Family therapy for conduct disorders

Low levels of parental skill and cooperation are the prominent roots of arrested socialization, and a lack of appreciation for intimate and gratifying human relationships is evident in children with CD. The relational problems are exaggerated further by the child's observation of chronic parental discord and internalization of a family image constructed around intrafamilial conflict and isolation. Skills deficits in parental and marital communication and problem solving and conflicts in these relationships play significant roles in producing family dysfunction. The low level of parental differentiation and identity formation plays a fundamental role in family dysfunction by interfering with the development of an adequate self-image, self-esteem, and internal codes of behavior in the child. The transmission of parental antisocial tendencies to their children is facilitated by the low level of differentiation between parent and child. Family treatment should focus on enhancing cooperation between parents and children and between parents as co-parents and as a couple. Enhancing parent management skills can undermine the use of coercive, punitive, and impulsive interactions in the families. The higher divorce rate in parents of children with CD should be addressed with parents directly and early in treatment with the hope of mobilizing the rehabilitative and cooperative marital forces. In terms of future directions, family studies should address and incorporate the expanding knowledge of biologic and psychologic characteristics of children with CD and the possible impact of such characteristics in undermining family development and integrity. Such investigations should include the following information: The role of sustained and intense aggression in some children on family functioning and development. The possible role of diminished response to punishment and excessive search for gratification in children with CD. The role of the child with CD in promoting marital and family discord and divorce. The role of neurotransmitters (such as serotonin) in the production of irritability, provocativeness, coercive family processes, and subsequent depression in the caregiver or the child. Effective models of intervention with children with CD in hospitals and residential treatment centers.