Conduct Disorder

Conduct disorder is a difficult-to-treat mental health problem that occurs in children under the age of 18 years. An estimated 2–10% of children and adolescents have conduct disorder. The disorder is more common in males than in females. About 60% of children and adolescents diagnosed with conduct disorder have another mental health disorder or a learning disability, complicating treatment. Conduct disorder is strongly associated with attention deficit/ hyperactivity disorder (ADHD), anxiety disorders, depression and mood disorders, post-traumatic stress disorder (PTSD), and substance abuse disorders.

Depending on the age at which it first appears, two forms of conduct disorder are specified: childhood-onset type and adolescent-onset type. Childhood-onset conduct disorder is often preceded by oppositional defiant disorder (ODD). The individual, usually a male, exhibits at least one aspect of conduct disorder before age 10 for a period of at least six months. Behaviors usually become more varied and serious by puberty. These children are more likely to progress to adult antisocial personality disorder, a diagnosis given when behaviors of conduct disorder persist beyond age 18.

Adolescent-onset conduct disorder tends to be milder, with no symptoms before age 10. This type of conduct disorder is only slightly more common in males than females. Individuals who develop adolescent-onset conduct disorder have less disturbed peer relationships and are less likely to progress to antisocial personality disorder as adults. Their antisocial behaviors may be much more marked when in the presence of others, especially their peers.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), conduct disorder is present when a child or adolescent (1) repetitively violates the rights of others or violates age-appropriate social norms and rules, and (2) this pattern of behavior causes significant impairment in social, academic, or occupational functioning.

Three or more of the following criteria must have been present repeatedly within the past 12 months, with one present within the past six months.

The child or adolescent:

The child or adolescent:

The child or adolescent:

The child or adolescent:

Because children and adolescents with conduct disorder often attempt to minimize the seriousness of their behavior, diagnosis is based on observations by parents, teachers, other authorities, peers, and by victims of the child's abuse. Generally, these children have an exterior appearance of toughness that conceals low self-esteem and demonstrates little empathy for the feelings of others or remorse for their actions. The disorder is associated with early sexual activity, substance abuse, reckless acts, and suicidal thoughts. Chronic health problems, ADHD, poverty, family conflict or a family history of alcohol dependence, mood disorders, antisocial disorders, and schizophrenia also commonly occur in conjunction with this disorder.

There is some concern that the behaviors associated with conduct disorder may potentially be considered normal responses in the context of certain highly violent social conditions, for example, war zones (a concern when treating some immigrants) and high-crime urban neighborhoods. In these areas, the routine threats posed to life and property may encourage aggressive and deceptive behaviors as protective responses. Thus, the social and economic context in which the behaviors occur must be taken into account to help differentiate conduct disorder from post-traumatic stress disorder or adaptive behavior.

Conduct disorder is difficult to treat effectively. No single psychotherapy has been successful in treating the disorder. Drugs may be used to treat concurrent conditions such as ADHD or depression. Parent management training may promote a higher level of compliance and pro-social behavior in the child. A combination of individual psychotherapy, family therapy, teaching social skills, and academic support can be effective. After age 18, individuals who still exhibit conduct disorder behaviors are given the diagnosis of antisocial personality disorder.

See also Antisocial personality disorder ; Oppositional defiant disorder.