Dublin: Breaking the Silence: 12: Understanding Children’s Mental Distress: ADD & Conduct Disorder

14 Feb


Children’s mental health disorders:

There are two potentially serious psychiatric disorders which quite frequently occur alongside a condition known as Attention Deficit Disorder or (ADD). They are; –

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). These disorders are not caused by ADD (Attention Deficit Disorder) they coexist, much as dyslexia tics or Tourette’s syndrome can coexist with ADD.

The oppositional defiant disordered child is stubborn, defiant, provocative and oppositional (always takes the opposite view).

The conduct disordered child’s behaviour is socially inappropriate, aggressive and often downright delinquent

These conditions, especially the aggressive form of conduct disorder occur predominantly in boys.

Though not caused by ADD some people believe their presentation is less severe, if we treat our ADD children properly from an early age.

Oppositional Defiant Disorder is more common than conduct disorder. It presents at an earlier age and is generally less-severe.

Conduct Disorder may be relatively mild, but when major, long-standing and unchanged by all treatment it can be serious and the situation unsalvageable. When you hear of ADD children being expelled from school, in trouble with the police, and involved in antisocial acts, the diagnosis is not ADD it is an extreme form of conduct disorder.

ADD is usually going strong before the oppositional behaviours kick in around the start of school (at about five years of age).

Parents first complain of blow-ups, arguing and open defiance which are worse ‘considerably worse’ than would be expected with ADD alone.

As they get older, these children may deliberately upset others, be spiteful, vindictive, angry, resentful, touchy and obscene in their language.

The diagnosis of ODD is made using fixed criteria, (I, e; a pattern of negativistic, hostile and defiant behaviour lasting at least six months, during which four (or more) of the following are present:

Often looses temper; often argues with adults;

Often actively defies or refuses to comply with adult’s rules or requests;

Often deliberately annoys people;

Often blames others for his/her mistakes or misbehaviour;

Is often touchy or easily annoyed by others;

Is often angry and resentful;

Is often spiteful or vindictive:

Where only a few of these behaviours are required to diagnose a degree of the disorder, obviously, the greater the intensity and number of behaviours, the more severe the condition. ODD may occur alone, though frequently it extends to merge with conduct disorder.

Living with an oppositional, attention deficit disordered child is not easy, but generally the situation can be greatly helped by the intervention of a child psychiatrist or psychologist.

(Author’s note; if such a service was available.)

Conduct disorder:

may present along a number of lines, some children are openly aggressive in their behaviour.

For example, fighting and menacing, while others behaviour intrudes on other peoples rights, such as, lying, vandalism, stealing.

This is further complicated by division into two groups; (one who can socialise and another group who are so socially disabled, they are incapable of normal mixing, preferring life alone or ’hunting in a pack’).

Conduct Disorder appears to have a significant hereditary link, particularly in its aggressive, antisocial form.

A diagnosis of conduct disorder is made with the presence of as few as three behaviours from a diagnostic list as follows;

A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past twelve months, with at least one criterion present

in the last six months:

Aggression to people and animals;

Often bullies threatens or intimidates others; often initiates physical fights;

Has used a weapon that can cause serious physical harm to others;

Has been physically cruel to people (or animals).

Has stolen while confronting a victim (e, g; mugging), purse snatching, extortion, armed robbery;

Has forced someone into sexual activity;

Destruction of property;

Has deliberately engaged in fire setting with the intention of causing serious damage;

Has deliberately destroyed other’s property (other than by setting fire);

Deceitfulness or theft;

Has broken into someone else’s house, building or car;

Often lies to obtain, goods or favours or to avoid obligations (I, e; cons others);

Has stolen items of non–trivial value without confronting a victim (e, g; shoplifting, but without breaking and entering; forgery).

Serious violations of rules; Often stays out at night despite parental prohibitions, (beginning before age 13 years).

Has run away from home at least twice, while living in parental (or parental foster home) or once without returning for a lengthy period;

Often truant from school, (beginning before age of 13 years);

The disturbance in behaviour causes clinically significant impairment in social, academic or occupational functioning.

If the individual is age 18 years or over, criteria are met for (Antisocial Personality Disorder).

As with ODD the extent of the problem depends on the number of behaviours present, and their severity.

The condition is worsened if there are major social disabilities.

Many people believe that conduct disorder is just a more severe form of ODD and certainly the two frequently occur together, children may have a pure form of conduct disorder (which usually presents in the adolescent years), it affects mostly boys, though antisocial, but generally non-aggressive forms may affect girls.

Management of oppositional defiant disorder ODD and conduct disorder CD generally requires specialist psychiatric help. Those with a major degree of conduct disorder, which does not respond to treatment, are of great concern.

Where aggression and inability to socialise are predominant problems, there is an unfortunate downside to conduct disorder as these behaviours occur mostly in males and both attention deficit disorder and conduct disorder carry a significant hereditary risk of bringing their problems to the next generation.

These unthinking, impulsive adults may not be able to form stable relationships, but this does not prevent them from having children.

Follow-up studies have shown that many children with ADD do extremely poorly in life.

It is now realised that children with (pure ADD) will generally progress well, it is those with (ADD with a major degree of ODD and conduct disorders who are the ones with the less favourable future).

When oppositional and conduct problems are mild, these children usually respond well to treatment, unfortunately, there are some children with conduct disorder, whose behaviours are so entrenched, extreme and antisocial, that professionals are powerless to change their course.

It is devastating for parents to watch while this happens, for some, home life reaches such a low ebb that techniques such as the ‘TOUGHLOVE’ approach are required, to break clear and protect the rest of the family.

When children with pure Attention Deficit Disorder are properly managed, the outlook must be viewed with optimism. When we hear of ADD children who have gone off the rails, it is rarely ADD that is the problem, it is the associated difficulties, particularly of conduct disorder, that when severe and resistant to treatment, represents a most tragic side to the condition known as Attention Deficit Disorder.

 www.aware.ie & www.teenline.ie & www.spunout.ie & www.letsomeoneknow.ie & www.3ts.ie


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