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Conduct disorder and Oppositional Defiant disorder

Also known as: Conduct disorder, Oppositional Defiant disorder

Background

Tantrums and some oppositional behaviour can be part of normal development for most young children and can be an expression of boundary testing when learning social rules. In roughly five per cent of children and young people this negative behaviour is severe, persistent and enormously challenging and may involve serious and repeated rule breaking and aggressive behaviour, which is often disturbing to others. Family relationships can become strained and school progress may be affected. Conduct disorder (CD) and oppositional defiant disorder (ODD) are the diagnostic terms for those types of long-lasting, aggressive and defiant behaviours that are extreme.

These problems are the most frequently occurring mental health difficulty in young people. It is more common in boys and may start at a very young age. Some children grow out of them but some do not.

Children who show such behaviours at a very early age (around two to three years) often have other problems such as a difficult temperament, hyperactivity and attention deficit hyperactivity disorder (ADHD), language disorders and some degree of learning disability. Older children may have depression and specific learning problems with reading. Sometimes these behaviours can result from chronic physical problems, anxiety, experience of traumatic events or autistic spectrum disorder (see entry Autism Spectrum disorders including, Asperger syndrome).

Some young people with difficult behaviour can become depressed and may be using alcohol and illicit substances in an attempt to cope. This strategy generally worsens the problems. Self-esteem is often low despite the superficial appearance of bravado. In some cases children may relish the attention their negative behaviour can bring.

Credits

Medical text written June 2011 by Dr A Graham, Child and Adolescent Psychiatrist, Child and Family Consultation Centre, Richmond, London, UK.

Oppositional defiant disorder

ODD is the term usually reserved for less severe, but equally persistent conduct problems in younger children. It describes behaviours such as aggression, defiance and disobedience rather than those that are severely antisocial or against the law. Children with ODD frequently defy adults, deliberately annoy people and seem angry and resentful. They may blame others for things that they themselves have done and will not take responsibility for their behaviour. They may be very provocative and rude, especially to those in authority.

How is it diagnosed?

The International Classification of Diseases, 10th revision (ICD-10) describes CD as including many of the following: severe fighting, aggressiveness, bullying, cruelty to animals or other people, theft, fire setting, severe destruction of property, persistent and severe lying, truancy from school, severe disobedience or extreme or very frequent tantrums. These behaviours must have persisted for six months or more for CD to be diagnosed.

How is it treated?

There are effective ways to treat CD and ODD in younger children (in particular in those aged 12 years and younger). These have been described in the NICE Guidelines (2003).

Group-based parent training/education programmes have been found to be effective. It is recommended that these are structured and comprise weekly sessions for 8 to 12 weeks. These should focus on parents' objectives, help build relationships, use roleplay and are given by appropriately trained facilitators. They may be combined with social skills programmes for children.

In contrast to parenting programmes for younger children, parenting programmes for antisocial behaviour in adolescence, on their own, have been less effective. Packages of help for the young person are usually required, involving individual, family and parenting interventions. The National Academy for Parenting Practitioners (NAPP) was established in November 2007 to train and support the practitioners that parents turn to for advice, training and information around parenting skills.

Parents and teachers can do a great deal to reduce negative and antisocial behaviour in children. It is important to play with children regularly in a warm, non-directive and interested way. Praise, verbal and through hugs and affectionate touches, is important to encourage positive behaviours. Instructions and commands given to children should be clear and specific. It is important to set limits and stick to these in a calm and predictable manner. These positive parenting strategies are helpful if used consistently from an early age and can help reduce antisocial behaviours in older children.

Is there support?

Information and support in the UK for conduct disorders and oppositional defiant disorder is provided by Young Minds (see entry Mental Health).

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