Running head: CONDUCT DISORDER

Conduct Disorder: A Case Study

Larissa Gill

Brock University

Teaching Assistant: Laura Murray

PSYC 3F20: Abnormal Psychology

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In this essay, conduct disorder will be explored through the discussion of how it is

diagnosed, its causes, and recommended treatment. This will be accomplished with a case study

examining Derek Pratt, a fifteen-year-old male that had multiple problem behaviours, including

crimes.

Diagnostic Criteria

Based on the fifth edition of Diagnostic and Statistical Manual of Mental Disorders

(DSM-5), Derek Pratt was diagnosed with moderate severity of adolescent-onset type conduct

disorder. According to criteria A, the patient must show at least three out of fifteen criteria in the

last year with minimum one criterion in the past six months that relate to a persistent pattern of

behaviour that defies social norms and infringes upon the rights of others (American Psychiatric

Association, 2013). Criteria A is divided into subcategories such as, aggression to people and

animals, destruction of property, deceitfulness or theft, and serious violations of rules, which

include the list of criteria/behaviours the patient must display for an appropriate diagnosis

(American Psychiatric Association, 2013). Derek meets the aforementioned requirements

because in the past year, he was arrested for vandalism by breaking windows and destroying

vehicles on school property, absent for approximately half of the school days since the beginning

of the academic year, and non-compliant with curfew hours (Case Study). Additionally, within

the past six months Derek was arrested for shoplifting a convenience store (Case Study).

Therefore, Derek fulfills the first criterion for conduct disorder.

Furthermore, criteria B in the DSM-5 for conduct disorder requires the patient’s

behaviour to cause significant impairment to occupational, social, and/or academic functioning

(American Psychiatric Association, 2013). In Derek’s case, he was not likely to pass his classes
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due to his extended absences (Case Study). This indicates an impairment in academic

functioning. Also, Derek had a history with the juvenile criminal system and a negative attitude

toward others (Case Study). This indicates impairment in social functioning.

Lastly, criteria C of the DSM-5 states the patient must be under the age of eighteen to be

diagnosed with conduct disorder; otherwise, he would be assessed for antisocial personality

disorder (American Psychiatric Association, 2013). Because Derek is fifteen years of age and

meets all other requirements according to the DSM-5, it is appropriate to diagnose him with

conduct disorder.

Based on the Case Study, Derek most likely developed conduct disorder during early

adolescence. The DSM-5 differentiates adolescent-onset type and childhood-onset type, where

the former is for patients who do not display conduct disordered behaviours before the age of

ten, while the latter is for patients who do (American Psychiatric Association, 2013). For the

assessment, Derek’s mother explained that she did not want her son to live with her because of

his negative behaviour for the past two years (Case Study). Additionally, it was indicated in his

educational records that there was a decline in academic functioning in junior high school (Case

Study). Assuming this was the beginning of the negative behaviour, Derek would have been

approximately thirteen years of age. With no evidence to suggest otherwise, it is safe to assume

Derek’s behaviour became disordered in early adolescence.

The DSM-5 also outlines the severity of the conduct disorder in the patient ranging from

mild to severe (American Psychiatric Association, 2013). The qualifying factor for severe

conduct disorder is physical harm to others and Derek has not escalated to this type of behaviour.

However, Derek has participated in behaviour that has caused some harm to others and has
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displayed many of the conduct disordered behaviours, such as shoplifting and vandalism (Case

Study). According to Derek’s behaviour, his conduct disorder is moderate in severity.

The classification in the DSM-5 for conduct disorder is important because it is used to

diagnose children and adolescents, and it can be used to predict antisocial behaviour into

adulthood, including aggressiveness and the propensity to commit violent crimes. Previous

versions of the DSM had focused on using a categorical approach to diagnosing patients.

However, it has been suggested that there should be a combination of the categorical and

dimensional approach in order to recognize that individuals may vary in severity of symptoms

and not just type (Frick & Nigg, 2012). Currently, the DSM-5 for conduct disorder has

accomplished this and therefore, makes the classification system sound.

Etiological Model

Like many mental disorders, conduct disorder does not have one single cause. It is a

complex disorder that takes into account multiple factors in one’s life that may affect the

likelihood of being diagnosed. There is an interaction of influences that may cause a young

person to behave antisocially. The bulk of research suggests that there may be a genetic

component that is affected by environmental events, which in turn increases the chance that an

individual will display disordered behaviours. Additionally, the progression of the mental

disorder highly depends on the age of onset. The etiological models for conduct disorder seem to

fit well with Derek’s case.

