Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms or rules are violated; to a lesser degree, it is called Oppositional Defiant Disorder (ODD) in younger children

Aetiology

Bio-psycho-social influences

Genetic

• Some evidence in twin studies

Brain injury

• Intrauterine or post-natal CNS trauma
• Antisocial behaviour in general is more common in children with neurological conditions

Environmental

• Individual child problem - difficult temperament
• Family circumstances
  • Families with parents with mental illness and intellectual difficulties
  • Drug and alcohol problems
  • Domestic violence
  • Single parent families
• Parenting style
  • Lack of house rules - no set routine
  • Lack of clarity as to how children are to behave
  • Inconsistent responses to undersired behaviour with failure to follow through on consequences or with rewards
  • Lack of techniques to deal with crises or resolve conflict within the family
  • Lack of supervision

Pathophysiology

Types

• Mild-moderate - restricted to family environment
• Severe
  • Unsocialised - predominantly violent behaviour and more likely to be dealt within the criminal justice system
  • Socialised - more coverty antisocial acts or better ability to avoid getting involved with the criminal justice system

Co-morbidities

ADHD

• ADHD characterised by inattention, hyperactivity, and impulsivity
• Frequently co-occurs with difficulty in self-regulation