Conduct disorder

Introduction Conduct disorder refers to a type of behavioral disorder that under 18 years of age, repeated recurring violations of age-appropriate social norms and ethics in children and adolescents, and infringement of the interests of others or the public. These abnormal behaviors are often referred to as so-called anti-social behaviors in foreign countries, mainly manifested in child lie, truancy, fight, sabotage, assault, stealing, fraud and other conduct issues. Conduct disorder has the following characteristics: 1 repeated and repeated occurrence; 2 exceeds the range of variation allowed by the child in severity and duration; 3 is difficult to adapt to the social environment; 4 is not caused by physical illness or mental illness; 5 with family education, society The environment has a close relationship. It can be divided into two subtypes: antisocial conduct disorder and opposite defiant disorder.

Cause

(1) Causes of the disease

The individual causes of conduct disorders and their serious types are complex. Although there have been more than 70 years of research, there have been no unanimously confirmed conclusions, but there are many opinions.

Because juvenile anti-social behavior is a more complex social behavior, involving both the physical quality of the individual and the physiological-psychological-social characteristics of the juvenile, and is also greatly influenced by the environment of the family and society. In the past, many Western scholars attempted to explain the individual causes of juvenile delinquency by the first factor, but only some cases were explained.

Most authors in our country insist on the multi-factor comprehensive view, which understands the causes of juvenile conduct disorder and its serious types as a multi-layered structural system, which has both biological and physical factors, social and family environments, and individual psychology. Consciousness factor. The cause of this disease is not isolated. It involves many aspects such as social culture, moral education, political economy, and family school. It is the result of many complicated and negative factors. Various negative factors should be considered as a unity of organic connections, that is, they should be discussed in the general connection and interaction of the whole. In order to facilitate the presentation, various factors that are more common in individual causes are discussed in detail in the pathogenesis.

(two) pathogenesis

Biological factor

(1) In recent years, many authors have shown that the conduct disorder has a certain role in the biological factors. For example, many authors such as DOLeuis (1981) pointed out that juveniles have a close relationship with social behaviors in children, adolescents, brain, facial trauma, and perinatal damage. The Institute of Mental Health of Beijing Medical University in the 1980s The systematic investigation of juvenile conduct disorder and juvenile delinquency proves that these children and adolescents are compared with the control group without conduct and disorder. The results of the study indicate that the study group children and juveniles are more likely to be in the personal history, the perinatal period during childbirth, and Infants and young children have significantly more craniocerebral trauma, perinatal diseases or trauma, as well as central nervous system infections, diseases including epilepsy and other diseases. A few cases (cases) have more serious physical illnesses than the control group. According to the results of juvenile offenders and the control group (non-adolescent offenders), many foreign scholars have explained the behavioral disorder and the parents of their serious types. The family members of the three generations have significantly more mental illness, mental retardation, dementia and other patients without antisocial behavior. There were many control groups, and some studies also pointed out that the study group had obvious developmental slowness in infants and young children, such as talking late, walking, and teeth growing late. In addition, the study also shows that the IQ test results of juvenile offenders are often low IQ (such as IQ is generally 90 or lower), especially for repeated offenses. Wect and Farriugton (1973) found that after controlling family factors, low IQ is still obvious.

Aggressiveness is also a psychological trait. It is regarded as a major component of conduct disorder. Like other psychological traits such as impulsiveness and stimulating behavior, it has an intrinsic biological connection with the occurrence of conduct disorder. Mednick (1981) studies of juvenile offenders with violent behavior suggest that those with abnormal EEG (excessively slow Theti waves and abnormally fast Beta waves) account for 1/4 to 1/2, but abnormal performance in the general (normal) population only 5% to 25% (Kovi, l978). This abnormal EEG change is explained by the slow development of the brain development of juvenile offenders. Zuckerman et al. developed a sensation seeking scale (SSS) to evaluate the most appropriate stimuli. SSS consists of four main aspects: finding stimuli and adventures, finding experiences, irresistible emotions, and susceptibility to troubles. Those with higher SSS scores have more mental abnormal behaviors, and the susceptibility to troubles is significantly related to children's behavioral disorders.

Raine et al. performed galvanic electrical response, heart rate and EEG measurements on 101 children aged 14-16 years. About 10 years later, they searched the criminal records of the 101 teenagers nationwide. The results showed that 17 teenagers had criminal records. Compared with teenagers without criminal records, their skin activity was low, their heart rate was low, and low frequency. More EEG activity. The Raine et al hypothesis that the low level of awakening of the juvenile offspring from the autonomic nervous to the cerebral cortex is the genetic quality of the crime.

