Clinical features

Aggressive and defiant behaviour is an important part of normal child and adolescent development which ensures physical and social survival. Indeed, parents may express concern if a child is too acquiescent and unassertive. The level of aggressive and defiant behaviour varies considerably amongst children, and it is probably most usefully seen as a continuously distributed trait. Empirical studies do not suggest a level at which symptoms become qualitatively different, nor is there a single cut-off point at which they become impairing for the child or a clear problem for others. There is no hump towards the end of the distribution curve of severity to suggest a categorically distinct group who might, on these grounds, warrant a diagnosis of conduct disorder.

Picking a particular level of antisocial behaviour to call 'conduct disorder' is therefore necessarily arbitrary. For all children, the expression of any particular behaviour also varies according to the child's age; for example, physical hitting is at a maximum at around 2 years of age but declines to a low level over the next few years. Therefore any judgement about the significance of the level of antisocial behaviour has to be made in the context of the child's age. Before deciding that the behaviour is abnormal or a significant problem, a number of other clinical features have to be considered.

• Level: severity and frequency of antisocial acts, compared with children of the same age and gender.

• Pattern and setting: the variety of antisocial acts, and the setting in which they are carried out.

• Persistence: duration over time.

• Impact: distress and social impairment of the child; disruption and damage caused to others. Change in clinical features with age

The type of behaviour seen will depend on the age and gender of the individual.

Younger children, say from 3 to 7 years of age, usually present with general defiance of adults' wishes, disobedience of instructions, angry outbursts with temper tantrums, physical aggression to people especially siblings and peers, destruction of property, arguing, blaming others for things that have gone wrong, and a tendency to annoy and provoke others.

In middle childhood, say from the ages of 8 to 11, the above features are often present. However, as the child grows older, stronger, and spends more time out of the home, other behaviours are seen including swearing, lying about what they have been doing, stealing others' belongings outside the home, persistent breaking of rules, physical fights, bullying other children, cruelty to animals, and setting fires.

In adolescence, say from 12 to 17, more antisocial behaviours are often added: cruelty and hurting other people, assault, robbery using force, vandalism, breaking and entering houses, stealing from cars, driving and taking away cars without permission, running away from home, truanting from school, and the extensive use of narcotic drugs.

Not all children who start with the type of behaviours listed in early childhood progress on to the later more severe forms. Only about half continue from those in early childhood to those in middle childhood;(2) likewise only about a half of those with the behaviours in middle childhood progress to show the behaviours listed for adolescence. However, the early-onset group are important as they are far more likely to display the most severe symptoms in adolescence, and to persist in their antisocial tendencies into adulthood. Indeed, over 90 per cent of severe recurrent adolescent offenders showed marked antisocial behaviour in early childhood. In contrast, there is a large group who only start to be antisocial in adolescence, but whose behaviours are less extreme and who tend to desist by the time they are adults. These groupings are discussed more fully below in the section on epidemiology.

Funny Wiring Autism

Funny Wiring Autism

Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.

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