Genetic-Environmental Influences

Conduct disorder is suggested to be caused by an interaction between genetic influences

and environmental influences. There are a number of genetic components that may be involved

in conduct disorder. Notably, genes that are involved in serotonergic, dopaminergic, and stress
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response systems that influence characteristic behaviour of conduct disorder (Salvatore & Dick,

2016). However, the progression of conduct disorder seems to rely on genetic predispositions

that are activated by environmental factors (Barlow, Durand, Hofmann, & Lalumière, 2015). To

study this effect, researchers have focused on using twin studies. These studies have indicated

that individuals who carry genetic components and raised in less restrictive environments (e.g.,

peer delinquency and/or minimal parental supervision), are more likely to develop conduct

disorder in their lifetime (Salvatore & Dick, 2016).

In reference to the Case Study, there is no record of genetic predispositions for conduct

disorder. However, under the assumption that Derek did have high genetic loading for the

disorder, his environmental influences seem to have played a part in its development. As

aforementioned, Derek’s friends do not seem to be the best influence for good behaviour. Derek

is incredibly peer-focused and therefore, spends a great deal of time with his friends (Case

Study). His friends are an environmental trigger for conduct disorder. Additionally, Mr. Pratt

(Derek’s father) was interviewed by the psychologist for the assessment. The relationship

between Mr. Pratt and Derek was civil, however, they did not seem to be a close-knit family unit.

Mr. Pratt had commented that he does not know of his son’s whereabouts but assumed he was

just playing video games with his friends and that he was planning on leaving Derek when he

turned eighteen years of age (Case Study). This suggests that the lack of heavy parental guidance

may have also been an environmental trigger for Derek’s conduct disorder.

Adolescent-Onset

As distinguished within the DSM-5, the age of onset is a part of diagnosing one with

conduct disorder. This is important because childhood-onset and adolescent-onset have different

causes or developmental pathways (Kostić, Nešić, Marković, & Stanković, 2015, p. 81). Conduct
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disorder in adolescence is related to an increase in frequency and severity of delinquent

behaviour. Its development is attributed to poor peer influences and exploitation of adult-like

privileges resulting in rebellion (Kostić et al., 2015, p. 81).

For Derek’s case, a cause of his negative behaviour may be due, in part, to the influence

his peers have on him. The situation pertaining to his most recent arrest for shoplifting included

multiple friends; despite him and another friend being the only ones who were arrested for the

crime. Derek’s assessment with the psychologist indicated that he considered his friends to be

family (Case Study). His outlook on his friends and the negative behaviour they participate in

together may have caused the conduct disorder. Additionally, due to the lack of involvement

from his father, it is plausible that the disordered behaviours stemmed from an exaggerated need

to take an adult role.

Treatment

Due to the dynamic and individualistic nature of conduct disorder, it is only fitting to

create an integrative plan for treatment that is specific to the patient. In Derek’s case (Case

Study), the treatment plan should include interventions for conduct disordered behaviours

influenced by environmental factors and low self-esteem. It is pertinent to prescribe a realistic

and effective treatment plan because due to his age, he is most likely to continue to behave

antisocially in adulthood.

Comorbid with Depression

It is not uncommon for individuals with conduct disorder to also show symptoms of

depression. The externalizing problem behaviours displayed by the patient are the most

noticeable to others and is probable cause for psychiatric assessment; however, often times it

coincides with internalizing behaviours, such as low self-esteem, and ultimately depression
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(Reinecke, 1995). The co-morbidity of these two disorders make treatment more difficult.

Overall, the clinician must use problem-solving skills to create an individualized plan that

integrates treatment for conduct disorder and depression (Reinecke, 1995).

Rohde, Clarke, Mace, Jorgensen, and Seeley (2004) conducted an experiment examining

the effectiveness of cognitive-behaviour therapy for juvenile adolescents with comorbid

depression and conduct disorder. A portion of participants underwent the Adolescent Coping

with Depression course (CWD-A) while others participated in a life skills training course (Rohde

et al., 2004). The CWD-A course, entailed targeting symptoms of depression and the use of

cognitive-behavioural techniques to change conduct disordered behaviours (Rohde et al., 2004).

Rodhe and colleagues (2004) trained the participants on how to better their social skills and

communication, strategies for conflict resolution, decrease depressed symptoms, and how to

prevent disordered behaviours. The researchers found significant improvements in depressive

mood states and social functioning after the intervention (Rohde et al., 2004). In terms of long-

term effectiveness, this intervention was better suited to treat the depression for the individuals

with comorbid conduct disorder (Rohde et al., 2004). It has been suggested to target each

disorder separately with multiple intervention measures (Rodhe et al., 2004).