(2) Genetic factors: As we all know, genetic factors play an important role in a person's behavioral pattern. In theory, the relationship between genetics and individual behavior is more or less influenced by social and environmental factors. It is difficult to determine which of the individual behaviors are genetically determined and which are determined by society and the environment. From clinical observations, if parents have anti-social behavior or criminal records, their children's behavior problems will increase significantly. Modern clinical genetic studies (Thrishiansn, 1977; Dalgaard et al., 1976) found that the common crime rates of monozygotic twins and twin twins were significantly different, with the former being 35% and the latter being 13%. It is obvious that there is a certain genetic effect on criminal behavior. The disadvantage of twin studies is that twins raised in the same family environment are difficult to distinguish between genetic and acquired environmental factors. Therefore, Crowe et al. (1978) proposed a foster child research method. Crowe's foster child research on adult criminals proves that if the father is a criminal, his son is also a criminal with a higher correlation, but it is not related to the adoptive father. Rutter (1983) believes that the genetic factors in the causes of juvenile delinquency are of less importance, and pointed out that genetic factors are of great significance for the juvenile antisocial behavior that continues to develop into adulthood.

Another group of scholars conducted a very meaningful study in the early 1990s. They surveyed 300 foster children and their foster families, all of whom were fostered separately from their biological parents after birth. . The survey found that the crimes or violations of the biological parents are related to the attention deficit hyperactivity disorder of the children who are fostered, and that fostering in low socioeconomic families can lead to antisocial personality disorder after adulthood (Cadoret and Stewart, 1991). In non-foster families, there are similar findings that illustrate the importance of genetic factors in the occurrence of conduct problems.

(3) Biochemical changes: The psychochemical study of individuals with impulsive, aggressive, and antisocial behaviors focuses on monoamine neurotransmitters such as norepinephrine, dopamine, and 5-HT and its two metabolic enzymes, dopamine. -hydroxylase (DH) and monoamine oxidase (MAO). Studies in adults have shown that 5-HT levels are associated with aggressive behavior and violent behavior. In children and adolescents, destructive behavioral disorders (including ADHD, contraband defiant disorder, and conduct disorder) are more common in individuals with low 5-hydroxyindole acetic acid, a metabolite of 5-HT in cerebrospinal fluid.

Norepinephrine, dopamine, and 5-HT systems play an important role in individual behavior and the environment and its regulation. Quay (1988) cites the behavioral promotion system (BFS) and behavioral inhibition system (BIS) described by Gray (1982, 1987) to explain child behavior.

BFS is a broad behavioral system whose function is to promote behavioral adaptation to the environment. It is integrated in the midbrain dopamine system and is activated by rewards and aversive stimuli.

BIS works by comparing and suppressing the actual environment and expected behavior. BFS is inhibited when inappropriate behavior occurs, which is accomplished by norepinephrine and 5-HT in the septal hippocampal system.

Normally, norepinephrine, dopamine, and 5-HT are in a state of equilibrium to maintain proper behavior.

The relative intensity of BFS/BIS, ie, dopamine/norepinephrine plus 5-HT, affects the individual's behavior at a certain point in time. When BIS is strong, it shows attention and good ability to distinguish the environment. Conversely, when BFS is relatively strong, self-control is poor and relies too much on the external environment to maintain proper behavior. Any kind of high or low transmitter function can break this balance, followed by the behavior of transmitter imbalance or imbalance.

2. Social environment and family environment factors: Many scholars have long emphasized that juvenile conduct disorder and its serious types are most common in families with low socioeconomic status. Although there have been different disputes in recent years, many scholars, such as Braithcoaite (1981), have confirmed juvenile delinquency. It has a relevance to low socioeconomic status, but may not be as close as previously envisaged. Studies in Japan and China in the past 10 or 20 years have shown that the parents of such teenagers are clearly workers and farmers are relatively large. West (1983) points out that such juvenile family characteristics are poor and low-cultural families. Repeated research over the past decades and repeated verification by different disciplines, different nationalities and social cultures prove that family environmental factors are the most important key reasons for the causes of juvenile conduct and its serious types. This has been recognized by scholars around the world.

