teen behavior problems – Troubled Teen Help

Why Conduct Disorder Is Difficult to Understand

The two primary guides to diagnosing disorders, both of which are used in the diagnosis of Conduct Disorder are the Diagnostic and Statistics Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).

In some cases, the two guides have a similar analysis of disorders and how they relate to each other. In the case of conduct disorder, however, the two views are different, complicating understanding.

The DSM-IV-TR View of Conduct Disorder

The DSM-IV-TR lists Conduct Disorder as a subcategory of “Attention-deficit and disruptive behavior disorders,” along with Oppositional Defiant Disorder, Attention-Deficit Hyperactivity Disorder, and Disruptive Behavior Disorder NOS (Not Otherwise Specified). There are three specific subcategories of Conduct Disorder, distinguished by the time of onset: in childhood, during adolescence, or unspecified.

Diagnosing Conduct Disorder using the DSM-IV-TR criteria, which should only be done by qualified mental health professionals. If the person is 18 or older, a diagnosis of Conduct Disorder cannot be given unless the criteria for Antisocial Personality Disorder are not met.

The descriptions make it clear that this is a more serious disorder than Oppositional Defiant Disorder. For a diagnosis, the person must demonstrate a pattern of behavior that has included three or more symptoms of those listed below for at least the past 12 months and shown at least one in the past 6 months:

• Aggression towards people and animals

frequently bullies, threatens, or intimidates
frequently initiates physical altercations
has employed a weapon capable of causing serious physical harm
has shown physical cruelty to people
has shown physical cruelty to animals
has confronted and stolen something from a victim
has forced sexual activity on someone

• Property destruction

has set at least one fire meaning to cause notable damage
has purposely destroyed property in some other way

• Deceit or theft

has forcibly entered someone else’s house or car without permission
frequently lies, conning others
has stolen items without a confrontation

• Serious rule violations

has frequently broken the house rules and stayed out at night, since before age 13
at least twice has stayed away from home overnight without permission or once for an extended period
has frequently been truant from school, since before age 13.

In addition, these behavior disturbances must:

• result in “clinically significant impairment” in either academic, social, or occupational functioning;

If Childhood-Onset type is diagnosed, at least one characteristic must have manifested prior to age 10, whereas is Adolescent-Onset is diagnosed, there must be an absence of manifestation of any of the behaviors prior to age 10. The severity can be designated as mild, moderate, or severe.

ICD-10 View of Conduct Disorder

ICD-10 takes a different approach to Conduct Disorder than the DSM-IV-TR. It includes Conduct Disorder under the category “Behavioral and emotional disorders with onset usually occurring in childhood and adolescence” and designates six subcategories, which are:

• Conduct disorder confined to the family context

• Unsocialized conduct disorder

• Socialized conduct disorder

• Oppositional Defiant Disorder (ODD)

• Other conduct disorders

• Conduct disorder unspecified.

So ODD is a subset of Conduct disorder in the ICD-10 analysis, but not in the DMS-IV-TR analysis, and the category of Conduct Disorder is subdivided in a completely different way, based not on age of onset, but on other specifics of how it manifests.

Diagnosis of any of the ICD-10 subgroups requires that a child first meet the criteria for Conduct disorders generally. This means that the pattern of disruptive behavior–which may be dissocial, aggressive, or defiant—must both be repetitive and persistent, notably beyond outside age-appropriate expectations, and last for six months or longer. If a different psychiatric diagnosis explains the symptoms, that diagnosis should be used.

The further criteria that separate the subcategories are:

• Conduct disorder confined to the family context occurs only or almost only in the home and with members of the family or household.

• Unsocialized conduct disorder is marked by serious abnormalities in relationships between the child and other children.

• Socialized conduct disorder is diagnosed when a person gets along well with peers, and is generally characterized by delinquent activities as a group, or gang, as well as truancy.

