A Review of Effective Therapeutic Treatments for Conduct Disorder Adolescent Onset

A Review of Effective Therapeutic Treatments for Conduct Disorder Adolescent Onset
Lavina L.G. Camacho
Capella University

Author Note Lavina Camacho, Graduate Student of Capella University Correspondence concerning this paper should be addressed to Lavina Camacho, 185 Nalao Place Barrigada, Guam 96913. Email: lavinacamacho@gmail.com

Abstract

Conduct disorder adolescent onset is very concerning since these youth not only engage in risky criminal behaviors that affect themselves, but also those around them. Effective intervention and treatment is needed to decrease the problematic behaviors that are symptoms of adolescent conduct disorder. Effective treatment is also needed since, children and adolescents who have been diagnosed with conduct disorder are at risk for their behaviors to progress with intensity and frequency into adulthood. The following paper will analyze and discuss various versions of cognitive behavioral therapies, family therapies, and multisystemic therapy in relation to the effectiveness in treating conduct disorder adolescent onset. After a literature review of the therapeutic approaches to treat adolescents with conduct disorder, it appears that those approaches that integrate addressing the function of family systems are most effective. Key Words: adolescent, teens, teenagers, conduct disorder, treatment, therapy

A Review of Effective Therapeutic Treatment for Conduct Disorder Adolescent Onset Conduct Disorder Adolescent Onset refers to Conduct Disorder that is diagnosed in young adolescents who develop the symptoms of the disorder after the age of 11. In order to appropriately diagnose conduct disorder in adolescents, the DSM-IV requires that the adolescent meets several criteria for a certain duration. As mentioned by Clarizio (1997) it is required that the adolescent manifests 3 of 15 symptoms that are divided into four categories which are aggression, destruction of property, lying or theft, and serious violation of rules over the past 12 months and have manifested at least one symptom consistently within the last 6 months (pp. 253). Although it is normal for a child during adolescence to venture into deviant behaviors due to their need for autonomy and influence of peers, deviant behaviors of conduct disorder are serious because it not only affects the child’s individual self, but others around them. The term conduct disorder refers to instances when children show a pattern of antisocial behaviors with significant impairment of everyday functioning at home, in school, or where behavior is regarded as unmanageable by significant others (van de Weil, Matthys, Cohen-Kettenis, Engeland, 2002, pp. 79). Conduct disorder in adolescents is concerning since many of these adolescents engage in risky behaviors that are considered criminal and put themselves and others in danger. Adolescents exhibit behaviors that are directly against another individual such as being verbally and physically aggressive or engaging in bullying at school. Their victims of aggression range from their peers at school, siblings, to authority figures such as parents, school personal, and law enforcement. Physical aggression can also take place towards animals by engaging in either torturing or killing of the animal. Other behaviors directed at others include lying and stealing. Conduct disorder also consist of behaviors that are not directed towards others and are also considered not a part of normal functioning. These behaviors include fire setting, truancy, and running away. The effective therapeutic treatment of adolescents with conduct disorder can be of a concern since many of them also have a co-morbid diagnosis. According to Hinshaw and Lee (2003) the problems for children and adolescents with conduct disorder are compounded by the co-occurrence of other childhood psychiatric disorders such as attention-deficit/hyperactivity disorder, oppositional disorder, substance abuse and

dependence disorders, depressive disorders, and anxiety disorders (Singh, Lancioni, Singh Joy, Winton, Sabaawi, Wahler, & Singh, 2007, pp. 56). As a result of the compounded issues of conduct disorder, adolescents are at risk for behaviors to not only progress in intensity and frequency, but also to continue into their adult years. There is a 40% risk factor for an adolescent to develop a serious psychological disturbance in adulthood (Mpofu & Crystal, 2001, pp. 21) and an 80% risk factor for the likely hood of meeting criteria for a psychiatric disorder (Singh et al., 2007, pp. 56). The following paper will serve to report and analyze therapeutic treatments that have been used to address the symptoms of conduct disorder in adolescents to determine the most appropriate therapeutic intervention. Empirical evidence that supports each treatment will also be mentioned. This discussion will be based off scholarly literature that was obtained by using the PsychInfo, ProQuest, and CINAHL databases. In addition, this learner will recreate the dialogue of a hypothetical counseling session which incorporates the theory of cognitive behavioral therapy. Theories of therapeutic treatments that are consistently mentioned in the literature review for treatment of conduct disorder adolescent onset include various methods of cognitive behavioral therapies, family therapy, and multisystemic therapy. Although each theory of therapeutic treatment consisted of individual techniques and outcomes, the secondary goal of all therapeutic interventions is to prevent continuation and worsening of disruptive behaviors as youth progress into adulthood (Eyberg, Nelson, & Boggs, 2008, pp. 217). Cognitive behavioral therapy appears to be researched the most with regards to effective treatment of conduct disorder adolescent onset. Mopfu and Crystal (2001) indicate that cognitive behavioral therapies comprise about 50% of treatment studies on conduct disorders spanning a period of about two decades with cognitive behavior therapies accounting for about 22%, where as other traditional forms of therapy accounted for less than 5% of the studies (pp. 22). There are various approaches of this therapy that are applied at an individual level, as well as with family and group settings. At an individual level, the therapist meets with client to address cognitive distortions about their behaviors. Blake and Hamrin (2007) report that therapeutic techniques range from affective education such as relaxation