Juvenile period is an important stage in which a person's physiology-psychological maturity and socialization are constantly perfected. It is an intermediate transition period from gradual development to maturity. There are complex and multi-faceted immature factors and mature factors intertwined. Instability. Family is the most important force affecting children and adolescents. One of the most important functions of the family is to raise and manage children, and to educate their children to gradually lead to perfect socialization. School age and adolescence are a period of accepting socialization. This stage is for children. The socialization has initially laid the foundation and the world outlook has gradually formed. The shaping and formation of social roles are mostly rooted in children and adolescence. Under the help and cultivation of the parents, the children accepted the social norms and codes of conduct step by step through social learning, and gradually internalized the behavior patterns recognized by the society into the components of their personalities, and internalized the social opposition behavior patterns into their own. The power spurred by the conscience forms the driving force that restricts one's behavior. In this way, the young man can be turned into a member accepted by the society from the original "natural person". This process is the process of socialization. The vast majority of young people can successfully complete socialization through the continuous improvement of socialization, but there are also A small number of young people, according to long-term longitudinal research in foreign countries, account for about 30% of teenagers, mainly due to the strong influence of certain non-social factors such as family and school, which led to the acquisition of bad behavior. The family is the basic unit of society. The function and influence of the family can affect the consolidation and development of the society to a large extent. The family's close emotional connection through family members, the function of parenting and education can violate a large number of social norms and codes of conduct. Bad thoughts and behaviors are bound, restricted or eliminated within the family, so as not to spread to society, thus ensuring social stability and stability. The powerful exertion of this social control function of the family is the most basic force and source of social control. Bad, non-social family environment factors, "problem family" factors are largely related to juvenile conduct disorders, especially juvenile delinquency, certain prevention and treatment measures, education and behavioral corrections, to a large extent It is also possible to rely on family members such as parents and the school community to work together to achieve better. The main family environmental factors are as follows:

(1) Serious family disharmony: such as serious contradictions within the family, long-term quarrels, family long-term negative emotional atmosphere, temporary or permanent separation of major family members, even divorce, parents and families, single-parent families, especially Single-parent families are often more difficult to raise and educate children from poor families. The early study of the meaning of the broken family in the cause, such as the American scholar Glueck's research on the 500 US juvenile offenders and non-adolescents in the control group, shows that about 60% of juvenile offenders were born in a broken family (that is, a family of parents), born in non- Juvenile offenders in broken families account for about 30%, and there are a lot of similar research reports in the future. However, in recent years, the study suggests that family structure is related to many factors such as race, gender, crime category, community, etc., and its importance is not as estimated by Glueck. important.

(2) Lack of love, warm parent-child relationship: Bolwly (1969) has long proposed the significance of parent-child relationship in childhood, which has a great effect and influence on the future development of children's physical and mental health and normal social relations. The results of scholars from different countries have consistently suggested that there is a lack of intimate parent-child relationship, children and parents lack emotional identity, lack of close emotional communication, children do not agree with the role of parents, and are closely related to the formation of juvenile delinquency. Mccord et al. (1982) conducted a 30-year follow-up study of children aged 5 to 15 years old who grew up in a ruptured family. As a result, among the children growing up in the ruptured family, boys who grew up in the home of the mother-infant family had juvenile delinquency. Accounted for 61.8%; while growing in a family with maternal love, only 21.6% of juvenile delinquents occurred in the future. This shows that the crux of the problem lies not in breaking the family, but in whether the mother has a close and beloved relationship with the child. The relationship between parent-child love and the above-mentioned parents and the supervision of parents and improper discipline are sometimes difficult to distinguish precisely. The interrelationship between these factors needs further study.

(3) Parents lack supervision or supervision of children: Many authors acknowledge that this is also one of the important causes. The lack of supervision of the child refers to the child's daily activities, the parents do not impose restrictions or control, for example, the child can be independent activities, the parents completely let go. China's systematic investigation of the causes of juvenile delinquency (1987) shows that juvenile depletion groups, which are completely unregulated by families, schools, and society, account for a very high rate (ie, more than 95%). Many studies at home and abroad have shown that losing family and school education, idle, no fixed occupation, wandering in the community, juvenile behavioral barriers, and a high rate of juvenile delinquency.

(4) The parental discipline of the child is too strict or inappropriate: the parents adopt excessively harsh and rude attitudes toward the child, such as excessive punishment and corporal punishment. This is consistently recognized by scholars at home and abroad as a barrier to conduct and juvenile delinquency. Behavior formation is one of the important reasons. In the study of Chinese and foreign scholars, it has also been found that the father or mother is strictly controlled, while the other side is biased or intensive in the manner of discipline and inconsistency, which will have serious consequences for the child. Too much pampering, excessive protection will also have a greater impact on the formation of anti-social behavior.

