6.2 Discussion and recommendations
This review of articles, researches and works about CD reveal some problems of studying this disorder. Statistics seems to be the first difficulty that a student reviewing CD will face. In Greece and Cyprus there are only numbers for limited period provided from justice, while in UK statistics come from health care services and some local school surveys mostly. In USA and Australia there are much more numbers in wide researches available from justice, national centres of diseases, educational institutes and governmental services. Rates from Asian countries are limited to some school numbers and are not country-wide. Questions posed in questionnaires of researches are another concern, too. Some questions are not totally clear or can be understood in a different way by parents, teachers and health services involved in a child’s or teen’s life. Even if questions are clear, each parents and teachers give different meaning to words like disobedience, offensive conduct, damage, harm etc. People from different geographical areas of each country, different cultures, different education level and age have different standards of obedience, offense etc. Moreover, parents frequently are not willing to give exact information in a research or a clinical assessment because they feel embarrassed for the conduct of the child, or even afraid of being accused for it. Public services and organisations do not gather information about youth’s aggression or cases of disorders, or even they don’t publish statistics as it becomes evident that there is limited care for bullying and juvenile delinquency or luck of willing to face it successfully, especially in Europe. Further, most research has been carried out with male offenders although girls’ numbers rise dramatically in recent years. Statistics do not reveal what kind of behaviour or activity is prevailing which makes CD numbers rise. Thus, there is a need for more research supported by the state, public services and universities in a larger scale all over each country, with more acceptable statistical methods.
Despite of different means of gathering information, all statistics agree that the rate of CD among children and teens is rising globally in recent two decades, that more girls are now diagnosed with it, and that offenders now start in younger age than in the eighties or nineties.
Clinical assessment is another aspect of this disorder that has to be addressed. It is not an easy task for the therapist to make an accurate diagnosis of CD and to find out possible commodities since CD often co-occur with ADHD and ODD or depression. Earlier medical evaluations are not available or usually no evaluation has performed before that would help therapist to check the grounds of developmental pathways of the child. In addition, parents are usually not willing to give details or information about family issues. Thus, clinical assessment of CD is not easy and the diagnosis can be mistaken if psychologist has no special experience and training with children or teens. Moreover, most institutions and public health care services don’t have resources for training mental health stuff for the administration of structured diagnostic interviews, methods and questionnaires. The luck of specialised personnel is an urgent problem that public administration has to deal with it by providing special training and qualification to psychologists involved.
Additionally, studies showed that a treatment that includes both parents and child or teen is more effective, but follow-up researches for more than a year after the completion of the program are very rare. It is an aspect of the intervention programs that should be investigated more. Furthermore, the therapeutic alliance of the clinician and the parents of children suffering with CD is an issue that should be studied further, too.
Out of all social factors that came up during this research, the link of parent’s socioeconomic status and the early onset of CD can’t be ignored. Parents with low income often have less education, more depression or psychiatric issues, more marital conflict and domestic violence, worse parental style and poor monitoring. These families also live in deprived urban areas with high rates of employment, dense housing, social seclusion, poor social cohesion, no community assistance and adequate health and social care. Children and teens that grow up there, tend to show academic failure, aggression and delinquency. Poverty and social injustice are closely connected with Conduct Disorder. Thus, it is urgent that governments should take serious decisions and generous measures to ameliorate the living conditions of socially deprived populations through a radical social policy that would help them to improve the quality of their lives. More jobs with better payments, more infrastructure in poor neighbourhoods, more funds for public health care services and for youth centres are necessary. Politicians and governments should realise the importance of mental health in our society and stop underfunding public social welfare and mental health care services. School interventions and mental health services inside schools and educational institutes should be the first priority if society really wants to face youth’s rising psychological disorders. Youth is the future of our society. It deserves a better care!