Conduct Disorder

Conduct disorder is a disruptive behavior disorder associated with aggression toward others and frequent violation of rules. It is treated with individual and family therapy, and patients may also take medication to treat co-occurring disorders, such as attention deficit hyperactivity disorder (ADHD), depression, or bipolar disorder ^[1].

What is conduct disorder?

Conduct disorder is a behavioral disorder in which a person repeatedly violates the rights of others and fails to follow age-appropriate social norms or rules. This disorder is diagnosed in children and adolescents ^[2].

Youth with conduct disorder engage in antisocial behaviors like destroying property, harming people or animals, and violating laws, which could include shoplifting or becoming truant from school. In addition, a child with conduct disorder may also display a lack of empathy and remorse when engaging in destructive behaviors or harming others ^[2].

What children are at risk of conduct disorder?

There is not one single contributing factor that leads a child to develop conduct disorder. Instead, a combination of risk factors increases the likelihood of someone developing this condition.

The following factors increase the risk of conduct disorder in children ^[1]:

• Biological factors like high testosterone levels, genetics, and low levels of brain chemicals like dopamine
• Exposure to domestic violence or frequent parental conflicts at home
• Poor parenting, such as lack of consistent discipline and supervision, or harsh parenting practices, like physical or verbal aggression
• Substance misuse or criminal behavior in parents
• Family stress from low socioeconomic status and unemployment
• Neurological problems or traumatic brain injury
• Developmental delays
• Gang violence

Symptoms of conduct disorder

Children and adolescents with conduct disorder demonstrate symptoms related to disregard for the rights of others, as well as a lack of regard for rules and social norms. Some signs of the condition are as follows ^[2]:

• Repeatedly bullying or threatening other people
• Getting into physical fights
• Using weapons, such as bricks, bats, guns, or knives, which could seriously injure others
• Physical cruelty to humans or animals
• Stealing from others in an aggressive manner, such as purse snatching
• Coercing someone to perform sexual activity
• Destroying the property of others
• Setting fires
• Breaking into homes or cars
• Conning other people to get what they want
• Staying out late at night despite parental disapproval
• Running away from home
• Truancy from school

Diagnosing conduct disorder in children

Conduct disorder is diagnosed using criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM 5). A clinician, such as a clinical social worker, psychologist, or psychiatrist, will review symptoms with the child and caregiver and examine the child’s medical and social history to make a diagnosis of conduct disorder. In addition, the clinician will ask a parent or caregiver about the onset and history of symptoms, and gather information about any stressors in the child or family’s life ^[1].

A clinician will perform a full psychiatric evaluation to determine if a child has coexisting conditions, such as ADHD. Ideally, they will gather information from the child’s school and determine if the child has a learning disability or cognitive delay that may contribute to symptoms. The clinician will also rule out alternative explanations for disruptive behavior, such as a mood disorder or psychotic episode ^[1].

Ultimately, a diagnosis is made if other explanations are ruled out and the child meets the following DSM 5 criteria ^[2]:

• A persistent pattern of behavior that shows disregard for the rights of other people and violation of rules or social norms expected for the child’s age
• Showing at least three of the following behaviors in the past year and at least one behavior in the six months before diagnosis:n
  • Bullying, threatening or intimidating other people
  • Frequently starting physical fights
  • History of using a weapon like a gun, knife, bat, or brick, which could cause serious harm
  • Engaging in physical cruelty to humans
  • Physical cruelty to animals
  • Engaging in purse snatching or armed robbery
  • Forcing someone to participate in sexual activity
  • Purposely setting fires to cause damage
  • Intentionally destroying others’ property
  • Breaking into a house, building, or car
  • Lying to obtain favors or avoid obligations
  • Stealing valuable items by shoplifting
  • Staying out at night despite parent disapproval, before the age of 13
  • Running away from home overnight two or more times or once and being gone for an extended period
  • Frequent truancy from school before age 13
• Significant difficulty functioning in academic, work-related, or social settings because of behaviors
• The person does not meet the criteria for antisocial personality disorder if they are 18 or older

Beyond these general diagnostic criteria, there are specifiers associated with a conduct disorder diagnosis ^[2]:

• The disorder is marked as childhood-onset (showing at least one symptom before age 10), adolescent-onset (showing no signs of conduct disorder before age 10), or unspecified onset (clinician unable to determine whether the first symptom appeared before age 10).
• The disorder is labeled as mild (few symptoms and mild harm to others), moderate (intermediate between mild and severe), or severe (multiple conduct problems and serious harm to others).

Causes of conduct disorder in children

There is no definitive cause of conduct disorder. Instead, medical research points to factors correlated with conduct disorder and therefore increases the risk that a child will develop this condition. Often, it is a combination of genetic and environmental factors that leads to the development of conduct disorder ^[3].

