Conduct Disorder (CD)

Definition
Conduct disorder is a childhood behavior disorder characterized by aggressive and destructive activities that cause disruptions in the child's natural environments such as home, school, church, or the neighborhood. The overriding feature of conduct disorder is the repetitive and persistent pattern of behaviors that violate societal norms and the rights of other people. It is one of the most prevalent categories of mental health problems of children in the United States, with rates estimated at 9% for males and 2% for females.

Description

The specific behaviors used to produce a diagnosis of conduct disorder fall into four groups: aggressive conduct that causes or threatens physical harm to other people or animals, nonaggressive behavior that causes property loss or damage, deceitfulness or theft, and serious violations of rules. Two subtypes of conduct disorder can be delineated based on the age that symptoms first appear. Childhood-onset type is appropriate for children showing at least one of the behaviors in question before the age of 10. Adolescent onset type is defined by the absence of any conduct disorder criteria before the age of 10. Severity may be described as mild, moderate or severe, depending on the number of problems exhibited and their impact on other people.

Youngsters who show symptoms (most often aggression) before age 10 may also exhibit oppositional behavior and peer relationship problems. When they also show persistent conduct disorder and then develop adult antisocial personality disorder , they should be distinguished from individuals who had no symptoms of conduct disorder before age 10. The childhood type is more highly associated with heightened aggression, male gender, oppositional defiant disorder , and a family history of antisocial behavior.

The individual behaviors that can be observed when conduct disorder is diagnosed may be both common, problematic, and chronic. They tend to occur frequently and are distressingly consistent across time, settings, and families. Not surprisingly, these children function poorly in a variety of places. In fact, the behaviors clustered within the term "conduct disorder" account for a majority of clinical referrals, classroom detentions or other sanctions, being asked to stop participating in numerous activities, and can be extremely difficult (even impossible) for parents to manage.

The negative consequences of conduct disorder, particularly childhood onset, may include illicit drug use, dropping out of school, violent behavior, severe family conflict, and frequent delinquent acts. Such behaviors often result in the child's eventual placement out of the home, in special education and/or the juvenile justice system. There is evidence that the rates of disruptive behavior disorders may be as high as 50% in youth in public sectors of care such as juvenile justice, alcohol and drug'



The overriding feature of conduct disorder is the repetitive and persistent pattern of behaviors that violate societal norms and the rights of other people. Youngsters with conduct disorder often exhibit aggressive behavior to other people (bullying, starting fights, etc.) or to animals. They may also damage others' property.
(Carolyn A. McKeone. Photo Researchers, Inc. Reproduced by permission.)
services, schools for youths with serious emotional disturbances, child welfare, and mental health.

The financial costs of crime and correction for repeated juvenile offenses by youth with conduct disorder are extensive. The social costs include citizens' fear of such behavior, loss of a sense of safety, and disruptions in classrooms that interfere with other children's opportunity to learn. The costs to the child and his or her family are enormous in terms of the emotional and other resources needed to address the consequences of the constellation of symptoms that define conduct disorder.

Causes and symptoms

There is no known cause for conduct disorder. The frustrating behavior of youngsters with conduct disorder frequently leads to blaming, labeling, and other unproductive activities. Children who are "acting out" do not inspire sympathy or the benefit of the doubt. They are often ostracized by other children. Parents of such children are often blamed as poor disciplinarians or bad parents. As a result, parents of children with conduct disorder may be reluctant to engage with schools or other authorities. At the same time, there is a strong correlation between children diagnosed with conduct disorder and a significant level of family dysfunction, poor parenting practices, an overemphasis on coercion and hostile communication patterns, verbal and physical aggression and a history of maltreatment.

