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Conduct Disorder

EAP Project on Emotional Disorders, March 2014.
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on 23 March 2014

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Transcript of Conduct Disorder

Conduct Disorder
What is Conduct Disorder?
Conduct disorder is a severe condition characterized by hostile and sometimes physically violent behavior and a disregard for others.
"Children with CD exhibit cruelty, from early pushing, hitting and biting to, later, more than normal teasing and bullying, hurting animals, picking fights, theft, vandalism, and arson. Since childhood and adolescent conduct disorder often develops into the adult antisocial personality disorder, it should be addressed with treatment as early as possible; the earlier treatment starts, the better the outlook," (Child Mind Institute, 2014).
Characteristics of CD
Children with emotional or behavioral disorders are characterized primarily by behavior that falls significantly beyond the norms of their age and cultural group. These patterns have an adverse effect on the child’s academic achievement and social interactions.
In the classroom, children with externalizing emotional behaviors frequently exhibit the following:
• Get out of their seats
• Yell, talk out, and curse
• Disturb peers
• Hit or fight
• Ignore the teacher
• Complain
• Argue excessively
• Steal
• Lie
• Destroy property
• Do not comply with directions
• Have temper tantrums (Heward, 2013, pp. 199-200).


Creditable studies show approximately 3-6% of school-age children have emotional or behavioral disorders that are serious enough to warrant intervention (Heward, 2013, p. 205).

According to the Missouri State Plan, 6,253 students (about 0.7%) receive services for emotional disturbance within the state.
 Almost 27% are African American.
 African Americans highly overrepresented in this disability category nationwide.


According to the American Academy of Child and Adolescent Psychiatry (2013), the prevalence of emotional disorders is between 1.5% and 3.4% of the child population in the United States.

In the United States, about 9.5% of the population has a conduct disorder (Nock, Kazdin, Kessler & Hiripi, 2006).

More than ¾ of students receiving services for conduct disorder are male.
 12% of the U.S. male population has conduct disorder.
 7.1% of the U.S. female population has conduct disorder (Mizock & Harken, 2011).

Differentiated Instruction Strategies
Students with conduct disorder and oppositional defiant disorder will need your help to be successful. In order to offer them the most effective support, you need to know what the student’s strengths are, insist they be included, set clear behavioral rules for everyone, and most importantly – remember that they are children, not time-bombs waiting to go off (Kupper, 2012).

Students with conduct disorder will need support not only from their classroom teacher, but from the entire staff for the student to achieve the most success. School-Wide Positive Behavioral Interventions benefit children with conduct disorders greatly – fortunately, many districts are moving toward these systems of preventing behaviors. Teachers with students with conduct disorders will need to stay in regular contact with the special education, IEP, and administrative team, as children with conduct disorders will need support at every level (OSEP, 2014). Most importantly, students need consistent intervention over a long period of time.

Other Findings
 In most cases, it is advisable to not touch a child with CD/ODD unless they ask or approach you first. Children with CD/ODD often have issues with personal space and see physical contact as threatening.

 Don’t take things personally, and never hold a grudge. Children with CD/ODD have a legitimate mental illness, and are suffering, too. It is unlikely that they are “out to get you,” (Lehman, 2011).

 CD/ODD cannot be cured – only managed. The earlier the intervention in a child’s life, the better for the child in life-long management of the disorder and developing self-regulating behavior.

 Effective treatment and therapy is intensive and long-term. For this reason, boot camps and shock camps don’t have a lasting effect on students with the disorder (McMains, Maynard & Conlan, 2003).

 Talk to parents. It’s the best way to understand what is and isn’t working at home for the child, and may offer insight as to what the child’s interests are.

 Educate yourself. If possible, speak to other mental health professionals involved with the student. Get your administration and principle involved. Talk to anyone with significant one-on-one experience with the child and find out what worked and didn’t work for them.

 Many students with CD/ODD have very high verbal IQs (Mizock & Harken, 2011).

 It is often a difficult, long process to qualify students with emotional and behavioral disorders for special education services. It is often months of documentation before a student is even eligible for consideration.

