Research studies show that as many as 20% to 56% of ADHD children and 44% to 50% of ADHD adolescents also suffer from Conduct Disorder (CD).¹ Children with CD areaggressive to people and animals, destroy property, lie, steal and seriously violate rules. Typically, patients with CD are not distressed by their behavior. There are two types of CD based on when the symptoms first appear. These are childhood onset or adolescent onset.
Answer these questions about your child or adolescent:
- My child bullies, threatens, or intimidates other.
- My child initiates physical fights.
- My child has used a weapon (a bat, brick, broken bottle, knife, gun, etc) that can cause serious physical harm to others.
- My child has been physically cruel to people.
- My child has been physically cruel to animals.
- My child has stolen while confronting a victim as in a mugging, purse snatching, extortion, armed robbery, etc.
- My child has forced someone into sexual activity.
- My child has deliberately engaged in fire setting with the intention of causing serious damage.
- My child has deliberately destroyed others’ property.
- My child has broken into someone else’s house, building, or car.
- My child often lies to obtain goods or favors to avoid obligations. My child cons others.
- My child has stolen items without confronting a victim as in shoplifting or forgery.
- My child often stays out at night despite parental prohibitions with the onset before age 13
- My child has run away from home overnight at least twice or at least once has stayed away for a lengthy period.
- My child is often truant from school with the onset before age 13.
If 3 or more of the above statements describe your child’s behavior during the last year with at least 1 occurring in the past 6 months, your child may have Conduct Disorder and he/she should be seen and evaluated immediately by a child or adolescent psychologist or psychiatrist. Your child may also suffer symptoms of learning problems, depression, hyperactivity and/or addiction. It is important to identify and treat Conduct Disorder as early as possible. Your primary care physician should be able to recommend a professional who can help you. If you cannot afford the fee, you should be able to find a mental health clinic in your area that offers services on a sliding fee scale. You and your child need all the help you can get!
Why do some children have conduct disorder? “There appear to be several pieces of this ”jigsaw” puzzle, including genetic, nutritional and biochemical, family and social factors. Children with CD may inherit decreased autonomic nervous system activity, requiring greater stimulation to achieve optimal arousal.”² Serotonin and other neurotransmitters in the brain play a role in aggression. There are also family factors that increase the risk for conduct disorder. These include parental substance abuse, psychiatric illness, marital conflict, child abuse and neglect.
In therapy parents are counseled to communicate more clearly with their children, to set consistent behavior guidelines, to reinforce good behavior and to set consistent penalties for noncompliance.
Drugs are sometimes used to help children with conduct disorder although there are no formally approved medications for conduct disorder and there have been few studies that have studied the effectiveness and safety of these drugs for children with CD. Stimulants such as Dexedrine and Ritalin are often prescribed for CD and may reduce aggressiveness. Antidepressants such as Wellbutrin and Prozac are also used.
What role does nutrition play in Conduct Disorder (CD)? Remember, all the cells and chemicals found in your child’s brain come from the breakdown of foods in your child’s diet. The diet supplies glucose, 10 essential amino acids from which neurotransmitters are made, 2 essential fatty acids to make the membrane and other chemicals that help cells to communicate with each other, and 12 vitamins and 20-30 minerals that participate in numerous biochemical reactions. Your child is what he eats! Garbage in, garbage out! Clearly, much more research needs to be undertaken to study the effects of diet on behavior but there are some interesting studies that may help you now.
First, make sure your child is eating a healthy diet. Get rid of the junk foods in your house so your child won’t be tempted. (I know, it’s tough to enforce this if your child has access to foods outside the home. He/she is not going to choose broccoli over candy!) You’ll want to buy products that are without sugar or other sweeteners or very low in sweeteners because your child won’t have room left for nutritious foods. Choose products that do not contain artificial colors and flavors. These are indicated on packages by the terms “artificial colors,” “tartrazine,” “yellow #5 or 6,” ”Red #40” etc. You’ll be surprised at how many of our foods are artificially colored! Skip those processed foods that are high in saturated, hydrogenated fats, partially hydrogenated fats and trans fatty acids.
