Conduct disorder diagnosis

[DammitJanet]

I have noticed a pattern here recently...ok...maybe not so recently to completely discount the diagnoses of a Conduct Disorder in a child when given by a professional. I think that is fairly odd considering the name of our website!

Conduct Disorder is a legitimate diagnosis listed in the DSM that can be co-morbid with any other diagnosis a child may have or it can be a stand alone diagnosis. Notice that it is a diagnosis of CHILDHOOD! In order to develop Anti Social personality Disorder a person must show evidence of Conduct Disorder before the age of 15. I think we are doing a disservice by denying that this diagnosis exists or saying that professionals are wrong. Parents could be delaying extremely important and needed therapy while searching for a new diagnosis that simply isnt there.



Here are the criteria:

Conduct Disorder

In psychiatry, conduct disorder is a pattern of repetitive behavior where the rights of others or the social norms are violated. Possible symptoms are over-aggressive behavior, bullying, physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.

After the age of 18, a conduct disorder may develop into antisocial personality disorder.

Diagnosis

The diagnostic criteria for Conduct Disorder (codes 312.xx, with xx representing digits which vary depending upon the severity, onset, etc. of the disorder) as listed in the DSM-IV-TR are as follows:

1. A repetitive and persistent pattern of behavior 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 12 months, with at least one criterion present in the past 6 months:
1. Aggression to people and animals
1. often bullies people, threatens, or intimidates others
2. often initiates physical fights
3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
4. has been physically cruel to people
5. has been physically cruel to animals
6. has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
7. has forced someone into sexual activity
2. Destruction of property
1. has deliberately engaged in fire setting with the intention of causing serious damage.
2. has deliberately destroyed others' property (other than by fire).
3. Deceitfulness or theft
1. has broken into someone else's house, building, or car
2. often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
3. has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)
4. Serious violations of rules
1. often stays out at night despite parental prohibitions, beginning before age 13 years
2. has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
3. is often truant from school, beginning before age 13 years
2. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
3. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

 

[flutterbee]

Thank you, Janet, for posting this.

As I stated in another thread, we are not professionals here and do not have the credentials nor the first hand experience with the child to determine if a diagnosis is correct or not. I think it does a disservice to those seeking solace and advice to discount a diagnosis out of hand. I feel it is our place to guide those in the right direction, i.e., the parent report and the multi-disciplinary evaluation, what kind of questions to ask and help with the schools, as well to offer support - not to usurp the professionals treating the child. This journey is very confusing to those just starting out.

All of us here have been down the road of many tdocs, psychiatrists, diagnosis's and medications - or are on our way. We can certainly help each other along that journey. I know I wish I had had the knowledge of this board starting out. It would have made things a lot smoother and I certainly wouldn't have felt so isolated.

I feel that knowledge is power. As such, comparatives such as, I see this kind of behavior in my child and she suffers from severe anxiety, to give the person another view on things - gives others more information and more questions to ask the professionals. We can certainly provide information such as ADHD and anxiety can look a lot alike - again to provide more information. Providing our own personal experiences with medications and diagnosis's - what we have seen, felt, heard, experienced - certainly goes with the kind of sharing that makes one think outside of the box. I often read posts that don't pertain to a diagnosis my child has and find myself thinking of things in a new way. I think we need to be careful, though, that we don't cross the line into the job of those educated and trained in the mental health field.

 

[Steely]

Thank you Jane. I have noticed this pattern as well. It seems many of us are divided over whether ODD and CD can be a stand alone diagnosis - as well as whether a child can be diagnosed with these disorders. So I appreciate you sending out info on the symptoms of this.

Don't you think though, that a child having only CD or ODD is pretty rare? Isn't ODD and CD usually developed because the predominant mental illness is not being treated, and they develop the ODD and CD as coping mechanisms? And don't you think that doctors sometimes temporarily slap these labels, (ADD included) on kids because the kids are so young they do not want to jump to conclusions yet about what the predominant mental illness is?

It just worries me that we would take these labels and then classify our kids as CD or ODD - when the fact of the matter is they may just be exhibiting these symptoms because the underlying illness is not being treated properly. I think it is a slippery slope, and begs for all of us to not be so wound up in labels and diagnosis' and be more concerned if our child is getting the right treatment.

 

[smallworld]

I don't disagree that ODD and CD exist. But from everything I've learned from our three psychiatrists, these are dxes of last resort. In other words, all other psychiatric and neurological disorders must be ruled out as underlying causes before a primary diagnosis of ODD or CD is given. Frequently ODD or CD is the result of an underlying disorder like anxiety, depression, bipolar disorder, Autistic Spectrum Disorder, etc.