There is a suggestion of an, as yet, unidentified genetic component to what has generally been viewed as a behavioral disorder. One study with adopted children in the mid-1990s looked at the relationship between birth parents with antisocial personality disorder, and adverse adoptive home environments. When these two adverse conditions occurred, there was significantly increased aggressiveness and conduct disorder in the adopted children. That was not the case if there was no indication of antisocial personality disorder in the birth parents. This finding has important implications for prevention and intervention of conduct disorders and its associated conditions of substance abuse and aggressiveness.

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (also known as the DSM-IV-TR ) indicates that for conduct disorder to be diagnosed, the patient has repeatedly violated rules, age-appropriate social norms and the rights of others for a period of at least twelve months. This is shown by three or more of the following behaviors, with at least one having taken place in the previous six months: aggression to people or animals, property destruction, lying or theft, and serious rule violations.

Aggression to people or animals includes:

* engaging in frequent bullying or threatening
* often starting fights
* using a weapon that could cause serious injury (gun, knife, club, broken glass)
* showing physical cruelty to people
* showing physical cruelty to animals
* engaging in theft with confrontation (armed robbery, extortion, mugging, purse snatching)
* forcing sex upon someone

Property destruction includes:

* deliberately setting fires to cause serious damage
* deliberately destroying the property of others by means other than fire setting

Lying or theft includes:

* breaking into building, car, or house belonging to someone else
* frequently lying or breaking promises for gain or to avoid obligations (called "conning")
* stealing valuables without confrontation (burglary, forgery, shop lifting)

Serious rule violations include:

* beginning before age 13, frequently staying out at night against parents' wishes
* running away from parents overnight twice or more or once if for an extended period
* engaging in frequent truancy beginning before the age of 13

Mild severity would mean there are few problems with conduct beyond those needed to make a diagnosis AND all of the problems cause little harm to other people. Moderate severity means the number and effect of the conduct problems is between the extremes of mild and severe. Severe is indicated if there are many more conduct symptoms than are needed to make the diagnosis (more than three in the previous twelve months or more than one in the previous six months), or, the behaviors cause other people considerable harm.

Diagnosis

Conduct disorder is generally diagnosed when somebody, often a child in school, comes to the attention of authorities (school, law enforcement, and others) most often because of behavior. The person might then be referred to a psychiatrist or psychologist for assessment and diagnosis . It is unlikely that any sort of specific test is given; rather, the individual would have to meet the criteria in the DSM-IV-TR. Usually there is a history of acting out in school, neighborhood, home, and other social settings. Court-ordered treatment would likely occur if the person comes to the attention of the police and if a crime is involved. A judge might order treatment as an alternative to jail, or before a sentence is served.

Treatments

Earlier treatments of youth with conduct disorder relied on legal processes to declare a child in need of supervision or treatment and thus able to be placed in residential settings established for this purpose. While residential placements may still be used, recent treatment models have relied less on such restrictive procedures. The increased visibility and sophistication of the consumer movement, comprised of families of children and youth with mental health disorders, is bringing pressure to bear on treatment providers to stop blaming families, stop removing children from their families for services, focus instead on strengths and assets in both the child and his or her family, and to use community-based interventions in several domains in which the child and family live.

Community-based interventions are sometimes called wrap-around services to describe the intention that they will be brought to the child's natural environment in a comprehensive and flexible way. The idea is to target a range of child, parent, family and social system factors associated with a child's behavioral problems. This approach has been successful in modifying antisocial behavior, rates of restrictive placement, and in reducing the cost of services.

Another treatment that has been used with some success is the Child Cognitive Behavioral Treatment and Skills Training which trains children with conduct disorder in anger-coping, peer coping, and problem-solving skills.

Parent Management Training and family therapy are also used to treat conduct disorder. Parents learn to apply behavioral principles effectively, how to play with their children, and how to teach and coach the child to use new skills.