(5) Bad social interaction: The theory of social learning believes that individual behavior is acquired, and the behaviors of surrounding people, parental behavior, and media propaganda directly affect children's behavior. Most of the juvenile delinquents do not have obvious criminal intentions or motives at the beginning, but are influenced by bad partners, friends or television violence, pornographic books and TV content in social interactions, which leads to illegal motives and illegal participation. Criminal activities that lead to sexual assault and sexual crimes. Therefore, bad social interactions are often the mediating factors that promote the behavior of juvenile conduct and its serious types of criminal motives. This shows that the influence of the subculture circle is a reason that cannot be ignored. In the context of local culture, peers or peers often have the same values and criteria for judging right and wrong. The correct guidance will become the "learning Lei Feng group" and "helping people to play squad" that people praise. If they are not properly guided, there will be groups such as collective smoking, destruction, fighting, extortion, and theft. Students with poor learning will have the same concept of learning. The problem of conduct will be more in these students, social unacceptable behavior will occur, and the decline in learning will be aggravated, and the prestige in the companion will decline.

In addition, the proportion of juvenile offenders in multi-population families (more than 5 in China) is high. Judging from the family's cultural quality and education level, the majority of the juvenile offenders belong to the low culture. Criminals among family members also have a more important role and influence on the generation of juvenile delinquency. The relationship between the above main factors and the theoretical mechanism are not enough. Although various hypotheses can support some cases, they are still difficult to apply universally, and they cannot effectively help such obstacles and their serious types of intervention (Ruttec et al., 1983). The representative hypothesis of the Chinese author's individual reason is a comprehensive theory of multiple (negative) factors. It is considered that anti-social behavior is a kind of social behavior that violates social norms by people whose natural attributes and social attributes are unified. Although in general, social factors always play a major role in the cause, any social factor is through the physiological-psychological mechanism of the individual's individual. It can also be said that it is formed through the material process of the individual brain. The psychological and behavioral barriers of criminal activities.

an examination

As long as the characteristics of children's behavioral disorders, the diagnosis of conduct disorder is not difficult. If the patient has anti-social behavior, aggressive behavior and the clinical manifestation of opposing defiant behavior, it lasts for more than half a year, and seriously affects peers, teachers and students, parent-child relationship or school, can be diagnosed as anti-social conduct disorder. If the patient is under 10 years of age and only exhibits opposing defiant behavior, and there is no antisocial or aggressive behavior, it is diagnosed as a contradiction.

Differential diagnosis

1. Children with ADHD: Due to hyperactivity and impulsiveness, patients often have problems with fighting and disputes with their peers, non-compliance with school discipline, and may also be rebellious and offensive because of setbacks. However, ADHD patients also have obvious attention deficits, and the symptoms can be improved after treatment with central nervous system stimulants, thus distinguishing them from conduct disorder. If ADHD patients have clinical manifestations of conduct disorder, two diagnoses should be made.

2. Mood disorder: In the episode of mania or depression, attack, destruction or confrontation may occur, but the patient has obvious emotional upswing or depression. Behavioral abnormality is only one aspect of clinical manifestation. All disappeared.

3. Children with schizophrenia: Patients may have behavior problems before, during and after the illness, but this is only part of the clinical manifestations. Patients also have the basic symptoms of schizophrenia, such as hallucinations, delusions, thinking disorders, perceptions. Symptoms and abnormalities in the language, after treatment with antipsychotic drugs, all symptoms including behavior will be alleviated or completely disappeared.

4. Mental retardation: due to mental retardation, poor thinking and judgment of patients, it is also prone to aggressive behavior, and some illegal and antagonistic behaviors may occur. However, patients with mental retardation have low intelligence and poor social adaptability, which can be distinguished from conduct disorder. If the patient has two types of problems at the same time, and the severity of the behavioral problem cannot be completely attributed to mental retardation, it should be diagnosed as a mental retardation with a conduct disorder.

5. Brain organic mental disorders: Behavioral disorders may occur due to brain tissue damage and impaired brain function. And brain trauma, epilepsy, etc. can occur aggressive behavior or anti-social behavior, such as impulsive wounding, destruction, difficult to manage. Some patients may also have behaviors such as lying, stealing, and sexual assaults, but they may be identified with a history of brain damage and positive signs of the nervous system.

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