What is Conduct Disorder?

A friend was diagnosed with Conduct disorder. What does that mean?

First, it’s important to know that all children will have short periods of bad behavior. However, when things start to get out of hand, it may be evidence that there is more that needs attention. Children can get irritable and even hostile when they are tired, or they may argue with parents or disobey other authority figures to show their independence and are that they are growing up. Children may also lie to get out of trouble. Most of this behavior is fairly normal as children learn to navigate the world but when it becomes regular and persistent and starts getting them into trouble at home, at school, or with other kids, they may have what we call a disruptive behavior disorder.

Conduct Disorder can be diagnosed in a child or youth who has repeatedly and consistently shown a number of severely aggressive and anti-social behaviors that continue for 6 months or longer. It is diagnosed in childhood and adolescence, and is characterized by a pattern of antisocial behavior and defiance of rules where basic rights or age-appropriate norms are violated and has difficulty behaving in socially acceptable ways. Often these youth are viewed as simply being “bad” rather than diagnosed as having a mental health problem.

The child exceedingly misbehaves against people, animals or property and can be characterized as quarrelsome, destructive, threatening, physically cruel, deceitful, disobedient, or dishonest. This may include stealing, intentional injury, forced sexual activity, vandalism and/or lying. These behaviors are referred to as antisocial behaviors and are often seen as the precursor to Antisocial Personality Disorder.

Children displaying the disorder before the age of 10 (called childhood-onset type) are more likely to continue the behavior over time and are more likely to be boys. However if symptoms appear after age of 10 (adolescent-onset type) the disorder appears equally in girls as it does boys.

It is also argued that some children may not have conduct disorder, but are actually engaging in typical developmentally appropriate disruptive behavior. This is particularly true of teenagers that are testing out the world around them, trying to understand it, and where they fit into their environment. This is a natural time of emerging adulthood where a person learns independence and who they are as a person. Not surprisingly, a greater number of adolescent-onset conduct disorders are diagnosed than childhood-onset disorders, suggesting that there is an exaggeration of normal behaviors that are typical in adolescence, such as rebellion against authority figures and rejection of conventional values.

There appears to be a relationship among Oppositional defiant disorder, Conduct disorder and Antisocial personality disorder. Oppositional defiant disorder may precede conduct disorder as a weaker variation of the disorder. Additionally, most adults with antisocial personality disorder were previously diagnosed with conduct disorder. Although these relationships are common, these patterns do not occur in all people diagnosed with these disorders.

A child is diagnosed with oppositional defiant disorder when he or she shows signs of being hostile and defiant for at least 6 months and may start as early as the preschool years, while conduct disorder generally appears when children are older. However, Oppositional defiant disorder and conduct disorder do not occur together.

Conduct disorder appears in up to 10% of the population but, the prevalence of incarcerated youth with the disorder is between 23% and 87%. Also, for approximately 25-30% of boys and 50-55% of girls, having ADHD is the condition most commonly associated with conduct disorders.

 Furthermore, it seems that there is a relationship between substance use and conduct problems, such that aggressive behaviors increase substance use, and in turn, substance use tends to increases aggressive behavior. Children with conduct disorder generally begin substance use and abuse earlier than those without the disorder and tend to use multiple substances.  Almost all adolescents who have a substance use disorder have conduct disorder traits but about half of the adolescents lose their conduct disorder symptoms after successful treatment of the substance use.

Empathy is being able to recognize feelings of others. However a child diagnosed with conduct disorder often displays a lack of empathy because they are unable to place themselves in the other person’s shoes. Therefore they are unable to understand the consequences of their actions towards others.

Another factor of conduct disorder is a lower level of fear. If a child does not learn how to handle fear or distress the child will be more likely to lash out at other children. If the caregiver is able to teach children at risk better empathy skills, the child will have a lower incident level of conduct disorder.

