Final assignment CAD conduct disorder

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C.Kiessling 1 Final Assignment : Conduct Disorder Department of Social Work, Rutgers University Social Welfare Policy 910:50:96 Professor Griffin December 4, 2023

C.Kiessling 2 Diagnosis: Criteria and Specifiers Conduct disorder (CD) is psychiatric disorder that occurs in children and adolescents under 18 years old. Children with this disorder have severe impairments in life roles due to this diagnosis having strong external symptoms of antisocial, aggressive, and sometimes violent behaviors (Fairchild 2019). These behaviors are repetitive and persistent for the child either starting in early childhood (under age 10) or adolescence (over age 10) (Sadek 2018). The DSM-V update did not change major criteria for CD instead it added specifiers regarding callous and unemotional behavior due to this signaling a more severe form of CD (DSM-V 2022) (Pomeroy 2015). The mean age for diagnosis of CD is 10-11 years old (Gray 2016). This diagnosis requires that the child have three or more out of the listed 15 symptomatic behaviors over one year, along with one behavior criteria met in the last six months. Symptomatic Behavior is defined as one that violates the rights of others and are listed in 4 major categories: aggression towards people/animals, theft, rule violations, and destruction of property (DSV-V, Pomeroy 2015). This disorder also has a severity measure rated mild-severe scale listed with examples in the DSM-V (2022). Misdiagnosis: Role of Stigma and Bias Clinicians have many tools to assist with the diagnosis of a disorder one that can be used to reduce bias and stigma from assessments is the Cultural Formulation Interview (CFI) tool. This tool allows clinicians the ability to obtain important social and cultural information that can impact symptoms and diagnosis of a disorder (DSM V). Keeping this tool in reach is imperative when CD is being suspected since stigma and bias directly affect the diagnosis rates for CD (Fadus 2020). Being able to differentiate between the easily detangled externalizing disorders like ADHD, ODD and CD requires nuance to disseminate, tools like the CFI can help practitioners accurately diagnose (Fairchild 2019).

C.Kiessling 3 Racial Bias: This tool can help avoid perpetuating misdiagnosis of a more severe disorder like CD in children of color has unfolded in current data (Fadus 2020). Youth of color are 2.5 times more likely than whites and 5 times more likely than Hispanic children to receive a diagnosis of CD. This diagnosis carries with it a lifetime of hurdles that put an already at-risk population for less success in life roles (Pomeroy 2015). Misdiagnosis of CD in children of color directly affects the trajectory of the child's life and is correlated with clinicians bias’s regarding social norms in externalizing behaviors (Fairchild 2019). Unites States persistent racism and discrimination cause increased risk to children of color (Pomeroy 2015) and need to be clinically avoided through implementing tools like the CFI. Socioeconomic Status (SES) Bias: Children who come from lower SES are more likely to receive a diagnosis of CD. Children from lower SES are more likely to witness trauma at home and exposed to violence in communities putting them at higher risk for mental illnesses and externalizing behaviors like aggression (Pomeroy 2015). Those who are diagnosed with CD and from a lower SES are 3.5 times more likely to carry the diagnosis into adulthood with pervasive negative effects on quality of life (Fairchild 2019). Clinicians are more likely to address social norms of aggression like yelling or fighting more negatively than for white peers. Being in a higher crime area which follows lower SES communities can increase the risk for children to misperceive threats of danger and have more external reactions for protection (Fadus 2020). Clinicians are responsible for keeping this information up to date when diagnosis closely related disruptive disorders and avoiding misdiagnosis of CD in children from lower SES. Differential Diagnosis: Conduct disorder (CD), Attention deficit hyperactivity disorder (ADHD), and Oppositional defiant disorder (ODD). CD requires a violation of others' rights, and social norms along with callus and is persistent over 1 year during childhood/adolescence to summarize the criteria listed above (DSM V). CD is the most severe of the three diagnoses listed as it is more negatively affects

C.Kiessling 4 aspects of the child's functioning even into adulthood (Fairchild 2019). Many children with CD can also have subsequent diagnoses of ADHD or ODD as they can be diagnosed with one or both at the same time (DSM V). Research indicated that substance use is more prevalent in children with CD and could be quantified in future studies to become a criteria to differentiate between these 3 disorders (Fairchild 2019) ADHD: A diagnosis of ADHD requires impulse and attention dysfunctions but remain typically non-violent in nature of external behaviors (DSM V). The most significant difference ADHD has from CD and even ODD is the focus on inattention effects on functioning especially related to school functioning. Children with CD are 15time more at risk for ADHD than those without CD diagnosis. The fact that these disorders share so much co-morbidity and symptoms is why differentiating can be so difficult between ADHD and CD along with ODD (Fairchild 2019). ODD: A diagnosis of ODD was added in the updating of the DSM-IV to V versions as a comorbid diagnosis with CD. Children with ODD present with defiant behavior to authority figures and deregulated mood which are not included in the criteria for CD (DSM V). It was previously thought that ODD lead to CD but it is now believed to be less transition from one to the next than before (Fairchild 2019). ODD does not include crime like theft, physical harm or destruction of property like the criteria required for CD (DSM V). Children with CD are 15times more likely to meeting the criteria of ODD Lastly it is important to mention the updated specifier for CD of prosocial emotions (PSE) which helps differentiate CD from ADHD and ODD that do not require this. These PSE are listed as callus, lack of concern for performance/guilt and deficient affect in the DSM V and require 2 criteria be met with in 12months for this specifier to be used. Prevalence: Gender and Race

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