Instead, you’ll want your child to eat more fruits and vegetables every day. Choosedifferent colored fruits and veggies because these contain different phytochemicals that are extremely important for good health. You may have read recently about phytochemicals. Unlike vitamins and minerals that must be supplied by the diet, normal metabolism can occur without phytochemicals. However, they appear to be very effective in lowering our risks of cancer, heart disease, diabetes, arthritis, etc. Their effects on behavior really haven’t been studied yet, but it only makes sense that they are important for good mental health given their roles in cells. Of course, fruits and veggies also supply vitamins and minerals. Whole grains also contain different phytochemicals so choose whole wheat bread, yellow kernel popcorn, oatmeal, brown rice, etc. You’ll also want to serve 2-3 servings of low-fat dairy a day. Don’t let your child fill up on milk because this may ruin your child’s appetite for other nutritious foods. Choose lean meats, poultry, fish, unprocessed nuts and beans as sources of protein. As you reduce the “bad” fats in your child’s diet, you’ll want to increase sources of essential fatty acids, especially the omega-3 fatty acids that are found in flax and flaxseed oil, canola oil, walnuts, some beans ( northern, navy, pinto, soy, and black) and cold water fish (fresh salmon, tuna, flounder, sardines, etc.)
Remember when your mother would say, “Don’t skip breakfast. It’s the most important meal of the day.” She was right! Start your child’s day with a good breakfast. This is extremely important. Studies have shown that children who don’t consume breakfast act out in school, can’t pay attention, are more hyperactive, and have more problems learning. Be sure the breakfast is high in protein and very low in refined carbohydrates. The protein sources could be eggs, homemade sausage, yogurt, cheese, or meat left over from the night before.
Unfortunately, many children with CD are picky eaters or prefer to eat foods that are not nutrient dense. You may want to give your child a multi vitamin and mineral tablet—not a mega dose, just the recommended daily allowance (RDA) for your child’s age and gender. This should at least include vitamin A, B1, B2, B6, niacin, folic acid, vitamin C, vitamin D, vitamin E, magnesium, calcium, zinc, and iron. In a fascinating double-blind, placebo-controlled study¹ of children ages 6 to 12, researchers gave the children either a low dose vitamin-mineral tablet or a look-alike placebo tablet for 4 months. The forty children with discipline problems who took the vitamin-mineral supplement were disciplined 47% less than 40 children who took the placebo. The behavior problems studied included threats or fighting, vandalism, being disrespectful, disorderly conduct, defiance, obscenities, refusal to work or serve, etc. There have been similar studies of institutionalized offenders, ages 13 to 17 or 18 to 26. Those who received the active tablets had about 40% less violent or antisocial behavior than those who took the placebo.
Essential fatty acids (EFA) may play an important role too. Essential fatty acids are critical molecules that help makeup the cell membrane that surrounds every cell in the body. EFA are also important for formation of a group of molecules called eicosanoids that help cells communicate with neighboring cells. So EFA are critical for normal brain function. A study of fatty acids in the blood of violent offenders found that violent offenders had values significantly different from the controls who did not have violent behavior problems.²
In 2002, researchers reported another double-blind placebo-controlled intervention study that looked at the impact of supplementing young violent prisoners with13 vitamins, 12minerals and essential fatty acids.³ The fatty acids supplied included 160 mg gamma linolenic acid (GLA), 80 mg eicosapentaenoic acid (EPA) and 44 mg docosahexaenoic acid (DHA). Those who received the active supplement committed on average a significant reduction (26%) of discipline incidents compared to those who took the placebo look-alike tablet. Violent incidents fell 37% in those who received the active capsule. Interestingly, the study also commented on the nutritional knowledge of the prisoners and found that some lacked even the most basic knowledge to choose a healthy diet. For example, some had never heard of vitamins!
Researchers at the Pfeiffer Treatment Center in Naperville IL studies have studied thecopper/zinc ratios in violence-prone young men. Copper was elevated in the serum of the blood while plasma zinc was depressed.4 They studied 135 violent young males and 18 non-violent male controls. The ratio of copper to zinc was significantly elevated in the aggressive subjects compared to the controls. The blood was analyzed at an independent lab, SmithKline Beecham Clinical Lab. Your doctor could easily order these tests if you are interested. Or you could try giving your child 15-30 mgs of zinc every day and observe his behavior over a couple of months. You don’t want to give too much zinc because that can create an imbalance in other important minerals!
A combination of counseling, effective parent discipline, appropriate school placement and intervention, medications such as stimulants and antidepressants, changes in diet and the addition of nutrients help many CD children. If you suspect or know your child has CD, act now because the earlier CD is evaluated and treated the better the outcome! Good luck!