Conduct Disorders in Children

This guideline is about conduct and other antisocial disorders affecting young people. It outlines the kinds of things to cover in the history as well as management strategies. There's not really anything groundbreaking here, but it's worth a look if your heart sinks at the mention of 'behavioural problems'. I've gone into more background than I normally do as I wasn't aware of a lot of this, though it makes sense.
It is also important to be aware of conduct disorders as intervention may help. Up to 50% of children with a conduct disorder go on to have an antisocial personality disorder as adults. It is also associated with poor educational performance, substance misuse and criminal behaviour. There is also a high prevalence of other mental health disorders in affected kids.

The stats are worth noting and just support what you'll have seen anyway. Prevalence is 5%, though up to 40% in looked after kids and other high risk groups. It is much more common in lower socio-economic groups.

To diagnose a conduct disorder, the child's behaviour must be:
- Persistent
- Repetitive
- Significantly violating the expected norms of social behaviour for that age.

History and assessment
Consider the following during assessment:
- Using the "Strengths and Difficulties Questionnaire".  Parents and teachers can fill this out.
- Core conduct disorder symptoms
• Under age 11 - negativistic, hostile or defiant behaviour
• Over age 11 - aggression to people or animals, destruction of property, deceitfulness, theft or severe violations of rules
- Coexisting mental health / neurodevelopmental problems (eg ADHD or autism).
- Learning disabilities
- Substance misuse
- Current functioning, at home, at school and with their peers
- Parenting ability
- Other parental factors (eg mental health problems, substance misuse, domestic violence, other strong adult ties)
- Any safeguarding issues.

Management
- Parent and child training programmes are the mainstay of treatment and we can refer directly to these (via health visitors, school nurses and Sure start Centres). Ensure parents don't feel blamed and explore concerns that they have about this. From age 9, young people can attend child only groups.
- In some areas identified as having large numbers of at risk children, schools are conducting child programmes.
- CAMHS should be used if there are complicating factors (eg coexisting mental health problem, learning difficulty, substance misuse, ADHD or autism).
- Co-existing ADHD should be treated with medication.
- Risperidone can be used by specialists in severe cases.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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