Counseling children with conduct disorder

By Laurie L. Hayes, Special to Counseling Today

As many as one in 10 children may have a conduct disorder, according to the U.S. Department of Health and Human Services. Conduct disorders are characterized by the repeated violation of personal or property rights of others and the basic expectations of society. It is among the more difficult behavior disorders to diagnose and even harder to treat.

Some signs of the disorder include aggressive behavior that harms or threatens other people or animals, destruction of property, lying and/or theft. Diagnosis is usually contingent on the exhibition of three or more of these behaviors over the past year and at least one in the six months prior to evaluation.

It is important to note that while "bullying" is common in children with conduct disorder, mental health experts stress that the condition goes far beyond self-assertive or antisocial behavior or isolated incidents of misconduct.

"We're talking about unusual and serious violations of rules," said Jeff Cochran, a counseling psychologist at Georgia Southern University. "A diagnosis of conduct disorder is not based on just a single incident. The behavior permeates the child's life"

Cochran said that children with conduct disorder rarely respond to punishment or any sort of rewards system for good behavior. In fact, he notes, the negative behaviours are likely to escalate along with the punishment.

Most childhood conduct disorders become apparent by age 10, Cochran said, although signs can begin to appear as early as five years of age. Conduct disorders are often seen in conjunction with other problems including hyperactivity, anxiety, depression, academic difficulties or problems with peer relationships. Teachers are usually the first to express concern about the behavior as the child begins to disrupt the school environment or engage their instructors in a power struggle.

This is not to say that the child is not acting out at home as well, Cochran noted. "Parents are slower to refer their children for help, because they often have feelings of guilt about the child's behavior," he said. "In the [upward] spiral of punishment, they may be concerned that they crossed the line of child abuse."

Contributing factors

Children with conduct disorders also are likely come from chaotic home environments. "If both parents are present in the home, there is frequently difficulty in the marriage, said Cochran. In addition, according to the HHS Center for Mental Health Services, children with conduct disorders often experience a lack of supervision or guidance, frequent changes in caregivers, poverty and neglect. They also may surround themselves with a delinquent peer group.

While the exact cause of conduct disorder remains a mystery, obviously all of these issues play a significant role in the onset of the disorder. Researchers continue to investigate several psychological, sociological and biological theories. Most experts do agree that successful treatment depends, in part, on an early diagnosis and the resolution of some or all of these contributing factors.

Effective treatment of conduct disorder is difficult, but necessary, as the problem will not go away without intervention, according to experts. Drugs are usually not effective; therapy can be problematic, but appears to be the most promising approach. Even Cochran, who has years of experience counseling children with conduct disorders, admits to the difficulty.

"These kids are very frustrating to work with," he said. "We're not talking about short-term treatment, especially if the child is living in a home environment that is less than ideal."

By nature, these youngsters are hard to reach and unless the treatment has been mandated by a school or court (which may make them even more uncooperative), they may not attend scheduled sessions. Cochran said it will take at least 10 sessions a year to build a helping relationship. And because of the inevitable stress involved, he recommends that the counselor have other professionals they can consult with without breaking their promise of confidentiality.

At the root of conduct disorder, Cochran believes, is a child's feeling that "no one will love me." This feeling leads to fear, loneliness and anxiety and as these emotions intensify the child begins to drive others away to avoid rejection, according to Cochran.

It is because of this thought process that early intervention is so important, Cochran said, because "you can help these children change their emotional and belief system before it solidifies and is entrenched in their life.

"Through a counseling relationship, you can help these children collect evidence that disputes this thought pattern and show them that they are able to be loved and accepted by the counselor," he continued. Once a counselor is able to challenge their belief system, the children may be ready for a group setting.

Parental involvement

Ideally, any counseling should be done in conjunction with the parent (s) or guardian(s). HHS recommends developing a "system of care" that is designed to improve the child's ability to function in all areas of his or her life - at home, in school and in the community. Whenever possible, children should be involved in the decisions about their care.

In situations where the parents are not available or choose not to participate, it is possible to treat conduct disorder without parental involvement, Cochran said. The child can be challenged to incorporate his or her new belief system into the existing home environment. While this is obviously not the ideal, he said, it can work.

Cochran also points out that a large percentage of a child's life is spent in school which can be a tremendous support system, especially if the school counselor is involved in the child's treatment. However, he notes that some school counselors are hesitant to take on the task of counseling children with conduct disorder because of the difficulty in dealing with their behaviors and the significant commitment of time and energy.

Cochran admits that the time crunch faced by many school counselors could make it difficult for them to accept every suspected case of conduct disorder, but he insists that it is "both possible and important" for them to become involved with the most troubling cases.

"School counselors have access to first hand knowledge of the child's behavior, while an agency has second hand information at best," he said. "They are also in a position to advise and consult with other adults who the child regularly comes in contact with. Most importantly, school counselors are there if a crisis erupts. They can be there to help the child realize what is happening and help them rethink their behavior."

Cochran stressed that dealing with children with conduct disorders requires a great amount of patience, but quickly added that the rewards can more than make up for the frustration. If you get through to them, you are, in essence, showing them how to be loved, he said.