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Mar 172013


If your child is defying authority, acting out, skipping school, bullying other kids, breaking the law, acting violent, using weapons or any number of symptoms such as this, s/he may be diagnosed with “Conduct disorder” CD. Here is a link to the American Academy of Child and Adolescent Psychiatry web site http://www.aacap.org/cs/root/facts_for_families/conduct_disorder giving easily understood information about this diagnosis.

You will notice however, if you read the article here and followed the link to Oppositional Defiance Disorder that the symptoms of the two diagnoses overlap almost completely. In my mind at least, there’s not enough difference in the two to be meaningful as far as treatment goes.

There is a percentage of these children who will, when they are over age 18, be accurately diagnosed as psychopaths or Anti-social personality disordered. Unfortunately there is no way to tell at 12, 13, or 15 for sure which of the adolescents with ODD or CD who will respond to treatment and which will not.

Not all medical insurance pays a significant portion, if any, of mental health treatments for adolescents with these problems, and it is sometimes difficult to impossible to find an appropriate treatment modality for these individuals. In addition to ODD or CD many of these adolescents also have ADHD or bi-polar disorder which may start rearing its head at this age. Finding a good clinician to evaluate the individual is sometimes also difficult. As the AACAP web site states, treatment will be lengthy and difficult as there may be little or no cooperation from the child.

There was a story in the news a while back about an American nurse who adopted a child from Russia and after some period of time, she put the child, alone, on a flight back to Russia with a note that said she couldn’t handle him and was sending him back. This event caused an international incident resulting in Russia stopping adoptions of children from that country by Americans.

Her hometown newspaper, said http://www.t-g.com/story/1625110.html

“a Shelbyville woman put a young Russian boy she had adopted on a one-way flight back to his homeland unaccompanied.Artyom Savelyev, who carried the adoptive name Justin Hansen, got off a flight from Washington on Thursday at a Moscow airport, the Kremlin children’s rights office said Friday. The boy was listed as 7 years old by some media outlets and 8 by others.

The office said he was carrying a letter from his adoptive parent, Torry Hansen of Shelbyville, saying she was returning him due to severe psychological problems.

“This child is mentally unstable. He is violent and has severe psychopathic issues,” the letter said, according to Russian officials, who sent what they said was a copy to The Associated Press. “

While the news reports and every article I read about this event criticized this woman for what she did, have some empathy for her. I don’t agree with how she handled this situations, but I do realize she was probably at her wit’s end in dealing with a child with probable CD or ODD at an early age.

Apparently many of the children available for adoption from Russia are ones from families with unstable emotional backgrounds and many of the children have been severely neglected or abused already, so it is not unusual for a child to have fetal alcohol syndrome to one degree or another or to come from a family with multiple mental problems. Add the neglect, abuse and poor DNA prospects, and the child may have little chance at that point to even bond with the very best of nurturing parents.

Even in the US the “adoption syndrome” has been noticed that a higher percentage of adopted children are problematic than in the general population. Back in the day when children were presumed to be born blank slates on which environment wrote all, the parents were blamed, or the child was assumed to blame the birth parents for abandoning them and this was accepted as why adopted children were more apt to be problems.

Now that medical science has finally accepted what every breeder of dogs or livestock has known for centuries, “attitude is genetic.” The average Beagle has one disposition and the average wolf has another disposition. True, you can take a wolf pup off its mother the day it is born and suckle it on the Beagle, but when it grows up, it will be a wolf, not a domestic dog. In most cases a “tame” wild animal is more dangerous than a wild one that at least fears man and tries to run away.

People have DNA that influences our behavior and attitudes just like animals do. Genes though are not destiny. Genes can be turned on or turned off by environment. My family has the gene for type II diabetes and I gained enough weight in middle age that I turned that gene on and my blood sugar went too high and my blood pressure started to rise. If I had not gained that weight I probably would never have had sugar problems or elevated blood pressure.

People who are born to parents who have the gene for alcoholism may or may not inherit that genetic tendency to become addicted to alcohol. I came from a family that had addictions to alcohol and nicotine and I apparently inherited the gene for addiction to nicotine and not alcohol as I can take alcohol or leave it, but I crave nicotine even though I long ago stopped smoking. Many psychological illnesses and problems are now known to be influenced by genes and by environment. Bi-polar, formerly called manic-depressive disorder, depression, schizophrenia, Conduct Disorder, Oppositional Defiance disorder, Anti-Social Personality Disorder, ADHD, and many many more.

If a child is abused or neglected, s/he I think is more inclined to develop any number of problems, but they can also develop these problems in what appears to be an ideal nurturing home with good parents who do their best to provide a good environment for their children in which their siblings grow up to be typical members of society.