Medication is sometimes used and may be effective in controlling aggression. Generally, a variety of treatment modes are used to address such a complex disorder. Severe antisocial behavior on the part of the child and adverse parenting practices may suggest that the family will stop treatment before it can be effective, or before meaningful change can result.
Prognosis

Early identification and appropriate and innovative treatment will improve the course of conduct disorder and possibly prevent a host of negative outcomes that are often a consequence of the behaviors associated with it. Unfortunately, the stigma of treatment and the undiagnosed problems of many parents are still significant enough that families whose children could benefit from treatment never find their way to a treatment setting. Instead their children come into contact with the juvenile and criminal justice system.
Prevention

Prognosis may best be improved by prevention of conduct disorder before it becomes so resistant to treatment. Research is being conducted on what early interventions hold the greatest promise. The research incorporates several components such as child tutoring, classroom intervention, peer training, social-cognitive skills training, parent training, and family problem-solving.

Other studies have included early parent or family interventions, school-based interventions and community interventions. Again, these include a variety of elements as suggested before, including parent training that includes education about normal child development, child problem-solving, and family communication skills training. Research is still needed to determine where and when to target specific preventive interventions.

Fetal Alcohol Spectrum Disorder Linked to High Prevalence of Epilepsy

ScienceDaily (Apr. 5, 2010) — Fetal alcohol spectrum disorder (FASD) refers to a range of negative developmental outcomes that result from maternal drinking during pregnancy. Children with FASD can suffer from many problems, including epilepsy, a disorder characterized by spontaneous recurrence of unprovoked seizures that affects 0.6 percent of the general population. A new study has found a much higher prevalence of epilepsy or history of seizures in individuals with FASD.

Results will be published in the June 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"There are very few studies that have examined the relationship between seizures and epilepsy among individuals with FASD," noted James Reynolds, a senior scientist with the department of pharmacology and toxicology and the Centre for Neuroscience Studies, at Queens University. Reynolds is one of the study's authors.

"Many patients with epilepsy have a history of exposure to a prenatal insult, so we reasoned that prenatal exposure to alcohol could be such an epileptogenic insult," added Peter Carlen, a neurologist and senior scientist for the division of fundamental neurobiology at the Toronto Western Hospital, another of the study's authors. "Secondly, there is a significant overlap in brain structures that suffer from deficits as a result of chronic prenatal alcohol exposure and those that are associated with seizures, specifically in the brain's hippocampus. Thirdly, previous studies had failed to examine other complications that occur in mothers who drink alcohol during pregnancy, such as the effects of drinking on seizure activity. Finally, previous studies used small sample sizes and failed to clearly define seizures and FASD."

"Recently, scientists have begun investigating whether fetal alcohol exposure increases the risk for developing other behavioral health and neurological problems," added Dan Savage, Regents' Professor and chair of neurosciences at the University of New Mexico. "Indeed, evidence has begun to suggest that children with FASD are at greater risk for alcoholism, substance abuse or depression later in life. While it is too soon in the relatively young history of this research field to assess whether maternal drinking during pregnancy increases the risk of aging-related neurologic disorders, such as stroke or Parkinson's disease, several recent large-scale retrospective studies have examined whether fetal alcohol exposure increases the risk of developing epilepsy."

For this study, researchers examined the histories of 425 individuals (254 males, 171 females), between the ages of two and 49 years, from two FASD clinics. Relationships between a confirmed FASD diagnosis and other risk factors -- such as exposure to alcohol or other drugs, type of birth, and trauma -- were examined for the co-occurrence of epilepsy or a history of seizures.

"This study revealed a much higher prevalence of epilepsy and seizure history in individuals with a diagnosis of FASD," said Stephanie H. Bell, a researcher with the Centre for Neuroscience Studies at Queens University and corresponding author for the study. "In the general population, less than one percent are expected to develop epilepsy; of those with FASD, six percent had epilepsy and 12 percent had one or more seizures in their life. Subjects were more likely to have epilepsy, or a history of seizures, if exposure to alcohol had occurred in the first trimester or throughout the entire pregnancy."

