A GUIDE TO CONDUCT DISORDER

1. A GUIDE TO CONDUCT DISORDER BY MAYA MAHLER

2. TABLE OF CONTENTS • INTRODUCTION (3) • GLOSSARY (4-6) • PODCAST SCRIPTS (7) • THINGS THAT CAN HELP (8-9) • THINGS TO AVOID (10-11) • A WORD GAME (12-13) • RESOURCES & READINGS (14-15) • REFERENCES (16) ©2008 MSMahler, University of Pittsburgh

3. INTRODUCTION Dear Reader, Hello! My name is Maya Mahler, and I am a graduate student at the University of Pittsburgh. In one of my Psychology classes this semester, we were asked to become highly knowledgeable about a disorder that is of interest to us. So, for the last fourteen weeks, I have spent a significant amount of time learning about a childhood and teen disorder known as “Conduct Disorder.” One of our assignments was to make a guide for friends and family of those who are struggling with our assigned disorder. This is that guide. In the following pages, I hope that you will find information that will give you, your family, and your friends hope about the future of your loved ones. Conduct Disorder is, without a doubt, a difficult disorder to live with, for all those involved. However, as you are about to find out, there is a lot that can be done for the teen, the family, and the school, to help ensure a typical adulthood. I have included a glossary of words you may hear doctors and therapists say in reference to the disorder. I have also given a link to two podcasts I have recorded. These podcasts, or online radio broadcasts, are geared toward parents of a child with Conduct Disorder or teens and children who are coping with a peer who has the disorder. Furthermore, you will read about some “do’s and don’ts” for working with a child or teen who has Conduct Disorder. Finally, you can look at some websites and books that I have included for further reading! I would like to stress that the most important thing to do when you feel your son or daughter may have Conduct Disorder is take them to a doctor. Early intervention is the best way to help him/her get better and cope with situations differently as an adult. I hope you find this guide helpful. Thank you for taking the time to use this resource! Sincerely, Maya Mahler

4. A LIST OF WORDS SOMETIMES USED WITH CONDUCT DISORDER • Abuse: a history of abuse is a risk factorfor conduct disorder • Adolescent-Onset: the type of Conduct Disorder that occurs when a child did not show ANY sign of the disorder before the age of 10. There is a better chance that a child will get better if they have Adolescent-Onset than if they have Childhood-Onset Conduct Disorder. • Anti-social Personality Disorder: an adult mental health disorder that involves breaking the law, stealing, lying, fighting, and having no guilt. Adults with this disorder often end up in jail and abusing drugs and alcohol. If Conduct Disorder in children starts early, becomes severe, and is never treated, then it could turn into Anti-social Personality Disorder in adulthood. • Childhood-Onset: the type of Conduct Disorder that occurs when a child DID show signs of the disorder before the age of 10. There is a reduced chance that a child will get better if they have Childhood-Onset than if they have Adolescent-Onset Conduct Disorder. • Conduct Disorder (CD): “Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when these symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools.”4

5. Labels: Doctors use mental health labels to help them know how to treat patients. “Conduct Disorder” is one label. These are helpful because they let the doctor know what kind of medication or therapy a patient might need. It’s important for doctors and for everyone else to remember that people are much more than their labels- the mental health problem is one small part of who a person is! A label helps in some ways, but it can hurt if we start treating people badly because of their label. • Mild: Mild Conduct Disorder is the label of Conduct Disorder that is given when they only show a few of the Conduct Disorder behaviors, and the behaviors shown by the child/teen are not very harmful. • Moderate: Moderate Conduct Disorder is a label of Conduct Disorder that is given when a medium amount of behaviors of Conduct Disorder are shown by a child/teen, or the behaviors are somewhat harmful. • Oppositional Defiance Disorder (ODD): A mental health problem in young children. The behavior shown by children with ODD is negative, defiant, and disobedient. Children with ODD may constantly argue with adults, test boundaries, and behave negatively. These behaviors are more serious than a typical child who tests boundaries or doesn’t want to do what they’re told. Some children with severe ODD can develop Conduct Disorder. ¹ • Parent Management Training (PMT): A method where the therapist and parent/s meet to help the parents understand how to help their child. They will work on how the parent(s) can act to help encourage good behaviors and to stop the bad behaviors.4 Back to Page 1 of Word List