Unfortunately, though, even many mental health professionals, schools and police, seem to tend to “blame” the parents 100% for the child’s conduct.

One lady I counseled had a 16 year old son who was frankly bi-polar and manic most of the time, and who was ODD, and threatening to burn the house down while she slept if she didn’t let him do what he wanted to, the psychiatrist told her, “Just make him take his medication.” How, pray tell, is she going to make this son who is bigger than she is swallow pills three times a day? She called the police, but they wouldn’t do anything until AFTER he committed a crime.

This poor woman was at her wit’s end, literally, in trying to find help for her son. Trying to save her son from himself. She wasn’t able to succeed in saving her son from himself, but with support, she came to accept that he is what he is and that she will never have a “typical” mother-son relationship with him. She still loves him, but sees him seldom and no longer spends her life worrying about him any more, but is moving on with her business and with her life.

Sometimes accepting what the situation is and realizing that you did the best you could to fix it will be the best outcome we can find, but other times we succeed in making the situation better. We just have to find the place when we know to keep working, or know that we must “let go, and let God.”

Joyce Alexander, RNP, retired








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  6 Responses to “Conduct Disorder”

  1. I am always somewhat reluctant to adopt labels such psychopaths, people with “conduct disorder”, or “personality disorder” as these have meanings can be applied to a great variety of abnormal personalities.
    The habit of labelling or diagnosing personalities comes from the tendency to imitate the medical profession where a disease can be labelled and then this label leads you to a treatment.

    This certainly does not always apply to labelling personalities. Let us face it, the psychiatric and psychological profession have been rather unsuccessful in providing successful treatments for personality]y disorders under whatever name.

    None of the labels seems to give a clue as to what causes a person to become addicted to drugs, and as a result behave in unacceptable ways following that addiction.

    Since most criminal behaviour involves drug addiction it may be worthwhile to examine why some people become addicted to drugs and while others don’t.

    I believe that one reason is the reluctance by many professionals to look outside their square by refusing to look at alternative interpretations and possibilities.

    See for instance:
    Why Addiction to Marijuana

    • Oh, I agree with you, about the “labels” in fact I read an article just yesterday in a medical professional magazine about such “labels.”

      With the cry in America for “gun control” and for back ground checks and to keep people who are “mentally ill” from being able to own or purchase a gun, those “labels” are very important.

      While medical science and the genome project have shown much about the heritability for the tendency for depression, bi-polar, etc. as well as a multitude of other mental illnesses, again, I repeat, genes are NOT destiny. Many other things in the environment influence a person’s thinking and acting.

      “Addictions” in many cases (including to alcohol) are shown to be attempts at “self medication” for depression, bi-polar, PTSD etc. and if the mental illness is appropriately treated, the “substance addiction” is not as difficult to treat.

      While I agree with you, Jurplesman that many “criminals” or the chronically mentally ill who because they lack proper medical care since the 1980s when the US “de-institunalized” these individuals and took them out of institutions and essentially cast them upon the street where they were unable to function, and the appropriate outpatient care that was supposed to materialize never did. These people make up, unfortunately many of the addicted, down trodden, homeless and unable to cope people who wind up in jails and prison on a revolving door process that takes up time that would better be spent with social workers and medical personnel treating these people and police going after the chronically violent sociopaths who are dangerous to society.

      Unfortunately you are righty Jurplesman, there is no successful treatment for the morally deficient person who is not “mentally ill” just without conscience or empathy. No drug, and no therapy helps, in fact, research has shown that psych therapy actually makes sociopaths worse, it gives them the “words” to pretend to “improve” but they use it to mask their real intentions for malice. Thanks for commenting.

  2. And yet, many of these unfortunate people can be helped if we were just able to broaden our mind and look at a new field of science ( for those who have never studied nutritional biochemistry) of nutritional psychotherapy.

    Even many nutritional scientists tend to overlook the overwhelming influence of pre-diabetc insulin resistance called hypoglycemia (http://www.hypoglycemia.asn.au/2011/what-is-hypoglycemia/,) on mood disorders.
    Hypoglycemia and Depression by Stephen Gyland

    showing that nearly 90% of hypoglycemic people suffer from depression, a figure that agrees with our own studies whilst testing offenders in the prison system.

    The incidence of hypoglycemia in the community is pretty prevalent and not generally acknowledged See: http://www.hypoglycemia.asn.au/2011/research-evidence-for-hypoglycemia/#Pre

    If you look at the Western diet since the second world war, the food industry dictates what we should eat and not eat. The natural paleolithic diet has virtually disappeared. Despite the “advances” made in medical science, more and more people are sick and it is no wonder that diabetes and its allied diseases has become the most common disease in our society. The cruel irony is that this disease is preventable if only doctor would recognize pre-diabetes (hypoglycemia) as a separate disease from diabetes and therefore be able to test for it. But so far few doctors are familiar with the test for hypoglycemia as distinct from diabetes.