training, behavior modification, such as anger control training, to cognitive skills training, such as cognitive restructuring (pp. 218). The goal of individualized cognitive behavioral therapy is to address self regulating behaviors. Cognitive behavioral therapies enable children and adolescents to engage in and take control of their own behaviors, which are important concepts for mental health recovery (Singh et al., 2007, pp. 57). This is accomplished by teaching the adolescent skills to address their anger and aggression as well as problem solving techniques. Skills and techniques are reinforced by assigning the client homework, which usually consist of implementing the skills that are learned in the therapy session into real life situations. Children with conduct disorder usually face their challenges in social contexts, where social cues from other individuals are inappropriately perceived, which then result in aggressive reactions. A technique in cognitive behavioral therapy used among adolescents is to addresses their negative reactions by the use of anger coping interventions or anger training programs. This technique seeks to train adolescents in perspective taking, awareness of physiological arousal as a precursor to antisocial action, use of self instruction, or self talk procedures and problem solving skills (Mpofu & Crystal, 2001, pp. 24). This can be done by engaging the adolescence in role playing. In role play, the therapist insinuates a situation and elicits a natural response from the adolescent while guiding the adolescent in appropriately responding by not inflicting any aggression. Anger training programs are also applied in group settings. In a group setting, adolescents also engage in role play, but with their peers who are within the group setting. Eyberg et al. (2008) describe this group process as a way for children to learn to use problem solving dealing with anger-provoking social situations as they practice appropriate social responses and self statements in response to different problem situations. As part of treatment, the group provides situations that cause the adolescent to become angry while at the same time providing support to the adolescent as she or he practices their new anger controlled strategies. Because of the consistent reinforcement and practice of anger coping interventions and the frequency and intensity of the sessions that occur, adolescents appear to greatly benefit from this technique. This is also made evident by Glover-Orr (1999) who demonstrated that cognitive behavioral therapy-based anger groups could reduce the frequency and severity of behavioral problems among children and adolescent with disruptive

behavior disorders due to parents reporting a decrease in the frequency and severity of problem behaviors (Blake and Hamrin, 2007, pp. 213). Problem solving skills training is also another technique of cognitive behavioral therapy used to assist adolescents in appropriately responding to a variety of behavioral situations. The focus of problem solving training is to assist the adolescent with self regulation and impulse control by encouraging them to stop and calm down, to think about the problem before they act, and to consider the consequences that lie ahead of them if they engage in inappropriate behaviors (Mpofu & Crystal, 2001, pp. 25). Behaviors that adolescents exhibited as a result of conduct disorder as mentioned earlier have great impacts on not just themselves, but also on the people around them. Parents of children and adolescents who have conduct disordered are usually faced with difficulties within the home and within the school as well as involvement in the juvenile court system and mental health system. Although it is not indicative of all conduct disorder cases, Blake and Hamrin (2007) indicate that there is evidence that suggest that negative parenting may indirectly influence antisocial behaviors in children by fostering poor social competence and academic failure (pp. 210). Because of the emotional toll on family members and in some situations poor parenting, systemic family therapy is also seen as an effective treatment for adolescents with conduct disorder. Pinsof (1986) state that family therapy may be defined as any psychotherapeutic endeavor that explicitly focuses on altering the interactions between or among family members and seeks to improve the functioning of the family as a unit and the functioning of the individual family members (Cottrel & Boston, 2002, pp. 573). The idea is that the family is a unit with the child or adolescence composing of a part of the unit. When one part of the unit (the child or adolescent) is negatively affected the whole system becomes malfunction. Family therapy therefore assists the family in not just understanding the symptoms of conduct disorder, but also serves to provide ways that the family can cope with the problems within the family as well as effectively communicate with one another. Family therapy is used in a variety of ways that include focusing on parent-child relational problems, sibling relational problems, and marital discord among husbands and wives. With regards to conduct disorder, conflict normally occurs between the adolescent and parents. Although based on the theories of cognitive behavioral approaches, parent training or parent management programs can also be incorporated as part of family therapy. Parent training programs are based on a model in which social interaction processes between parent and child are thought to play a role in the persistence of antisocial behaviors, hence, parent training models are used to teach parents how to promote desirable behaviors while at the same time minimizing undesirable behaviors (van de Weil et al., 2002, pp. 80). When parents are empowered in addressing their child or adolescent’s behaviors there are improvements seen in the functioning of the family as well as the child or adolescent exhibiting the concerning behaviors.
A third therapeutic approach to treating adolescent conduct disorder is multisystemic therapy. Multisystemic therapy is an intense approach that combines both techniques of cognitive behavioral therapies and family therapies. The goal of multisystemic therapy is to promote responsible behaviors and to prevent the need for out of home placement by providing intensive family and community based interventions design specifically for the family (Eyberg et al., 2008, pp. 228). Treatment is intense since it requires the therapist to meet or have contact with the family on several occasions throughout the week. In addition, the family has unlimited access to the therapist to address any of their concerns. The therapist is also accommodating to the family where sessions occur not just in an office setting, but also in the home setting, where families may be most comfortable. Multisystemic therapy as stated by Eyberg et al. (2008) is guided by nine core principles that include assessing how identified problems are maintained by the family’s current social environment, emphasizing the positive aspects of family systems, focusing on interventions that increase responsible behaviors, orienting interventions that are specific to the family and ensuring that the family understands the interventions, fostering the interactions of the youth outside the family, consistently evaluating treatment plans and positive outcomes, and teaching caregivers the skills needed to address problems across multiple context (pp. 228).
Multisystemic therapy addresses the youth and family’s needs in all life domains and implements consistent treatment among the life domains. Cotrell and Boston (2002) support the effectiveness of this

