Write up on cbt for conduct disorder along with low academics and antisocial behaviour
Answers
his guideline is concerned with the management of conduct disorder and oppositional defiant disorder, as defined in the International Classification of Diseases, 10th Revision (ICD-10) (World Health Organization, 1992) and the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000), and associated antisocial behaviour in primary, community and secondary care. Conduct disorder is an overarching term used in psychiatric classification that refers to a persistent pattern of antisocial behaviour in which the individual repeatedly breaks social rules and carries out aggressive acts that upset other people. Oppositional defiant disorder is a milder variant mostly seen in younger children. The term ‘conduct disorders’ (or ‘a conduct disorder’) is used in this guideline to encompass both disorders. Because the term is not well known among the public, or even among healthcare professionals, the guideline title includes the term ‘antisocial behaviour’ to make it clear to as wide a range of people as possible what the guideline addresses.
Globally, conduct disorders are the most common mental health disorders of childhood and adolescence, and they are the most common reason for referral to child and adolescent mental health services (CAMHS) in Western countries. A high proportion of children and young people with conduct disorders grow up to be antisocial adults with impoverished and destructive lifestyles; a significant minority will develop antisocial personality disorder, among whom the more severe will meet criteria for psychopathy. Conduct disorders in childhood and adolescence are becoming more frequent in Western countries and place a large personal and economic burden on individuals and society, involving not just healthcare services and social care agencies but all sectors of society including the family, schools, police and criminal justice agencies. It is therefore appropriate that this guideline has been developed by NICE jointly with SCIE.
2.1.1. Medicalising a social problem?
Infringement of the rights of other people is a requirement for the diagnosis of a conduct disorder. Because manifestations of conduct disorders and antisocial behaviour include a failure to obey social rules despite relatively intact mental and social capacities, many have seen the disorders as principally socially determined. It could therefore be argued that the responsibility for their cause and elimination lies solely with people who can influence the socialisation process, such as parents, schoolteachers, social service departments and politicians, rather than by healthcare professionals. Additionally, because the disorders are so prevalent, it would be logistically impossible for CAMHS to see all children and young people – adding a further reason not to medicalise the problem. Certainly, all of the above mentioned agencies have major roles to play in the recognition, assessment and management of conduct disorders/antisocial behaviour.
However, there are several reasons why CAMHS services also have a role to play. First, advances in the last three decades have shown that in addition to social causes there are substantial genetic and biological contributions to conduct disorders/antisocial behaviour; therefore, the contribution of these factors needs to be assessed and factored into intervention plans. Second, many children and young people exhibiting conduct disorders/antisocial behaviour have coexistent mental health and learning problems, or disorders that require recognition and assessment, including for example attention and concentration problems (attention deficit hyperactivity disorder [ADHD]), attachment problems, traumatic memories (post-traumatic stress disorder [PTSD]), autistic traits and dyslexia. Third, the quality of the parent–child relationship needs to be assessed systematically using well-validated constructs; this will include assessment of mental health problems in the parents such as depression and alcohol and drug problems. Fourth, all of these factors need to be weighted and judged for their relative contribution in the individual concerned, and an appropriate intervention plan drawn up taking these into account, including personal meanings and cultural sensitivities. Finally, it is mainly work from the fields of child and adolescent psychology and mental health that has clarified many of the mechanisms contributing to the development and persistence of antisocial behaviour, and has led this discipline to develop notably effective treatments, mostly psychosocial in nature, which are often not available from other agen