Conduct Disorder

Conduct Disorder

Conduct disorder (CD) is more than just bad behavior from children or teenagers. It is a mental health condition that is marked by persistent, repetitive behavioral patterns that violate societal rules or the rights of other people.

Conduct Disorder: What Does It Mean?

While most children become disruptive from time to time, conduct disorder involves problematic behaviors that are more serious and long-lasting. These disruptive behaviors generally fall into four groups: aggressive conduct that threatens or causes harm to people or animals, nonaggressive conduct that involves property damage or loss, theft or deceitful conduct, and persistent violations of important rules.

Youths with conduct disorder find it challenging to control their emotions. Disruptive behaviors typically occur in a variety of settings and may cause serious problems. In many cases, people with mental health conditions such as anxiety or depression direct their distress inward. However, individuals with CD direct their distress outward where it may affect other people.

Stats: How Many Suffer from this Disorder?

Approximately 1-4% of children age 9-17 years old have conduct disorder. The prevalence of the condition is consistent across various ethnicities, races, and countries. Conduct disorder is more common among teenagers than younger children. Males are more likely to develop CD than females.

What Causes Conduct Disorder?

The specific causes of conduct disorder are unknown. However, mental health experts believe there are genetic and environmental factors that influence its onset. Conduct disorder is more likely to develop in children who have:

  • A history of physical or sexual abuse
  • Parents with substance addiction
  • Family members with conduct disorder
  • Parents with depression, bipolar disorder, or schizophrenia
  • Abnormalities in brain areas that control emotional regulation

Oppositional defiant disorder (ODD) may be a precursor to conduct disorder. When ODD is untreated, children are more likely to develop conduct disorder later in life.

Signs and Symptoms of Conduct Disorder

Children may show many signs and symptoms of conduct disorder. The disruptive behaviors are persistent, repetitive, and socially inappropriate. Symptoms of conduct disorder may change as children get older, stronger, smarter, and more sexually mature. Problematic behaviors may include:

  • Physically abusing animals or people
  • Bullying others
  • Forced sexual activity
  • Damaging property
  • Breaking into buildings, cars, or houses
  • Shoplifting
  • Lying
  • Skipping school before the age of 13
  • Running away from home at least twice

What are the Common Behaviors/Characteristics?

The behaviors that characterize conduct disorder go beyond what people may expect during teenage rebellion. They cause serious concern among peers, parents, and teachers.

Youths with conduct disorder are usually aggressive. They are more likely to misperceive the actions of others as threatening, and may respond with aggressive behavior they believe is justified. Young people with CD display a low tolerance for frustration, poor self-control, high irritability, recklessness, thrill-seeking behavior, and insensitivity to punishment. Substance misuse is associated with CD, especially among adolescent females. Young people with CD are at higher risk of suicidal ideation and physical fights with a weapon.

Testing: What are the Diagnostic Criteria Per the DSM 5?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) gives the following guidelines for diagnosing conduct disorder:

  • 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 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 to People and Animals

  1. Often bullies, threatens, or intimidates 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).
  1. Has been physically cruel to people.
  2. Has been physically cruel to animals.
  3. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
  1. Has forced someone into sexual activity.

Destruction of Property

  1. Has deliberately engaged in fire setting with the intention of causing serious damage.
  2. Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

  1. Has broken into someone else’s house, 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. Often stays out at night despite parental prohibitions, beginning before age 13 years.
  2. Has run away from home 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.
  • 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.

Conduct Disorder and Other Conditions

Conduct disorder is more prevalent among youths with oppositional defiant disorder and attention deficit hyperactivity disorder (ADHD). CD may also occur with other mental health issues such as anxiety, mood disorders, learning disorders, and substance-related disorders. Young people with conduct disorder may have lower intelligence than expected for their age. They may have lower achievement in communication, reading, and other verbal skills.

Conduct Disorder vs Intermittent Explosive Disorder

Conduct disorder and intermittent explosive disorder (IED) are behavioral issues that are characterized by high levels of aggression. However, there are differences between both conditions. Aggressive conduct in CD is often premeditated and purposeful (for example, to gain money or power), while aggressive conduct in IED is impulsive and unplanned. While CD has nonaggressive symptoms such as lying or truancy, IED does not have similar nonaggressive symptoms that characterize the condition.

Conduct Disorder vs Oppositional Defiant Disorder

Conduct disorder and oppositional defiant disorder are marked by disruptive behaviors toward parents, teachers, and other authority figures. However, the behaviors that define conduct disorder are more severe than those in oppositional defiant disorder. Youths with conduct disorder may engage in destruction of property, theft, and physical abuse toward animals or people. While children with ODD have emotional issues such as irritability and anger, young people with CD do not have similar emotional issues that define the condition.

Conduct Disorder vs Antisocial Personality Disorder

Individuals with conduct disorder or antisocial personality disorder tend to externalize their distress. Conduct disorder is usually diagnosed in young people up to the age of 18; adults with similar symptoms may be diagnosed with antisocial personality disorder. Youths with conduct disorder are at higher risk for developing antisocial personality disorder as they age.

Related Conditions

Pyromania and kleptomania are behavioral issues that are related to conduct disorder. Individuals with pyromania are fascinated with fires and my start fires to release pent-up emotions. People with kleptomania have an urge to steal things they do not need. While conduct disorder is more prevalent among males, kleptomania is three times more common among females.

Conduct Disorder In Adults/Children

Although conduct disorder usually affects older children and teenagers, onset may occur during a child’s preschool years. The DSM-5 defines two subtypes of conduct disorder:

  • Childhood-onset type – the child shows at least one criterion symptom of conduct disorder before the age of 10. Children with this subtype are at increased risk of criminal behavior, substance abuse, and antisocial personality disorder in adulthood.
  • Adolescent-onset type – the child does not show any criterion symptoms of conduct disorder before the age of 10. Youths with this subtype tend to achieve adequate occupational and social adjustment as they get older.