Definition from the Diagnostic & Statistical Manual of Mental Disorders

(DSM IV – TR)

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

Aggression to people and animals 

-           often bullies, threatens, or intimidates others 

-           often initiates physical fights 

-          has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

-           has been physically cruel to people 

-          has been physically cruel to animals 

-          has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) 

-          has forced someone into sexual activity 

Destruction of property 

-          deliberately engaged in fire setting to cause serious damage

-          deliberately destroying others' property

Deceitfulness or theft 

-          has broken into someone else's house, building, or car 

-          often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) 

-          has stolen valuable items without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) 

Serious violations of rules 

-          often stays out at night despite parental prohibitions, beginning before age 13 years 

-          has run away from home overnight at least twice while living in parental or parental surrogate

-          home (or once without returning for a lengthy period) 

-           is often truant from school, beginning before age 13 years 

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

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

Young people may be diagnosed with conduct disorder if they have displayed three or more of the following symptoms in the past 12 months, with at least one symptom also present in the past six months:

Children with conduct disorder or oppositional defiant disorder also may experience:

·         Higher rates of depression, suicidal thoughts, suicide attempts, and suicide

·         Academic difficulties

·          Poor relationships with peers or adults

·         Sexually transmitted diseases

·         Difficulty staying in adoptive, foster, or group homes; and

·         Higher rates of injuries, school expulsions, and problems with the law.

Other factors that may make a child more likely to develop conduct disorder include:

·         Early maternal rejection

·         Separation from parents, without an adequate alternative caregiver

·         Early institutionalization

·         Family neglect

·         Abuse or violence

·         Parental mental illness

·         Parental marital discord

·         Large family size

·         Crowding

·         Poverty.

What can be done to help?

Conduct Disorder is harder to treat than Oppositional Defiant Disorder and becomes worse as a child gets older. This makes early intervention extremely important.  Behaviors are hard to change after they have become learned so the earlier the conduct disorder is identified and treated, the better the chance for success. Most children or youth with conduct disorder are probably reacting to events and situations in their lives so it is important to look for the signs and try to understand the reasons why this may be happening to try and improve the situation. Getting help is a good way to start.

For children and youth:

·         Get to know about behavioral disorders by getting accurate information from your library, hotlines, community sources, or go online

·         See your family doctor

·         Talk with a mental health or social services professional, teacher, counselor, psychiatrist, or psychologist specializing in childhood and adolescent disorders.

·         Get training for the child in problem solving skills for the children

·         Get training for the child in social skill, and anger management

·         Monitor children's activities peer group influences nonschool hours promote curfews.

·         Encourage involvement in structured and supervised activities sports, like scouting, art, recreational programs at churches, schools or youth groups helps protect children from negative peer influences

·         Discuss and demonstrate clear and specific parental communication techniques.

·         Introduce rewards for desirable behavior.

·         Introduce realistic, clearly communicated consequences for noncompliance.

·         Establish a daily routine of child-parent activities.

It also extremely important to focus on other conditions the child may have. Children who have AD/HD, depression, anxiety and substance abuse to name a few, tend to lose symptoms of disruptive behavior when other problems are successfully treated

For parents:

Parents of children with conduct disorder are more likely to exhibit stress, anxiety, depression, substance abuse or antisocial personality traits. Various parental problems which may include mental disorders, high stress or marriage and financial problems can greatly influence a child's behavioral problems as well as inconsistent parenting, harsh discipline or lack of discipline, impaired parental attachment and minimal supervision can also greatly affect a child’s well being and behavior. Therefore it is just as important to address parent issues as well as the child’s issues because many of these things can be triggers for conduct problems in children.

o   Training in social skills, anger management

o   Training for parents on how to handle child and adolescent behavior

o   Training in problem solving skills for parents

o   Help with parental mental health issues and other personal coping skills

Changing parenting practices can help the child and benefit the family as a whole. If the parents, particularly the mothers, are unable to develop new ways of parenting, their children may go on to develop the more serious conditions.