儿童心理健康与行为障碍
2018-04-10 信源 / WebMD Medical Reference， Reviewed by Smitha Bhandari, MD 华协翻译整理
编者按：行为障碍在我们身边的例子很多，但是，大多数妈妈们并未发现自己孩子的行为异常，直到学校老师找到了一无所知的家长们，才知道问题的严重性，而且，往往遗误了最佳治疗时机。下文由小编根据加拿大医科指南翻译整理，希望对有需要的爸爸妈妈们有一定的指导意义。
Mental Health and Conduct Disorder
Mental Health and Conduct Disorder
Conduct disorder is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and have problems following rules.
It is not uncommon for children and teens to have behavior-related problems at some time during their development. However, the behavior is considered to be a conduct disorder when it is long-lasting and when it violates the rights of others, goes against accepted norms of behavior and disrupts the child's or family's everyday life.
What Are the Symptoms of Conduct Disorder?
Symptoms of conduct disorder vary depending on the age of the child and whether the disorder is mild, moderate, or severe. In general, symptoms of conduct disorder fall into four general categories:
Aggressive behavior: These are behaviors that threaten or cause physical harm and may include fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity.
Destructive behavior: This involves intentional destruction of property such as arson (deliberate fire-setting) and vandalism (harming another person's property).
Deceitful behavior: This may include repeated lying, shoplifting, or breaking into homes or cars in order to steal.
Violation of rules: This involves going against accepted rules of society or engaging in behavior that is not appropriate for the person's age. These behaviors may include running away, skipping school, playing pranks, or being sexually active at a very young age.
In addition, many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Some may abuse drugs and alcohol. Children with conduct disorder often are unable to appreciate how their behavior can hurt others and generally have little guilt or remorse about hurting others.
What Causes Conduct Disorder?
The exact cause of conduct disorder is not known, but it is believed that a combination of biological, genetic, environmental, psychological, and social factors play a role.
Biological: Some studies suggest that defects or injuries to certain areas of the brain can lead to behavior disorders. Conduct disorder has been linked to particular brain regions involved in regulating behavior, impulse control, and emotion. Conduct disorder symptoms may occur if nerve cell circuits along these brain regions do not work properly. Further, many children and teens with conduct disorder also have other mental illnesses, such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, depression, substance abuse, or an anxiety disorder, which may contribute to the symptoms of conduct disorder.
Genetics: Many children and teens with conduct disorder have close family members with mental illnesses, including mood disorders, anxiety disorders, substance use disorders and personality disorders. This suggests that a vulnerability to conduct disorder may be at least partially inherited.
Environmental: Factors such as a dysfunctional family life, childhood abuse, traumatic experiences, a family history of substance abuse, and inconsistent discipline by parents may contribute to the development of conduct disorder.
Psychological: Some experts believe that conduct disorders can reflect problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing.
Social: Low socioeconomic status and not being accepted by their peers appear to be risk factors for the development of conduct disorder.
How Common Is Conduct Disorder?
It is estimated that 2%-16% of children in the U.S. have conduct disorder. It is more common in boys than in girls and most often occurs in late childhood or the early teen years.
How Is Conduct Disorder Diagnosed?
As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular problem. If symptoms of conduct disorder are present, the doctor may begin an evaluation by performing complete medical and psychiatric histories. A physical exam and laboratory tests (for example, neuroimaging studies, blood tests) may be appropriate if there is concern that a physical illness might be causing the symptoms. The doctor will also look for signs of other disorders that often occur along with conduct disorder, such as ADHD and depression.
If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitudes and behavior. The doctor will often rely on reports from the child's parents, teachers, and other adults because children may withhold information or otherwise have trouble explaining their problems or understanding their symptoms.
How Is Conduct Disorder Treated?
Treatment for conduct disorder is based on many factors, including the child's age, the severity of symptoms, as well as the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:
Psychotherapy : Psychotherapy (a type of counseling) is aimed at helping the child learn to express and control anger in more appropriate ways. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve problem solving skills, anger management, moral reasoning skills, and impulse control. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior in the home.
Medication : Although there is no medication formally approved to treat conduct disorder, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or major depression.
What Is the Outlook for Children With Conduct Disorder?
If your child is displaying symptoms of conduct disorder, it is very important that you seek help from a qualified doctor. A child or teen with conduct disorder is at risk for developing other mental disorders as an adult if left untreated. These include antisocial and other personality disorders, mood or anxiety disorders, and substance use disorders.
Children with conduct disorder are also at risk for school-related problems, such as failing or dropping out, substance abuse, legal problems, injuries to self or others due to violent behavior, sexually transmitted diseases, and suicide. Treatment outcomes can vary greatly, but early intervention may help to reduce the risk for incarcerations, mood disorders, and the development of other comorbidities such as substance abuse.
Can Conduct Disorder Be Prevented?
Although it may not be possible to prevent conduct disorder, recognizing and acting on symptoms when they appear can minimize distress to the child and family, and prevent many of the problems associated with the condition. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of disturbing behavior.
