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Conduct Disorder

    What Is Conduct Disorder

    Conduct disorder is a condition where a child or adolescent displays a group of behavioral and emotional problems. These behaviors are often referred to as anti-social behaviors.

    What Is Conduct Disorder (CD)?

    Conduct disorder is a condition that involves persistent patterns of emotional and behavioral problems in children or adolescents that are not anti-social and aren’t age-appropriate. It refers to a range of persistent and repetitive emotional & behavioral problems in children and adolescents. According to a 2005 research paper 1 violation of social norms and the rights of others is the major characteristic of this disorder. The researchers explain that CD may be expressed through different behavioral patterns, “from the frequent and intense temper tantrums and persistent disobedience of the difficult child to the delinquent’s serious acts of aggression, such as theft, violence and rape.” A recent study 2 claims that conduct disorder “lies on a spectrum of disruptive behavioral disorders.” It is often found to be a precursor to antisocial personality disorder which isn’t diagnosed until the individual is 18 years old.

    Further studies 3 have estimated it to affect 51.1 million people globally as of 2013. Research 4 shows that children who fall in this group have higher levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and a higher likelihood of aggression and violence. Studies 5 have found that only 25 to 40 percent of youths with this disorder will develop an antisocial personality disorder. A 2009 Study 6 that was conducted to determine the prevalence rate found that 6-16% were found in males and from 2-9% in females in the United States. The Journal of Abnormal Child Psychology 7 found evidence that suggests that 90% of children diagnosed with conduct disorder had a previous diagnosis of oppositional defiant disorder.

    Effects Of Conduct Disorder

    Children with this disorder find it extremely difficult to follow rules, respecting the right of others, showing empathy, and behaving in a socially acceptable way. These children usually display antisocial behaviors. Brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences are all factors that can lead to a child developing this disorder. It is not uncommon for children or teens to display behavioral problems at some point in their lives. However, some children are found to display extreme antisocial behaviors that are harmful to them as well as their families.

    The anti-social behaviors in a child are considered a conduct disorder when it is long-lasting. Instead of having a mental illness, adults and other children may regard them as “evil” or “delinquent”. If your child is suffering from this disorder, they may appear to be tough and confident. But in reality, they are often insecure and believe that people are being aggressive and threatening towards them. Many children with this disorder may have coexisting conditions such as mood disorders, post-traumatic stress disorder (PTSD), substance abuse, Attention Deficit Hyperactivity Disorder (ADHD), learning, or thinking problems.

    Read More About Post-Traumatic Stress Disorder (PTSD) Here

    Types Of Conduct Disorder

    Types Of Conduct Disorder
    Conduct Disorder

    There are usually three types of this disorder. They are categorized according to the age at which symptoms of the disorder first occur. Children who are diagnosed with a specific type of disorder are often described as callous and unemotional. The types of CD are as follows:

    1. Childhood Onset Type

    When indicators of conduct disorder show before the age of ten, it is called childhood onset. Children in this group have greater levels of ADHD symptoms, neuropsychological deficits, academic problems, increased family dysfunction, and increased likelihood of aggression and violence.

    2. Adolescent Onset Type

    This occurs when the signs of conduct disorder appear during the teenage years of a child. Studies 8 have found that the child exhibits less impairment than the childhood onset type and is not characterized by similar pathology. Rebellion against authoritative people and rejection of traditional norms are common behavioral traits.

    3. Unspecified Onset Type

    This usually means the age at which this disorder developed is unknown.

    Symptoms Of Conduct Disorder

    Symptoms Of Conduct Disorder
    Conduct Disorder

    Your child may be suffering from this disorder if they constantly display one or more of the following behaviors:

    • Aggressive Conduct Behavior
    • Deceitful Conduct Behavior
    • Destructive Conduct Behavior
    • Violation of Rules

    Aggressive Conduct behavior includes the following:

    • Intimidating or bullying others
    • Physically harming people or animals on purpose
    • Committing rape
    • Using weapons that can cause serious harm such as bricks, bat, knife or gun
    • Often initiates physical fights
    • Threatens others

    Deceitful Conduct Behavior includes the following:

    • Lying
    • Breaking and entering
    • Stealing
    • Forgery

    Destructive Conduct behavior may include:

    • Deliberately engaged in a fire setting with the intent of causing serious damage to another’s property.
    • Other intentional destruction of property.