By: Chelsea Fullington Egli
Deema and his sisters have a severe form of Conduct Disorder.
In the nature versus nurture debate, CD falls heavily under the "nurture" side. Children with CD are often victims of abuse, neglect, or other traumatizing life experiences.
It is important to note that most children diagnosed with Conduct Disorder are also diagnosed with other learning disabilities -- most commonly, ADD, ADHD, Autism, or other mental illness (depression, severe anxiety, bi-polar disorder, schizophrenia, psychosis, etc.).
Conduct Disorder is rarely a singular diagnosis.
References:
Child Mind Institute. (2014). mental health guide: Conduct disorder. Retrieved from http://www.childmind.org/en/health/disorder-guide/conduct-disorder
Children's Mental Health Services/REACH. (2013). Disorder: Oppositional defiant disorder. Retrieved from http://www.cmhsreach.org/disorder_odd.html
Demanchick, S. P., Rangan, M., & Douthit, K. (2006). Addressing conduct disorder in elementary school children: an application of the asca national model. (Master's thesis, University of Rochester), Available from ERIC. Retrieved from http://files.eric.ed.gov/fulltext/EJ901145.pdf
Heward, W. L. (2013). Exceptional children: An introduction to special education (10th Ed.) Boston, MA: Pearson Education, Inc.
Koning, P., Webbink, D., Vujić, S., & Martin, N. G. (2010). The effects of childhood conduct disorder on human capital. Informally published manuscript, Retrieved from http://ftp.iza.org/dp4940.pdf
Kupper, L. (2012). Teaching students with emotional disturbances: 8 tips for teachers. Retrieved from http://nichcy.org/teaching-students-with-e-d
Lehman, J. (2011, June 20). 4 ways to manage oppositional defiant disorder in children. Retrieved from http://psychcentral.com/blog/archives/2011/06/20/4-ways-to-manage-oppositional-defiant-disorder-in-children/
McMains, B., Maynard, A., & Conlan, L. (2003). Conduct disorder: treatment recommendations for vermont youth . Informally published manuscript, Available from ERIC. Retrieved from http://mentalhealth.vermont.gov/sites/dmh/files/publications/DMH-CAFU_Conduct_Disorder_Treatment.pdf
Missouri Department of Elementary & Secondary Education. (2012). State plan for special education, part b. Retrieved from file:///C:/Users/Chelsea/Downloads/MO%20State%20Plan%20for%20SPED%20-%20Reg%20III%202013%20(1).pdf
Missouri Department of Elementary and Secondary Education Special Education State Profile. (2013). Missouri Department of Elementary and Secondary Education Special Education State Profile. Dese. Retrieved February 11, 2014, from http://www.dese.mo.gov/divspeced/PDF/MOProfile.pdf
Mizock, L., & Harken , D. (2011). Diagnostic bias and conduct disorder: Improving culturally sensitive diagnosis. Child & Youth Services, 32(3), 242-53. ERIC Database.
National Association of Special Education Teachers , (. (2007). Emotional and behavioral disorders. Retrieved from https://www.naset.org/emotionaldisturbance2.0.html
Nock, M. K., Kazdin, A. E., Kessler, R. C., & Hiripi, E. (2006). Prevalence, subtypes, and correlates of dsm-iv conduct disorder in the national comorbidity survey replication. In R. Kessler (Ed.), Psychological Medicine (36 ed., Vol. 5, pp. 699-710). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925033/
OSEP. (2014). School wide positive behavioral interventions & support. Retrieved from http://www.pbis.org/school/school_mental_health/default.aspx
PSYCH CENTRAL. (2014, March 12). Conduct disorder symptoms. Retrieved from http://psychcentral.com/disorders/conduct-disorder-symptoms/
The REACH Institute. (2012). Conduct disorder/oppositional defiant disorder. Retrieved from http://www.thereachinstitute.org/conduct-disorderoppositional-defiant-disorder.html
Schwartz, J. (Producer) (2013). Retrieved from https:// www.youtube.com/watch?v=THsIP7pM9Oc
Tang, J. (Performer) (2008, August 18). Conduct disorder song. [Video podcast]. Retrieved from
Tomlinson, C.A. (2005). The differentiated classroom: Responding to the needs of all learners. Upper Saddle River, NJ: Pearson Education, Inc.
Wong, P. (2010). How to address conduct disorder symptoms in the classroom and at home, Retrieved from http://www.videojug.com/interview/how-to-address-conduct-disorde symptoms-in-the-classroom-and-at-home
Yale. (2014). Technology. The Yale center for dyslexia & creativity. Retrieved March 12, 2014, from http://dyslexia.yale.edu/Technology.html
Prevalence
1.
Cognitive/Perceptual:

Students with Conduct Disorder are not able to process emotions and stress the way other students are. When presented with a stressful or undesirable situation, a child with Conduct Disorder will begin to show some of the behaviors listed above. The child may become very anxious and simply ignore the directions and the teacher, or the child could have a temper tantrum, yell, curse, or cause physical harm to him/herself, peers, or teacher. The perceived level of stress or undesirableness by the student may cause them to react in a more or less violent manner (Demanchick, Rangan, & Douthit, 2006).


