Conduct Disorder

Conduct Disorder Defined

The essential feature 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 fall into four main 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.

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 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 against People and Animals
  1. Often bullies threaten or intimidate 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 intending to cause 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. 1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
   2. Has run away 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.

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 that 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 everyday 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  

Some medications can assist in the treatment of conduct disorder. Stimulants are sometimes prescribed for children and adolescents with severe Conduct Disorder to reduce impulsivity and aggressive behavior. If an individual is taking medications, it is important to know the side effects of the medication and consult a psychiatrist.

Resources

• American Psychiatric Association (2019). Diagnostic and statistical manual of mental disorders. (5th ed.) Arlington, VA: American Psychiatric Association.
• Child Mind Institute. (2019). 
• Healthline. (2019). 
• Mental Health America (2019). Conduct Disorder. 
• Psychology Today. (2019). Conduct Disorder. 
• WebMD. (2019). Mental Health and Conduct Disorder.