There is a genetic risk for conduct disorder,
although no specific gene marker has been identi-
fied (Steiner, 2000). The disorder is more common in
childrenwho have a sibling with conduct disorder
or a parent with antisocial personality disorder,
substance abuse, mood disorder, schizophrenia, or
ADHD (APA, 2000).
A lack of reactivity of the autonomic nervous
system has been found in children with conduct dis-
order; this nonresponsiveness is similar to adults
with antisocial personality disorder. The abnormal-
ity may cause more aggression in social relationships
as a result of decreased normal avoidance or social
inhibitions. Research into the role of neurotransmit-
ters is promising (Steiner, 2000).
Poor family functioning, marital discord, poor par-
enting,and a family history of substance abuse and
psychiatric problems are all associated with the devel-
opment of conduct disorder. Child abuse is an espe-
cially significant risk factor. The specific parenting pat-
terns considered ineffective are inconsistent parental
responses to the child’s demands and giving in to de-
mands as the child’s behavior escalates. Exposure to
violence in the media and community is a contributing
factor for the child at risk in other areas. Socioeconomic
disadvantages such as inadequate housing, crowded
conditions, and poverty also increase the likelihood of
conduct disorder in at-risk children (Steiner, 2000).
Academic underachievement, learning disabili-
ties, hyperactivity, and problems with attention span
are all associated with conduct disorder. Children
with conduct disorder have difficulty functioning in
social situations. They lack the abilities to respond
appropriately to others and to negotiate conflict, and
they lose the ability to restrain themselves when emo-
tionally stressed. They often are accepted only by peers
with similar problems (Steiner, 2000).
Cultural Considerations
Concerns have been raised that “difficult” children
may be mistakenly labeled as having conduct disorder.
Knowing the client’s history and circumstances is
essentialfor accurate diagnosis. In high-crime areas,
aggressive behavior may be protective and not nec-
essarily indicative of conduct disorder. In immigrants
from war-ravaged countries, aggressive behavior may
have been necessary for survival so they should not be
diagnosed with conduct disorder (APA, 2000).Treatment
Many treatments have been used for conduct dis-
order with only modest effectiveness. Early interven-
tion is more effective, and prevention is more effec-
tive than treatment. Dramatic interventions such as
“boot camp” or incarceration have not proven effectiveand may even worsen the situation (Steiner, 2000).
Treatment must be geared toward the client’s devel-
opmental age; no one treatment is suitable for all
ages. Preschool programs such as Head Start result
in lower rates of delinquent behavior and conduct dis-
order through use of parental education about normal
growth and development, stimulation for the child,
and parental support during crises.
For school-age children with conduct disorder, the
child, family, and school environment are the focus of
treatment. Techniques include parenting education,
social skills training to improve peer relationships,
and attempts to improve academic performance and
increase the child’s ability to comply with demands
from authority figures. Family therapy is considered
essential for children in this age group (Steiner, 2000).
Adolescents rely less on their parents and more
on peers, so treatment for this age group includes in-
dividual therapy. Many adolescent clients have some
involvement with the legal system as a result of crim-
inal behavior, and they may have restrictions on their
freedom as a result. Use of alcohol and other drugs
plays a more significant role for this age group; any
treatment plan must address this issue. The most
promising treatment approach includes keeping the
client in his or her environment with family and indi-
vidual therapy. The plan usually includes conflict res-
olution, anger management, and teaching social skills.
Medications alone have little effect but may be
used in conjunction with treatment for specific symp-
toms. For example, the client who presents a clear
danger to others may be prescribed an antipsychotic
medication or a client with a labile mood may bene-
fit from lithium or another mood stabilizer such as
carbamazepine (Tegretol) or valproic acid (Depakote)
(Steiner, 2000).APPLICATION OF THE NURSING
PROCESS: CONDUCT DISORDER
Assessment
HISTORY
Children with conduct disorder have a history of dis-
turbed relationships with peers, aggression toward
people or animals, destruction of property, deceitful-
ness or theft, and serious violation of rules (e.g., tru-
ancy, running away from home, staying out all night
without permission). The behaviors and problems
may be mild to severe.GENERAL APPEARANCE AND
MOTOR BEHAVIOR
Appearance, speech, and motor behavior are typically
normal for the age group but may be somewhat ex-
treme (e.g., body piercings, tattoos, hairstyle, clothing).496 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS