Child and Adolescent Psychiatry

Disruptive Behaviour 69

Box 6.2ICD-10∗criteria for conduct disorder (CD)‡

At least three of the following items in the previous six months:

Cons others.

Often starts fights.

Has used serious weapons.

Often out at night without permission (onset before13 years).

Physically cruel to people.

Physically cruel to animals.

Deliberately destroys others’ property.

Fire-setting to cause damage.

Stealing without force.

Often truants (onset before 13 years).

Ran away from home overnight at least twice.

Stealing with force.

Has forced someone into sexual acts.

Often bullies, threatens or intimidates.

Has broken into car or house.

Notes:∗DSM-IV criteria for conduct disorder are generally similar, though the

reference period is the past 12 months.The ICD-10 Classification of Mental and

Behavioural Disorders: Diagnostic Criteria for Research(World Health Organiza-

tion, 1993).

‡Narrowly defined, i.e. not including oppositional-defiant disorder.

Educational failure
Many affected individuals have poor achievements in terms of grades
and level of work, and often have specific learning deficits. On testing,
up to a third of those with a disruptive behavioural disorder have spe-
cific reading disorder (SRD), commonly defined as being more than two
standard deviations below the reading level expected for their age and
intelligence (see Chapter 31). Conversely, up to a third of those with SRD
have a disruptive behavioural disorder. The association between disruptive
behavioural disorders and SRD could be due to any of three possibilities,
and each needs to be considered in individual cases. First, disruptive
behaviour may interfere with classroom learning. Second, individuals who
do not have the ability to understand and participate in class may become
frustrated and disruptive as a result. Third, both disruptiveness and reading
problems may stem from a third factor such as ADHD or unsupportive
and negative parenting. Independently of poor achievement, lower IQ is
associated with disruptive behavioural disorders.

Poor interpersonal relations
Disruptive children and adolescents often become unpopular with their
peers and frequently have no enduring friends. They commonly show
poor social skills with both peers and adults, for example, they have
difficulty sustaining a game or promoting positive social interchanges.
Poor peer relationships predict an unfavourable outcome. ICD-10 divides