"While this report supports a growing impression that fetal alcohol exposure may predispose the immature brain to the development of epilepsy, the results do not establish a direct cause-effect relationship between FASD and epilepsy," cautioned Savage. "Establishing a direct link between these clinical conditions will be a difficult challenge given our incomplete understanding of how ethanol damages the developing brain and what neuropathological changes in brain tissue lead to the development of different types of epilepsy."

Nonetheless, Savage added that it is clear that alcohol can damage the fetal brain. "The extent to which this damage leads to adverse neurobehavioral consequences likely depends upon a multitude of factors, including the amount and patterns of drinking during pregnancy, the presence of other pregnancy risk factors, such as cigarette smoking, substance abuse, or poor prenatal care, and the presence of other diseases affecting a mother's health, such as diabetes or high blood pressure," he said. "As risk factors accumulate, the risk of adverse neurodevelopmental outcomes also increases."

"Epilepsy and/or seizures in children are often missed in clinical assessments," noted Carlen, "and if it is untreated it can lead to increased or unrecognized cognitive problems. In the long-term, it can also result in problems in attention and memory and the risk of unattended and dangerous seizures. Many children may not have a predisposition to epilepsy and do not have the physical signs of FASD, but the physician should be aware of alcohol exposure during pregnancy when considering their patient's health and the etiology of particular diagnoses."

"This report builds on a growing body of evidence that maternal drinking during pregnancy may put a child at greater risk for an even wider variety of neurologic and behavioral health problems than we had appreciated before," said Savage. "The consensus recommendation of scientists and clinical investigators, along with public health officials around the world, is very clear -- a woman should abstain from drinking during pregnancy as part of an overall program of good prenatal care that includes good nutrition, adequate exercise, sufficient rest, and proper prenatal health care."

Posted by Lew Hui Teng, T3

Peer Interaction May Provide A Learning Opportunity For Autistic children

The numbers are startling: New research now indicates that that 1 in 110 children in the United has an Autism Spectrum Disorder (ASD). "While researchers seek to assess the risk factors and better identify potential causes, there is an urgent need to provide opportunities for children and adults with autism to live their best lives," says Michelle Rowe, Ph.D., executive director of the Kinney Center for Autism Education and Support and professor of Health Services at Saint Joseph's University.

Some of the most valuable learning experiences, she maintains, are not traditionally provided by many school districts. "Learning skills such as saying 'hello, approaching others, making eye contact and initiating social interactions - and how to respond to others who do those things - are often overlooked in the classroom." In the Kinney Center's recently launched after-school program, children ages three and up acquire the building blocks of these social skills in a fun, supportive environment.

"Neurotypical children easily learn these skills in preschool and on the elementary school playground. Children with autism can also learn them, but they need more help and coaching in doing so," notes Rowe.

Interacting with age-equivalent peers who do not have autism in a structured setting also gives those with autism a learning opportunity: "Picking up subtle nuances such as eye contact and facial expressions—these are critical skills in developing good relationships with friends," she adds.

The Kinney Center's summer program, Camp Kinney, will adopt this inclusive model, offering two- to five-week programs for both children with autism and neurotypical youngsters. "They will learn from each other, playing games and sports together, doing art together, making and eating lunch together, singing together and laughing together. And they'll have lots of fun doing it.

"Connecting with others doesn't come naturally to those with autism. Our goal is to help them acquire the skills to make the connections that will enrich their lives."

Source: Kinney Center for Autism Education and Support

Posted by Lew Hui Teng, T3

Real Life Sleeping Beauty: Louisa Ball Has Kleine-Levin Syndrome

Call her a Real Life Sleeping Beauty. Her name is Louisa Ball, a 15-year-old girl in the UK has a rare illness that is commonly known as the Sleeping Beauty Syndrome. She will take a nap and end up asleep for days, even weeks at a time as a result of this rare illness. Ball suffers from this uncommon sleeping disorder that has no cure or known cause at this time.