• Oppositional Defiant Disorder is usually diagnosed in younger children and the behaviors demonstrated are better characterized as disobedient, defiant, and disruptive rather than delinquent, dissocial, or aggressive.

Understanding a Diagnosis of Conduct Disorder

If you or someone you know has a child who has received a diagnosis of conduct this order, you can use the information in this article to ask questions and find out more. Which type of conduct disorder has been diagnosed and according to which definition? Which criteria were met to support the diagnosis?

Sources

http://www.surgeongeneral.gov/library/mentalhealth/
chapter3/sec6.html#disruptive

http://apps.who.int/classifications/apps/icd/icd10online/?gf90.htm+f913

http://www.surgeongeneral.gov/library/mentalhealth/
chapter3/sec6.html

Not everything that can happen will happen. This is a good thing to keep in mind when considering the range of issues that can afflict adolescents. It is also important to remember that because of chemical and hormonal imbalances, the difficulties of creating an identity, the sensitivities of adolescents, and the tensions between being cool to peers and respectful to parents, all teens are likely to—at least occasionally—behave in a way that their parents deem unacceptable.

But here, we’re not discussing a child who occasionally swears, breaks curfew, takes more ice cream than you said he or she could, or argues heatedly for more time with the family car. This article focuses on and provides an overview of the more concerning behavior problems that can afflict a teen.

What Is a Behavior Problem?

Although some people may casually lump all issues when teens act in a problematic way as “behavior problems,” it is actually useful to distinguish behavior problems from other types of issues. For example, a mental health issue may lead to problematic behaviors, but a mood disorder, like bipolar disorder, is not a “behavior problem” per se.

In addition, what appears to be a behavior problem may be caused by a different type of underlying issue—for example, substance abuse that arises out of an attempt to deal with a major depression. If this is the case, treating the behavior in isolation from its root cause will not be successful: the substance abuse and depression need to be addressed in tandem.

The role of an apparent behavior problem in signaling other issues may be more evident in a teen than in an adult. For example, an adult who can’t afford to lose his or her job may have the maturity, experience, and self-preservation instincts to hide his or her feelings about some practice or situation that seems entirely unfair in the workplace. A teen faced with the same situation or practice at school or at work and not having the same level of maturity may manifest his or her contempt or righteous indignation by his or her behavior, whether words or actions or facial expressions.

In addition, some types of problem seem to defy clear categorization. When one person does physical harm to another person or property, is it even without some other type of mental health issue? It’s difficult to say. Even the International Statistical Classification of Diseases and Related Health Problems, 10^th Revision (ICD-10) groups “Mental and behavioral disorders” as a group. For these reasons, the list below does not attempt to be complete or to sort out all the issues of what is a behavior problem and what would be better classified in another way.

Some Behavior Problems that May Afflict Adolescents and Require Expert Help

• Teenagers are curious, and they may try substances that are illegal period or illegal for them to use at their age. If there is no other underlying cause, then substance abuse is a behavior problem.

• There are several behavior problems that the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Text Revision) classifies under the heading Attention-deficit and disruptive behavior disorders. These include the following:

Attention-Deficit Hyperactivity Disorder (AD/HD), which has four subtypes
Conduct Disorder, which has three subtypes
Oppositional Defiant Disorder
Disruptive Behavior Disorder Not Otherwise Specified (NOS)

• The DSM-IV-TR also includes Antisocial behavior with two subtypes

• The ICD-10 classifies a group of “Behavioral syndromes,” that lists eating disorders—including anorexia nervosa, bulimia nervosa, overeating, and vomiting—are often linked to adolescence.

• The ICD-10 also lists “Behavioral and emotional disorders with onset usually occurring in childhood and adolescence.” The ones most closely tied to behavior include:

Hyperkinetic disorders, of which Attention-deficit hyperactivity disorder is a subgroup
Conduct disorders, which in the ICD-10 includes Oppositional defiant disorder