Conduct disorder
| Classification according to ICD-10 | |
|---|---|
| F91.0 | Conduct disorder confined to the family setting |
| F91.1 | Disorder of social behavior in the absence of social ties |
| F91.2 | Disturbance of social behavior with existing social ties |
| F91.3 | Disorder of social behavior with oppositional, defiant behavior |
| F91.8 | Other conduct disorders |
| F91.9 | Conduct disorder, unspecified |
| ICD-10 online (WHO version 2019) | |
Conduct disorders are mental disorders and behaviors in children and adolescents that violate the basic rights of others or important age-related expectations. The international classification of diseases ( ICD-10 ) defines it as a repetitive and persistent pattern of antisocial , aggressive or rebellious behavior.
Classification
According to ICD-10
In ICD-10 the WHO all internationally recognized diseases are listed and encrypted. The disorder of social behavior was divided into different subgroups, as there are significant differences in severity that also play a role in diagnostics and prognosis :
- F91 conduct disorder
- F91.0 Conduct disorder confined to the family
- F91.1 Disorder of social behavior in the absence of social ties
- F91.2 Disorder of social behavior in the presence of social ties
- F91.3 Conduct disorder with oppositional, rebellious behavior
- F91.8 other conduct disorders
- F91.9 Conduct disorder, unspecified
(The following is excluded from this disorder: F90.1 Hyperkinetic disorder with disorder of social behavior. The hyperkinetic disorder corresponds to attention deficit and hyperactivity disorder (ADHD) of the DSM .)
The following also count as a separate group of disorders:
- F92 Combined conduct and emotional disorder
- F92.0 conduct disorder with depressive disorder
- F92.8 Other mixed conduct and emotional disorder
- F92.9 combined disorder of conduct and emotions, unspecified
In the DSM-IV TR , the manual of psychiatric disorders of the American Psychiatric Association (APA ), “ behavioral disorders ” in children and adolescents are understood more broadly than in the WHO manual. Relatively minor violations of social norms are permitted as key symptoms.
Description of the individual subgroups
- Social behavior disorder related to the family setting: The abnormal behavior here is almost entirely limited to the members of the nuclear family or can be found in the domestic setting.
- Disorder of social behavior in the absence of social ties: Regarding the above The main symptom is a clear and extensive impairment of relationships with peers and usually also with adults.
- Disorder of social behavior with existing social ties: The integration with groups of peers is intact. These are often antisocial or delinquent peers. Relationships with adults are mostly bad.
- Disorder of social behavior with oppositional, rebellious behavior: This form of disorder is typical in children under 10 years of age. It is characterized by clearly rebellious, disobedient and defiant behavior. Outbursts of anger are often found with low frustration tolerance. The behavior is mostly directed against adults.
- Combined disorder of social behavior and emotions: In addition to the main symptoms of the disorder of social behavior, symptoms of an age-specific emotional disorder, an adult-typical neurotic disorder or an affective disorder must also be met. Depression is very common here.
frequency
The prevalence in primary school age is around 1–2 percent, in adolescents between 4 and 6 percent. The rates have probably increased in recent years. They are higher in cities than in the country. The proportion of conduct disorders in late childhood in psychiatric treatment cases is around 50 percent.
Often delinquent acts are not recorded in official statistics. The dark field (i.e. the criminal offenses not recorded) is much higher. In anonymous surveys, almost all 14-year-old boys admit that they have committed acts that violate applicable legal norms. Overall, boys are 4 to 5 times more likely to be affected than girls.
diagnosis
In order to be able to make a diagnosis according to the ICD-10, various requirements must be met. This means that the child or adolescent must show rebellious or aggressive behavior over a period of six months.
Guiding symptoms
- Significant level of disobedience, arguing, or bullying
- Unusually frequent or severe outbursts of anger
- Cruelty to other people or animals
- Significant destructiveness to property
- Ignition
- Steal
- Frequent lying
- Skip school
- Running away from home
If the symptoms are correspondingly severe , such as repeated willful destruction of the property of others, a single one of the key symptoms mentioned may be sufficient for the diagnosis. Individual antisocial or criminal acts, however, such as the one-time stealing of chewing gum or a minor brawl in the school yard do not justify a diagnosis. It is important that the frequency and seriousness go beyond normal stupidities or pranks by children and adolescents.
In many cases, the behavior is characterized by numbness and malice, as well as a lack of repentance.
If the child or adolescent is a member of a gang and he does not show any psychiatric abnormalities, the diagnosis cannot be made either.
