Tackling Conduct Disorder and Anti-social Personality Disorder in Adolescents: A Multidisciplinary Approach

Introduction

 

Conduct disorder (CD) and anti-social personality disorder (ASPD) are complex and challenging behavioural issues among adolescents. This article aims to discuss the most recent research on CD and ASPD among adolescents, exploring the definitions, recognition, assessment, therapeutic approaches, collaboration with other agencies, challenges, and support for counsellors. Additionally, the article will provide statistics on CD among children aged 12-18 in the UK and highlight the role of teachers in addressing this issue.

 

Understanding Conduct Disorder, Anti-social Behaviour, and Anti-social Personality Disorder

Conduct disorder (CD) is a mental health disorder characterised by persistent patterns of aggressive, deceitful, or destructive behaviour that violate societal norms and the rights of others (NICE, 2013). Anti-social behaviour (ASB), on the other hand, involves a range of actions that harm others or disturb public order (Millie, 2009). Although ASB can be a symptom of CD, not all individuals with ASB have CD. Anti-social personality disorder (ASPD) is a more severe and pervasive pattern of disregard for the rights of others, beginning in adolescence and continuing into adulthood (NICE, 2009).

 

Recognising Conduct Disorder and Anti-social Personality Disorder

CD is commonly diagnosed during adolescence when symptoms manifest more clearly. Key signs of CD include aggression towards people and animals, destruction of property, deceitfulness, and serious rule violations (DSM-5, 2013). ASPD symptoms often involve recurrent criminal behaviour, deceit, impulsivity, irritability, and irresponsibility (DSM-5, 2013). It is crucial for mental health professionals to differentiate between normal adolescent rebelliousness and the pathological patterns of behaviour indicative of CD and ASPD (Lynam et al., 2009).

 

Assessment Using the Moss-PAS ChA

The Moss-PAS Child and Adolescent Assessment (Moss-PAS ChA) is a comprehensive and systematic evaluation tool for children and adolescents with psychiatric disorders, including CD and ASPD (Moss et al., 2021). This assessment tool combines clinical interviews, observations, and collateral information from parents, teachers, and other professionals, thus providing a thorough understanding of the adolescent's mental health and functioning.

 

Therapeutic Approaches and Treatment for Adolescents with CD and ASPD

Evidence-based interventions for adolescents with CD and ASPD include cognitive-behavioural therapy (CBT), multisystemic therapy (MST), and functional family therapy (FFT) (Henggeler & Sheidow, 2012). These interventions aim to enhance social skills, problem-solving, empathy, and self-control, as well as improve family functioning and support. For adolescents who have committed crimes, restorative justice approaches may be employed to facilitate accountability and repair harm (Daly, 2013).

 

Inpatient Observation and Treatment

Inpatient observation and treatment are necessary when adolescents with CD or ASPD pose a significant risk to themselves or others, or when they require intensive monitoring and specialised care (NICE, 2013). This may include cases of severe aggression, substance abuse, or self-harm behaviours.

 

Collaboration with Social Services and Police

Counsellors working with adolescents with CD or ASPD often collaborate with social services and police to ensure the safety of the community and to provide appropriate support for the young person and their family (NICE, 2013). This multidisciplinary approach helps to address the complex and multifaceted needs of these adolescents.

 

Challenges and Handling Difficulties in Therapy

Therapy for adolescents with CD and ASPD can be challenging due to their resistance to change, lack of insight, manipulation, and difficulty forming trusting relationships (Salekin, 2017). To manage these challenges, counsellors should establish clear boundaries, be consistent, maintain a non-confrontational stance, and utilise a strengths-based approach to promote engagement (American Psychological Association, 2019).

 

Support for Counsellors

Counsellors working with adolescents with CD and ASPD may benefit from regular supervision, case consultations, and ongoing professional development to enhance their skills and prevent burnout (Trippany et al., 2004). Access to a network of experienced professionals can provide valuable guidance and support in navigating the complexities of this client population.

 

Situations When Counsellors Should Not Provide Therapy

Counsellors should not provide therapy for adolescents with CD and ASPD if they lack appropriate training, experience, or competence in addressing these disorders (BACP, 2018). In such cases, it is crucial to refer the client to a more suitable mental health professional to ensure ethical and effective treatment.

 

Statistics on Conduct Disorder in the UK

According to a study by Ford et al. (2020), the prevalence of CD among children aged 12-18 in the UK is estimated to be between 2% and 5%. The study highlights the need for early intervention and support to prevent the escalation of problem behaviours and the potential development of ASPD.

 

The Role of Teachers in Supporting Adolescents with Conduct Disorder

Teachers can play a pivotal role in supporting adolescents with CD by fostering a positive classroom environment, implementing effective behaviour management strategies, and collaborating with mental health professionals (Stichter et al., 2018). Teachers should also be aware of the warning signs of CD and promptly refer students to appropriate support services when necessary (NICE, 2013).

 

The Importance of Early Intervention

Early intervention is crucial in addressing CD and ASPD among adolescents, as it can prevent the escalation of problem behaviours, reduce the risk of developing ASPD in adulthood, and promote positive outcomes (Frick, 2012). By identifying and addressing risk factors such as family dysfunction, low academic achievement, and peer problems, professionals can enhance the effectiveness of interventions and support the adolescent's development (Frick, 2012).

 

Parental Involvement and Support

Parents play a significant role in the treatment of adolescents with CD and ASPD. Parent management training (PMT) and parent-child interaction therapy (PCIT) have been shown to be effective in improving parental skills, reducing child behaviour problems, and enhancing family functioning (Eyberg et al., 2008). Involving parents in the therapeutic process and providing them with education, guidance, and support can contribute to better outcomes for the adolescent.

 

Community-Based Programs

Community-based programs can serve as a valuable resource for adolescents with CD and ASPD, offering services such as mentoring, after-school activities, and skill-building workshops (Hawkins et al., 2000). By fostering positive relationships and providing structured activities, these programs can contribute to the prevention and management of CD and ASPD among adolescents.

 

Future Research Directions

Despite advances in the understanding and treatment of CD and ASPD, more research is needed to identify the most effective interventions and strategies for different populations and contexts (Salekin, 2017). Longitudinal studies can help to elucidate the developmental trajectories of these disorders, while cross-cultural research can shed light on the influence of cultural factors on their manifestation and treatment.

 

Conclusion

Addressing conduct disorder and anti-social personality disorder among adolescents requires a comprehensive understanding of these disorders, as well as a collaborative and multidisciplinary approach. By recognising the signs of CD and ASPD, utilising appropriate assessment tools such as the Moss-PAS ChA, and employing evidence-based therapeutic interventions, counsellors, teachers, and other professionals can work together to support adolescents and their families in overcoming the challenges associated with these disorders.

Dr Robert Becker, MCMA, Mental Health Specialist, Neuropsychologist, Psychotherapist, Certified Moss-PAS assessor.

References:

American Psychological Association. (2019). Clinical practice guideline for the treatment of conduct disorder. https://www.apa.org/about/offices/directorates/guidelines/conduct-disorder

 

BACP. (2018). Ethical Framework for the Counselling Professions. British Association for Counselling and Psychotherapy. https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf

 

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