Conduct Disorder: Symptoms, Causes, Treatment

Conduct disorder is an ongoing pattern of behavior marked by emotional and behavioral problems. Children with conduct disorder behave in angry, aggressive, argumentative, and disruptive ways. 

Conduct disorder in children goes beyond bad behavior. It is a diagnosable mental health condition that is characterized by patterns of violating societal norms and the rights of others. It's estimated that around 3% of school-aged children have conduct disorder. It is more common in boys than in girls.

Symptoms

Conduct disorder extends beyond normal teenage rebellion. It involves serious behavior problems that are likely to raise alarm among teachers, parents, peers, and other adults. In order to qualify for a diagnosis of conduct disorder, children must exhibit at least three of these symptoms in the past year and at least one in the past six months:

Aggression Toward People and Animals

• Bullying, threatening, or intimidating others
• Initiating physical fights
• Using a weapon that could cause serious harm
• Physical cruelty to people
• Physical cruelty to animals
• Stealing while confronting a victim
• Forced sexual activity

Property Destruction

• Deliberate fire setting
• Other destruction of property

Deceptiveness or Theft

• Breaking or entering a house, car, or building
• Lying for personal gain
• Stealing without confronting the victim (such as shoplifting)

Serious Rule Violation

• Staying out at night before the age of 13 years
• Running away from home overnight at least twice
• Truancy beginning before the age of 13

Impact

Conduct disorder isn't just a challenge for caregivers—it actually impairs a child's ability to function. Some areas where the condition may affect a child's life include:

• Education: Children with conduct disorder misbehave so much that their education is affected. They usually receive frequent disciplinary action from teachers and may skip school. Children with conduct disorder may be at a higher risk of failure or dropping out of school. 
• Legal issues: Adolescents with conduct disorder are also more likely to have legal problems. Substance abuse, violent behavior, and a disregard for the law may lead to incarceration.
• Relationships: Children with conduct disorder also have poor relationships. They struggle to develop and maintain friendships. Their relationships with family members usually suffer due to the severity of their behavior.
• Sex: They may also engage in risky sexual behavior. Studies show that teens with conduct disorder are more likely to have multiple sexual partners and are less likely to use protection.

Diagnosis

Conduct disorder in children can be diagnosed by a mental health professional or a physician. Often, a diagnosis is made after attempts to remedy behavior problems at school and at home aren't effective.

A professional may interview the child, review records, and ask that parents and teachers complete questionnaires about the child’s behavior. Psychological testing and other assessment tools may also be used to evaluate the child.

Causes

Researchers aren’t exactly sure why some children develop conduct disorder. A variety of biological, psychological, and social factors are likely involved. Quite often, those factors overlap. Some that may play a role include:

• Brain abnormalities: Imaging studies suggest children with conduct disorder may have some abnormalities in certain areas of the brain. The pre-frontal cortex (which affects judgment) and the limbic system (which affects emotional responses) may be impaired.
• Cognitive deficits: Low IQ, poor verbal skills, and impairment in executive functioning may make children more vulnerable to conduct disorder.
• Genetics: Studies suggest that inherited genes may be responsible for about half of anti-social behavior. Researchers aren’t sure which specific genetic components contribute to conduct disorder.
• Social issues: Poverty, disorganized neighborhoods, poor schools, family breakdown, parental mental illness, harsh parenting, and inadequate supervision are all strongly linked with conduct disorder.

Common Comorbid Conditions

Many children with conduct disorder have other mental health issues or cognitive impairments. These can include:

• ADHD
• Self-harm
• Substance misuse
• Depression and anxiety
• Posttraumatic stress disorder
• Learning disability

Children with conduct disorder may be more likely to develop antisocial personality disorder later in life.

Types

There are three subtypes types of conduct disorder. These subtypes are distinguished by the age at which symptoms first appear.

• Childhood-onset indicates that the symptoms started before the age of 10.
• Adolescent-onset indicates that the signs of the condition began during a child's teens.
• Unspecified-onset indicates the age exact age that the symptoms first began is not clear.

The Diagnostic and Statistical Manual (DSM-5), which is used to diagnose mental illnesses, also distinguishes between conduct disorder with or without "limited prosocial emotions."

Individuals with limited prosocial emotions are characterized by callousness and a lack of remorse and empathy. They are unconcerned about their performance at school or work and have shallow emotions. When present, their emotional expressions may be used to manipulate others.

Treatment

Treatment for conduct disorder depends on several factors, such as a child’s age and the severity of behavior problems. The most common treatment methods include:

• Family therapy: Parents, siblings, and other family members may be invited to attend therapy with the child. Sometimes, improving the relationship between parents and a child may improve family interactions.
• Medication: There isn’t a medication that specifically treats conduct disorder. But sometimes doctors may prescribe medication to treat the disorder's symptoms or to address other underlying mental illness.
• Parent training: Treatment often involves caregivers and parents. Parents may be taught behavior management strategies and techniques to increase safety in the home if a child is aggressive or violent.
• Psychotherapy: Individual therapy may be helpful when a child could benefit from learning new skills, such as anger management and impulse control.
• Residential placement: In cases where a child or adolescent's behavior has become out of control, treatment in a residential program may be necessary to keep everyone safe. A therapeutic environment may address substance abuse issues, sexualized behavior, or violence.

Early intervention is key to getting the most effective treatment, so it’s important for parents, educators, and physicians to be aware of the signs of conduct disorder in children so that appropriate referrals and interventions can be put into place.

Coping

Research suggests that taking part in psychosocial treatments can help both children and families cope with the effects of conduct disorder. Such approaches often involve working with parents and caregivers to help them find effective ways of managing their child's behavior. This may include such things as:

• Creating structure
• Enforcing limits
• Providing clear instructions
• Rewarding positive behaviors
• Using time-outs after inappropriate behaviors or outbursts

The ultimate goal of such training is to help parents and children interact more effectively. This can lead to less conflict and help children better regulate their behavior.