ODD-CD part 6

In some ways, conduct disorder is just a worse version of ODD.  However recent research suggests that there are some differences.  Children with ODD seem to have worse social skills than those with CD.  Children with ODD seem to do better in school.  Conduct disorder is the most serious childhood psychiatric disorder.  Approximately 6-10% of boys and 2-9% of girls have this disorder.  Here is the Definition.

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major society rules are violated.  At least three of the following criteria must be present in the last 12 months, and at least one criterion must have been present in the last 6 months.

• often bullies, threatens, or intimidates others
• often initiates physical fights
• has used a weapon that can cause serious physical harm to others (a bat, brick, broken bottle, knife, gun)
• physically cruel to animals
• physically cruel to people
• has stolen while confronting a victim ( mugging, purse snatching, extortion, armed robbery)

• has deliberately engaged in fire setting with the intention of causing serious damage
• has deliberately destroyed other's property other than by fire setting

• has broken into someone else's house, building or car
• often lies to obtain goods or favors or to avoid work
• has stolen items of nontrivial value without confronting a victim (shoplifting, forgery)

• often stays out at night despite parental prohibitions, beginning before 13 years of age
• has run away from home overnight at least twice without returning home for a lengthy period
• often skips school before age 13

B. The above problem causes significant impairment in social , academic, and occupational functioning.

Currently, the research shows that in many respects, CD is a more severe form of ODD.  Severe ODD can lead to CD.   Milder ODD usually does not.   The common thread that separates CD and ODD is safety.   If a child has CD there are safety concerns.   Sometimes it is the personal safety of others in the school, family, or community.   Sometimes it is the safety of the possessions of other people in the school, family or community.   Often the safety of the child with CD is a great concern.   Children with ODD are an annoyance, but not especially dangerous.   If you have a child with CD disorder in your home, most likely you do not feel entirely safe.   Or, you do not feel that your things are entirely safe.   It is the hardest pediatric neuropsychiatric disorder to live with as a sibling, parent, or foster parent.   Nothing else even comes close.   It is worse than any medical disorder in pediatrics.   Some parents have told me that at times it is worse than having your child die

It has been common in the past for people to think that conduct disorder is just the beginning of being a criminal.  Up until the last few years, children with conduct disorder were often "written off".  It is now clear that this is true only with a minority of cases.  It is very easy to focus on the management of the CD child and forget to check the child out for other neuropsychiatric disorders.  A careful examination of children with CD almost always reveals other neuropsychiatric disorders.  Some of the most exciting developments in this area of medicine involve understanding this phenomena.  It is called comorbidty, that is the tendency for disorders to occur together.

It is very common to see children with CD plus another one or two neuropsychiatric diagnoses.  By far the most common combination is CD plus ADHD.  Between 30-50% of children with CD will also have ADHD.  Another common combination is CD plus depression or anxiety.  One quarter to one half of children with CD have either an anxiety disorder or depression.  CD disorder plus substance abuse is also very common.  Also common are associations with Learning Disorders, bipolar disorder and Tourettes Syndrome.  It is exceptionally rare for a child to present for evaluation by a pediatric psychiatrist to have pure CD.  Here are some examples of the comorbid presentations.

Looking for comorbid disorders in every child with conduct disorder is absolutely essential.  Many of the treatments of these children depend on what comorbid disorder is also present.