Conduct Disorder No.

33; Updated May 2012 Click here to download and print a PDF version of this document. "Conduct disorder" refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill. Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences. Children or adolescents with conduct disorder may exhibit some of the following behaviors: Aggression to people and animals

bullies, threatens or intimidates others often initiates physical fights has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun) is physically cruel to people or animals steals from a victim while confronting them (e.g. assault) forces someone into sexual activity

Destruction of Property

deliberately engaged in fire setting with the intention to cause damage deliberately destroys other's property

Deceitfulness, lying, or stealing

has broken into someone else's building, house, or car lies to obtain goods, or favors or to avoid obligations steals items without confronting a victim (e.g. shoplifting, but without breaking and entering)

Serious violations of rules

often stays out at night despite parental objections runs away from home often truant from school

Children who exhibit these behaviors should receive a comprehensive evaluation by an experience mental health professional. Many children with a conduct disorder may have coexisting conditions such as mood disorders, anxiety, PTSD, substance abuse, ADHD, learning problems, or thought disorders which can also be treated. Research shows that youngsters with

conduct disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive treatment. Without treatment, many youngsters with conduct disorder are unable to adapt to the demands of adulthood and continue to have problems with relationships and holding a job. They often break laws or behave in an antisocial manner. Treatment of children with conduct disorder can be complex and challenging. Treatment can be provided in a variety of different settings depending on the severity of the behaviors. Adding to the challenge of treatment are the child's uncooperative attitude, fear and distrust of adults. In developing a comprehensive treatment plan, a child and adolescent psychiatrist may use information from the child, family, teachers, community (including the legal system) and other medical specialties to understand the causes of the disorder. Behavior therapy and psychotherapy are usually necessary to help the child appropriately express and control anger. Special education may be needed for youngsters with learning disabilities. Parents often need expert assistance in devising and carrying out special management and educational programs in the home and at school. Home-based treatment programs such as Multisystemic Therapy are effective for helping both the child and family.Treatment may also include medication in some youngsters, such as those with difficulty paying attention, impulse problems, or those with depression. Treatment is rarely brief since establishing new attitudes and behavior patterns takes time. However, early treatment offers a child a better chance for considerable improvement and hope for a more successful future.

Conduct Disorder

mental disorder Attention-Deficit and Disruptive Behavior Disorders

This mental disorder may be diagnosed when a child seriously misbehaves with aggressive or nonaggressive behaviors against people, animals or property that may be characterized as belligerent, destructive, threatening, physically cruel, deceitful, disobedient, or dishonest. This may include stealing, intentional injury, and forced sexual activity.

Diagnostic criteria for 312.8 Conduct Disorder

(DSM IV - TR) (cautionary statement) (new code as of 10/01/96: 312.xx) A. 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 (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., abat, 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 (8) has deliberately engaged in fire setting with the intention of causing serious damage (9) has deliberately destroyed others' property (other than by fire setting) Deceitfulness or theft (10) has broken into someone else's house, building, or car (11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) (12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules (13) often stays out at night despite parental prohibitions, beginning before age 13 years (14) 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) (15) 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. Specify type based on age at onset: Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years (new code as of 10/01/96: 312.81) Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years (new code as of 10/01/96: 312.82)

(new code as of 10/01/96: 312.89 Unspecified Onset) Specify severity: Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others Moderate: number of conduct problems and effect on others intermediate between "mild" and "severe" Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others Conduct disorder is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and have problems following rules. 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 longlasting and when it violates the rights of others, goes against accepted norms of behavior and disrupts the child's or family's everyday life.

What Are the Symptoms of Conduct Disorder?

Symptoms of conduct disorder vary depending on the age of the child and whether the disorder is mild, moderate, or severe. In general, symptoms of conduct disorder fall into four general categories:

Aggressive behavior: These are behaviors that threaten or cause physical harm and may include fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity. Destructive behavior: This involves intentional destruction of property such as arson (deliberate fire-setting) and vandalism (harming another person's property). Deceitful behavior: This may include repeated lying, shoplifting, or breaking into homes or cars in order to steal. Violation of rules: This involves going against accepted rules of society or engaging in behavior that is not appropriate for the person's age. These behaviors may include running away, skipping school, playing pranks, or being sexually active at a very young age.

In addition, many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Some may abuse drugs and alcohol. Children with conduct disorder often are unable to appreciate how their behavior can hurt others and generally have little guilt or remorse about hurting others.

What Causes Conduct Disorder?

The exact cause of conduct disorder is not known, but it is believed that a combination of biological, genetic, environmental, psychological, and social factors play a role.

Biological: Some studies suggest that defects or injuries to certain areas of the brain can lead to behavior disorders. In addition, conduct disorder has been linked to particular brain chemicals called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms. Further, many children and teens with conduct disorder also have other mental illnesses, such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, depression, substance abuse, or an anxiety disorder, which may contribute to the conduct disorder. Genetics: Many children and teens with conduct disorder have close family members with mental illnesses, including mood disorders, anxiety disorders, substance use disorders and personality disorders. This suggests that a vulnerability to conduct disorder may be inherited. Environmental: Factors such as a 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. Psychological: Some experts believe that conduct disorders can reflect problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing. Social: Low socioeconomic status and not being accepted by their peers appear to be risk factors for the development of conduct disorder.