心理健康和行为障碍
行为障碍是一种严重的行为和情绪障碍，可发生在儿童和青少年身上。有这种疾病的孩子可能会表现出一种破坏性和暴力行为的模式，并且遵循规则存在问题。
儿童和青少年在发育过程中的某个时候出现与行为有关的问题并不少见。然而，如果行为持久且侵犯他人权利，违背公认的行为规范并破坏儿童或家庭的日常生活，则该行为被认为是一种行为失调。
行为障碍的症状是什么？
行为障碍的症状取决于孩子的年龄以及疾病是轻度，中度还是重度。一般来说，行为障碍症状分为四大类：
攻击性行为：这些行为是威胁或造成人身伤害的行为，可能包括战斗，欺凌，对他人或动物的残忍，使用武器以及强迫他人进行性行为。
破坏性行为：这涉及蓄意破坏财产，如纵火（故意燃烧）和破坏行为（损害他人财产）。
欺骗行为：这可能包括反复说谎，偷窃商品或闯入家中或汽车以窃取。
违反规则：这涉及违反公认的社会规则或参与不适合该人年龄的行为。这些行为可能包括逃跑，逃学，玩恶作剧，或者在很小的时候性活跃。
此外，许多行为障碍的儿童烦躁不安，自尊心低下，并且经常发脾气脾气暴躁。有些人可能会滥用毒品和酒精。有行为障碍的儿童往往无法理解他们的行为会如何伤害他人，并且通常对伤害他人没有什么内疚或懊悔。
什么导致行为障碍？
行为障碍的确切原因尚不清楚，但相信生物，遗传，环境，心理和社会因素的综合作用。
生物学：一些研究表明，脑部某些区域的缺陷或损伤可能导致行为障碍。行为障碍与调节行为，冲动控制和情绪所涉及的特定大脑区域有关。如果沿这些大脑区域的神经细胞回路不能正常工作，则可能会发生行为障碍症状。此外，许多患有行为障碍的儿童和青少年还患有其他精神疾病，如注意力缺陷/多动症（ADHD），学习障碍，抑郁症，物质滥用或焦虑症，这可能导致行为障碍症状。
遗传学：许多患有行为障碍的儿童和青少年患有精神疾病的亲密成员，包括情绪障碍，焦虑症，物质使用障碍和人格障碍。这表明，对品行障碍的脆弱性可能至少部分是遗传的。
环境：诸如家庭生活失调，儿童期虐待，创伤性经历，药物滥用家族史以及父母纪律不一致等因素可能导致行为障碍的发展。
心理学：一些专家认为，行为障碍可以反映道德意识（特别是缺乏内疚和悔恨）和认知加工缺陷方面的问题。
社交：社会经济地位低下并且未被同伴接受似乎是发生行为障碍的风险因素。
常见的行为障碍是什么？
据估计，美国有2％-16％的儿童患有混乱。男孩比女孩更常见，大多发生在儿童晚期或青少年时期。
如何诊断行为障碍？
与成年人一样，儿童的精神疾病根据表现出特殊问题的体征和症状进行诊断。如果出现行为障碍症状，医生可以通过执行完整的医疗和精神病史开始评估。如果担心身体疾病可能导致症状，则体格检查和实验室检查（例如神经影像学检查，血液检查）可能是适当的。医生还会寻找其他通常伴随行为障碍发生的病症，如多动症和抑郁症。
如果医生无法找到症状的物理原因，那么他或她可能会将孩子转介给经过专门培训的儿童和青少年精神病医生或心理医生，以诊断和治疗儿童和青少年的精神疾病。精神科医生和心理学家使用特别设计的面试和评估工具来评估儿童精神障碍。医生根据孩子的症状和他或她对孩子的态度和行为的观察报告进行诊断。医生通常会依靠孩子的报告
如果医生无法找到症状的物理原因，那么他或她可能会将孩子转介给经过专门培训的儿童和青少年精神病医生或心理医生，以诊断和治疗儿童和青少年的精神疾病。精神科医生和心理学家使用特别设计的面试和评估工具来评估儿童精神障碍。医生根据孩子的症状和他或她对孩子的态度和行为的观察报告进行诊断。医生通常会依靠孩子的父母，老师和其他成人的报告，因为孩子可能会隐瞒信息或无法解释他们的问题或理解他们的症状。
如何治疗行为障碍？
行为障碍的治疗基于许多因素，包括儿童的年龄，症状的严重程度，以及儿童参与和耐受特定治疗的能力。治疗通常由以下各项组合而成：
心理治疗：心理治疗（一种咨询）旨在帮助孩子学习以更恰当的方式表达和控制愤怒。一种称为认知行为疗法的疗法旨在重塑孩子的思维（认知），以提高解决问题的能力，愤怒管理，道德推理能力和冲动控制。家庭治疗可以用来帮助改善家庭成员之间的家庭互动和交流。一种称为家长管理培训（PMT）的专业治疗技术教导家长如何积极改变孩子在家中的行为。
药物治疗：虽然没有正式批准用于治疗品行障碍的药物，但可以使用各种药物来治疗一些令人不安的症状，以及任何其他可能存在的精神疾病，例如ADHD或严重抑郁症。
行为障碍儿童的展望是什么？
如果您的小孩出现行为障碍症状，请向合格的医生寻求帮助，这一点非常重要。具有行为障碍的儿童或青少年如果不及时治疗，可能会成为其他精神障碍的成年人。这些包括反社会和其他人格障碍，情绪或焦虑症和物质使用障碍。
有品行障碍的儿童也面临学校相关问题的风险，如失败或辍学，药物滥用，法律问题，由于暴力行为导致的自我或其他人受伤，性传播疾病和自杀。治疗结果可能差异很大，但早期干预可能有助于降低监禁，心境障碍和发生其他合并症（如药物滥用）的风险。
可以防止行为障碍吗？
尽管可能无法预防行为障碍，但在出现症状时识别并采取行动可最大限度地减少对儿童和家人的痛苦，并防止许多与症状相关的问题。此外，为爱与纪律的平衡提供一个培育，支持和一致的家庭环境可能有助于减少症状并防止干扰行为的发作。