Conduct Disorders

Conduct disorder refers to a group of behavioral and emotional problems where the person has great difficulty following rules and behaving in a socially acceptable way, and where the rights of others or the social norms are violated. 

Many factors may contribute to a person developing conduct disorder, including brain damage, child abuse, genetic vulnerability, school failure, and traumatic life experiences.  Possible symptoms are over-aggressive behavior, bullying, physical aggression, cruel behavior toward people and pets, destructive behavior, lying, truancy, vandalism, and stealing.  Conduct disorder is a disorder of childhood and adolescence; after the age of 18, a conduct disorder may develop into antisocial personality disorder.

The exact cause of conduct disorder is not known, but it is believed that a combination of biological, genetic, environmental and social factors play a role. Conduct disorder has been associated with dysfunctional family life, inconsistent discipline by parents, child abuse, poverty, traumatic experiences, injuries to certain areas of the brain, special chemicals in the brain called neurotransmitters, genetic factors, and parental drug addiction or alcohol addiction. The diagnosis is more common among males.  Children with conduct disorder tend to be impulsive, difficult to control, and unconcerned about the feelings of others.

It is estimated that 2%-16% of children in the U.S. have conduct disorder. It is more common in boys than in girls and most often occurs in late childhood or the early teen years.

It is not uncommon for children and teens to have behavior-related problems at some time during their development. However, the behavior is considered to be a conduct disorder when it is long-lasting and when it violates the rights of others, goes against accepted norms of behavior and disrupts the child's or family's everyday life.

The diagnostic criteria for Conduct disorder is published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The diagnostic criteria for Conduct Disorder as listed in the DSM-IV-TR are as follows:

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning and there is present 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 people, 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
has deliberately engaged in fire setting with the intention of causing serious damage.
has deliberately destroyed others' property (other than by fire)
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 items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)
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

Many children with a conduct disorder may have coexisting conditions such as mood disorders, anxiety,   PTSD, substance abuse, attention deficit disorder (ADHD), learning problems, or thought disorders. Research shows that persons with conduct disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive treatment. Treatment is rarely brief since establishing new attitudes and behavior patterns takes time.

Treatment is based on many factors, including the persons age, the severity of symptoms as well as the person's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:

Behavior therapy as well as reality therapy and psychotherapy are usually necessary to help the person learn to appropriately express and control anger.  Cognitive-behavioral therapy aims to reshape the child's thinking (cognition), to improve problem solving skills, and develop anger management and impulse control.

Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior in the home. 

Treatment may also include medication.  While no specific medication has been formally recognized and approved to treat conduct disorder, various medications may be used to treat some of its distressing symptoms such as attention deficit disorder (ADHD) and depression.

For more information about conduct disorder and other mental health problems, please click on the linked websites listed below.

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