Treatment of Conduct Disorder
Behavioral and Cognitive-Behavioral Therapy
Behavioral therapy for children with Conduct Disorder is based on scientifically-derived learning theory. The basic idea is that behavior patterns are in large part learned from exposure to rewards and consequences, and therefore, inappropriate behaviors can be "unlearned", and replaced by more appropriate pro-social behaviors through the systematic manipulation of rewards and consequences that promote pro-social behavior and discourage antisocial behavior.
Behavioral strategies used during treatment of Conduct Disorder focus on reducing blame (parents often blame themselves for creating the problem in addition to blaming their child), increasing parental monitoring and supervision of children's behavior (e.g., role-playing, teaching), and on implementing behavioral contracting. In behavioral contracting, a specific agreement is drawn up between caregivers and children. Each behavioral contract describes in explicit detail exactly what behavior changes are desired. For example, a contract designed to reduce disrespectful behaviors might describe multiple ways that disrespect can be conveyed, such as mumbling under one's breath, talking back, rolling one's eyes, etc. The consequences for engaging in a disrespectful behavior are spelled out, as are more desirable alternative behaviors and the rewards that will accompany these appropriate behaviors. Though this focus on rewards and punishments can seem totalitarian at first glance, it is actually not that way at all. By spelling out consequences in detail, the behavioral contract actually discourages parent's tendency to punish arbitrarily, replacing it with a consistently applied program of rewards and punishments that can be clearly anticipated by children.
In addition to addressing specific problem behaviors, therapy also tends to focus on helping parents understand how to be more effective and fair disciplinarians. Parenting skills such as figuring out which minor problematic behaviors to ignore and which to address, giving children clear rather than vague instructions for how to behave, and developing and communicating specific rules are often taught to parents as part of the therapy, as are conflict resolution (problem solving) and communication skills.
Modern behavior therapists recognize that it is as important to address children's thoughts as it is to address their actual problem behaviors. This is because thoughts can serve a motivating function. If children have a wrong, overgeneralized or otherwise exaggerated understanding of a situation, this can make them more likely to misbehave. Cognitive-behavioral approaches to therapy teach children and parents both to identify and address faulty beliefs that make conflict more likely and to help dismantle and debunk those beliefs.
As a part of cognitive behavior therapy, therapists work with children to help them develop several important cognitive skills, including cognitive reframing of stressful events (e.g., helping children to generate alternative, more peaceful ways of thinking about the meaning of stressful situations so that anger is not an automatic consequence). Anger management training, which generally involves teaching people to better manage frustration feelings by learning to recognize and defuse anger sensations with reframing and relaxation techniques such as muscle relaxation or deep breathing, may also be taught.