Symptoms, Causes, Diagnosis, and Treatment

What Is Conduct Disorder?

Conduct Disorder (CD) is a highly impairing psychiatric disorder characterized by severe and enduring antisocial and aggressive behavior such as destroying property, picking fights, and mistreating animals. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), defines CD as “A repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated.” CD is associated with neurocognitive impairments and functional abnormalities in areas of the brain that are responsible for emotion processing, emotion regulation, and reinforcement-based decision-making.

Conduct disorder typically appears in children and adolescents and is frequently comorbid with attention deficit hyperactivity disorder (ADD or ADHD). Both ADHD and CD are associated with disability beyond immediate health loss, namely adverse outcomes including academic under-achievement, other mental and substance use disorders, and criminality.

CD is twice as prevalent in males as it is in females and is diagnosed in approximately 6 to 16% of school-age boys and 2 to 9% of school-aged girls. Subtypes of CD are determined by age of onset (childhood-onset vs. adolescent-onset) and the presence or absence of callous-unemotional traits, such as deficits in empathy and guilt. CD can often lead to antisocial personality disorder in adulthood.

What Are the Symptoms of Conduct Disorder?

Individuals with conduct disorder often exhibit the following symptoms:

  • Aggression to people and animals: initiating physical fights, bullying others, subjecting animals and/r humans to physical cruelty, mugging, or assaulting
  • Destruction of property: setting fires or breaking items that belong to others
  • Deceitfulness or theft: breaking and entering, shoplifting, “conning” others
  • Serious violations of rules: staying out late at night, running away from home, skips school regularly
    According to the DSM-V, these disturbances in behavior must cause significant impairment in social, academic, or occupational functioning to warrant a diagnosis of conduct disorder.

What Causes Conduct Disorder?

Both genetic or biological and environmental risk factors contribute to a diagnosis of conduct disorder. Conduct disorder in children is linked to a problem in the frontal lobe of the brain, which can interfere with a child’s ability to stay away from harm and learn from negative experiences. What’s more, adults who exhibited conduct problems when they were young are more likely to have children with conduct disorder, however the following factors can also play a significant role in predicting conduct disorder and delinquency:

Genetic and Biological Factors for Conduct Disorder

  • Impairment in regions of the brain responsible for impulse control, behavior regulation, and emotional regulation
  • Family history of mental illness, depression, substance abuse, anxiety disorder, an/or conduct disorder

Environmental Factors for Conduct Disorder

  • Poor parental supervision
  • Punitive or erratic parental discipline
  • Cold parental attitude
  • Parental conflict
  • Disrupted families
  • Antisocial parents
  • Large family size
  • Poverty

Other Risk Factors for Conduct Disorder

  • Child neglect or abuse
  • Other experienced trauma
  • Low IQ and low achievement
  • Boys are twice as likely as girls to have CD
  • Antisocial peers
  • High-delinquency-rate schools
  • High-crime neighborhoods

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The traumatic experiences that can occur due to the environmental factors above are believed to contribute to depressed mood, behavior problems, and involvement in defiant peer groups.

How Is Conduct Disorder Diagnosed?

Many children and teens exhibit behavior-related problems during their development, but a diagnosis of conduct disorder is considered only if the behavior persistently violates the rights of others, goes against accepted norms of behavior, and disrupts everyday life.

If a physical cause for the symptoms is not found, most doctors will refer the patient to a child and adolescent psychiatrist or psychologist, or another mental health professional who is trained to diagnose and treat mental illnesses in children and teens.

The Child Behavior Checklist, the Disruptive Behavior Disorders Rating Scale, and the National Institute for Children’s Health Quality Vanderbilt Assessment Scales can all be used to screen for conduct disorder. Though rating scales are helpful, the diagnosis of CD is dependent on patient history. Physical findings during testing do not contribute to the diagnosis, although evidence of injuries, such as injuries due to fighting, may provide pertinent information.

Diagnosis is based on the child’s symptoms and observation of the child’s attitudes and behavior. The doctor will often rely on reports from the child’s parents, teachers, and other adults because children may withhold information or otherwise have trouble explaining their problems or understanding their symptoms.

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Conduct Disorder Treatment

Treatment for conduct disorder primarily includes parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used. There are currently no medications approved by the FDA to treat conduct disorder. Psychostimulants are highly recommended for patients who have comorbid ADHD and conduct problems. There is some evidence to support the treatment of conduct disorder and aggression with risperidone.

Additional interventions include treating comorbid conditions, prioritizing positive communication within the family, and taking advantage of community resources.

Does Conduct Disorder Go Away?

If left untreated, children and teens with conduct disorder are at risk of developing other mental disorders in adulthood. These children are also at greater risk for school-related problems, substance abuse, sexually transmitted diseases, and suicide. Early interventions may reduce the risk of mood disorders, incarcerations, and the development of other comorbid-disorders.

Conduct Disorder: Next Steps

Sources

Fairchild, Graeme, et al. Conduct disorder. Nature Reviews Disease Primers (2019). https://www.nature.com/articles/s41572-019-0095-y

Conduct Disorder. Mental Health America. https://www.mhanational.org/conditions/conduct-disorder

Erskine, Holly, et al. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry (2016). https://www.sciencedirect.com/science/article/abs/pii/S0890856716311571

McDonough-Caplan, Heather, et al. Conduct disorder: A neurodevelopmental perspective. Developmental Pathways to Disruptive, Impulse-Control and Conduct Disorders (2018). https://www.sciencedirect.com/science/article/pii/B9780128113233000031

Lillig, Mathias, et al. Conduct Disorder: Recognition and Management. American Family Physician (2018). https://www.aafp.org/afp/2018/1115/p584.html

DSM-5 Diagnostic Criteria Conduct Disorder (2013). http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ConductDisorder.pdf

Murray, Joseph. Risk Factors for Conduct Disorder and Delinquency: Key Findings from Longitudinal Studies. The Canadian Journal of Psychiatry (2010). https://journals.sagepub.com/doi/abs/10.1177/070674371005501003

Conduct Disorder. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/conduct-disorder


Updated on September 2, 2020

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