Description:
When asked to work as a group, the student may ignore directions or become distracting and/or disrupt his/her peers. When asked to stop and stay on task, the student may become upset and begin yelling or cursing at the teacher. When told this behavior is not appropriate, the student may begin throwing things or destroying classroom property. The student could threaten physical violence toward him/herself or others.


Impact on learning:
Not only is the student impacting his/her own learning, but the student is often disruptive toward his/her peers as well. Defiant and disruptive behavior interrupts instruction and limits understanding of directions. Lack of engagement and understanding can lead to failure to learn.

2.
Communication/Language:
Students with Conduct Disorder will often be unable to vocalize their needs and feelings in an appropriate manner.


Description:
Student may yell, curse, or talk out in order to try to communicate his/her needs. If this is not responded to, the child may begin to threaten harm to him/herself or others or become disruptive. The student may have a temper tantrum since the student views this as an appropriate reaction to stress or way to have his/her needs met.


Impact on learning:
Students who cannot communicate effectively with peers and teachers will have a difficult time following instructions and staying on task. Since Conduct Disorder is often coupled with another learning disability, impact on learning may be magnified depending on the severity of the disabilities.

3.
Academic/Learning:
Students with Conduct Disorder are often low achievers. Two-thirds cannot pass a competency exam for their grade level. Students with emotional and behavioral disorders have the highest rate of absenteeism of any group of students and a whopping 60% will drop out in high school (Heward, 2013, p. 201).


Description:
Students with Conduct Disorder are often disruptive to instruction and to the learning environment. This can limit participation in both classroom activities and assignments. Lack of engagement in the classroom can lead to a failure to learn.


Impact on learning:
In a continued pattern, students fall further and further behind. Teachers becoming increasingly less able to address their deficits and students become frustrated and disenchanted. This decrease in motivation can lead to further academic deficit.


Description:
Students with Conduct Disorder often have a dual-diagnosis with another learning disability. This can mean challenges in multiple content areas.


Impact on learning:
Conduct disorder coupled with another learning disability can mean compound difficulty in mastering content and skills. This adds to the student’s frustration, which can lead to further acting out and discontent with school.

4.
Social Skills
: Students with Conduct Disorder are often rejected by their peers, making it difficult for students with CD to make and keep friends.


Description:
Students with Conduct Disorder have reported lower levels of empathy toward others, decreased participation in social activities, less frequent contact with friends, and lower-quality, more transient relationships than their peers.


Impact on learning:
Students know when they are not accepted by their peers. Lack of meaningful relationships in a student’s life can lead to withdrawal, depression, and social anxiety.


Impact on learning:
Students with emotional and behavioral disorders are
14 times
more likely to be arrested during their school careers than their peers. 47% of incarcerated youth were classified as having an emotional or behavioral disorder (Koning, Webbink, Vujić & Martin, 2010). Students who are frequently arrested and jailed will be transient in the classroom – preventing meaningful intervention and learning.

Like many mental illnesses, there is no pinpoint cause of externalizing emotional disorders, and children diagnosed with conduct disorders come from a variety of cultural and genetic backgrounds.

