Conduct disordered adolescents are complex and some of the most frequent inhabitants of the criminal justice system. The goal of the justice system is to get them treatment so that they can be rehabilitated and grow in to successful adults. Conduct disorder differs from other psychological conditions in that is a pattern where the person continually violates the rights of others and does not obey typical social norms for their age (Gathright & Tyler, 2014). They may deliberately break the rules, act aggressively towards other people or animals, destroy property, lie, steal, or violate school rules (Gathright & Tyler, 2014). These are the activities that typically lead to involvement with the criminal justice system.
Without treatment, it is likely that conduct disordered behaviors in adolescents will become anti-social disorders in adulthood. In the 1990s, it became popular to treat conduct disordered youth and adult offenders with selective serotonin reuptake inhibitors (SSRIs). The practice was controversial based on several ethical and moral grounds. The first is patient autonomy. If the patient did not wish to take them, they were often coerced until they agreed to comply.
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"Treatment Models for Conduct Disordered Adolescents".
It is now considered a common trait that adolescents with conduct disorder are comorbid with other conditions. These can include major depression, bipolar, or ADHD (Gathright & Tyler, 2014). The presence of comorbidity with other conditions make administering SSRIs as a treatment for conduct disorder unethical on the basis of nonmaleficence. Administering SSRIs may make other conditions worse or have serious side effects. In this manner, the administration of SSRIs for conduct disorder could to the person harm. In addition, there is a slightly increased risk of suicide in youth taking SSRIs (Gathright & Tyler, 2014).
The ethical principle of beneficence means the practitioner has an obligation to provide treatments that will benefit the patient. This is where the topic of SSRIs in conduct disordered adolescents becomes more difficult. There is no treatment clinically approved by the FDA for treatment of conduct disorder (Gathright & Tyler, 2014). Behavioral treatments do not work for all children with conduct disorder. Some respond to behavioral therapy, while others do not. The problem is that little is known about the sequencing and effectiveness of various treatments for conduct disorder (APA, 2006). SSRIs have been demonstrated to decrease aggressive behaviors in certain children, but they have not been found to be helpful in treating conduct disorder (Gathright & Tyler, 2014). The APA recommends that more research be conducted on the use of pharmaceutical treatments in adolescents with conduct disorder.
The fourth ethical principle is justice. For adolescents who are not involved in the justice system, the ultimate decision for treatment lies with the parents. However, once the adolescent enters the judicial system, the courts can order them to get evaluation and treatment. This is not punitive, but rather an attempt to prevent the adolescent from having any future encounters with the law and to become a productive adult member of society. The rules are different for those who are in the judicial system, as opposed to those who are not.
As the manager of clinical programs, the best way to apply the four principles of clinical ethics is to avoid blanket policies regarding SSRIs, or any other treatment protocol. The proper treatment should only be prescribed after an individual evaluation of each adolescent. The proper treatment should be based on the individual needs and what it likely to be most effective. This approach is more expensive than a blanket policy on pharmaceutical treatment, but it will have better individual outcomes and will have the best social outcomes for society as well. An individual approach is the best approach for treating the complexities of conduct disorder.
- American Psychological Association (APA). (2006). Report of the Working Group on
Psychotropic Medications for Children and Adolescents Psychopharmacological,
Psychosocial, and Combined Interventions for Childhood Disorders: Evidence Base, Contextual Factors, and Future Directions. Retrieved from http://www.apa.org - Gathright, M. & Tyler, L. (2014, March 31). Disruptive Behaviors in Children and Adolescents. Division of Medical Services, Arkansas Department of Human Services. Retrieved from http://psychiatry.uams.edu/
