20 CHILD ANDADOLESCENTDISORDERS 495
- Severe:The person has many conduct prob-
lems with considerable harm to others. Ex-
amples include forced sex, cruelty to animals,
use of a weapon, burglary, and robbery.
The course of conduct disorder is variable. People
with the adolescent-onset type or mild problems can
achieve adequate social relationships and academic or
occupational success as adults. Those with the child-
hood-onset type or more severe problem behaviors are
more likely to develop antisocial personality disorder
as adults. Even those who do not have antisocial per-
sonality disorder may lead troubled lives with difficult
interpersonal relationships, unhealthy lifestyles, and
an inability to support themselves (Steiner, 2000).Etiology
Researchers generally accept that genetic vulnerabil-
ity, environmental adversity, and factors such as poor
coping interact to cause the disorder. Risk factors
include poor parenting, low academic achievement,
poor peer relationships, and low self-esteem; protec-
tive factors include resilience, family support, positive
peer relationships, and good health (Steiner, 2000).Conduct disorderTom, 14 years of age, leaves the principal’s office after
being involved in a physical fight in the hall. He knows
his parents will be furious because he is suspended for
1 week. “It wasn’t my fault,” he thinks to himself. “What
am I supposed to do when someone calls me names?”
Tom is angry that he even came to school today; he’d
much rather spend time hanging out with his friends
and having a few drinks or smoking pot.
On his way home, Tom sees a car parked next to
the grocery store, and it is unlocked and running. Tom
jumps in, thinking, “This is my lucky day!” He speeds
away, but soon he can hear police sirens as a patrol car
closes in on him. He is eventually stopped and arrested.
As he waits for his parents at the station, he’s not sureCLINICALVIGNETTE: CONDUCTDISORDER
what to do next. He tells the police officer that the car
belongs to a friend and he just borrowed it. He pro-
mises never to get into trouble again if the officer will
let him go. But the officer has Tom’s record, which
includes school truancy, underage drinking, suspicion
in the disappearance of a neighbor’s pet cat, and
shoplifting.
When Tom’s father arrives, he smacks Tom across
the face and says, “You stupid kid! I told you the last time
you’d better straighten up. And look at you now! What
a sorry excuse for a son!” Tom slumps in his chair with
a sullen, defiant look on his face. “Go ahead and hit me!
Who cares? I’m not gonna do what you say, so you
might as well give up!”◗ SYMPTOMS OFCONDUCTDISORDER
Aggression to people and animals
Bullies, threatens, or intimidates others
Physical fights
Use of weapons
Forced sexual activity
Cruelty to people or animals
Destruction of property
Fire setting
Vandalism
Deliberate property destruction
Deceitfulness and theft
Lying
Shoplifting
Breaking into house, building, or car
Cons other to avoid responsibility
Serious violation of rules
Stays out overnight without parental consent
Runs away from home overnight
Truancy from school