Conduct disorder (CD) is a mental health disorder characterized by persistent and repetitive behaviors that violate age-appropriate societal norms and the basic rights of others. It is usually diagnosed in childhood or adolescence.
The prevalence of conduct disorder is 2-5% in children between five and12 years of age and 5-9% in adolescents between 13 and 18 years of age (1).
Children with conduct disorders may find it difficult to follow the rules, respect others, and behave in socially acceptable ways. They may also lack empathy towards people and animals and often find delight in hurting others.
Read this post to know more about the types, causes, symptoms, complications, diagnosis, and treatment options for conduct disorder in children.
Types Of Conduct Disorder
Conduct disorder in children can be of the following subtypes based on the onset (2) (3).
- Childhood-onset: Children with childhood conduct disorder may show at least one symptom before ten years of age. They may have difficulty following rules and behaving in socially acceptable ways. Property destruction such as setting fires and breaking things, aggression, and poor peer relationships are typical symptoms.
- Adolescent onset: Adolescent conduct disorder is often considered in social contexts. Conduct disorders in adolescents can often be linked to basic survival needs such as stealing food or being part of gang culture. Adolescents may be less psychologically disturbed than those children with childhood-onset conduct disorder.
- Unspecified onset: Children are included in this group if the age at onset is unknown and the diagnostic criteria for conductive disorder are met.
Sometimes, children or teens may also develop new-onset conduct disorder behaviors such as running away from home, skipping school, and shoplifting as a result of family stressors. These can often be corrected with appropriate support and care.
Causes Of Conduct Disorder
Multiple factors may contribute to the development of conduct disorder in children. These may include the following (4).
Parental and family factors
- Exposure to frequent domestic violence
- Disruptive or criminal behaviors of caregivers and parents
- Lack of adequate supervision and structure in the family due to marital conflicts between parents
- Harsh parental behavior and verbal aggression
- Substance abuse, such as alcohol dependence or use of illicit drugs, in parents
- Poor living conditions
- Studies show that heritability could be responsible for antisocial behavior, temperament, and aggression.
- Low levels of 5-HIAA (5-Hydroxy Indole acetic acid) in cerebrospinal fluid (CSF) are seen in some adolescents with aggressive and violent behaviors.
- High testosterone levels may contribute to aggressive behavior.
- Low plasma dopamine beta-hydroxylase is associated with behavioral disturbances and conduct disorder in some children.
- Traumatic brain injury
- Brain damages
- Developmental delays
School and social factors
- Exposure to frequent gang violence in the community
- Lack of positive feedback from teachers
- Lack of counseling and supportive staff in the school setting
- Large classroom size and increased student-teacher ratio
- Past failure in school
Although some children may be exposed to these factors, they may not develop conductive disorder. This can be due to protective factors such as self-soothing ability, affectionate parenting, and positive role models around them.
Risk Factors For Conduct Disorders
The following factors and events may increase children’s risk of developing conduct disorders in children (5).
- Parental abuse, neglect, and rejection
- Poor nutrition
- Poor parenting
- Poverty and lack of adequate care
- Residing in an urban area as opposed to a rural area
- Maternal psychopathology
- Lack of discipline in the family
- Psychological disorders
- Parents with depression, bipolar disorder, ADHD, alcohol use disorder, or schizophrenia
- History of emotional, physical, or sexual abuse
- Exposure to violence
Children need affection and care from their parents and the people around them since childhood experiences play a significant role in shaping one’s personality.
Symptoms And Signs Of Conduct Disorders
Clinical features of conduct disorder can be classified into four types (6) (7).
1. Aggressive behavior
Children with conduct disorders can exhibit aggression toward people and animals. The following aggressive behaviors are usually linked to conduct disorders in children.
- Intimidating, threatening, or bullying other children and elders
- Harming people or animals
- Not showing genuine regret after being aggressive with someone
- Initiating physical fight with others
- Stealing from the victim while hurting them
2. Destructive behavior
Children with conduct disorder may find delight in destroying others’ property. Common destructive behaviors may include
- Arson: Deliberately setting fire to damage others property
- Vandalism: Destroying someone’s property
Vehicle vandalism is often seen in children with conduct disorders. They may deliberately scratch, break windows, or cause other damages to vehicles.
3. Deceitful behavior
Lying, stealing, and deceitfulness may coexist in children with conduct disorders. They may show the following deceitful behaviors.
- Breaking into someone’s car, house, or property
- Lying to avoid obligations and seeking goods or favors
- Stealing items without confronting a victim or shoplifting without breaking in
4. Violations of rules
The following rule-violations behaviors are typically seen in children, primarily those below 13 years, with conduct disorder.
- Staying out at night regardless of parental objections
- Running away from home or skipping school
- Skipping school
- Very early sexual activity
Children with any of these symptoms require a comprehensive evaluation by a mental health professional since conduct disorder may often coexist with other mental health disorders such as anxiety, ADHD, mood disorders, substance abuse, and learning problems.
Diagnosis Of Conduct Disorders
A pediatric psychiatrist may diagnose conduct disorder in a child by observing the child and asking parents and teachers about the child’s behavior. Some may ask children to do specific mental health tests to identify coexisting mental health disorders (8).
Diagnostic tests, such as imaging, are often ordered in suspected cases of brain damages. It is essential to seek help from a healthcare professional to diagnose unusual behaviors in children since early treatment can improve outcomes.
Treatment For Conduct Disorder
Although there is no specific cure for this disorder, certain therapies can improve outcomes and often change a child’s behavior. These are often opted based on age, symptoms, severity, and health status of the child.
Pediatric psychologists may recommend certain psychosocial interventions to children with conduct disorders. These therapies may take years to show results and are often done by certified professionals under the supervision of psychiatrists.
The following methods are often used to manage a child with conduct disorders (9).
- Cognitive-behavioral therapy (CBT) may help the child handle stress, control anger, solve issues, and communicate well.
- Family therapy is beneficial for families to understand the child’s condition and improve their communication and interaction with the child.
- Peer group therapy helps the child develop interpersonal and social skills.
- Medications are not recommended for treating conduct disorders in the US and many other countries. In some cases where the child shows symptoms of other disorders, such as ADHD, which may occur along with conduct disorder, the doctor may provide medications for treating the accompanying symptoms. Some countries, such as Canada, allow the use of psychostimulants to treat conduct problems.
Doctors recommend that overall stress reduction at home is beneficial for managing conduct disorder in children. Avoiding harsh punishments and practicing warm parental interaction could help your child. Parents should modulate their emotional expressions and be empathetic while communicating with the child.
Complications Of Conduct Disorder
Mismanaged or untreated conduct disorder may worsen over time and often result in devastating outcomes, including (10)
- Poor educational outcomes or academic failures
- Legal troubles and imprisonment
- Injuries to others or self
- Substance abuse and addiction
- Occupational and relationship problems
- Antisocial personality disorder
- Suicidal ideas
Some children may develop self-harming behaviors. Conductive disorders may often make the child resort to life-threatening behaviors. Some children with conduct disorder can also develop antisocial personality disorder in adulthood.
Children can access various support services to manage the symptoms, and parents may attend training to improve parenting skills. The second step is a school-based program to reduce aggression and impulsivity in children. Triple P (positive parenting program) helps improve parents’ skills and confidence to reduce behavioral and emotional problems in children.
You may seek support from organizations, such as school or church groups, which offer positive interactions. The National Alliance on Mental Illness (www.nami.org), and Big Brothers Big Sisters of America (www.bbbsa.com) also help the family encourage the child.