QuestionSBA
QuestionChoice
Methylphenidate is not recommended in conduct disorder but is occasionally used in attention deficit hyperactive disorder (ADHD) to control challenging behaviour
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c
Start methylphenidate
QuestionChoice
This would be appropriate if the child had a co-existing mental health problem, a neurodevelopmental condition, or learning disability, or if there was any indication of underlying mental health disorder
33139
b
Refer to Child and Adolescent Mental Health Services (CAMHS)
QuestionChoice
This child is exhibiting behaviour typical of conduct disorder. Child-focused programmes are usually offered to children aged 9-14 with conduct disorder, involving group social and cognitive behavioural problem-solving exercises with rehearsal and feedback to improve behaviour
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a
Refer to child-focused programmes
QuestionChoice
In parent training programmes, parenting skills are improved by using modelling, rehearsing, and feedback. Parent training is usually focused on children younger than 11 years old and so would unlikely be suggested in this scenario
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e
Refer the father to parent training programmes
QuestionChoice
A health and social care assessment assesses what help and support can be provided at home, such as disability equipment and adaptations to the home, organising respite, and arrangements for parenting classes. In this case, there is no information suggesting they require functional adaptations to their home. Parent training is usually focused on children younger than 11 years old and so would unlikely be suggested in this scenario
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d
Refer for a health and social care assessment by social services
QuestionComment
Patient.info "Community-based help
If the behavioural problems are severe and persistent or a conduct disorder is suspected, ask your GP for advice.

Antisocial behaviours are commonly seen in specialist services. If specialist help is needed, the GP will make a referral to your local child and adolescent mental health service (CAMHS). This specialist team will work together with you, the school and other community groups to support you and your child."
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QuestionComment
I'm also sure that a lot of oppositional defiant disorders (<18y/o) are co-morbid with mood/mental health disorders 
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Zygomatic Lymph
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Chronic Malignant
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# Summary
 
Conduct disorder is a diagnosis characterised by persistent behaviour in patients under 18 that repeatedly violates the rights of others and demonstrates a disregard for societal norms. Key signs include demonstration of physical aggression, destructive behaviour, and stealing. Primary investigations into conduct disorder often involve psycho-social assessments and physical examinations to rule out potential differential diagnoses such as Oppositional Defiant Disorder (ODD) or Attention-Deficit/Hyperactivity Disorder (ADHD). Management strategies typically involve a combination of psychotherapy, family therapy, and in some cases, pharmacological treatments.
 

# Definition
 
Conduct disorder is a psychological diagnosis given to patients under the age of 18 years old who consistently exhibit behaviours and attitudes that disrespect and violate the rights of others, often breaching societal norms and rules, and interfering with the patient's ability to live a normal life. 
 

# Epidemiology
 
While the prevalence rates can vary, conduct disorder is found in 4.6% of 5-19-year-olds in England according to an NHS survey in 2017. Higher rates were observed in boys (5.8%) compared to girls (3.4%). It is most common in those ages 11-16 and is less common to onset after age 16. It is also more common amongst white British compared to Black/Black British or Asian/Asian British populations. 

The disorder is more common in urban areas and among families with lower socioeconomic status. Looked after children in foster care or children's homes show higher rates of conduct disorder.  


# Aetiology
 
The aetiology of conduct disorder is multifactorial, involving a complex interplay of genetic, environmental, and psychological factors. These can include a family history of mental health disorders, childhood maltreatment or neglect, peer influence, and underlying neurological abnormalities. 
 

# Signs and Symptoms
 

The key clinical manifestations of conduct disorder are:
 

 -  Persistent and serious violation of rules, societal norms, and the rights of others
 -  Physical aggression directed towards people and animals
 -  Destructive behaviour, such as arson or vandalism
 -  Deceitfulness or theft
 -  Serious violation of rules, such as truancy or running away from home
 

# Differential Diagnosis
 

In evaluating conduct disorder, several other disorders should be considered, including:
 

 -  **Oppositional Defiant Disorder (ODD)**: Presents with angry and irritable mood, argumentative and defiant behaviour, but usually lacks the severe aggression, violation of societal norms, and respect for the rights of others seen in conduct disorder.
 -  **Attention-Deficit/Hyperactivity Disorder (ADHD)**: Characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. This can be distinguished from conduct disorder by the absence of consistent antisocial behaviours.
 -  **Mood Disorders**: Depressive and bipolar disorders can sometimes be associated with disruptive behaviours. However, in these conditions, mood symptoms predominate and there is usually no persistent pattern of violation of the rights of others.
 

# Investigations
 

Investigations for conduct disorder primarily involve psycho-social assessments by CAMHS, which include:
 

 -  Interviews with the child and parents to gather a comprehensive developmental, familial, and social history
 -  Observations of the child’s behaviour in various settings
 -  Use of standardised assessment tools and questionnaires (Strengths and Difficulties Questionnaire) 
 -  Physical examination and other tests to rule out medical conditions that could contribute to the behaviour
 

# Management
 

Management strategies for conduct disorder may include:
 

 -  **Psychotherapy**: Cognitive-behavioral therapy (CBT) can be effective in helping the child to control their anger and improve their problem-solving skills.
 -  **Family therapy**: This can help improve family interactions and communication, which in turn can reduce symptoms of conduct disorder. 
 -  **Parent training programmes**: Use modelling, rehearsal and feedback to improve parenting skills. 
 -  **Pharmacological treatments**: Not used first line, but in some cases medications may be used to manage comorbid conditions or specific problematic behaviours, such as impulsivity, aggression, or mood symptoms.
 -  **School-based interventions**: These may also be beneficial in promoting positive behaviours and reducing disruptive behaviours.
 

# Prognosis
 

The prognosis of conduct disorder is generally poor:
 

 -  Around 50% of children with conduct disorder develop antisocial personality disorder
 -  Around 50% develop substance misuse issues
 -  Around 40% become recurring young offenders

Younger age of behavioural problems increases the risk of the patient becoming involved with crime. 
 
 
#  NICE Guidelines
 
 [NICE Guideline on Antisocial behaviour and Conduct Disorders in children and Young People: recognition and Management](https://www.nice.org.uk/guidance/cg158) 
 

# References
 
[Royal College of Psychiatrists " Behavioural problems and conduct disorder"](https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/behavioural-problems-and-conduct-disorder-for-parents)

 [Information on Conduct Disorder](https://patient.info/childrens-health/behavioural-problems-and-conduct-disorder)
 
 [WHO Conduct Disorder](https://applications.emro.who.int/docs/EMRPUB_leaflet_2019_mnh_217_en.pdf)
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Conduct disorder
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Paediatrics
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Children with conduct disorder should be reffered to child-focused programmes that utilise cognitive behavioural strategies to improve social skills and behaviour.
A 12-year-old boy is brought to the GP by his father for 12 months of recurrent vandalism, frequent theft of other children's property, repeated episodes of lying to his teachers, and has started smoking. His son does not feel his behaviour is problematic. He often becomes "uncontrollable" at home breaking dishes and furniture with no guilt or remorse in harming others.

He has no history of mental health problems and there is no indication of an underlying mental health disorder. He does not have any developmental disorders or learning disabilities.

Which of the following is the most appropriate next management step?
a