approach by stating that parent’s reports of behavioral problems of delinquent adolescents who were repeated offenders decreased significantly after their engagement in multisystemic therapy.
After reviewing the different theories of therapeutic approaches, in this learner’s opinion, the multisytemic therapy approach is most appealing in it’s effectiveness in treating adolescents with conduct disorder. Although it appears time consuming, this learner is attracted to the family centered and family driven philosophy it encompasses. Multisystmic therapy takes into account the individualized needs of the adolescent as well as of the family. The therapist’s dedication to meeting those needs is essential in effectively addressing the symptoms exhibited by the adolescent with conduct disorder and also the emotional toll that the family members experience. In treating children and adolescents it is important to always consider holistic treatment, which multisystemic takes into account. In conclusion, as seen in the literature review, conduct disorder in adolescents can result in behaviors with serious consequences. These behaviors can also greatly impact those around them. As a result effective treatment and intervention is needed to counter the negative symptoms of conduct disorder. When adolescents and parents are given the appropriate techniques to address the concerning behaviors this can result in a decrease of problematic behaviors and improve the daily function of the adolescent and the family as a unit.

References
Blake, C.S., & Hamrin, V. (2007). Current approaches to the assessment and management of anger and aggression in youth: a review. Journal of Child and Adolescent Psychiatric Nursing, 20(4), 209-221.
Clarizio, H.F. (1997). Conduct disorder: developmental considerations. Psychology in the Schools, 34(3), 253-265.
Cottrell, D. & Boston, P. (2002). Practitioner review: the effectiveness of systemic family therapy for children and adolescents. Journal of Child Psychology and Psychiatry, 43(5), 573-586.
Eyberg, S.M., Nelson, M.M., Boggs, S.R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37(1), 215-237. doi: 10.1080/15374410701820117
Mpofu, E.& Crsytal, R. (2001). Conduct disorder in children: challenges, and prospective cognitive behavioural treatments. Counseling Psychology Quarterly, 14(1), 21-32. doi: 10.1080/09515070110053355
Singh, N.H., Lancioni, G.E., Singh Joy, S.D., Winton, A.S.W., Sabaawi, M., Wahler, R.G., & Singh, J. (2007). Adolescents with conduct disorder can be mindful of their aggressive behavior. Journal of Emotional and Behavioral Disorders, 15(1), 56-63. van de Wiel, N., Matthys, W., Cohen-Kettenis, P.C., & van Engeland, H. (2002). Effective treatment of school aged conduct disordered children: recommendations for changing clinical and research practices. European Child & Adolescent Psychiatry, 11, 79-84.

References: Blake, C.S., & Hamrin, V. (2007). Current approaches to the assessment and management of anger and aggression in youth: a review. Journal of Child and Adolescent Psychiatric Nursing, 20(4), 209-221. Clarizio, H.F. (1997). Conduct disorder: developmental considerations. Psychology in the Schools, 34(3), 253-265. Cottrell, D. & Boston, P. (2002). Practitioner review: the effectiveness of systemic family therapy for children and adolescents. Journal of Child Psychology and Psychiatry, 43(5), 573-586. Eyberg, S.M., Nelson, M.M., Boggs, S.R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37(1), 215-237. doi: 10.1080/15374410701820117 Mpofu, E.& Crsytal, R. (2001). Conduct disorder in children: challenges, and prospective cognitive behavioural treatments. Counseling Psychology Quarterly, 14(1), 21-32. doi: 10.1080/09515070110053355 Singh, N.H., Lancioni, G.E., Singh Joy, S.D., Winton, A.S.W., Sabaawi, M., Wahler, R.G., & Singh, J. (2007). Adolescents with conduct disorder can be mindful of their aggressive behavior. Journal of Emotional and Behavioral Disorders, 15(1), 56-63. van de Wiel, N., Matthys, W., Cohen-Kettenis, P.C., & van Engeland, H. (2002). Effective treatment of school aged conduct disordered children: recommendations for changing clinical and research practices. European Child & Adolescent Psychiatry, 11, 79-84.