ODD-CD part 9

Conduct disorder is diagnosed like all things in pediatric psychiatry.  The child and the caregivers will be interviewed together and separately to go over the history and check out all other possible comorbid conditions.  Usually there are school reports, too.  The child is examined to look for signs of many disorders.  This usually includes some school work, some parts of the physical exam, and getting the child's perspective on things.  Occasionally, there are lab tests and xrays to do.  There is no lab test that shows these problems.

Perhaps about 30% of conduct disorder children continue with similar problems in adulthood.  It is more common for males with CD to continue on into adulthood with these types of problems than females.  Females with CD more often end up having mood and anxiety disorders as adults.  Substance abuse is very high.  About 50-70% of ten year olds with conduct disorder will be abusing substances four years later.  Cigarette smoking is also very high.  A recent study of girls with conduct disorder showed that they have much worse physical health.  Girls with conduct disorder were almost 6 times more likely to abuse drugs or alcohol, eight times more likely to smoke cigarettes daily, where almost twice as likely to have sexually transmitted diseases, had twice the number of sexual partners, and were three times as likely to become pregnant when compared to girls without conduct disorder

Looked at from the other direction, by the time they are adults, 70% of children no longer show signs of Conduct disorder.  Are they well?  Some are, but what often happens is that the comorbid problems remain or get worse.  That is a girl with CD and depression may end up as an adult with depression, but no conduct disorder.  The same pattern can be true of CD plus bipolar disorder and other disorders.  Here are some examples that illustrate this.

• Age 4-12 Classic problems with aggressiveness towards others, hyperactivity, and impulsiveness along with running away and shoplifting
• Age 12-16 ADHD symptoms become less prominent. Continued fights with teachers, shoplifting, and lying
• Age 16-24 Fighting decreases, returns to school and succeeds.
• Age 25-35 No sign of psychiatric problems.

• Age 3-7 Reggie shows lots of aggression and hyperactivity.
• Ages 7-12 Besides being hyperactive, Reggie lies, cheats, steals, and eventually forces a child to take of their clothes
• Ages 13-18 In and out of trouble with the law, and more involved with alcohol, Reggie quits school at age 16.
• Age 18-24 Reggie has spent two years of the last six behind bars. He sucessfully stays off drugs and alcohol, but meets old friends, quits his job, and is back bootlegging again.

• Age 4-12 Sarah slowly gets into more and more trouble with everyone. She starts to get irritable
• Age 12-18 Sarah continues to have troubles with gambling, shoplifting, and vandalism. Occasional thoughts of suicide
• Age 18-24 Sarah is hospitalized twice for depression, eventually recovers and seems to settle down
• Age 24-50 A few more hospitalizations for post partum depression but no CD features.

• Age 4-12 Trouble in School, zero social skills, and constant conflict with family and peers
• Age 13-18 Using drugs and occasionally hears voices and sees things. Goes away when he is clean
• Age 18-30 Slowly but surely he gets the substance abuse under control. The hallucinations and unusual thoughts continue on and require medical treatment.

• Age 4-11 typical ADHD
• Age 12-14 Totally out of control. Assaults everyone, gets drunk, pulls fire alarms, attacks father, steals a car all in the space of a week. Diagnosed by a psychiatrist who visits the youth prison as manic.
• Age 14-20 At least 10 episodes of mania and or depression. Hyperactivity and CD not present except while manic.

It is not unusual to see signs of stress in the parents and other siblings when a child has CD.  One of the hardest questions is figuring out whether or not difficulties in the family are causing CD or whether the stress of CD is causing family problems.  Often it is impossible to determine this or there are reasons to suggest both the CD is casing the family problems and the family is causing the CD to be worse.  CD is a very difficult problem to live with.  It would be very unusual to see a family where it was not causing grave distress.  This obviously needs to be addressed in any treatment plan.  Some of the things parents have told me about their conduct disordered child are noted below.

"If you have a child with CD, everyone will initially assume it is your fault.  You will be blamed by everyone for what the child does.  You may know all about Family and children services, probation, youth court, residential homes, RCMP procedures, and mental health services. "

"You will often have the feeling that no one knows what they are doing with your child and they are just trying to pass the buck to someone who does. "

"You can end up divorced, depressed, alcoholic, hopeless, or all of these from dealing with such a child.  It will often make or break your faith in yourself and your faith in God."

"You can see yourself where the child's problems are leading, but can be unable to do anything about it or find anyone else who can do anything about it."

Don't give up! There is a lot to that can be done!