| 1.
Differential Diagnosis
Although Oppositional Defiant
Disorder includes some of the features observed in Conduct
Disorder (e.g., disobedience and opposition to authority figures),
it does not include the persistent pattern of the more serious forms
of behavior in which either the basic rights of others or age-appropriate
societal norms or rules are violated. When the individual's pattern
of behavior meets the criteria for both Conduct Disorder and Oppositional
Defiant Disorder, the diagnosis of Conduct Disorder takes precedence
and Oppositional Defiant Disorder is not diagnosed.
Although children with Attention-Deficit/Hyperactivity
Disorder often exhibit hyperactive and impulsive behavior
that may be disruptive, this behavior does not by itself violate age-appropriate
societal norms and therefore does not usually meet criteria for Conduct
Disorder. When criteria are met for both Attention-Deficit/Hyperactivity
Disorder and Conduct Disorder, both diagnoses should be given.
Irritability and conduct problems often occur in children
or adolescents with a Mood Disorder. These can usually
be distinguished from the pattern of conduct problems seen in Conduct
Disorder based on the episodic course and accompanying symptoms characteristic
of the Mood Disorder. If criteria for both are met, diagnoses of both
Conduct Disorder and the Mood Disorder can be given.
The diagnosis of Adjustment Disorder
(With Disturbance of Conduct or With Mixed Disturbance of Emotions
and Conduct) should be considered if clinically significant conduct
problems that do not meet the criteria for another specific disorder
develop in clear association with the onset of a psychosocial stressor.
Isolated conduct problems that do not meet criteria for Conduct Disorder
or Adjustment Disorder may be coded as Child or Adolescent
Antisocial Behavior. Conduct Disorder is diagnosed only if
the conduct problems represent a repetitive and persistent pattern
that is associated with impairment in social, academic, or occupational
functioning.
2. DSM IV Criteria
A. A repetitive and persistent pattern
of behavior in which the basic rights of others or major age-appropriate
societal norms or rules are violated, as manifested by the presence
of three (or more) of the following criteria in the past 12 months,
with at least one criterion present in the past 6 months:
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Aggression to people and animals
(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others
(e.g., a bat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching,
extortion, armed robbery)
(7) has forced someone into sexual activity
_____________________________________________
Destruction of property
(8) has deliberately engaged in fire setting with the intention of
causing serious damage
(9) has deliberately destroyed others' property (other than by fire
setting)
_____________________________________________
Deceitfulness or theft
(10) has broken into someone else's house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations
(i.e., "cons" others)
(12) has stolen items of nontrivial value without confronting a victim
(e.g., shoplifting, but without breaking and entering; forgery)
Serious violations of rules
(13) often stays out at night despite parental prohibitions, beginning
before age 13 years;
(13) often stays out at night despite parental prohibitions, beginning
before age 13 years;
(14) has run away from home overnight at least twice while living
in parental or parental surrogate home (or once without returning
for a lengthy period);
(15) is often truant from school, beginning before age 13 years
_____________________________________________
B. The disturbance in behavior causes clinically
significant impairment in social, academic, or occupational functioning.
C. If the individual is age 18 years or older, criteria
are not met for Antisocial Personality Disorder.
Code based on age at onset:
312.81 Conduct Disorder, Childhood-Onset
Type: onset of at least one criterion characteristic of Conduct
Disorder prior to age 10 years
312.82 Conduct Disorder, Adolescent-Onset Type: absence
of any criteria characteristic of Conduct Disorder prior to age 10
years
312.89 Conduct Disorder, Unspecified Onset: age at
onset is not known
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Specify severity:
Mild: few if any conduct
problems in excess of those required to make the diagnosis and
conduct problems cause only minor harm to others
Severity: few if any problems in excess
of those required to make the diagnosis problems cause only minor
harm to others
Moderate: number of conduct problems and effect on
others intermediate between "mild" and "severe"
Severe: many conduct problems in
excess of those required to make the diagnosis or conduct problems
cause considerable harm to others
For individuals over age 18 years, a diagnosis of Conduct Disorder
can be given only if the criteria are not also met for Antisocial
Personality Disorder. The diagnosis of Antisocial Personality
Disorder cannot be given to individuals under age 18 years.
3. Diagnostic Tools:
4. Reference:
American Psychiatric Association: Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition, Text Revision. Washington, DC,
American Psychiatric Association, 2000.
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