Having a child with CD in the family can have major consequences for the social and emotional well-being of siblings and other members of the family (Encyclopedia of Children’s Health, no date). Parents need to be aware of the social and emotional needs of their other children and modify family routines to adjust for the detrimental effects of having a child who exhibits antisocial behaviors. Parents should not leave the child with CD alone with other siblings, and if possible, they should get help with childcare. When the safety or the emotional well-being of family members is threatened, the parents may find it necessary to place the child with conduct-related problems in a residential or hospital-based therapy program for a while.
In Australia, Hazell et al. (2002) surveyed families who had one or more children with conduct-related disorders and comorbid conditions. The families rated main- stream community treatment which focused on counseling services as the highest priority. The families rated respite services and inpatient facilities as a lower prior- ity. However, respite care, inpatient, and other out-of-the home services were ranked high in priority among low socioeconomic status families and those exposed to high stress. More research is needed regarding the ease with which families have access to community treatment services and the effectiveness of those services.
Case Study
The following case study illustrates the experiences of a male adolescent who was diagnosed with CD and substance dependence.
Josh is a 15-year-old adolescent, who resides in a residential treatment program for disturbed adolescents. His mother, a nurse, works full time and often works the night shift (11 p.m. to 7 a.m.). His father, an accountant, works traditional hours. He has two older sisters, both in college. Both sisters have had histories of
References 145 drug and alcohol abuse and were hospitalized in the past. One sister has also had a history with the criminal justice system as an adolescent for the distribution of drugs.
Developmental milestones were all normal. When Josh began preschool, at age 3, he was seen as shy with peers and as cognitively in the low average range. In kinder- garten, he was not seen as a problem. In first grade, he experienced some difficulty with reading, but no other problems were noted. In second grade, he began to receive assistance for reading. In third grade, his teacher perceived him as having atten- tion problems and he was referred to the school psychologist for an evaluation. No evidence of ADHD was evident, but his reading problem was perceived to be sig- nificant, for he was still reading at a first-grade level. In fourth and fifth grades, Josh began to exhibit behavior problems. Specifically, he would disrupt the class. He was also suspected of stealing money from the teacher’s purse, but there was no clear evidence and the accusation was dropped.
In middle school, Josh began to be friendly with older students who were per- ceived as troublemakers by staff. In sixth and seventh grades, he was twice caught shoplifting at local stores. In school, he was also caught stealing another student’s hand-held game. During this time, his parents suspected that he was using mari- juana, although he denied it. By eighth grade, he was threatening younger students and forcing them to pay him daily for “protection.” He also had a physical fight with another student and was suspended for 5 days. At that time, his parents had him attend counseling on a weekly basis. He consistently missed appointments and the therapist reported that Josh had no investment in making changes. Counseling was terminated.
As a freshman in high school, he was arrested for breaking into a neighbor’s home and stealing electronics. He was placed on supervision. Within 6 weeks, he was again arrested – for possession and distribution of marijuana at a local middle school. He was subsequently placed on house arrest for 2 months, placed on 2 years’
probation, required to attend weekly counseling, and required to have random drug checks. When he failed a drug test, he was ordered to participate in an intensive outpatient drug treatment program. He was subsequently placed in a therapeutic school for children and adolescents with emotional and/or behavioral problems.
Josh was again arrested for breaking and entering and his house arrest was con- tinued for another 6 months. He was then arrested for burglary. While awaiting trial, his parents placed him in a long-term residential facility in another state (on the advice of their attorney). At that time, he was diagnosed with CD, as well as substance dependence.
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