Comorbidity
A very common comorbidity found in attention deficit hyperactivity disorder (ADHD) and substance abuse of alcohol, drugs and medicines. Further cormorbid disorders are depressive disorders , phobic or anxiety disorders , suicidality and paranoid attributions.
frequency
Behavioral disorders are the most common diagnoses in child and adolescent psychiatry. Research has shown that 8 percent of boys and 3 percent of girls between the ages of 4 and 16 suffer from a conduct disorder. In adolescence, this proportion increases to as much as 16 percent among boys. The peak of the occurrence is around 17 years, but declines sharply later. Violence and property crimes can mostly be traced back to male adolescents.
causes
Overall, unfavorable psychosocial influencing factors, especially those from the family environment, seem to be of decisive importance in the development of behavioral disorders . There is evidence that families who “show affection for their children, clearly express moral principles and require their children to abide by them, use punishment fairly and consistently, and explain and justify their behavior” generally do not Raising behavioral children.
Another model for the development of the disorder of social behavior states that the combination of various factors favors the occurrence of the disorder and the increased occurrence of unfavorable developmental conditions also allows a statement to be made about the course of the disorder. Both unfavorable temperament factors in the child (motor restlessness, impulsiveness and attention disorders) and the child's tendency to break social rules in order to achieve their own goals or to increase self-esteem play a role. In the family environment, emotional neglect , witnessing parental disputes and a style of upbringing that threaten or use violence are particularly unfavorable. Behavioral disorders of the parents also have an aggravating effect. This is where rule violations and antisocial behavior can have an unfavorable effect. In the case of social behavior disorders, it was also possible to demonstrate that young people in particular who display violent behavior were often physically and / or sexually abused as children by their parents or other caregivers . In addition, partner problems and the dominant behavior of a caregiver are also mentioned as significant risk factors. A negative or inconsistent relationship pattern, the lack of warmth, acceptance, and emotional support seem to be just as significant. Psychiatrically conspicuous family members represent a further risk factor. Delinquency, alcohol addiction, affective disorders, schizophrenia and activity and attention disorders, which are often found in the families of affected adolescents and children, are particularly important here.
In addition to these personal risk factors in the families of those affected, other risk factors play a role. Psychosocial factors such as a large number of children in the family as well as cramped and unfavorable living conditions show statistically negative effects.
The families of those affected are often characterized by few joint actions. There is no teaching of how to deal adequately with everyday stress, as is the teaching of clear rules. It is noticeable that the educators are rarely informed about the whereabouts of their children. The inadequate communication does not give the children any expectation that their parents will even find out about their children's misconduct.
These unfavorable influences lead to disorders in the development of self and self-worth in the child. Possible influencing factors are also poor performance in school (here a partial performance weakness , language development disorder can also be responsible). The child's negative self-image as well as negative future expectations and multiple defense mechanisms distort social perception. Adolescent risk behavior can emerge and stabilize. The development tasks can no longer be mastered. After all, the young person can only join deviant groups who deliberately do not behave in accordance with the norms.
In children and adolescents, there is relatively little involvement of genetic factors in the disorder of social behavior . However, there are indications that milder forms of recurring delinquent behavior are more strongly attributable to genetic influences than serious individual acts. A much greater involvement of genetic factors has also been demonstrated in adults. The correlations with hyperkinetic disorders also indicate a significant contribution to genetic influences.
Gradient forms
The prognosis for conduct disorders are different. Around half of those affected meet the criteria of a dissocial personality disorder in adulthood . Antisocial and aggressive behavior often start in childhood. Nevertheless, after one to four years, around half of those affected no longer have all of the symptoms necessary to justify the diagnosis. Nevertheless, most of the people examined continued to have behavioral problems . Overall, the course of a disorder of social behavior is very often unfavorable.
The conduct disorder may have two different courses. One in which the behavioral problems begin at the age of three and persist into adulthood with serious legal violations. In the other form, the abnormalities are limited to adolescence.
So if you start before the age of 10 you have to assume a rather unfavorable chronic course to antisocial personality disorder . The prognosis is more favorable if it starts after the age of 10.
The treatment options are varied. The interventions depend on the severity of the disorder and the ways in which it can be treated. A possibly diagnosed comorbid disorder also plays a role. In certain cases, different disorders should be treated at the same time.
treatment
Outpatient treatment
Outpatient treatment begins primarily with the parents. So the positive parental qualities need to be reinforced. Training in developing consistent positive and negative consequences, rethinking tough, permissible parental parenting practices. Negative and stressful factors in the parents must also be reduced or treated.
The child or adolescent should be separated from problematic peer groups. He should be helped to find suitable peer groups. Problem-solving training, the involvement of family help or the search for extra-family accommodation and the search for a suitable type of school can also help.