I personally would not trust a primary diagnosis of ODD or CD given by a psychologist. If that happened to one of my children, I would insist upon evaluations by a child psychiatrist, a neurologist and a neuropsychologist to rule out underlying psychiatric and neurological disorders as a cause of the ODD or CD behaviors.

 

[DammitJanet]

I think there can be different reasons for a child to have a diagnosis ODD or CD or mental illness. Some kids may have ODD or CD due to environmental conditions. There is no mental illness involved there.

I would not lump ADD or ADHD into this discussion at all because in my opinion that is a completely separate and very real disorder but if you would like to argue that one out we can do that on another thread sometime!

Then there are kids who have ODD or CD simply because they are genetically wired to have it even though they come from perfectly fine homes. No one knows why this happens. There is no explanation for it, it just happens. There is something wrong in the way the person thinks that causes the behavior. Sometimes therapy and medication can help alleviate symptoms but it takes a lot of work.

Then there are the kids who have symptoms of oppositional behavior secondary to a mental illness. This is not true conduct disorder or ODD.

 

[branbran]

I have posted a few times regarding this. My daughter has been diagnosis BiPolar (BP) 3 years ago by 8 different docs and was hospitalized 8 times, each time diagnosis of discharge was BiPolar (BP). Now my difficult child is in an Residential Treatment Center (RTC), has been there 3 months and only on Concerta and Lexapro the entire time. Her psycchologist has mentioned CD. Not the psychiatrist. The reason I am reluctant to belive this diagnosis (aside from the obvious ones) is that the doctor is forming an opinion only knowing my child for a short period of time, while on medications that have been known to have an adverse effect. In the past my difficult child has reacted to the Concerta in a very negative way. It makes her very angry and easily enraged. I don't think it is fair to make a diagnosis of CD under these circumstances. The docs are seeing my child with side effects of her current medication. What are the odds that all of the other doccs were wrong and this one is right? Not to mention she is only a psychologist. She does fit some of the criteria of a CD diagnosis, however it could ring true for BiPolar (BP) as well. For instance, she is very aggressive, lacks social cues, immature, angry, has stayed out past curfew, smoked alot of weed, caught shoplifting and is hard to get along with. However, she is not cruel to animals, does not destruct property, has never used a weapon, does not start fires, she is capable of empathy, she has guilty feelings, she is kind to animals (loves them), has never forced any sexual activity on anyone. Her symptoms could very well be poorly treated BiPolar (BP). Until we have tried everything we can with regards to treating BiPolar (BP), I will not believe she only has CD. At the very least, they should take her off all medications and start over. This way they will be seeing the real symptoms, not side effects to her medications.

I do understand what you all are saying, CD does exist and denial is no good for our children. I just don't think it is right to rush a diagnosis, especially of this nature. After all there are no simple blood tests, it's all about observation.

My daughter will be starting new medications, a mood stabilizer alone, I will keep you posted as to how that goes.

Hoping for the best.

 

[flutterbee]

branbran - have you completed a parent report for your daughter? That would be extremely helpful for those working with her that don't have all the history. You can find it on the FAQ board.

 

[BusynMember]

Dr. Chandler, who wrote the ODD Chandler Papers, even said it rarely stands alone. Those words are his words, exactly. They are there for all to see.
in my opinion and in the opinion of my psychiatrists (of which I'd had many...lol) we've talked about CD, ODD, BiPolar (BP), ADHD, etc. (almost everything, since I'm interested), and the PSYCHIATRISTS tend to agree with each other that it doesn't stand alone, at least the ones I've had. Psychologists tend to diagnose ODD and CD, but not too many MD Psychiatrists do. I don't think it's doing a disservice to parents to tell them what we are told (DSM or not--That DSM changes SO often). ODD often responds well to mood stabilizers. So does CD. At any rate, CD is such a dismal diagnosis, which such a poor prognosis, in my opinion, it's a very good idea to tell parents to explore other areas before accepting that this is for their child--this doomsday diagnosis. Bipolar is often mistaken for both ODD and CD. It's expedient, in my opinion, to make sure by going to a few (not just one) CHILD PSYCHIATRISTS (with the MD) and NeuroPsychs (psycologists who have training in the brain and do extensive testing) before agreeing to a diagnosis of simple ODD (of which there is little treatment) or CD (of which there is no treatment--it is essentially an antisocial personality disorder meaning NO CONSCIENCE. It is grim). I feel it is ALWAYS best to get more than one opinion, and to go to the top, most educated professionals for diagnoses. I feel you have a better shot with those who have had more schooling. I know I've had bad luck for myself AND my son with plain psychologists, so I can't be the only one. I will continue recommending Child Psychiatrists (with MDs) combined with neuropsychologist exams because I feel, in good conscience, that this is the best way to get the most accurate results. I will continue recommending not to trust your diagnosis to just a social worker, therapist, counselor, pediatrician or psychologist--they really aren't supposed to diagnose anyways. To me, I am giving the soundest advice I can offer and I will always give my all in my answers. If people don't agree with me, they don't need to listen to my advice. They are certainly free to accept ODD/CD diagnoses or to let psychologists diagnose. We are all telling what has worked for us. ODDers who improve often have moved onto taking mood stabilizers. in my opinion that indicates they really have early onset bipolar, but the label doesn't really matter as long as the child improves. If a child is still in crisis, despite a diagnosis from some professional, and the child is NOT improving with treatment---in my opinion, it's smart to get another opinion. Any professional can be wrong, and, if one isn't helping your child, perhaps another type of professional will. I'm not revisiting this thread, because I'm not in fight mode, but I'm also not going to change my advice, that people are free to take or disregard. I am fairly confident that recommending a Child Psychiatrist and a neuropsychologist is good advice. Have a nice day to all.

