Case 17: Conduct Disorder – Bill Franklin
1. According to the American Psychological Association (APA, 1994, 2000), the diagnosis of conduct disorder is linked to what specific factors in the child’s life?
Conduct disorder has been linked to such factors as parental rejection or neglect, inconsistent and often harsh child-rearing practices, physical or sexual abuse, lack of supervision, early institutional living, frequent changes of caretakers, peer rejection, a delinquent peer group, and neighborhood violence

2. What was the first sign of trouble for Billy, indicating that he might have a behavioral disorder?
The first clear sign of trouble came toward the end of 3rd grade, when Billy was still 9 years old. Jennifer received a phone call at her day job in a grocery store from the vice-principal informing her that Billy had been in a fight and was going to sit out recess for the rest of the week. Billy had hit another child after the child had called Billy a “retard.”

3. What other behavioral problems might children have, in addition to conduct disorder that makes it difficult for them to succeed in an academic setting?
Individuals with conduct disorder have a heightened prevalence of learning disorders, ADHD, anxiety disorders, mood disorders, or substance related disorders.

4. Although boys seem to receive the diagnosis of conduct disorder more often than girls, both sexes can manifest this disorder. How do behaviors differ in males and females who have been diagnosed with conduct disorder?
Boys frequently exhibit fighting, stealing, and school discipline problems.
Girls are more likely to exhibit lying, truancy, running away, substance ues, and prostitution.

5. As he got older, what activities did Billy demonstrate that suggested he had a major behavioral problem?
His behavior worsened through fourth and fifth grades with constant fighting with his mother, uncontrollable temper outbursts, throwing things in class, running away from a class field trip, sneaking into rated-R movies, and vandalism.

6. When was Billy finally forced to seek professional therapy regarding his behaviors?
After Billy was sent to the library for making rude comments to his teacher and lighting fire to a book inside of the library, the school chose to have Dr. Constanti assess him.

7. Why did Billy’s mother have to take the clinical assessment tests regarding Billy’s behavior?
Because Jennifer was despondent, Dr. Constanti chose to administer a series of structured assessments.

8. What were the assessments she completed and what were the results?
She completed the CBCL (Child Behavior Checklist) and the Eyberg Child Behavior Inventory. From this, Dr. Constanti determined that Billy had manifested a range of disruptive symptoms and often externalized them by directing his inner problems outward at others.

9. Why did Billy finally decide to meet with the “shrink”? What did Dr. Constanti learn from Billy about his behavioral problems?
He was afraid that his mother’s accounts of his behavior might be unfair and biased.

10. What was Dr. Constanti’s official diagnosis for Billy and why did he arrive at this diagnosis?
By the end of his visits with Billy, and with the school reports in hand, Dr. Constanti arrived at a diagnosis of conduct disorder – childhood onset type with “moderate” severity.

11. How does a diagnosis of oppositional defiant disorder differ from conduct disorder?
ODD is a less severe pattern of defiant behavior by children and adolescents. In this type of behavior, the child repeatedly argues with adults, loses their temper, and feels great anger and resentment. Often they ignore adult rules and requests, deliberately annoy others, and blame others for their mistakes and problems. The big difference is that they do not repeatedly violate the basic rights of others, as those with CD do.

12. Why did Dr. Constanti feel that Billy’s mother, Jennifer, also needed therapy?
It was her pattern of self-blame and self-criticism, feelings of hopelessness, inability to make decisions, and general lack of energy. Billy’s behavior patterns were definitely affecting his mother, and hers were equally affecting Billy as well. Dr. Constanti also believed that Jennifer was suffering from clinical depression, considering she lacked the social support in her life.

13. Dr. Constanti organized a “wide-ranging treatment program” for Billy. That program included family, school, and individual interventions. What were the major components in each of these treatment programs?
For the family realm, Jennifer participated in several psychoeducational sessions designed to help her recognize that Billy’s behaviors were not due to fixed, stable traits. Instead of thinking of Billy’s conduct problems as a global disposition, she learned that each behavior was the result of a situational antecedent.
The next step was the parent management training where Jennifer was taught how to modify, through constant rewards and punishments, Billy’s behavior at home.
The third section in the family realm was learning interaction and communication training. After about a month of psychoeducational treatment, both mother and son began weekly meeting with a family therapist and worked on their communications and interactions.
With interventions at school, along with school agreed individual, specialized tutoring each day, this would help Billy start learning properly. There was also meeting with Billy’s teacher and Dr. Constanti about having them to consider in greater detail Billy’s misbehaviors in the classroom. There would now have to be antecedents and consequences as well, just like at home, if Billy acted out in class.
Finally, with individual interventions, Dr. Constanti believed that Billy would benefit from an impulse-control and problem-solving intervention. With Billy’s appreciation for music, Dr. Constanti and his mother agreed that for every two meeting that Billy had with his counselor, she would buy him a cd of his choice.

14. Why may Billy’s treatment have come “too late” to make a complete recovery and reverse some of Billy’s impulse-control problems?
He was unable to make a complete recovery and continued to display a number of impulsive behaviors throughout his adult years. It had been to late to reverse Billy’s early direction, but the treatment had altered its course from Billy becoming diagnosed with antisocial personality disorder.

15. What adult disorder may eventually result from a child who has a diagnosis of conduct disorder?
Although most cases of CD do improve over time, a substantial number of severe cases continue into adulthood, developing into antisocial personality disorder or other psychological problems.

16. How do theorists explain conduct disorder?
As a maladaptive or abnormal behavior, conduct disorder is learned through the interaction of the individual and his environment. His inappropriate behavior, starting fires in a library, throwing things at others, physical cruelty to animals (ducks), frequent truancy from school, and physical fights, have all been learned because it has been rewarded at various times. Billy became constantly disruptive in the classroom and behaved that way because he found that with such behavior he received attention. When the other children avoided Billy and called him names, Billy first found that he could avoid the situation when he was uncomfortable. This behavior eventually brought Billy into conflict with his entire environment.