6. Podcast: a short radio broadcast or audio clip that can be accessed anytime by going online • Psychotherapy: “Treatment for mental and emotional disorders using specific psychological techniques such as "talk therapy." The goals of psychotherapy are relief of symptoms and changes in behavior.” ² • Risk Factors: These are things that increase the chances that a child or teen may have Conduct Disorder. Some examples of risk factors for Conduct Disorder are being separated from parents when someone is young, neglect, abuse, parents with mental illness, a lot of fighting in the family5 • Severe:Severe Conduct Disorder is a label of Conduct Disorder that is given when many of the behaviors of Conduct Disorder are shown by a child/teen, and the behaviors are serious and harmful. • Stigma: “a mark of shame or disgrace,” refers to “negative attitudes toward health problems and other conditions.” • “…certain language that is common in our culture can have negative consequences. Offensive words like loony, psycho, or crazy, though they may seem harmless, can be hurtful and help to fuel stigma. Learning the facts about mental health and spreading accurate information helps to decrease stigma and promote understanding. This is especially important because at its worst, stigma can stop people with mental illnesses from getting the help they need. Just like people with other illnesses like asthma, people who are dealing with mental health problems have nothing to feel ashamed of and the wisest, most courageous way to cope is to seek and stay in treatment.” ² Back to Page 1 of Word List

7. Scripts for Podcasts • The podcasts, or short online radio broadcasts, about Conduct Disorder (CD), can be found at www.sbbh.pitt.edu. • One podcast is meant for parents of children or teens with CD. • The other podcast is meant to help children or teens who are around teens with CD understand the behavior.

8. THINGS THAT CAN HELP WHEN FACED WITH CONDUCT DISORDER • The sooner the child or teen gets help from a doctor, the better it is for the family and the child. • The best therapy to treat Conduct Disorder treats all the child’s and family’s needs. • This means that the child may need to take medication • The child should also have individual counseling. • Plus, it is very helpful for the parents to get some Parent Management Training. • If the doctor and family agree it might help, the parents can get counseling for themselves or get marital counseling. • It is best for parents to have a plan for how to react to negative behaviors. Also, they should have boundaries that are simple and have been clearly laid out. Finally, parents should have punishments and rewards that have been clearly laid out. • Keeping rules, boundaries, punishments, and rewards that are clear and consistent will help the child to feel in control, which they need. • It will also help them to know what to expect so that it takes away the feeling that everyone is being “unfair.” • It also helps the parent to know how to react to sometimes shocking behavior they may not be prepared for. So, it helps keep parents in control.

9. Children and teens with Conduct Disorder often make very reckless decisions. Therefore, it is very helpful for parents, guardians, and teachers, to be especially careful in checking where they go, who their friends are, what time they come home, and what they are doing when they are out. This will keep the child/teen and others safe. • The child/teen, parent(s), teachers, and guidance counselor should all be working together for the success of the child and the family. Parents and the school should: • form a working relationship between the home and school. • maintain an open and honest relationship. • keep lines of communication constantly open so the child/teen knows they can’t “play” the parents or the school against each other. • It is best for adults to keep rules, boundaries, and consequences consistent between home and school. This will make it easier for the child/teen so they don’t have to change their thinking several times a day. • Everyone in the family can get involved in parent, family, and teen support groups. These groups can help to make sure that everyone is getting the best possible care, and remind them that they are not alone in their struggles. There are people that understand!

10. THINGS TO AVOID WHEN FACED WITH CONDUCT DISORDER • It is helpful for parents to try to not take their child’s behavior personally.  It is difficult to not feel personally attacked, and then react that way. But, it is easier for parents to deal with the behavior if they think of it as a result of the disorder and not as a personal attack.  • The best way for adults to deal with negative behavior is to not "push back.“ This will only make the reaction worse.  • Parents should not use the Conduct Disorder as an excuse for poor behavior! • A child/teen with Conduct Disorder is still responsible for their behavior. • The family and child/teen should work together to do everything they can to make it better. • Excusing the behavior as “just their Conduct Disorder” makes it seem, to that child and to others, that children and teens have the right to act that way. • Using Conduct Disorder as an excuse for poor behavior does not help the child/teen get better.

11. It is best for parents to avoid sending the child/teen to treatment by themselves without any family involvement. • Success with Conduct Disorder only happens when the entire family is involved. • The child/teen cannot make the changes by him/herself no matter how much medication or therapy they have. • The family needs to learn how to help the child with the Conduct Disorder, how to respond to the child, and how to set boundaries. • If there is a lot of conflict in the family, the therapy for the child’s Conduct Disorder will not be as effective. • The family members that are having their own personal problems should get therapy, too. • By getting better themselves, the other family members can help the child they love get better and be good role models of loving behavior. • Everyone involved should avoid BLAMING: Trying to figure out whose fault it is that a child has Conduct Disorder does not help him or her to get better. Looking backward to find out who or what caused the disorder will not help the Conduct Disorder go away. While it can be a very difficult situation, it is best to look forward to the solution. With the whole family’s cooperation, some therapy, medication, and hard work, a child/teen with Conduct Disorder has a chance to get better and grow up to lead a typical adult life.