Conduct disorder is rarely diagnosed in adults as symptoms may remit by adulthood. However, adults may be given a diagnosis of conduct disorder if symptoms persist and the criteria for antisocial personality disorder is not met.

Example Case of Conduct Disorder

Megan, 16, visits a therapist with her parents after a referral from her doctor. Her father explains that her behavior has become very disruptive over the past 18 months. Megan has been caught shoplifting, setting fires in the school library, and skipping classes without permission. In the past year, she ran away twice. After speaking with Megan, the therapist learns that she has unprotected sex at parties. Megan’s father reveals she was suspended from school a week ago for fighting her classmate. The therapist diagnoses Megan with adolescent-onset type conduct disorder and recommends a combination of peer group therapy and social skills training. After 9 months of bi-weekly sessions, Megan reports better emotional control and improved relationships with her classmates, parents, and teachers.

Conduct Disorder

How to Deal/Coping With Conduct Disorder

Many therapeutic strategies have been developed to help youths cope with conduct disorder. When treating preadolescent children, parent training and family-based interventions have proven to be most effective. As children get older, they may try to individuate and separate from their family. Consequently, older children and teenagers may respond better to individual therapy and peer group therapy.

Look out for These Complications/Risk Factors

Children with conduct disorder tend to have lower academic achievement than their peers. They are also at higher risk of dropping out of school. Frequent behavior problems mean youths with CD have fewer friends and poorer relationships. They are more likely to display violent behavior, misuse substances, have legal problems, and contract sexually transmitted infections.

Children with oppositional defiant disorder are at higher risk of developing conduct disorder. Other risk factors that may contribute to the onset of CD include parents with addiction issues, sexual abuse, physical abuse, and family members with the condition.

Conduct Disorder Treatment

Psychotherapy (talk therapy) is the recommended treatment for conduct disorder. Different types of psychotherapy may be used depending on the specific circumstances of the child. Therapy may be presented in individual, group or family settings. Therapeutic approaches that have proven to be effective include:

  • Functional family therapy – teaches the family about CD and how to improve family interactions.
  • Social skills training – teaches the child how to initiate conversations, respond to others, make requests, and refuse requests.
  • Parent management training – teaches parents behavior management strategies to control aggressive conduct and promote safety.
  • Wilderness school and treatment interventions – offers an intensive therapeutic program that eliminates triggers and focuses on building positive behaviors.
  • Residential placement – provides a therapeutic environment and professional care for children with uncontrollable behaviors and helps keep the family safe
  • Medication – treats coexisting issues

Possible Medications for Conduct Disorder

There are no specific FDA-approved medications that treat conduct disorder. However, medications may be prescribed to treat co-occurring issues such as depression or ADHD.

Home Remedies to help Conduct Disorder

There are no home remedies that are clinically proven to help with conduct disorder.

Living with Conduct Disorder

Conduct disorder can disrupt a person’s school, work, family, and social life. Behaviors that may cause harm to people or animals require immediate professional care.

If your child has been diagnosed with conduct disorder, consider these strategies to improve your family life:

  • Model and promote the healthy behaviors you want your child to imitate
  • Set clear limits to help curb disruptive behavior
  • Establish daily routines
  • Praise your child for his/her positive behaviors
  • Do not overreact to challenges
  • Help older children to understand they are responsible for their conduct

Insurance Coverage for Conduct Disorder

Conduct disorder is a diagnosable behavior disorder. Your child’s insurance plan may provide coverage for this health condition. Call your child’s insurance provider to confirm coverage and obtain any authorization you may need before visiting a doctor or mental health provider.

How to Find a Therapist

Speak with your child’s physician or school guidance counselor if your child is showing symptoms of conduct disorder. They may be able to refer you to a licensed therapist who specializes in behavioral disorders.

What Should I be Looking for in an LMHP?

Your therapist should have training and/or clinical experience in treating behavioral disorders. He or she should relate well to adults and youths, without giving the impression of taking sides. As serious or embarrassing issues may be discussed, it is important for therapists to be direct, positive, and encouraging. Having a therapist who makes your entire family feel comfortable goes a long way toward successful treatment.

Questions to Ask a Potential Therapist

Questions you can ask your child’s therapist include:

  • Does my child have conduct disorder?
  • Which subtype of conduct disorder does my child have?
  • Are there any other co-occurring mental health conditions?
  • What factors contributed to my child developing conduct disorder?
  • Are there any long-term complications?
  • What adjustments may improve my child’s behavior?
  • How long will these behavioral issues last?
  • What treatment do you recommend?

Conduct Disorder Resources and Support Helpline

If your child is threatening to commit suicide or harm others, call any of the following numbers immediately:

  • 911 or your local emergency services number
  • The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a trained therapist

Conduct disorder can cause serious issues in the lives of young people. However, early intervention and effective psychotherapy can help affected youths control their emotions and learn the social skills they need to succeed.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Bressert, S. (2016, May 17). Conduct disorder symptoms. Retrieved from https://psychcentral.com/disorders/conduct-disorder-symptoms/

Conduct disorder. (2013). Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Conduct-Disorder-033.aspx

Connor, M. G. (2014, May 21). Understanding and dealing with conduct and oppositional disorders. Retrieved from http://www.oregoncounseling.org/Handouts/ConductOppositional.htm

Morin, A. (2018, May 26). What are the signs of conduct disorder in children? Retrieved from https://www.verywellmind.com/signs-of-conduct-disorder-in-children-4127239

Parekh, R. (2018). What are disruptive, impulse-control and conduct disorders? Retrieved from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders

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