Innovative Approaches for Effective Treatments for Conduct Disorder in Teens with ADHD

If your teen struggles with behavioral issues. You may not be sure where to start to figure out the root cause—whether it’s Attention Deficit Hyperactivity Disorder (ADHD) or something else like Conduct Disorder, OCD, or other behavioral disorder. The key to making informed decisions and choosing the best treatment lies in obtaining the proper diagnosis.

ADH and Conduct Disorder needs specialized interventions and treatment. It’s important for parents and caretakers to understand the intricacies of these conditions in order to get their child the highest level of care.

Revisiting the Definitions

What is ADHD?

Attention deficit/hyperactivity disorder (ADHD) is estimated to affect three to five percent of children between three and 18 years old. It is a neurodevelopmental/neurobehavioral disorder characterized by deficits in attention span, impulse control, and hyperactivity.

ADHD is thought to be caused by the combination of environmental influences, genetics, prenatal use of drugs or alcohol, and brain abnormalities involving the amygdala and/or prefrontal cortex.

For reasons still unknown, boys have a much higher risk of ADHD than girls.

Children with ADHD are typically diagnosed for the first time after they start preschool or kindergarten. Academic and peer-oriented situations highlight the signs of ADHD, such as not paying attention to instructions, talking too much, inability to sit still, and lack of motivation to complete schoolwork.

In addition, kids with ADHD experience difficulty making friends because they interrupt others when they are talking, speak in a loud or domineering tone of voice, and may want to discuss subjects that are inappropriate or unsettling to their peers. In short, these kids struggle in social situations.

What is Conduct Disorder?

According to DSM5 Conduct Disorder is a psychiatric disorder mostly affecting boys between the ages of five and 16; conduct disorder is more serious than ADHD because it involves aggressive, sometimes sociopathic behaviors. Kids with conduct disorder lie, steal, destroy other people’s property, engage in criminal activity, and physically hurt people or animals without remorse.

Risk factors for conduct disorder include being male, exposure to childhood abuse, living in poverty, and witnessing domestic violence in the home. To be clinically diagnosed with conduct disorder, a child must have exhibited three or more symptoms of conduct disorder continuously for at least 12 months.

 

How are Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) Different?

The symptoms and their severity are the main difference between Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). 

The symptoms and behaviors of ODD in teenagers include: 

• a pattern of anger towards others
• disruptive behaviors
• disrespect towards authority figures
• irritability
• argumentative
• defiance – resistance to follow rules
• vindictiveness 
• refuses to comply with requests or rules

 

In contrast, Conduct Disorder is a disruptive behavior disorder that involves more aggression, destruction of property and violation of others’ rights. Teens with Conduct Disorders actions and behaviors are atypical and not adolescent rebellion. 

Co-morbidity and Overlapping Symptoms

Conduct disorder is often co-diagnosed with oppositional defiant disorder (ODD), substance abuse disorder, and ADHD. Between 16 percent to 20 percent of children and teens with conduct disorder also have ADHD.

Although studies have found that over 50 percent of kids diagnosed with conduct disorder have never been diagnosed with ODD, about 60 percent of those kids actually meet the criteria guidelines for ODD.

Consequently, some children with conduct disorder may be suffering from symptoms of both ADHD and ODD.

Treatments for ADHD and Conduct Disorder

What are the Current Treatments for ADHD?

Training in behavior therapy for parents of young children with ADHD is a priority treatment that has proven to help ADHD kids do better academically and socially. Behavior therapy teaches a parent how to use positive reinforcement, consistently administer discipline in the home, and create a structured environment for their child.

Devising situations at school and home that encourage positive behavior is a strategy that builds self-esteem and improves communication between kids with ADHD and their teachers and parents.

Kids under six or seven years of age who have ADHD respond better to their parents working with them to manage their symptoms than talking to pediatric psychologists. Older children benefit from a combination of parental behavior therapy and cognitive behavioral therapy.

CBT therapists help preteens and teens with ADHD restructure negative thought patterns and accomplish academic goals by breaking down the completion of homework into smaller, progressive tasks.

Medications approved for treating ADHD include Strattera, Ritalin, and Adderall. Strattera is a nonstimulating, selective norepinephrine reuptake inhibitor (SNRI) that increases levels of norepinephrine in the brain. Research shows that insufficient levels of norepinephrine cause ADHD symptoms in some children.

Adderall and Ritalin increase the availability of norepinephrine and dopamine in a child’s brain. Dopamine is a neurotransmitter responsible for regulating attention, focus, and decision-making. It also helps kids with ADHD manage disruptive behaviors.

The majority of children and adolescents with ADHD respond positively to Adderall or Ritalin. However, all ADHD medications cause side effects that may interfere with their benefits, such as chronic headaches, insomnia, abdominal pain, and agitation.

Since the reactions to ADHD medications differ widely among children, parents may need to try different medicines until they find one that works best for their child.

What are the Differences Between Treatments for Conduct Disorder and ADHD?

Conduct disorder and ADHD are often co-morbid, meaning they occur together as a constellation of symptoms. Consequently, doctors are compelled to combine specific ADHD and CD therapies and medications to treat conduct disorder (a psychiatric disorder) and ADHD (a behavioral disorder).

Psychostimulants such as Adderall or Ritalin are first-line medications for kids with conduct disorder and ADHD. Some evidence also points to Risperidone as an effective alternative to Adderall or Ritalin. However, Risperidone should only be given to kids with severe symptoms of conduct disorder involving episodes of physical aggression and explosive anger.

Risperidone is an atypical antipsychotic drug that is prescribed for treating schizophrenia, bipolar disorder I and II, and PTSD. Due to side effects such as weight gain and metabolic changes, Risperdal is only given as a short-term treatment for conduct disorder after ADHD symptoms have been addressed.

Parents should be aware that studies indicate there is a high risk of ADHD developing into oppositional defiant disorder without treatment. In addition, some kids with ADHD and ODD may later exhibit symptoms of CD, with an overlapping of symptoms emerging at the onset of each disorder.

Experts recommend that parents who think their child may have ADHD receive an accurate diagnosis as soon as possible to reduce the risk of the child developing CD.