The term Cognitive Developmental Treatment describes a family of techniques which are designed to address factors that contribute to the development of Conduct Disorder, including: 1) inconsistent parenting (i.e., the failure to provide a consistently supportive and nurturing environment; inconsistent use of discipline; and an over-reliance on punishment to change behavior), 2) genetic and biological factors (such as temperament, sociability, and impulsivity), 3) poor social skills, and 4) maladaptive beliefs about one's personal worth. According to the cognitive-developmental model, these factors combine to contribute to children's increased risk of developing Conduct Disorder. The danger is particularly acute when vulnerable children are faced with highly stressful life events.
Multiple therapy approaches, including Parent Management Training, Cognitive Problem-Solving Skills Training, Functional Family Therapy, and Multisystemic Therapy, are used to treat Conduct Disorder according to the cognitive-developmental treatment model.
During Parent Management Training, parents and therapists work together to develop a specific and systematic plan to change oppositional behavior in their child. These plans often include the setting of specific limits and boundaries, as children with Conduct Disorder often believe that they are entitled to behave any way they want to.
Cognitive Problem-Solving Skills Training (PSST) teaches children new and better ways of thinking about and solving stressful problem situations, particularly those that involve relating with others. Appropriate behavior is modeled for the children by the therapist (and later by the parents) and then children are reinforced and rewarded when they later choose to act appropriately according to the model.
Functional Family Therapy aims to change a child's communication and interaction styles by using various cognitive and behavioral techniques to create more positive exchanges and interactions within the family unit. This type of therapy examines family interactions (rather than focusing solely on the child), bonding styles, and roles, and relies on the presence and involvement of all family members.
Many of the other treatment approaches used for Conduct Disorder are used simultaneously in Multisystemic Therapy (MST), which attempts to analyze and then correct all of the major environmental contributing factors which have led a given child to develop Conduct Disorder. In the context of multisystemic therapy, a system is an environment or institution in which a child with conduct disorder spends a lot of time, such as school and home environments, peer and other social groups, and the local neighborhood. All of a conduct disordered child's relationships are analyzed within a MST framework, and interventions are made so as to create distance between the child and deviant peers. Strategies to help the child bond better with safer, more conventional peers, to help enhance the child's academic and social skills, and to help parents become more effective and fair disciplinarians are also used. Because of the necessarily broad nature of the therapy context in MST, there is no single space in which therapy occurs. Instead, therapy occurs across all systems at once.
Family Therapy approaches to treating Conduct Disorders utilize a number of different theoretical perspectives concerning how family units function to understand how problems such as conduct disorder occur within families and how they can be corrected.
Therapists examine how various family members interact by watching them in the context of therapy. They look out for particular sorts of structural problems within the family context that can make it more likely that problems will occur. For example, parents who are not getting along well may triangulate their conversation through a child, using that child as a messenger (rather than talking directly to each other). Alternatively, a child may exploit a lack of unity or communication between parents so as to get his or her way. Still another variation occurs when one parent conspires with the children against the other parent.
Therapists are able to use the knowledge they glean from observing family relationships to help correct faulty or dysfunctional relationship patterns. Typical family therapy interventions are designed to help the parents work together better as a unit, to help them cope better, to help them be better disciplinarians, and to strengthen the boundary between parents and children so that the children remain insulated from adult problems.
Stimulants such as Ritalin, Dexedrine and Cylert are sometimes prescribed for children with severe Conduct Disorder in order to reduce impulsivity and aggressive behavior. Ritalin is the most frequently prescribed stimulant medication used for this purpose. For more information about Ritalin and the use of other stimulants as treatments for behavior problems, please see our article on ADHD. Lithium, a medication traditionally reserved for the treatment of Bipolar Disorder, has also been used to treat severe aggressive behavior. Properly prescribed, it can help reduce mood fluctuations, irritability, restlessness, hostility, and explosiveness. For more information on Lithium treatment, please see our article on Bipolar Disorder.