It’s well-known that Conduct Disorder treatment is difficult, and very often not very successful. When your child is diagnosed as having Conduct Disorder (CD), what are the “Best Practices?” Where do you find help? It’s not easy.
As you may know, there are two varieties. A diagnosis made before age ten is referred to as the “childhood-onset” type. (Some children begin showing signs as young as age three, or even age two.) If the child doesn’t begin showing signs of CD before age ten, he or she is referred to as having “adolescent-onset” CD.
Adolescent-onset CD has a much better prognosis, and is the type to be discussed here. Adolescent-onset Conduct Disorder is diagnosed where a youngster over age 10 shows any three of these behaviors:
- Aggression against people or animals
- Non-aggressive destruction of property
- Deceitfulness, lying, and theft
- Serious violations of rules
CD is very often preceded by “Oppositional Defiance Disorder”, or “ODD”. Some authorities think that ODD is simply an early stage of CD, but most investigators think that there is a qualitative difference between the two, as evidenced by the aggressive and destructive aspects of CD which are much more evident than they are in ODD.
Conduct Disorder is often accompanied by ADHD, or with learning disorders like dyslexia or reading problems, or both, which really compounds the problems. Now you have an angry, defiant child exhibiting anti-social, even criminal behavior, who is failing in school, not that he seems to care. At the same time, because of his antisocial behavior, most of his peers reject him or her at exactly the time when peer relationships are most important.
Add all this to the difficult family situation, and you have a prescription for a nightmare for the teen, the school, parents and family, and society.
It’s a complex disorder, and treatment usually requires that parents learn better parenting skills, that family therapy be entered into, and, often, that medication be employed, especially when ADHD is a co-existing condition, as it is about 50% of the time. None of these are simple or easy, especially in severe cases where there is little communication, and huge resistance on the part of the teenager.
Parent Management Training (PMT), is an approach that teaches parents very specific techniques and procedures designed to improve parent-child interactions. The idea is to improve inconsistent and ineffective parenting. Parents are taught to notice and reinforce positive, appropriate behaviors, while employing brief, not overly harsh, punishments and logical consequences when negative behavior crops up. If the parent(s) are willing to learn and able to utilize the concepts, they can make significant progress.
Group therapy isn’t often very useful. Some studies have demonstrated some success, but most studies have found that group therapy tends to make the behaviors worse, presumably because through discussions with, and exposure to others with CD, the negative behavior and attitudes get reinforced.
Individual therapy alone is generally not very effective, although it sometimes helps to assist the teen to adhere to a comprehensive program. Boot camps have often shown good results at first, but not very good long-term results.
Boot Camp graduates consistently are found to be arrested more often and to commit more serious crimes. Just as with group therapy, it is believed that the attitudes and behaviors are reinforced by others in the camp. Also, there isn’t any mechanism for changing the family dynamics or for teaching better parenting skills. In addition, at the end of the camp session, the teen is likely to find himself back in the same old environment, where the learning and skills learned at camp are not likely to be supported or reinforced.
What to do? What are the prospects?
As the parent of a youngster with CD, you have a very tough row to hoe, with no guarantees. Some youngsters diagnosed as having Conduct Disorder resist treatment, and don’t outgrow it. They may become adults having severe behavior issues, regularly in trouble with the law.
Fortunately, many youngsters do get through it, and become responsible members of society. A complete evaluation will help determine if there are other issues, such as ADHD, learning disabilities, or serious depression compounding the problem. Only when you know and understand all facets of the problem, can a comprehensive treatment plan with a chance of working be designed and successfully implemented.