional defiant disorder (ODD). CD is characterized by a persistent pattern of behavior that ignores the rights of others with consistent violations of rules and age-appropriate behavior. A hallmark feature of CD is antisocial behavior without court involvement.
(Ref: Clinical Consult to Psychiatric Nursing/1/367)
Causes of conduct disorder:
1. Child factor:
➤ Children often neglected or abused
➤ Brought up in chaotic situations, e.g. angry, disruptive, demanding, unable to progress or develop tolerance for frustration no role model for ego ideal and conscience, little or no motivation to follow societal norms.
➤ Neuro psychological deficits and difficulties, e.g. deficit in diverse functions related to language like verbal fluency
2. Parental Factors:
➤ Prenatal and perinatal complications-maternal infection, prematurity, low birth weight, minor birth injury, impaired respirations at birth
➤ Parental psychopathology and stress
➤ Poor parental practices-Coercive parent-child commu tions
3. Family factors:
➤ Broken family
➤ Negligence
➤ Sociopath
➤ Negative attitude
➤ Substance abuse
➤ Less parental acceptance
➤ Less warmth, affection, attachment and emotional support
4. Marital discard: Marital detachment, unhappy or strained marital relationship, interpersonal conflicts and aggression of parents.
5. Social problems:
➤ Poverty
➤ Overcrowding.
➤ Unemployment
➤Poor housing
6. Scholastic factors:
➤Little emphasis on academic work
➤Little teacher guidance
➤ Infrequent usage of positive reinforcement by the teacher for child’s accomplishments
7. Socio-cultural factors: Socio-economically deprived children
8. Organic factors: Brain damage
9. Neuro biological factors: Decreased production of noradrenaline.
[Ref: KP Neeraja/1/Vol-2/513-514)
Clinical features of conduct disorder:
1. Bullying or threatening others.
2. Fighting
3. Causing harm physically to others or to animals by using weapons;
4. Stealing while confronting a victim (e.g. Mugging, purse snatching, extortion, armed robbery)
5. Rape or forcing someone into sexual activity
6. Fire setting
7. Destroying property of others, e.g. damaging some body’s house, building or car
8. Frequently ‘lying’ or’ connecting’ others
9. Staying out late at night despite parental prohibitions
10. Running away from home
11. Being truant from school
12. Physical aggression
(Ref: KP Neeraja/1/Vol-2/514)
treatment of conduct disorder
1. Medications to address aggression, inattention, hyperactivity, and impulsivity:
2. Caution: avoid formulations that have abuse potential or street value.
3. Behavior Therapy
4. Parent training courses
5. Intensive individual, family, and in-home therapy
6. Treatment is often difficult because kids typically first interface with the juvenile justice system
Patient education:
➤ Several studies have found that families that participate in therapy and training courses significantly reduce the amount of time their child spends in psychiatric and legal institutions
➤ Lower rates of sibling offenders in families that seek mental health services
➤ Patients need education on the importance of following through with community services to reduce the risk of detention or incarceration.
[Ref: Clinical Consult to Psychiatric Nursing/1/3701
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