Learn more about Sleeping Beauty Syndrome, Kleine-Levin Syndrome

While a lot remains unknown about the Sleeping Beauty Syndrome, doctors do believe that the illness will not last forever. It's expected that Ball will have the Sleeping Beauty Syndrome for another 8-12 years approximately. Ball has formally been diagnosed with Kleine-Levin Syndrome. The illness is uncommon and only present in about 1,000 people worldwide. People who suffer from the Kleine-Levin Syndrome will seem fine one day, and then sleep for an extended period of time without warning or explanation.

Ball once slept for almost two weeks reaching the 13 day mark when she finally woke up. She sometimes wakes briefly during the sleeping episodes, but appears generally non-responsive and disoriented. As far as treatment goes, scientists are still trying to understand the rare Sleeping Beauty Syndrome.

Researchers suspect that the Kleine-Levin Syndrome could possibly originate from a viral infection, something that teenagers commonly get. They believe that a viral infection could in some cases cause the sleeping center of the brain to be affected. The affected change could remain in place for a prolonged period of time, even years. Research suggests that some people may even be genetically pre-disposed to getting the Sleeping Beauty Syndrome.



Credits to Jolyn Hong, T3

Alice in Wonderland syndrome

-------------------------brief introduction

Alice in Wonderland syndrome (AIWS, named after the novel written by Lewis Carroll), also known as Todd's syndrome, is a disorienting neurological condition which affects human perception. Sufferers may experience micropsia, macropsia, and/or size distortion of other sensory modalities. A temporary condition, it is often associated with migraines, brain tumors, and the use of psychoactive drugs.It can also present as the initial sign of the Epstein-Barr Virus . Anecdotal reports suggests that the symptoms of AIWS are fairly common in childhood, with many people growing out of them in their teens. It appears that AIWS is also a common experience at sleep onset.

The AIWS is a result of change in perception as opposed to the eyes themselves malfunctioning. The hallmark sign of AIWS is a migraine, and may in part be caused by the symptom itself. AIWS affects the sufferer's sense of visual, sensation, touch, hearing as well as one's own body image.

The most prominent and often most disturbing symptom is that of altered body image: the sufferer will find that they are confused as to the size and shape of parts of (or all of) their body.

The eyes themselves are normal, but the sufferer 'sees' objects with the wrong size or shape and/or finds that perspective is incorrect. This can mean that people, cars, buildings, etc. look smaller or larger than they should be, or that distances look incorrect; for example a corridor may appear to be very long, or the ground may appear too close.

In addition, some people may experience more intense and overt hallucinations, seeing things that are not there and misinterpreting events and situations in conjunction with a high fever.

---above descriptions comes from wikipedia: http://en.wikipedia.org/wiki/Alice_in_Wonderland_syndrome

Sleeping Beauty Syndrome

>>>>more information about the girl with the syndrome :
http://www.dailymail.co.uk/news/article-1249895/Louisa-Ball-Real-life-Sleeping-Beauty-sleeps-weeks-time.html


---------------------brief explanation

Kleine-Levin syndrome
Kleine-Levin Syndrome or KLS (also known as Sleeping Beauty Syndrome) is a neurological disorder characterized by recurring periods of excessive amounts of sleep and altered behavior.

At the onset of an episode the patient becomes drowsy and sleeps for most of the day and night (hypersomnolence), waking only to eat or go to the bathroom. When awake, the patient’s whole demeanor is changed, often appearing “spacey” or childlike. They also experience confusion, disorientation, complete lack of energy (lethargy), and lack of emotions (apathy). Individuals are not able to attend school or work or care for themselves. Most are bedridden, tired, and uncommunicative even when awake.

Most patients report that everything seems out of focus, and that they are hypersensitive to noise and light. In some cases, food cravings (compulsive hyperphagia) are exhibited. Instances of uninhibited hypersexuality during episodes (mostly males) and instances of depression (mostly females) have also been reported.
Affected individuals may go for a period of weeks, months or even years without experiencing any symptoms, and then they reappear with little warning. In between episodes those diagnosed with KLS appear to be in perfect health with no evidence of behavioral or physical dysfunction.