12. CONDUCT DISORDER WORD SCRAMBLE Use words from the podcasts about conduct disorder or mental illness to unscramble the words below. Some of them are more than one word! Name: _________________________________  1.urotspp________________________________ 2.basekngielurr________________________________ 3.lulby________________________________ 4.hokcssliop________________________________ 5.senaitgl________________________________ 6.roepulpthe________________________________ 7.ingifght________________________________ 8.tehayrp________________________________ 9.eiceimdn________________________________ 10.ipnehgl________________________________ 11.prnetsa________________________________ 12.ugsdr________________________________ 13.lolaohc________________________________ 14.agtmis________________________________ 15.oerfuootufon________________________________ 16.slblae________________________________ 17.persetc________________________________ ANSWERS

13. ANSWERS 1.urotspp     support 2.basekngielurr     breaking rules 3.lulby     bully 4.hokcssliop     skip school 5.senaitgl     stealing 6.roepulpthe     hurt people 7.ingifght     fighting 8.tehayrp     therapy 9.eiceimdn     medicine 10.ipnehgl     helping 11.prnetsa     parents 12.ugsdr     drugs 13.lolaohc     alcohol 14.agtmis     stigma 15.oerfuootufon     one out of four 16.slblae    labels 17.persetc     respect

14. WEBSITES FOR KIDS, TEENS, PARENTS, AND TEACHERS • CYKE:http://www.cyke.com – This site has “The Land of Cyke,” which is an interactive, educational game for young children. It also has information on Conduct Disorder, ODD, Substance Abuse, different types of therapy and medications, and some great resources and supports for parents to use in the home and in the school. • Cope, Care, Deal:http://www.copecaredeal.org/ - This site has some books written by teens, for kids and teens, as well as some written for parents, about dealing with mental illness and treatment. While there isn’t a book specifically about conduct disorder, there are resources about dealing with stigma, how to cope with some of the stresses of mental illness, and other great resources! • National Alliance for the Mentally Ill:http://www.nami.org/ - go to “find support”, then “child and teen support” to find some links for children, teens, and parents. This includes some sites where teens can talk with other teens about their feelings. • SAMHSA:http://mentalhealth.samhsa.gov/publications/allpubs/CA-0010/default.asp - a good, brief description of conduct disorder, along with some facts about it, and what families can do to help themselves and their loved one. • SAMHSA:http://mentalhealth.samhsa.gov/child/childhealth.asp- This site lists and describes some resources and programs offered by the United States Department of Health and Human Services. • Mental Health Association of Southeastern Pennsylvania:http://www.mhasp.org/coping/guardians.html - This site is a resource for parents or guardians. It will help you talk to your children to help them better understand mental illness.

15. BOOKS TO READ For parents: • Barkley, R & Benton, C. Your defiant child: 8 steps to better behavior. • Johnson, J.T. Hidden Victims: An eight-stage healing process for families and friends of the mentally ill. • Marsh, D.T. & Dickens, R. Troubled journey: Coming to terms with the mental illness of a sibling of parent. • Woolis, R. When someone you love has a mental illness: A handbook for family, friends, and caregivers. For siblings and teens: • Brindamour, L. Someone in my family has a mental illness: A workbook. (http://www.bccf.bc.ca/cgibin/miva?Merchant2/merchant.mv+Screen=PROD&Store_Code=BCCF&Product_Code=MSC+135&Category_Code=FL) • Diner, S.H. Nothing to be ashamed of: Growing up with mental illness in your family. • SANE Australia. You’re not alone: SANE guide for children. (www.sane.org)

16. REFERENCES • American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision). Washington, DC: Author. • CopeCareDeal- A mental health site for teens. (2008). Retrieved November 12, 2008, from: The Annenberg Foundation Trust at Sunnylands www.copecaredeal.org. • CYKE. (2007). Conduct Disorder. Retrieved September 18, 2008 from: http://www.cyke.com/health/s_conduct.html. • Martin, A. & Volkmar, F. R. (2007). Lewis's child and adolescent psychiatry a comprehensive textbook (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. • SAMHSA’s National Mental Health Information Center. (2008). Mental Health Dictionary. http://mentalhealth.samhsa.gov. • School Express. (2008). Word Unscramble. Retrieved November 19, 2008 from: http://www.schoolexpress.com.