Assessment

The diagnostic criteria for CD are summarized in eBox 24-2. The clinician should not quickly accept the diagnosis of CD in a youth, because no specific effective treatment exists, and instead should diligently search for other, more treatable psychiatric conditions. Other psychiatric diagnoses that should be considered as the primary disturbance in a child presenting with CD symptoms include ADHD, ODD, intermittent explosive disorder, psychoactive substance use disorder, mood disorders (bipolar and depressive disorders), posttraumatic stress disorder (PTSD), dissociative disorder, borderline personality disorder, and adjustment disorder with disturbance of conduct. A manic episode must be seriously considered in a teenager presenting with frequent lying, physical aggression against others, impulsive sexual activity, stealing, sneaking out in the middle of the night, grandiosity, and persistent pervasive irritability.

The interview of an adolescent with CD is not sufficient, in itself, for the psychiatric evaluation. Lying is a common problem for these teenagers, as is conscious and unconscious underreporting of their problem behaviors. Other sources of information, including parents, teachers, other professionals, past records, and court personnel, are essential to obtain a valid evaluation. Complications seen in association with CD symptoms include impairment in school performance, poor social and family relationships, problems with the legal system, poor work performance, physical injuries from fighting or carelessness, sexually transmitted diseases, teenage pregnancy, drug problems, suicide, and homicide. Common examples of interpersonal impairment in these children include suspiciousness or paranoia, misperception of others' actions as hostile, difficulty relating to peers and adults, lack of guilt, and lack of empathy.

Children with CD respond differently to punishment than normal children. The frequency of negative behavior of normal children decreases when they are punished, whereas the negative behavior of children with CD increases when they are punished.

There are no specific laboratory tests that assist in making the diagnosis of CD. However, the differential diagnosis for CD symptoms includes conditions for which tests may be important. These include head trauma, seizure disorder, birth injury to the brain, and encephalitis.

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