Disorders of Childhood: Attention-Deficit and Disruptive Behavior Disorders

Children who have chronic difficulties in maintaining attentional focus, completing work, being impulsive, or repeatedly engage in antisocial behaviors such as lying and cheating may have one or more Attention-Deficit and Disruptive Behavior Disorders. The disorders in this category include Conduct Disorder, Attention-Deficit Hyperactivity Disorder, and Oppositional Defiant Disorder. These three disorders are grouped together within the same category because of similarities between symptoms and prevalence rates For example, children with these disorders often have academic difficulties, poor social skills, and impulsivity (i.e., a tendency to act without thinking through potential consequences). In addition, boys far exceed girls in terms of rates of occurrence (although some researchers suggest that girls with ADHD may be overlooked because they tend to be more inattentive than hyperactive).

The Attention Deficit and Disruptive Behavior Disorders are the most commonly diagnosed disorders of childhood, and make up the majority of referrals of children to mental health treatment services. It used to be thought that the majority of children ultimately "grew out" of these disorders prior to the onset of adulthood. Recently, however, there is an increasing awareness that these disorders often do not disappear as children mature, but rather continue on into adulthood.

Introduction to Conduct Disorder

Conduct Disorder is one of the most frequently diagnosed mental disorders in children. A child with Conduct Disorder engages in repetitive, persistently deviant, impulsive, and/or antisocial behavior that violates the basic rights of other people, or age-appropriate social norms for expected behavior. Children with Conduct Disorder: 1) act aggressively in a way that causes or threatens to cause physical harm to others, 2) cause serious property damage even if they are not actually aggressive towards other adults or children, 3) steal, and are deceitful, and/or 4) frequently violate rules.

Symptoms of conduct disorder vary with age, changing as children develop increased strength, cognitive abilities and sexual maturity. Less severe symptomatic behaviors, such as lying and shoplifting, usually emerge first, while other, more severe behaviors, such as burglary or auto theft, usually emerge later.

Symptoms of conduct disorder may include:

• Bullying, threatening, or intimidating behavior towards other children
• Frequent starting of physical fights
• Use of weapons or tools capable of causing serious physical harm to people or property (e.g., bricks, bats, broken bottles, knives, guns)
• Physical cruelty toward animals or people
• Stealing while confronting a victim (e.g., mugging, purse snatching, armed robbery)
• Physical violence towards others (in the form of rape, assault, homicide, etc.)
• Destruction of property (e.g., fire setting, breaking of windows, breaking into homes, buildings or cars)
• Frequent and manipulative telling of lies or breaking of promises in order to obtain goods, favors, or to avoid debts or obligations (e.g., "conning" people)
• Staying out at night despite parent's curfew rules (before the age of 13)
• Repeatedly running away from home, or running away from home for a lengthy period of time
• Use of alcohol or drugs
• Truancy (skipping school) before the age of 13

According to the DSM, three or more of the above symptoms must be present within the space of 12 consecutive months before a child can receive the diagnosis of Conduct Disorder. In addition, the child's symptoms must also interfere with his or her social or academic functioning.

There are two subtypes of Conduct Disorder: Childhood-Onset Type and Adolescent-Onset Type. The Childhood-Onset specifier applies when a child has exhibited at least one symptom of the disorder prior to age 10. Most of the children diagnosed with childhood-onset conduct disorder are males who are also physically aggressive. These children usually have disturbed peer relationships and may also be diagnosed with Oppositional Defiant Disorder (see below) during their early childhood years.

In the Adolescent-Onset type, there are no symptoms of the disorder before age 10. These children are less likely to show aggressive behaviors, and usually have more normal peer relationships. Males and females appear develop this subtype at approximately the same rates. Individuals with this subtype also are less likely to have persistent Conduct Disorder or to go on to develop Antisocial Personality Disorder or another personality disorder in adulthood.

Conduct disorder is common, and the number of children diagnosed with this illness has increased over the past few decades. According to the DSM, current prevalence rates for conduct disorder suggest that between 1% and 10% of children will qualify for the diagnosis.

Research suggests that Conduct Disorder is influenced by a combination of genetic and environmental factors. The disorder is more common among biological children of parents diagnosed with Alcohol Dependence, Mood Disorders (such as Major Depression or Bipolar Disorder), Schizophrenia, ADHD, or Conduct Disorder. Individuals with lower verbal intelligence IQ scores and brain-based problems (concentrating, remembering, thinking abstractly, etc.) have an increased chance, statistically, of also qualifying for a simultaneous (co-morbid) diagnosis of Conduct Disorder. These conditions affect how well children are able to solve problems, pay attention, exercise good judgment and to prevent themselves from impulsively engaging in inappropriate but otherwise rewarding (at least in the short term) behaviors.

Environmental triggers of conduct disorder include: family dysfunctions (e.g., exposure to protracted marital conflict, limited financial and emotional resources, instability, and disturbances of family values), peer rejection, and poor performance in school. The environmental triggers of conduct disorder generally come as a package deal. Children who perform poorly in school are often rejected by peers and teachers, fall behind in class, and show a greater likelihood of dropping out of school. The occurrence of any one of these factors lead to a greater likelihood that other behavioral problems will also develop.