In the case of adolescents, multisystemic treatment with approaches from those affected, family relationships, the school or work environment, the peer group and leisure time behavior can be helpful. Vocational preparation measures, cooperation with the juvenile courts, juvenile court assistance and probation assistance are also useful.
Partial inpatient accommodation
There must be a helpful therapeutic milieu, if the group is not composed predominantly of dissocial children / adolescents. Modification of behavior in the group must also be possible. Necessary parent training is easier to implement with day-care accommodation . The school program offered can help to catch up with school difficulties and provide support for partial performance weaknesses if it is structured sufficiently in terms of behavioral therapy. Problem-solving training is easier to incorporate in this context and it is easier to increase social competence. Concomitant psychiatric disorders can be treated more systematically if the parents agree. Otherwise, the procedure is the same as for outpatient treatment.
Inpatient treatment
Is similar to that of day-care treatment. A gradual return to the family should be started here.
Pharmacological treatment
A causal treatment of the disorder is not possible. Rather, it is common to treat individual symptoms such as restlessness and aggressiveness symptomatically. As a rule, low-potency neuroleptics such as B. Pipamperon or Melperon application.
Basically, psychopharmacotherapy should be integrated into an overall treatment plan that also includes psychotherapy and sociotherapeutic measures.
Youth welfare measures
The possibilities of youth welfare according to the Child and Youth Welfare Act (KJHG) are above all family help and educational assistance . The accommodation can also be provided by youth welfare. A children's home , an intensive living group or a socio- educational community (SpLG) should be considered here. Classic long-term foster families who work in accordance with Section 33 SGBVIII are excluded from this work. The main reasons for this are the lack of professional background.
Often, even if there is a disorder of social behavior, aids to educate the affected children and adolescents are used. Above all, intensive socio-educational individual care , which combines elements of individual aid and experiential education , is used here to help young people.
See also
- Dissocial Personality Disorder
- Borderline personality disorder
- Psychopathy
- Sociopathy
- Juvenile delinquency
literature
- Andreas Beelmann, Tobias Raabe: Dissocial behavior of children and adolescents. Hogrefe, Göttingen 2007, ISBN 978-3-8017-2041-4 .
- Hautzinger (eds.), Davison and Neale: Clinical Psychology . BelzPVU, Weinheim 2002, ISBN 3-621-27458-8 .
- Horst Dilling, Werner Mombour, Martin H. Schmidt : International classification of mental disorders. ICD-10 Chapter V (F). Clinical diagnostic guidelines. 5th edition. Huber, Bern 2002, ISBN 3-456-84124-8 .
- Resch et al .: Developmental Psychopathology of Childhood and Adolescence. A textbook . PVU, Weinheim 1999.
- Manfred Döpfner , Stephanie Schürmann, Gerd Lehmkuhl : Wobble Peter and Defiant Head. Help with hyperkinetic and oppositional behavior . BelzPVU, Weinheim 1999.
Individual evidence
- ↑ Helmut Remschmidt , Martin Schmidt , Fritz Poustka: Multiaxial classification scheme for mental disorders of children and adolescents according to ICD-10 of the WHO . 6th edition. Huber Verlag, Bern 2012, ISBN 978-3-456-85102-0 .
- ↑ a b c d e B. Blanz: 2003 disorders of social behavior and juvenile delinquency . In: Günter Esser (ed.): Textbook of clinical psychology and psychotherapy of children and adolescents . Thieme, Stuttgart 2003.
- ↑ B. Blanz et al. (1990): Conduct disorders: The reliability and validity of the new ICD-10 categories . In: Acts Paedopsychiatrica , 53; 93-103.
- ↑ MH Schmidt (1998): Dissociality and aggressiveness: knowledge, action and ignorance . In: Journal for Child and Adolescent Psychiatry , 26th year, pp. 53–62.
- ↑ a b c d Hautzinger (Ed.): Davison and Neale (2002): Klinische Psychologie. Weinheim: BelzPVU.
- ↑ Horst Dilling, Werner Mombour, Martin H. Schmidt : International Classification of Mental Disorders. ICD-10 Chapter V (F). Clinical diagnostic guidelines . 5th edition. Huber, Bern 2002.
- ↑ a b Dt.Ges.f. Child and adolescent psychiatry and psychotherapy etc. a. (Ed.): Guidelines for the diagnosis and therapy of mental disorders in infants, children and adolescents . 2nd revised edition. Deutscher Ärzte Verlag, 2003.
- ↑ a b Resch et al. (1999) Developmental Psychopathology of Childhood and Adolescence. A textbook . PVU, Weinheim.