A study on genetic factors linked to conduct disorder found that genetics contribute moderately to the development of the condition. Some specific genes may be linked to conduct disorder, but the condition seems to develop due to environmental influences and genetic risk factors. There is evidence that children with a genetic risk of conduct disorder may be more likely to place themselves in risky environments, which affects the development of the condition ^[3].

A second study that evaluated environmental risk factors for conduct disorder found that the following factors are strongly linked to the development of conduct disorder ^[4]:

• Impulsivity
• Low IQ
• Poor academic performance
• Lack of parental supervision
• Harsh or inconsistent discipline
• Lack of warmth from parents
• Childhood physical abuse
• Parental conflict and family disruption
• High levels of neighborhood crime
• Exposure to antisocial parents and peers
• Coming from a low-income family
• Attending a school with high delinquency rates

Study authors noted that while the above factors increase the conduct disorder risk, there is not enough evidence to say that these factors directly cause a child to develop conduct disorder ^[4].

Prevention of conduct disorder in children

There is no surefire way to prevent conduct disorder. However, some evidence suggests that affectionate parenting, positive role models, and developing healthy emotional regulation skills can be protective against conduct disorder ^[1].

Early intervention and treatment can also be helpful. Children must receive treatment for trauma and other neurological disorders, like ADHD, associated with conduct disorder ^[1]. One recent study found that a school-based training program effectively reduced children’s emotional callousness, impulsivity, and conduct disorder symptoms ^[5].

Given that there is no exact cause of conduct disorder, it is impossible to prevent every case of it; however, there are steps that parents and caregivers can take to reduce risk factors.

Treatment for conduct disorder

Conduct disorder is often treated with psychosocial interventions, including various counseling or therapy techniques. Some common therapies used to treat conduct disorder are described below:

• Parent Training: In training programs, parents can learn how to set effective, consistent discipline for their children and how to help their children develop prosocial behaviors, such as being empathetic toward others and showing cooperation and respect ^[1].
• Family Therapy: Family therapy sessions can improve family dynamics, reducing negative behaviors associated with conduct disorder. Family therapy programs that use a multisystemic approach are particularly helpful because this approach also engages with the school to improve the child’s behavior across multiple settings ^[1].
• Cognitive-Behavioral Therapy (CBT): CBT effectively reduces externalizing behaviors, including aggression, and may be suitable for treating conduct disorder symptoms. It is more effective when parents and the child participate together, demonstrating how important parents are in managing conduct disorder. CBT helps people to change distorted or unhelpful thoughts and replace them with healthier ways of thinking ^[6].

Living with a child with conduct disorder

Living with a child with conduct disorder can create stress for parents, so it’s important to practice self-care and take steps to manage the condition effectively. The following tips can help you learn to live with a child who has conduct disorder:

• Participate in support groups. Joining a local support group for parents who have children with conduct disorder or other behavioral conditions can be helpful. These groups provide a safe setting for you to discuss your struggles and receive feedback and guidance from others experiencing similar challenges.
• Take part in therapy. Being a part of your child’s treatment is essential, as you play an important role in helping them to change disruptive behaviors. Beyond participating in family therapy with your child, you may benefit from individual therapy sessions to help you process your emotions and develop healthy coping mechanisms.
• Practice relaxation techniques. The stress of parenting a child with disruptive behaviors can take a toll on you. Therefore, it can be helpful to practice relaxation techniques, such as mindfulness meditation or yoga, to have a healthy outlet for stress ^[7].

Frequently asked questions about conduct disorder

The answers to the following questions provide additional information about conduct disorder:

How long does conduct disorder last?

The length that conduct disorder symptoms last can vary widely from person to person. The length of symptoms will depend upon the disorder’s severity and whether or not a child receives treatment. Early identification and treatment can reduce the duration of conduct disorder symptoms.

What is the difference between antisocial personality disorder and conduct disorder?

Conduct disorder is generally diagnosed in children, whereas antisocial personality disorder is diagnosed in adults. Research suggests that as high as 50% of children with conduct disorder will develop antisocial personality disorder as adults ^[8]. While the diagnostic criteria for conduct disorder include a specification of either childhood or adolescent onset ^[2], the criteria for antisocial personality disorder state that a person cannot be diagnosed before age 18 ^[9].

Symptoms of antisocial personality disorder include impulsivity, failing to comply with laws or social norms, showing a lack of remorse for hurting others, irresponsibility, lying or conning others, disregarding the safety of other people, and aggressive behavior that leads to physical fights. In addition, a person with antisocial personality disorder must have a history of conduct disorder with onset before age 15 ^[9]. In summary, conduct disorder and antisocial personality disorder appear similar, but conduct disorder is diagnosed in children, whereas antisocial personality disorder is diagnosed in adults.