Cognitive Behavioral Interventions for Conduct Disorder

Conduct disorder affects somewhere between 2 percent and 9 percent of girls and between 6 and 16 percent of boys, according to Mental Health America. Children and adolescents with conduct disorder may engage in patterns of lying, stealing, destruction of property, cruelty to animals, aggression and general disregard for rules. Behavior seen in conduct disorder goes beyond typical "naughty child" behavior and requires different interventions. Cognitive behavior therapy (CBT) has proven effective in treating many of these challenging kids.

What is CBT?

• Cognitive behavioral therapy is a form of psychotherapy. Whereas some therapies look into your past and to external causes for your thoughts, feelings and behavior, CBT emphasizes that you are responsible for and in control of all of those things. The goal of CBT is to replace negative thoughts and behaviors with positive ones, regardless of the situation you're in. Essentially, you control how you exist in the world; you don't allow the world to control how you respond to it.

Why Intervention is Important

• Children with conduct disorder don't outgrow their negative behavior. It isn't a developmental phase like a toddler saying "no" or a preschooler marking on the walls. Untreated, conduct disorder can lead to expulsion from school, substance abuse, and serious crimes such as armed robbery, rape or assault. With proper and effective treatment, children with conduct disorder can be taught to alter their behavior and grow up to lead healthy and productive lives.

Why it Works

• Kids with conduct disorder often display a lack of concern for others' feelings and needs. CBT focuses on the child and enables him to make the world work for, not against, him. Once he sees that he can get what he wants by making positive choices and realizes that his negative behavior doesn't get him anything he wants, he will be compelled to change.

Positive Reinforcement

• In treating a child with conduct disorder, consequences--positive and negative--must be immediate and appropriate. Positive consequences aren't the same as bribery: you are not paying your child to do what you want. You are allowing her to experience natural consequences for the choices she makes. If your child is skipping school, yelling at her that she better go all week or else probably won't have much effect. If anything, she'll enjoy knowing she'll get a rise out of you. Let her know that if she goes all week, she can go to a movie over the weekend. Follow through with that promise, and be sure you praise her for doing well.

Negative Consequences

• Continuing with the school example above, let's say she skips school again. Rather than seeing the movie with her friends, she will have to stay home all weekend and study to make up for the time she missed. It is essential to enforce these consequences, as difficult as it may be. Enlisting the help of another adult to ensure that she stays home may be a good idea. If she throws a fit, ignore her. If she leaves after being told she must stay home, call the police and report her as a runaway. The point of CBT in treating kids with conduct disorder is to make following the rules work for them, and they must see that not following the rules won't get them anywhere.