 

[branbran]

I have. I have filled out one of those a gizzillion times. I have filled out one for the Residential Treatment Center (RTC). as well. I am in close contact with her therapist as well as the psychologist. I have yet to hear from the psychiatrist, still waiting on that phone call. My difficult child will be getting an MRI and an EEG soon. Even though I'm quite sure they will come back fine as I do believe her problems are psychiatric.

I don't want to give off the impression that I totally discount the idea of a CD diagnosis. That is not the case. I just feel that so many of the symptoms of so many of the disorders are so similar that CD should be a last resort diagnosis. If a child does have BiPolar (BP) and is not on the right medication, that can look alot like CD. I think we as parents, should not accept any diagnosis of this nature easily. If there were distinctive tests that could be taken to see what is really going on, then of course there really couldn't be much of an argument. Until those tests are available we should be very careful as to what lables our children are walking around with.

Just my opinion.

 

[branbran]

Midwestmom,

THANK YOU. Well said. I totally agree with you. CD is a very grim diagnosis, especially for a child, who is not fulling grown, who is in all probability immature. I don't think there is anyting wrong with leaving parents with a little hope. As far as I can see there is little hope with Conduct Disorder. That being said, if everything else is definitively ruled out, and CD is ultimately the diagnosis, it is what it is.

 

[flutterbee]

I'm always going to put more stock into the opinion of a social worker, counselor, therapist, psychologist, psychiatrist - those educated and trained in the profession - than that of a lay person.

What some don't understand is that the insurance in all states does not cover mental health the same as physical health. Because of that in my state, we get 20 visits per year for mental health coverage - that covers therapist, psychiatrist and anything else that crops up. Psychiatrists in my state do not do treatment. Some don't even do evaluations - they rely on the psychologists for that. You get a 45 minute visit and then 15 minute medication checks. You cannot possibly diagnosis in that amount of time. Yes, psychologists, at least in Ohio, can legally diagnosis. As far as MSW's (in Ohio at least, I don't know if it varies by state), by the time they get their masters they've completed almost as many credit hours as the psychologist with his/her doctorate. We've gotten farther with difficult child's therapist (a MSW) in terms of an accurate diagnosis and moving in the right direction than with psychiatrists and psychologists with their PhD's. So all experiences are not equal.

What is most important is the working relationship with whatever professional is being used and the level of trust.

 

[Nancy]

Thank you Janet, you are very wise. I think you know my feelings on this subject. I get so tired of hearing that ODD and CD are really bipolar or something else in disguise and if you fix that the ODD or CD will go away.

"Then there are kids who have ODD or CD simply because they are genetically wired to have it even though they come from perfectly fine homes. No one knows why this happens. There is no explanation for it, it just happens. There is something wrong in the way the person thinks that causes the behavior. Sometimes therapy and medication can help alleviate symptoms but it takes a lot of work"

I completely agree.

It's funny because I first came to this site because it was a site on "Conduct Disorders." That's what I was looking for, not bipolar or adhd or any other mental disorder. It seems like the last couple years some try to negate that it exists at all. I have been told by someone here who shall remain anonymous that my difficult child really has bipolar and I just don't want to accept it. So much for just giving friendly advice.

Nancy

 

[branbran]

It's not so much that I disagree with CD as my daughter diagnosis because it was mentioned by a psychologist, it's the time frame and the medications my difficult child is on. This doctor has only known my daughter for a few months while on medications that are proven to have adverse effects. And have had adverse effects on my difficult child in the past. So please don't misunderstand me, if she is CD, then I will deal with it and love her as I do now. I just want to be sure. I have seen my daughter stable on mood stabilizers in the past, nothing mirraculous, but did see some improvement. She hasn't tried them all yet. Let's rule out everything else first, that's all I'm saying.

