Conduct disorder is a repetitive and persistent pattern of behavior in children and adolescents in which the rights of others or basic social rules are violated. The child or adolescent usually exhibits these behavior patterns in a variety of settings- at home, at school, and in social situations and they cause significant impairment in his or her social, academic, and family functioning. It is estimated that 2%-16% of children in the U.S. have conduct disorder. Conduct disorder may be diagnosed in adulthood, but symptoms most commonly begin by the age of 16. Some children who have conduct disorder go on to develop a similar condition known as antisocial personality disorder as adults.

Conduct Disorder Defined

The essential features of conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. These behaviors call into four mail groupings: aggressive conduct that causes or threatens physical harm to other people or animals, non-aggressive conduct that causes property loss or damage; deceitfulness or threat; and serious violation of rules. Individuals with conduct disorder often initiate aggressive behavior and react aggressively to others. The onset of conduct disorder may occur as early as the preschool years, but the first significant symptoms usually emerge during the period from middle school through middle adolescence. Oppositional defiant disorder is a common precursor to the childhood-onset type of conduct disorder. Males with a diagnosis of conduct disorder frequently exhibit fighting, stealing, vandalism, or school discipline problems. Females with a diagnosis of conduct disorder are more likely to exhibit truancy, running away, lying, substance abuse, and prostitution. Few children with impairing conduct disorder receive treatment.

Different Types of Conduct Disorder

There are not different types of conduct disorders, but there are levels of severity. These levels are listed in the Diagnostic Statistical Manual for Mental Disorder V.

  • Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking).
  • Moderate: The number of conduct problems and the effect on others are intermediate be tween those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism).
  • Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

Conduct Disorder Causes

Conduct disorder can be caused by various factors. 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. Many children and adolescents with conduct disorder also have other mental disorders, such as attention-deficit/hyperactivity disorders, learning disorders, depression, substance abuse, or an anxiety disorder, which may contribute to the symptoms of conduct disorder. Children and adolescents with a parent (biological or adoptive) or a sibling with conduct disorder are more likely to develop the disorder. 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. Some experts believe that conduct disorders can reflect problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing. Low socioeconomic status and not being accepted by their peers appear to be risk factors for the development of conduct disorder.

Conduct Disorder Symptoms

To be diagnosed with a conduct disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months.

  • Aggression to People and Animals
    1. Often bullies, threatens, or intimidates others.
    2. Often initiates physical fights.
    3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
    4. Has been physically cruel to people.
    5. Has been physically cruel to animals.
    6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
    7. Has forced someone into sexual activity.
  • Destruction of Property
    1. Has deliberately engaged in fire setting with the intention of causing serious damage.
    2. Has deliberately destroyed others’ property (other than by fire setting).
  • Deceitfulness or Theft
    1. Has broken into someone else’s home, building, or car.
    2. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
    3. Has stolen items of nontrivial value without confronting a victim(e.g., shoplifting, but without breaking and entering; forgery).
  • Serious Violations of Rules
    1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
    2. Has run away from overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
    3. Is often truant from school, beginning before age 13 years.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

How to Approach a Loved One:

Depending on the loved one, there can be different ways to approach them. It is important to let a loved one know to seek the help of a mental health professional, or if you are a caregiver, take them for an evaluation as soon as possible. Be as supportive as possible and depending on who the loved one is, consistently participating in treatment can also be helpful.

Types of Conduct Disorder Treatment

There are effective treatments for conduct disorder. Treatments for conduct disorder are designed to decrease or eliminate as many identified problem behaviors as possible in the short-term and also to work towards the long-term goal of preventing children’s behavioral problems from worsening over time (for instance, becoming an adult and having Antisocial Personality Disorder). Treatment usually consists of a combination of medication and psychotherapy. The earlier the condition is diagnosed, the more successful the therapy will be.

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, beliefs, etc. that may impact individuals with conduct disorder.

Behavioral therapy/ Cognitive behavioral therapy: Treatment is often long-term psychotherapy and behavior therapy to help the child learn healthier and more acceptable ways of thinking and behaving. Short-term behavioral interventions designed to address behavior problems with potentially extreme negative consequences (e.g., physical aggression or theft) are usually given more priority than interventions for problems which are less likely to cause wider troubles (e.g., talking back to parents). Close coordination between therapists and parents is important, as is the consistent use of treatment (by parents) during every day family situations. As a part of cognitive behavior therapy, therapists work with children to help them develop several important cognitive skills, including cognitive re-framing of stressful events (e.g., helping children to generate alternative, more peaceful ways of thinking about the meaning of stressful situations so that anger is not an automatic consequence) as well as anger management training.

Medication  

There are medications that can assist in the treatment of conduct disorder. Stimulants such as Ritalin, Dexedrine and Cylert are sometimes prescribed for children and adolescents with severe Conduct Disorder in order to reduce impulsivity and aggressive behavior. Ritalin is the most frequently prescribed stimulant medication used for this purpose.  If an individual is taking medications, it is important to know the side effects of the medication and consult a psychiatrist.

Differences Between Common Disorders

There are other possible causes that resemble conduct disorder but do not qualify as a conduct disorder. These are common disorders but the differences between them and conduct disorder.

  • Oppositional defiant disorder (ODD)- Conduct disorder and oppositional defiant disorder are both related to symptoms that bring the individual in conflict with adults and other authority figures (e.g., parents, teachers, supervisors). The behaviors of ODD typically  are of a less severe nature than those of individuals with conduct disorder and do not include aggression toward individuals or animals, destruction of property, or a pattern of theft or deceit.
  • Attention-deficit/hyperactivity disorder- Although children with ADHD often exhibit hyperactive and impulsive behavior that my be disruptive, this behavior does not by itself violate societal norms or the rights of others and therefore does not usually meet criteria for conduct disorder. If criteria is met for both, both diagnosis should be given.
  • Depressive and bipolar disorders- Irritability, aggression, and conduct problems can occur in children or adolescents with a major depressive disorder, a bipolar disorder, or disruptive mood  dysregulation disorder. The behavioral problems associated with these mood disorders can usually be distinguished from the pattern of conduct problems seen in conduct disorder based on their course.
  • Intermittent explosive disorder- Both conduct disorder and intermittent explosive disorder involve high rates of aggression. However, the aggression in individuals with intermittent explosive disorder is limited to impulsive aggression and is not premeditated, and it is not committed in order to achieve some tangible objective (e.g., power, money, intimidation).
  • Adjustment disorder- The diagnosis of an adjustment disorder (with disturbances of conduct disorder or with mixed disturbances of emotions and conduct) should be considered if clinically significant conduct problems that do not meet criteria for another specific disorder develop in clear association with the onset of a psychosocial stressor and do not resolve within 6 months of the termination of there stressor (or its consequences).

 

Resources

  • American Psychiatric Association (2019). Diagnostic and statistical manual of mental disorders. (5th ed.) Arlington, VA: American Psychiatric Association.
  • Child Mind Institute. (2019). Retrieved from: https://childmind.org/guide/guide-to-conduct-disorder/
  • Healthline. (2019). Retrieved from: https://www.healthline.com/health/conduct-disorder
  • Mental Health America (2019). Conduct Disorder. Retrieved from: http://www.mentalhealthamerica.net/conditions/conduct-disorder
  • Psychology Today. (2019). Conduct Disorder. Retrieved from: https://www.psychologytoday.com/us/conditions/conduct-disorder
  • WebMD. (2019). Mental Health and Conduct Disorder. Retrieved from: https://www.webmd.com/mental-health/mental-health-conduct-disorder#3