I stand in the bathroom stall of the courthouse, texting a friend. “I can’t do this,” I write and lean my head against the cold partition of the stall.
“You’ve got this,” she replies. “Breathe, Honey.”
I hear the restroom door open and a singsong voice I recognize as my daughter, Debbie, quietly calls my name. I quickly pull my feet up, trying to be invisible. “I know you’re in here, you stupid bitch. Come out, come out, where ever you are.”
My breath halts and my pulse pounds in my ears. Be still, be quiet, I think. Maybe she will go away.
Footsteps approach as door after door of the stalls bang open. I quake in fear as the steps come nearer until I see her shoes in front of my door.
“You can’t hide forever,” Deb says in a lilting, singsong voice. She quickly tells me how plans to murder me and what she will do with my body before setting it and my home on fire. She reminds me that she has had months to perfect her plan, while in juvenile detention, without my interference.
I don’t respond.
Tiring of her game, Deb’s voice acquires the hard edge I’ve come to associate with rage. “Get out here, you bitch. I hate you. I want to see you scream as you die. Your precious boy will die, you will all die.” I cower behind the door as her diatribe continues; the words increasingly vulgar.
Suddenly the door into the hall opens and a new voice speaks. “Deb, are you in here?”
I hear Deb whisper, “Shit.” Then she begins to sob.
“Baby, what’s wrong? What happened?” I recognize the newcomer as Deb’s caseworker.
Still sobbing, Deb says, “I saw Mommy come in here. I just wanted a hug. She hates me.” She wails and sobs as though her world has just ended. “Why doesn’t she love me, Miss C?”
Debbie is only 14. Debbie has Conduct Disorder.
What is Conduct Disorder?
The DSM-5 (the manual used by mental health professionals to make diagnoses) defines Conduct Disorder (CD) as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.”
Children with Conduct Disorder (CD) may exhibit behaviors such as:
- bullying, threatening, or intimidating others
- initiates physical or verbal altercations
- physically or verbally cruel to others
- physically cruel to animals
- forces someone into sexual activity or is sexually aggressive
- frequently lies
- deliberately sets fires or destroys property
- lack of empathy
- lack of remorse
- grandiose thinking
- highly manipulative
- rages (or “tantrums”) lasting 25 minutes or more
- inability to learn from mistakes
- lacks critical thinking skills/has difficulties understanding abstracts
- shallow affect
- superficial charm/has a public and private demeanor
- lack of fear
Recent scientific studies indicate CD is in part due to abnormal brain activity, as well as an under development of the amygdala and prefrontal cortex. The amygdala is known to be responsible for controlling aggression as well as the perception of emotions. The prefrontal cortex handles executive functions such as controlling short-sighted or reflexive behaviors in order to plan long-term goals, make informed decisions, and exhibit self-control.
But what does all of this really mean?
In simple terms it means that the child with Conduct Disorder has a brain that is structurally different from that of a neuro-typical child. Because of this difference, the child with CD does not respond to rules, discipline, and societal norms the way a typical child does.
Conduct Disorder is evidenced by some, or all, of the behaviors listed above. The spectrum of behaviors is wide and varies between mild to severe. The tendency to lie, manipulate, and gaslight are strong and seemingly innate behaviors.
Standard parenting techniques are not effective. Discipline, rewards for good behavior, star charts, and other techniques fall short of managing behaviors long- term. Conduct Disorder transcends race, ethnicity, environment, location, and socioeconomic backgrounds. Unlike attachment disorders CD is not always due to trauma, abuse, or neglect. However, many children diagnosed with Reactive Attachment Disorder (RAD) at younger ages are ultimately diagnosed with CD as teenagers. CD can manifest at 2 years old or 15 years old, and any age in between.
There are an estimated 7 million children in the U.S. alone with Conduct Disorder. This translates into approximately 1 in 10 children affected.
For families affected by CD, it can mean very little in terms of treatment. Children with Conduct Disorder do not respond well to traditional talk therapy. In general, these children will use the counselor to further manipulate caregivers. Some go so far as to employ triangulation, in which the counselor becomes the unwitting accomplice of the child to further demoralize caregivers. Medication cannot relieve the symptoms of CD but it may be prescribed for co-morbid diagnoses such as ADHD.
At present there are very few viable inpatient treatment centers for children with Conduct Disorder. Many programs state that CD is treated at their facility, however most apply standard practices toward the treatment of other mental illnesses to CD. This is highly inappropriate and may lead to further issues for both the child and family living with CD.
Often, families feel vilified and become isolated due to the harsh judgment they face. Family and friends lack understanding of what is happening and drift away, unable to provide support for something they seldom witness. Parents beg doctors and mental health professionals for help, only to be mocked and treated with derision. The community, hearing of the child’s disrespect and abusive nature when the police are called, make assumptions about the parents: too lenient, too strict, not enough activities, too many activities, set boundaries, spank him/her, it’s all because of poor parenting, they say. All this does it further isolate families who are living in a constant war zone, created by someone they love and for whom they are legally responsible. Love does not cure Conduct Disorder (CD), nor does being a model family.
If there are no treatment options available, what can be done?
Fortunately, CD is being researched more in recent years. Unfortunately for those living with CD, viable treatment options are still years in the making. The founders of Compass for Conduct Disorder realized the need for community support programs, resources for parents/caregivers, and early childhood detection and intervention.
Compass for Conduct Disorder is a nonprofit organization whose goal is to provide resources, services, and hope for those living with CD. In addition to a parent/caregiver support group, Compass also provides an information and awareness group, parent advocacy, crisis buddies, the Compass Peer Network for professionals to exchange information relating to CD, and an awareness raising campaign. In the planning stages is the Compass Child and Family Support Center, which will be geared toward children ages 2 to 5 showing early signs of Conduct Disorder, and their families.
If you have a child with Conduct Disorder, Compass for Conduct Disorder is a place to find support, resources, and community.
Karen Huff is the mother of four children, one of whom has Conduct Disorder.
She is the President for Compass for Conduct Disorder and an admin for the Compass Cares support group, as well as for the Compass for CD Information and Awareness group.
Connect with her on Facebook and Twitter.