  3. Jurplesman, Hypoglycemia (low blood sugar) frequently DOES come before full on diabetes, you are right about that. However, “diabetes” per se is now seen as a part of a triad of diseases consisting of “diabetes” (problems regulating sugar into and out of the blood steam and cells) vascular diseases (hardening of the arteries along with plaque build up) and high blood pressure now called “Metabolic syndrome”–because if you have one chances are you have all three but they are interconnected.

    Yes, there is some dietary problems there, and LACK OF EXERCISE as well as the genetic tendency for high cholesterol and high triglycerides manufactured by the body, plus, a diet high in refined sugars, transfatty acids, and cholesterol.

    Since the body and the mind/brain are NOT “two” different things, but INTERCONNECTED PARTS of a WHOLE, these things all work together to control emotional ups and downs and thinking, which are strongly influenced by geneticly targeted anatomy and chemistry.

    It has long been proven that “stress kills” both in animals and in humans, and physical and emotional stress decrease not only the quality of life but the quantity as well. Stress also has a negative effect on metabolic syndrome, and they have now recently proven how the “broken heart syndrome” works, and YES people DO die of a “broken heart.” The stress of the death of a loved one or some great disappointment can actually STOP the heart chemically.

    The medical and psychological field need to look at the human body and brain as a whole, and realize that what does damage to one damages the other. Stress reduction and nutrition and both important aspects of a healthy life.

  4. Joyce, I wanted to rekindle this discussion because it’s an important factor in determining toxicity to the “Self.” Whether the individual is our own offspring, or another family member (or, friend), understanding and accepting what ODD is, in essence, is priceless in self-protection.

    For me, Mike was clearly dangerous. He refused to adhere to rules, EVEN when it was to his own benefit to do so. Yes, I had a difficult time sitting still and keeping my mouth shut, and I often was impulsive and did very stupid things. But, I had a conscience and felt sorry for the things that I did and, after having done enough of them, made an effort to avoid the impulsivity because it always ended badly.

    A formal diagnosis of ODD or CD should be taken seriously inasmuch as nothing is going to alter this individual’s brain functions. They MAY outgrow rebellion and teenaged angst, and that cannot ever be predicted. But, chances are that ODD or CD will evolve into either criminal choices or behaviors that are more subtle and manipulative.

    In retrospect, the exspath used to recollect stories of how he avoided gym classes and academics by faking illnesses. I remember his family members also talking about the epic tantrums that he threw prior to adolescence. Screaming fits and tantrums were commonplace, and nothing could be done to prevent them. As an adult, the exspath was a SUPREMELY passive/aggressive manipulator that would cause others to believe that THEY actually came up with hairbrained ideas and that bad outcomes were THEIR faults – all the while, he would use words and insinuations to his successful advantages.

    While I agree with some aspects of nutrition and so forth, I also know that ODD and CD behaviors result in frustration, defeat, and a sense of helplessness for parents. I have heard SO many parents recall that physicians, psychologists, and psychiatrists treated their dire concerns about their children’s behaviors as overblown and obsessive by the parents! “Why would you WANT me to diagnose your child with ___________?” was what one professional said to a very concerned parent.

    UGH………..there’s no easy solution to this.

  5. Truthy, my son Andrew is VERY ADHD and was diagnosed and Rx’d Ritalin way back in the day when this was the new “wonder drug” in the 70s….but it made him like a zombie, so I took him off and sought alternative ways…I stumbled upon the Feingold Diet for ADHD and thought “it can’t hurt” and maybe could help, so though it was a 24/7 project I did it 100% and guess what IT HELPED HIM A LOT…but it had to be adhered to 100% to be effective at all, and he felt better so he did it and I did it and it worked.

    Years later, doctors said “this is voo doo” and not at all useful, and so for years the diet method languished in the “voo doo” closet, but recently they have done some very good double blind studies and GUESS WHAT? For a SUBSET of kids with ADHD it DOES WORK, and so I was not crazy, the diet works for SOME kids, but not all, who are ADHD.

    Yet, in addiction to medication or diet, etc. there needs to be good parenting going along with the treatment (whatever that is) to help a child, and unfortunately, there are some kids that the BEST in medication, diet and parenting is NOT GOING TO HELP. They will grow up to be Adam Lanza or my son Patrick or probably your son Mike.

    And, you are right, many mental health professionals are loath to diagnose someone with a condition for which there is not much if any “hope.”

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