How Common Is Conduct Disorder?

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.

How Is Conduct Disorder Diagnosed?

As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular problem. If symptoms of conduct disorder are present, the doctor may begin an evaluation by performing a complete medical history and psychiatric history. A physical exam and laboratory tests (for example, neuroimaging studies, blood tests) may sometimes be appropriate if there is concern that a physical illness might be causing the symptoms. The doctor will also look for signs of other disorders that often occur along with conduct disorder, such as ADHD and depression. If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitudes and behavior. The doctor often must rely on reports from the child's parents, teachers, and other adults because children often have trouble explaining their problems or understanding their symptoms.

How Is Conduct Disorder Treated?

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

Psychotherapy : Psychotherapy (a type of counseling) is aimed at helping the child learn to express and control anger in more appropriate ways. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve problem solving skills, anger management, moral reasoning skills, 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. Medication : Although there is no medication formally approved to treat conduct disorder, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or major depression.

What Is the Outlook for Children With Conduct Disorder?

If your child is displaying symptoms of conduct disorder, it is very important that you seek help from a qualified doctor. A child or teen with conduct disorder is at risk for developing other mental disorders as an adult if left untreated. These include antisocial personality disorder, mood or anxiety disorders, and substance use disorders. Children with conduct disorder are also at risk for school-related problems, such as failing or dropping out, substance abuse, legal problems, injuries to self or others due to violent behavior, sexually transmitted diseases, and suicide. Treatment outcomes can vary greatly, but early intervention may help to reduce the risk for incarcerations, mood disorders, and the development of other comorbidities such as substance abuse.

Can Conduct Disorder Be Prevented?

Although it may not be possible to prevent conduct disorder, recognizing and acting on symptoms when they appear can minimize distress to the child and family, and prevent many of the problems associated with the condition. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of disturbing behavior.

Causes
Conduct disorder has been associated with:

Child abuse Drug addiction or alcoholism in the parents

Family conflicts Genetic defects Poverty

The diagnosis is more common among boys. It is hard to know how common the disorder is, because many of the qualities needed to make the diagnosis (such as "defiance" and "rule breaking") can be hard to define. For an accurate diagnosis, the behavior must be far more extreme than simple adolescent rebellion or boyish enthusiasm. Conduct disorder is often associated with attention-deficit disorder. Both conditions carry a risk for alcohol or other drug addiction. Conduct disorder also can be an early sign of depression or bipolar disorder.

Back to TopSymptoms
Children with conduct disorder tend to be impulsive, hard to control, and not concerned about the feelings of other people. Symptoms may include:

Breaking rules without obvious reason Cruel or aggressive behavior toward people or animals (for example: bullying, fighting, using dangerous weapons, forcing sexual activity, and stealing) Failure to attend school (truancy -- beginning before age 13) Heavy drinking and/or heavy illicit drug use Intentionally setting fires Lying to get a favor or avoid things they have to do Running away Vandalizing or destroying property

These children often make no effort to hide their aggressive behaviors. They may have a hard time making real friends.

Back to TopExams and Tests

There is no real test for diagnosing conduct disorder. The diagnosis is made when a child or adolescent has a history of conduct disorder behaviors. A physical examination and blood tests can help rule out medical conditions that are similar to conduct disorder. Rarely, a brain scan may also help rule out other disorders.

Back to TopTreatment

For treatment to be successful, the child's family needs to be closely involved. Parents can learn techniques to help manage their child's problem behavior. In cases of abuse, the child may need to be removed from the family and placed in a less chaotic home. Treatment with medications or talk therapy may be used for depression and attentiondeficit disorder, which commonly occur with conduct disorder. Many "behavioral modification" schools, "wilderness programs," and "boot camps" are sold to parents as solutions for conduct disorder. These programs may use a form of "attack therapy" or "confrontation," which can actually be harmful. There is no research to support these techniques. Research suggests that treating children at home, along with their families, is more effective. If you are considering an inpatient program, be sure to check it out thoroughly. Serious injuries and deaths have occurred with some programs. They are not regulated in many states.

Back to TopOutlook (Prognosis)

Children who have severe or frequent symptoms tend to have the poorest outlook. Expectations are also worse for those who have other illnesses, such as mood and drug abuse disorders.

Back to TopPossible Complications

Children with conduct disorder may go on to develop personality disorders as adults, particularly antisocial personality disorder. As their behaviors worsen, these individuals may also develop drug and legal problems. Depression and bipolar disorder may develop in adolescence and early adulthood. Suicide and violence toward others are also possible complications of this disorder.

Back to TopWhen to Contact a Medical Professional

See your health care provider if your child:

Regularly gets in trouble Has mood swings Is bullying others or cruel to animals Is being victimized Seems to be overly aggressive

Early treatment may help.

Back to TopPrevention
The sooner the treatment for conduct disorder is started, the more likely the child will learn adaptive behaviors and prevent some of the potential complications.