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Conduct Disorder with Joshua



INTRODUCTION: In our day to day dealings, we might have come across individuals (adults) that leave a bad impression on us, which made us tag them as “inhuman, wicked, criminals”. More often than not, these behaviors began in childhood, manifesting as total disregard for the basic rights of others, and their parents would have been unsuccessful at impacting any morals or discipline in them. Such children/adolescents are known for cruelty; assaulting people (teachers, parents, peers), and inflicting injuries, or bringing harm to them in various other ways. The misbehaviors aren't limited to physically assaulting human beings, but extends to harming animals, destruction of properties, burglary and robbery, possession of weapons, kidnapping and purposeful violation of basic societal norms. These children often go through life, undiagnosed with Conduct Disorder. When conduct Disorder is undiagnosed and thus not managed in childhood, they grow up to exhibit Antisocial behaviors, which has devastating implications on society at large. WHAT IS CONDUCT DISORDER (CD)? Conduct disorder is a psychiatric condition that is found predominantly in childhood and adolescence, and is characterised by “recurring and persistent patterns of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated”. These behaviors disrupt the social, academic or occupational functioning of the person and also causes suffering and distress to people at the receiving end of the behaviors. Research has also shown that individuals with conduct disorder are more likely to get arrested and as such become Juvenile delinquents. HOW COMMON IS CONDUCT DISORDER (CD)? Conduct disorder is commonly seen in child mental health practices. The worldwide prevalence of conduct disorder is between 2%-6% among adolescents, with males showing significantly higher rates of conduct disorders than girls. A study conducted in Southwest Nigeria, found the prevalence of CD in Secondary school inmates of a Correctional facility to be 32.9% vs 18.8% in public Secondary school students in the same locality. As replicated in the study quoted, CD is more prominent in forensic settings than the general population. A Northern study of juvenile delinquents reported 60% prevalence rate. Similarly, another Nigerian study reported a 56.5% prevalence rate, from individuals in juvenile homes. The studies found the diagnosis of conduct disorder to be more likely in boys than in girls, as it is estimated to occur 3 or 4 times more in boys than in girls. HOW DOES CONDUCT DISORDER EMERGE IN CHILDREN? Conduct disorder comes from an interaction of “genetic, familial and social factors”. Conduct disorder is higher in children or adolescents with parents or siblings previously diagnosed with the disorder. The disorder is seen in children of biological parents with severe alcohol misuse, other substance use disorders, mental disorders and coexists with childhood psychiatric conditions. Environmental factors such as familial and social events implicated in the evolution of CD include parental rejection, neglect, inconsistent parenting practices, harsh discipline, childhood abuse and sexual abuse, the presence of criminality in parents, association with delinquents groups (area boys, hooligans louts) within the society. SUBTYPES OF CONDUCT DISORDER Conduct disorder is classified based on the age of onset of the disorder. They include; The unspecified-onset: This exists for individuals who have little or no information about when symptoms of the disorder first emerged. The childhood-onset conduct disorder. The symptoms for a childhood-onset diagnosis must be present before the 10 years. This sub-type if left untreated has very poor prognosis, with continuity into adult antisocial personality disorder. The adolescent-onset is considered in social contexts involving peer influence thus leading to moving with and operating in gangs. The diagnosis of this sub-type occurs if no symptom of conduct disorder has occurred before 10. SYMPTOMS OF CONDUCT DISORDER Aggression to people and animals: bullying people, deliberate use of weapons to hurt people or animal, initiating sex through coercion, etc. Destruction of property: destroying things belonging to other people, deliberately starting fires that cause damage to property. Deceitfulness or theft: tricking people for personal benefit, shoplifting, stealing, breaking into someone's house, lying to get what you want, etc. Serious violations of rules: skipping school, staying out late, running away from home. MANAGEMENT AND TREATMENT OF CONDUCT DISORDER For a diagnosis of conduct disorder, persistent levels of aggression, lack of respect for others' rights, and violation of societal norms, should be present which affects social and academic functioning. Family members are psycho-educated on conduct disorders, and the possible seriousness/ poor prognosis if there is absence of parental care. Therapies here will cover: parenting skills training, family therapy. Child Therapy: cognitive behavioral therapy, anger management, building interpersonal relationships is applied in the treatment of this disorder. Individuals with conduct disorder are rewarded when they exhibit appropriate behavior. The use of medication is best avoided except for treatment of impulsive behaviors, aggression and co-existing psychiatric conditions. CONCLUSION. The onset of Conduct disorder is common in childhood or adolescence, however, the onset of the disorder is very rare after 16 years. Early onset behaviors tend to be mild (lying, denying or transferring blame of bad behaviors to siblings, bullying peers, stealing from parents, etc). However, they become worse and progressive due to inconsistent parenting and poor supervision. In boys, conduct disorder could manifest in fighting, stealing, vandalism, and school discipline problems, while in females, lying, running away, substance use, prostitution, are some of the behaviors exhibited. By adolescence, many become beyond parental control and run away from home. The life on the streets exposes them to being sexually exploited, recruited into criminal gangs, drug addiction and resorting to varying degrees of crimes to cater for their survival. This consequently, leads to arrests by law enforcement agents and contact with the criminal justice system. PLEASE LIKE OUR POST AND DROP A COMMENT BELOW. #maymhawareness

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