Conduct Disorders
What is conduct disorder?
Conduct disorder (CD) is a mental health condition that affects children and teens that’s characterized by a consistent pattern of aggressive behaviors and actions that harm the well-being of others. Children with conduct disorder also often violate rules and societal norms.
Conduct disorder lies on a spectrum of disruptive behavioral disorders, which also includes oppositional defiant disorder (ODD). In some cases, ODD leads to CD.
Conduct disorder often occurs alongside other psychiatric conditions, including:
Learning disorders.
What is the difference between conduct disorder and personality disorders?
A personality disorder is a mental health condition that involves long-lasting, disruptive patterns of thinking, behavior, mood and relating to others. Most personality disorders begin in the teen years when personality further develops and matures. As a result, almost all people diagnosed with personality disorders are above the age of 18.
One exception to this is antisocial personality disorder (ASPD) — approximately 80% of people with this disorder will have started to show symptoms by the age of 11.
There’s not much difference between conduct disorder (CD) and ASPD, but CD is typically diagnosed in children. If an adult meets the criteria for both conditions, then a mental health professional would give them a diagnosis of ASPD instead of CD.
Who does conduct disorder affect?
Conduct disorder affects children and adolescents. It can have early onset before age 10, but commonly develops in adolescence (between ages 10 years to 19 years).
The condition is more common in children assigned male at birth (AMAB) than children assigned female at birth (AFAB). The average age of presentation is 10 years to 12 years in children AMAB and 14 years to 16 years in children AFAB.
How common is conduct disorder?
Conduct disorder affects anywhere between 2% and 10% of children and adolescents in the United States.
What are the signs and symptoms of conduct disorder?
Characteristic behaviors of conduct disorder develop gradually over time. Children with conduct disorder tend to be impulsive and difficult to manage. They don’t seem to be concerned about the feelings of other people.
The four core behaviors of conduct disorder include:
Aggression toward people and animals and/or violating others’ basic rights.
Destruction of property.
Deceiving, lying and/or stealing.
Serious violations of rules.
Signs of aggressive behavior toward others include:
Bullying.
Physical violence (potentially with a weapon).
Verbal fights.
Threatening.
Forcing sexual activity.
Blaming others for their own behavior.
Hurting animals.
Signs of the destruction of property include:
Intentionally setting fires.
Vandalizing or destroying others’ property.
Signs of deceiving, lying and stealing include:
Lying to get a favor or to avoid responsibilities.
Stealing from individual people or stores.
Breaking into houses or businesses.
Signs of violations of rules include:
Breaking rules without clear reason.
Not going to school (truancy).
Running away from home.
Frequently breaking any rules set by their parents.
Other common signs of conduct disorder include:
Heavy alcohol drinking and/or heavy substance use.
Engaging in frequent and risky sex.
Becoming easily frustrated.
Making no effort to hide their aggressive behaviors.
Not showing remorse for their actions.
Difficulty making and maintaining friendships.
It’s important to note that occasional rebellious behavior is common during childhood and adolescence. The signs and symptoms that lead to the diagnosis of conduct disorder demonstrate a disruptive and repetitive pattern.
Signs of conduct disorder in adults
Adults who have conduct disorder may have difficulty keeping a job or maintaining relationships. They may be prone to illegal or dangerous behavior.
Symptoms of conduct disorder in an adult may be diagnosed as antisocial personality disorder.
What causes conduct disorder?
Researchers aren’t sure what exactly causes conduct disorder (CD), but they think it’s a complex combination of genetic/biological and environmental factors.
Genetic/biological factors:
Various studies show that certain characteristics of CD can be inherited, including antisocial behavior, impulsivity, temperament, aggression and insensitivity to punishment.
High testosterone levels are associated with aggression.
Traumatic brain injury, seizures and neurological damage can contribute to aggression.
Parental, familial and environmental factors:
Parents of adolescents with CD often have engaged in substance use and antisocial behaviors. They’re also frequently diagnosed with ADHD, mood disorders, schizophrenia or antisocial personality disorder.
A home environment that lacks structure and adequate supervision with frequent conflicts between parents can lead to maladaptive behavior in children, which can lead to CD.
Children exposed to frequent domestic violence are more likely to develop CD.
Living in low social and economic environments with overcrowding and unemployment leads to economic and social stress with a lack of adequate parenting. CD affects more children living in low economic environments than not.
Availability of drugs and increased crime in a child’s neighborhood increases their risk of developing CD.
It’s important to note that conduct disorder can occur in children from high-functioning, healthy families.
How is conduct disorder diagnosed?
A mental health professional diagnoses conduct disorder using criteria provided in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
They diagnose conduct disorder in children or adolescents who’ve demonstrated three or more of the following behaviors in the previous 12 months, in addition to at least one in the previous six months:
Aggression toward people and/or animals.
Destruction of property.
Deceiving, lying or stealing.
Serious violations of parental rules.
These behaviors must be significant enough to impair functioning in relationships, at home, at school and/or at work.
Your child will likely need to see a child and adolescent psychologist or psychiatrist if they’re showing signs of conduct disorder. These mental health professionals use specially designed interview and assessment tools to evaluate a child for a mental health condition.
Psychologists and psychiatrists often rely on reports from the child’s parents, siblings, friends and teachers to get a full understanding of the child’s behavior.
How is conduct disorder treated?
The go-to treatment for conduct disorder (CD) is multiple forms of psychotherapy (talk therapy) for your child and family, as well as community-based treatment.
Therapies include:
Parent management training: The goal of this therapy is to train the child’s parents to set consistent discipline with proper rewarding of positive behaviors.
Psychotherapy: “Psychotherapy” is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional can provide support, education and guidance to the person and their family. Psychotherapy for conduct disorder usually needs to target family life and school with a focus on improving family dynamics, academic functioning and improving your child’s behavior in the context of various environments.
Anger management training: The goal of anger management is to reduce both your child’s emotional feelings and the physiological arousal that anger causes. You can’t get rid of or totally avoid the things or people that make them angry, so anger management training teaches your child how to control their reactions.
Individual psychotherapy, such as cognitive behavioral therapy: Individual therapy for a child with conduct disorder focuses on developing problem-solving skills, strengthening relationships by resolving conflicts and learning skills to decline negative influences in their environment.
Community-based treatment: This treatment involves therapeutic schools and residential treatment centers that can provide a structured program to reduce disruptive behaviors.
Healthcare providers typically don’t use medication to directly treat conduct disorder, but as other mental health conditions often occur alongside conduct disorder, your child may benefit from medication to manage these conditions.