 Environmental Factors:
 There are strong implications that extreme poverty, abuse and neglect early in life may predispose a child to developing a conduct disorder.
 Home life:
 Children with conduct disorders are more likely to come from homes with extreme poverty, food insecurity, inconsistent discipline, excessive punishments, spend little time engaged in prosocial activity with their parent(s), receive little love or affection for good behavior, or have parents that do not monitor their whereabouts or activities.
 School life:
 Children with conduct disorders often bully school officials or are disruptive until they get what they want. Since children with conduct disorders tend to struggle academically anyway, their actions often escalate until the teacher feels defeated and withdrawals the request – often excusing the student from doing the work or preferred behavior. This has worked for the student in the past, so they have continued the behavior.
 Community
:
Since children with conduct disorders are often also classified as “high risk,” they are often tempted into gang activity, drug use, deviant sexual behavior, and other illegal activities that contribute to the development of antisocial behavior from an early age.
Causes
Biological Factors:

Brain Disorders:
 Many individuals with brain disorders have problems processing emotion and behavior. Brain disorders can happen due to abnormal brain development, or traumatic brain injury. Either condition can impair cognitive function – however, in most cases involving conduct disorders there is no evidence of brain disorder or injury.

Genetics:
 There is some debate that, like schizophrenia, conduct disorders could follow genetic patterns. For an unexplained reason, relatives of schizophrenics are more likely to develop the disease themselves. Though science cannot yet explain why this is true, there is some speculation this could also hold true for emotional and behavioral disorders.

Temperament:
 Students who exhibit a difficult temperament early in life may be at higher risk for developing conduct disorder later in life.
 It is unlikely that this is the sole cause of conduct disorder, rather a factor that is coupled with one or more other causes to achieve a diagnosis.
Content:
Children with conduct disorder are often lagging academically, but will be insulted if you present them material that is well-below that of their perceived capability or the content of their peers. The teacher must be careful to find material that is of interest to these students, but also appropriate for their level.

Materials need to be high-interest to the student.
Students with conduct disorders need choices – not ultimatums. If possible, the teacher should always present materials in a way that makes the student feel they have options. This builds a sense of control for the student.
Students with Conduct disorder will need incentives in order to stay in task – “If you can do this or this for me, your reward will be…”
It is important to remember that students struggling with conduct disorder may need frequent breaks or a “safe space,” where they can retreat when they begin to feel overwhelmed, frustrated, or angry.

Process:
Students with conduct disorder will need lots of one-on-one instruction in order to stay on task.
Peer tutoring is a great way to include a student with conduct disorder – they are able to socialize as well as receive the one-on-one instruction they need.
Teachers need to promote inclusion and insist the student be part of group activities and assignments to the best of their ability. Students with conduct disorder often feel rejected by their peers and will need teacher intervention to promote positive relationships.
Because many students with CD/ODD also have ADD or ADHD, it may be appropriate to use differentiation strategies you would use for a child with ADD/ADHD.
Be clear that all students are accepted in the classroom community – no bullying or teasing will be allowed of any student. This sets clear boundaries for everyone; the student with CD/ODD doesn’t feel unfairly limited by the rules.
It is very important to remember that students with conduct disorders will be difficult, but not impossible. Every child struggling with CD/ODD is different and will have different needs.
It is unlikely that any single strategy will be successful when dealing with students with CD/ODD. You will have to find what works with each child.

Product:
When assessing students with CD/ODD, it is important to play to their strengths.
Students with CD/ODD may need extra time to test, may need to take it in the resource room, or may need a quiet, “safe space,” with little distraction.
Students may need one-on-one direction in order to stay on task and not become frustrated.
May need frequent breaks while testing in order to decrease frustration and stress level.
Students with CD/ODD tend to have high verbal IQs. If possible, students should be able to give oral instead of written answers.

Key Resources
 National Association of Special Education Teachers (NASET). (2007). Emotional and behavioral disorders. Retrieved from https://www.naset.org/emotionaldisturbance2.0.html
o Links to professional websites with tools, tips, and tricks for helping students with conduct disorder be successful in the classroom.

 OSEP. (2014). School wide positive behavioral interventions & support. Retrieved from http://www.pbis.org/school/school_mental_health/default.aspx
o Great resource for teachers looking for support on school-wide positive behavioral interventions & support (SWPBIS) and referral materials for students needing mental health services
Treatment
There is no single prescribed treatment for conduct disorder. In the classroom, it can be managed with various behavior plans to varying degrees of success. The teacher will have to work diligently to help these students find strategies that work for them and promote self-regulating behaviors. Often students with these types of disorders also have Behavior Improvement Plans (BIP) included as part of their IEPs.
Outside the classroom, parents and families may seek therapy or counseling. Often, the entire family is involved in these sessions. Since conduct disorder is often diagnosed alongside another disability, medication may be prescribed, but this is not always the case.

What is the impact on learning?
Full transcript