The cause of Kleine-Levin syndrome is not known. Thus, family support and education are the best management currently available.



>>>>above descriptions from wikipedia : http://en.wikipedia.org/wiki/Kleine-Levin_syndrome

Received form: Jolyn Hong, T3

Separation Anxiety

How do I get my child to let me leave him?

A frequent question about childhood behavior is how to handle separations when the child clearly doesn't want Mom or Dad to go. Separation anxiety is a normal developmental process, but sometimes it can represent a failure of normal development. How do you tell the difference?

Separation anxiety usually appears between 6 and 8 months of age. The smiling infant who would happily be passed from lap to lap at the family reunion just a few months before, now becomes visibly anxious and fretful when Mom or Dad hands him off to someone else. Unfortunately, this is often the age when Mom and Dad want to be able to leave the baby with a sitter for a night out!

The onset and resolution of separation anxiety requires the achievement of three developmental milestones: attachment to a care giver, realization of object permanence, and development of trust. Here's how this works: a 6 month old infant is not “spoiled” just because she cries when Mom leaves the room or is handed to someone else. Instead, her crying represents her developing sense of attachment to her Mom and Dad. (I used the terms “Mom” and “Dad,” but I really mean whoever is the primary care giver.) If she did not have a sense of attachment, she would not be concerned when they left the room.

On the other hand, until the infant develops the realization that Mom and Dad are permanent figures, known as object permanence in developmental terminology, she will continue to cry or fuss when she cannot see them. She does not know that just because she cannot see them doesn't mean they have ceased to exist. She cries when they leave because she's attached to them (that is she loves to be with them - they are her favorite things) but, she thinks they have vanished because she cannot see them. Finally, she must learn that Mom and Dad will return and will love her still even after they have been gone.

Although separation anxiety shows up between ages 6 and 8 months and object permanence appears roughly at 9 to 10 months, separation anxiety may take until age 2 to 3 years to finally peter out. As in much of infant development, the child's temperament plays a role. A child who adapts to new situations easily will probably have less anxiety than the child who has a difficult time with change.

Parents can help their children with separation anxiety by making sure that any temporary care giver is a familiar figure. This may mean having the sitter come over and visit while the parent is still there before attempting a night out. It may mean bringing the child to daycare and planning on staying with the child the first day and leaving together, then trying a brief stay the second day without the parent, gradually increasing the time the child is left with the substitute care giver. It means leaving with clear reassurances that Mom and Dad will return at a certain time. It also means recognizing that some anxiety is normal.

When does separation anxiety become abnormal? This occurs when the child has reached an age when these three development milestones should have been completed, but the child is still having excessive anxiety upon separation. This is known as separation anxiety disorder.

This can happen for a couple of reasons: failure to form a secure attachment to a care giver or repeated disruptions to that attachment from outside influences such as hospitalization or jail or travel. Another risk factor for separation anxiety disorder is a history of anxiety disorder in the parent. Some signs in the child can be

* recurrent excessive distress when separated
* excessive worry about harm occurring to the major attachment figure (e.g., Mom or Dad)
* reluctance to go anywhere without the major attachment figure
* reluctance to be alone
* reluctance to sleep away
* repeated nightmares with the theme of separation
* vague complaints of physical symptoms like stomachaches or headaches that occur in anticipation of a separation from the attachment figure.

Although even children without this disorder can occasionally express what seems like excessive worry or concern about a parent or other care giver, children with this disorder have these symptoms for at least 4 weeks and have impairment of normal functioning such as not being able to attend school or be left with a sitter. The treatment includes behavioral therapy, play therapy, and desensitization. Occasionally, medication can help reduce feelings of anxiety. If you think your child shows excessive anxiety with separation, inappropriate for her age, talk to your pediatrician about getting help.


by Barb Durso, MD


Posted by Fang Jui, T3