Clinical psychologist Ronel de Villiers explains the causes of conduct disorder, and how families can cope.
is disturbing because it’s often a precursor to antisocial personality disorder, which in turn is associated with criminality. Worldwide, an estimated 6-16% of boys and 2-9% of girls under the age of 18 have conduct disorder and, says Cape Town clinical psychologist Ronel de Villiers, the South African incidence is similar.
Ronel attributes a variety of bio-psychosocial factors to the development of the disorder. ‘Chaotic home conditions, such as constant strife between parents, conflicting or inappropriate child-rearing practices, and child abuse and neglect, are associated with conduct disorder and delinquency,’ she says. She also cites sociopathy, alcohol dependence and substance abuse in the parents as a factor, and points out that where the parents have themselves been scarred by their own upbringing, they might model and pass on generations of neglect, abuse and self-absorbed attempts to have own needs met at the cost of others, including their own children.
And Ronel pinpoints a particularly South African problem. ‘The high incidence of Aids among South Africa’s lower socioeconomic communities has decimated families of parental figures, leaving children as young as 5 to fend for themselves and youngsters of 9 or 10 to look after their younger siblings.’
In addition, she points out, ‘Socioeconomically deprived children sometimes become involved in subcultures, such as street children or gangs, where thieving and muggings are the accepted norm for survival.’
But it’s not only the socioeconomically deprived who are at risk. ‘Children brought up in overindulgent, laissez-faire families often develop a sense of entitlement with low frustration tolerance, which can be a fertile feeding ground for incipient conduct disorder. Where children grow up in chaotic, negligent conditions, they often become angry, disruptive, demanding and unable to form mutually supportive relationships. With poor social skills, they have little motivation to follow societal norms and are often lacking in conscience or remorse.’
Therapy a must
Conduct disorder requires the earliest possible professional help
. ‘The earlier one starts with the therapy, the better,’ says Ronel, ‘since the aim is to avoid negative behaviour patterns entrenching themselves.’
And while individual psychotherapy for the child, focusing on improving problem-solving skills, can be useful, Ronel cautions that the teenager is not the only one who will have to change. ‘You will, too,’ she says, ‘but the whole family may be better for it.’
Parents often need to develop more effective parenting skills, with consistent house rules and expected consequences. ‘And where the parents’ own substance abuse or psychopathology gets in the way of the new approach, parental psychiatric evaluation and treatment need to precede the implementation of a family behavioural programme for the teen,’ Ronel advises.
Ronel is very clear on what not to do. ‘Often, in response to their previous inconsistent style of parenting, exasperated parents then swing towards severe punishment and over-restriction. This unfortunately almost invariably increases the teenager’s rage, frustration and acting-out behaviour.’
Where the family is abusive or too chaotic, the child may have to be removed from the home (to, for instance, a boarding school or foster home) to benefit from a consistent and structured environment. And medication such as Tegretol or Lithium might be considered to decrease aggression.
Ronel says that since conduct disorder often coexists with Attention Deficit Hyperactivity Disorder (ADHD), learning disorders and eventually mood disorders such as depression and anxiety, as well as substance abuse, treatment of concurrent disorders also needs attention.
Do you suspect your teen may suffer from conduct disorder?
Read more about conduct disorder:Teens out of control
Conduct disorder resources