In general, cognitive-behavioural therapy is an effective treatment for individuals who are

diagnosed with conduct disorder. This intervention targets multiple factors that contribute to the

disorder and aims to change cognitions and behaviours (Choo, 2014). In order to accomplish

this, the psychologist should focus on giving instructions for effective social skills and self-

reflection and rewarding prosocial behaviour while discouraging antisocial behaviour (Choo,

2014). Choo (2014) suggests the integration of anger management interventions specifically for
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aggressive individuals that use hostility as a form of conflict resolution. It is also important to

incorporate parental involvement and academics for maximal rehabilitation (Choo, 2014).

An individual like Derek Pratt would benefit from intervention programs as described

above. In his assessment with the psychologist, it was noticed that Derek was expressing

negative feelings about himself suggesting a subclinical form of depression (Case Study). In

order to improve his self-esteem, the Adolescents Coping with Depression course (Rodhe et al.,

2004) may be effective. Additionally, cognitive-behavioural therapy should be used in order to

treat the moderate conduct disorder. According to Derek’s assessment, it would be effective to

incorporate anger management and social skills training because of multiple hostile comments

toward the psychologist and his overall lack of respect for others. Derek would benefit from

rewards for prosocial behaviour and discouragement for disordered behaviours in order to

prevent recidivism and ultimately, keep him away from the criminal system.

Family Therapy

An individual’s environment influences the progression of conduct disorder. Logically, it

is important to target these factors within the patient’s environment in treatment.

There are a number of family therapy strategies that are effective based on the specific

situation in which conduct disorder exists. Multisystemic therapy is prescribed for individuals

who display disordered behaviours and includes his or her family (Henggeler & Sheidow, 2012).

It is theoretically based on the understanding that poor academics, limited parental guidance, and

delinquent peers contribute to conduct disorder (Henggeler & Sheidow, 2012). As such,

multisystemic therapy acts to target these factors and improve them. To accomplish this,

qualified therapists will work focus on the specific problem areas the patient is experiencing,

such as behavioural therapy to target disordered behaviours, and on how to reduce caregiver
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barriers (Henggeler & Sheidow, 2012). There are multiple ways to treat conduct disorder but

importantly, it is highly individualized. The therapist will create intervention programs for the

patient and their families until there is improvement (Henggeler & Sheidow, 2012).

This therapeutic strategy is especially important for Derek and his father. The onset of

Derek’s conduct disorder seems to have been highly influenced by multiple environmental

factors. The relationship that he has with his friends is toxic because they participate in

delinquent behaviours together and do not care for the consequences. Also, Derek’s academic

performance has severely declined (Case Study). Multisystemic therapy would work to correct

these negative aspects of Derek’s life to increase the chance of rehabilitation. Additionally, Mr.

Pratt would benefit from therapy to increase his involvement in his child’s life and ultimately,

improve positive role modelling skills to display to his son. However, the therapist would have to

conquer the issue of active involvement in the treatment of Derek because he and his father do

not have a good attendance record for previous attempts for family therapy (Case Study).

Overall, Derek would benefit from an integrative approach to treating the moderate

conduct disorder. This treatment regimen should be effective in the prevention of antisocial

personality disorder in adulthood.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing.

Barlow, D. H., Durand, V. M., Hofmann, S. G., & Lalumière, M. L. (2015). Abnormal

psychology: An integrative approach (5th ed.). Toronto, ON: Nelson Education Ltd.

Case study.

Choo, C. (2014). Adapting cognitive behavioural therapy for children and adolescents with

complex symptoms of neurodevelopmental disorders and conduct disorders. Journal of

Psychological Abnormalities in Children, 3(3), 1-3. doi: 10.4172/2329-9525.1000124.

Frick, P. J., & Nigg, J. T. (2012). Current issues in the diagnosis of attention deficit hyperactivity

disorder, oppositional defiant disorder, and conduct disorder. Annual Review of Clinical

Psychology, 8, 77-107. doi: 10.1146/annurev-clinpsy-032511-143150.

Henggeler, S. W. & Sheidow, A. J. (2012). Empirically supported family-based treatments for

conduct disorders and delinquency in adolescents. Journal of Marital and Family

Therapy, 38(1), 30-58.

Kostić, J., Nešić, M., Marković, J., & Stanković, M. (2015). Developmental taxonomy of

conduct disorder. Acta Medica Medianae, 54(4), 79-83. doi: 10.5633/amm.2015.0412.

Reinecke, M. A. (1995). Comorbidity of conduct disorder and depression among adolescents:

Implications for assessment and treatment. Cognitive and Behavioural Practice, 2, 299-

326.

Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An

efficacy/effectiveness study of cognitive-behavioural treatment for adolescents with

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comorbid major depression and conduct disorder. American Academy of Child and

Adolescent Psychiatry, 43(6), 660-668.

Salvatore, J. E., & Dick, D. M. (2016). Genetic influences on conduct disorder. Neuroscience

and Biobehavioral Reviews, p. 1-11.