 

[flutterbee]

branbran -

You are playing this smart with your daughter. It is absolutely imperative that all bases be covered and I don't think anyone here is saying otherwise. We have to become advocates for our children and we have to learn as we go. My daughter definitely has ODD behaviors, but in her case it is a manifestation of her depression and anxiety (and probably her executive function issues) and I don't list it as a separate diagnosis because without the co-morbid diagnosis's, it wouldn't exist. While I do agree that it is more common as a co-morbid disorder, it still can and does stand alone. If, as a parent, you feel that a diagnosis doesn't fit it is your responsibility to question it. It is also your responsibility as a parent to ensure that a complete and thorough evaluation is done and sometimes that can require a hell of a battle. difficult child's therapist (who I adore and have a very good relationship with) was positive that difficult child had depression and not bipolar, but I wasn't so convinced. Turns out therapist was right, however the neuropsychologist report stated to keep our eyes open for bipolar. So I wasn't so far off base, and therapist admitted to neuropsychologist that I walked into her office saying the same things. The point is, I could question it because I had a good working relationship with the therapist. If one doesn't have that kind of relationship, it's time to find a new psychiatrist/therapist.

What I take issue is discounting something out of hand. Really - what information, training or education do we have to be able to do that so arbitrarily?

 

[DammitJanet]

CD is not a completely grim diagnoses if it is treated aggressively when diagnosed. What would be a tragedy is if someone treated a mental illness and the underlying conduct disorder was not treated when it could have been.

I happen to think this is exactly what happened in my sons case. My son exhibited all the classic signs of CD. No where in there does it say they dont have a conscience though...That would be a psychopath or sociopath...there is a difference and I cant remember exactly which one it is. However, we treated him for the bipolar disorder and because the psychological treatments and therapies were different than they would have been for conduct disorder we lost the time that may have made the difference for him. There are multi-modal approaches for treatment of CD.

 

[Nancy]

"If there were distinctive tests that could be taken to see what is really going on, then of course there really couldn't be much of an argument. Until those tests are available we should be very careful as to what lables our children are walking around with."

I completely agree with you branbran. I think you should continue seeking answers for your daughter. I don't agree though that there is no hope for conduct disorders. I believe people can change and it is proven everyday with people who commit a crime, take their punishment, and continue on their lives never commiting another crime.

But I agree that we should all be very careful about labeling our children, and fortunately the professioanls I've dealt with have felt the same way. There are still many stigmas in our society with insurance companies and employers and government agencies. I see that changing a little over the years but we have a long way to go. It's too easy to label someone bipolar or adhd or cd or odd the perhaps their personality is just very impulsive or moody and it gets them into a lot of trouble until they reach a certain maturity level and can think before they act.

Nancy

 

[Nancy]

LOL Janet, I swear we did not talk to each other but we ended up saying the same thing at the same time.

And I agree that CD can be helped with the right interventions at the right time. I would have to say my difficult child moved into the CD category last year when she used drugs and alcohol and ran away and broke the law. We intervened at the right time and thank goodness it helped.

Nancy

 

[DammitJanet]

LOL Nancy...its all these years on the board! We have psychic abilities now.

 

[branbran]

I just want to say that I appreciate EVERYONE'S opinion. I have learned so much from all of you over the last few weeks. I feel very confident in posing a question on this site. The answer's are never taken in vain (on my part anyway), we are all allowed to have a difference of opinion once in a while. I think everyone's intentions are the same. That is the important thing. We all come to this site daily to give and receive support, as we all need cyber hugs to lift our spirits from time to time.

Sending out positive thoughts to all.

 

[Hound dog]

Janet

I am very glad this was brought up. CD and ODD wouldn't be in the DSM if they weren't considered "real" disorders.

Sure, maybe some professionals don't agree, but how many of us have run into professionals who don't believe aspergers or Pervasive Developmental Disorder (PDD) exist or childhood bipolar?? I've even met those who believe ADHD is nonsense. Does that make those disorders any less valid?

Diagnosing mental illness isn't an exact science. One can't simply get a specific test done and know they have a certain disorder like one can with diabetes or epilepsy. The disorders listed in the DSM classify specific symptoms and behaviors so that they can be treated by the best known methods.

Sure these disorders don't always stand alone. Believe it or not the diagnosis of cerebral palsy often has a diagnosis of Pervasive Developmental Disorder (PDD) along with it. But that doesn't mean that a person with Pervasive Developmental Disorder (PDD) always has CP or vice versa.

And I won't even get into the genetic/environment aspect. (that can be a hot topic of debate with any of the dxes)

branbran and to any other parent, I always think it wise to persue all possiblities medical and mental before settling on a diagnosis. And if you don't agree with a diagnosis, then get another opinion.

Hugs