    Violation of Rules may include the following behaviors:

    • Skipping school
    • Eloping home
    • Drug and alcohol use
    • Sexual behavior at a young age

    Read More About Alcoholism Here

    Causes Of Conduct Disorder

    The causes of this disorder are complex and can result from an interaction between multiple biological and psychosocial factors. The causes are laid down as follows:

    1. Biological Factors

    • Studies have indicated a moderate degree of heritability for antisocial behavior, impulsivity, temperament, aggression, and insensitivity to punishment.
    • Low levels of plasma dopamine beta-hydroxylase support the finding of decreased activity of the noradrenergic system.
    • Low levels of 5 Hydroxy Indole Acetic Acid (5-HIAA) levels in Cerebrospinal Fluid may be correlated with aggression and violence.
    • High testosterone levels can also be a cause of this disorder
    • Impairment of the frontal lobe can cause a lack of impulse control or an inability to plan future actions.

    2. Parental Factors

    • A home lacking in structure and supervision, as well as frequent parent-child confrontations.
    • Harsh parenting, including verbal and physical abuse of children.
    • Being exposed to domestic violence.
    • Family history of criminality and disruptive behaviors.
    • Substance abuse in parents.
    • Living in low social and economic conditions with too many family members and unemployment.
    • Lack of adequate parenting.

    Read More About Drug Abuse Here

    3. Neurological Factors

    • Studies suggest a correlation between resting frontal brain electrical activity (EEG) and aggression in children.
    • Neuropsychological deficits in the brain during early life can cause deficits in language, memory and executive functioning that can become a contributing factor to poor judgment and inability to plan.
    • Developmental delays that cause poor social skills, learning disability, and below average intellectual capacity can lead to children engaging in disruptive behaviors.
    • Traumatic brain injury, seizures, and neurological damage can also cause aggression and violence.

    4. Other Factors

    • Lack of positive feedback from teachers at school
    • Lack of supportive staff and counseling to address socio-economic difficulties in children
    • Exposure to increased gang violence in the community.

    Degree Of Conduct Disorder

    Degree Of Conduct Disorder
    Conduct Disorder

    The severity of symptoms of conduct disorder occurs in three degrees- mild, moderate, and severe.

    1. Mild

    If the child has mild symptoms, it means that they display limited behavioral problems and it can be managed. Their behavior is relatively harmless. Common issues include lying or staying up after dark without permission.

    2. Moderate

    In the case of a child showing moderate symptoms, they are more likely to display numerous behaviors. This can have a mild to severe impact on others around them. These problems may include stealing or destroying property.

    3. Severe

    Your child may have severe symptoms when they display excessive issues that are required to be diagnosed and treated. Severe conduct problems can have a harmful impact on the child as well as others. These behaviors may include rape, the use of weapons, or breaking and entering.

    Risk Factors Of Conduct Disorder

    Risk Factors Of Conduct Disorder
    Conduct Disorder

    The following are the factors that may contribute to developing this disorder:

    • Being a male
    • Living in an urban environment
    • Poverty
    • A family history of conduct disorder
    • A family history of mental illness
    • Having other associated psychiatric disorders
    • Parents with an alcohol or drug addiction
    • A dysfunctional home
    • History of experiencing traumatic events
    • Being abused or neglected

    Diagnosis Of Conduct Disorder

    If you see any signs of CD in your child it’s best to see a doctor. The doctor will do a physical exam that may include blood tests & neuroimaging to rule out any physical illness that may be causing this disorder. If no physical illness is present, the doctor will refer a mental health professional to the patient. The mental health professional will ask your child several questions that are associated with their mental health and assess the behavioral patterns to make a correct diagnosis. The doctor will also look for other signs that may occur along with this disorder such as ADHD or depression.

    The child must show symptoms of conduct disorder for at least six months. The behavioral problems may also show significant changes in your child’s life socially or at school.

    Read More About Major Depressive Disorder (Depression) Here

    Treatment For Conduct Disorder

    Children suffering from this disorder usually don’t realize that they have underlying issues that are triggering the symptoms. There are several treatment methods to help children suffering from this disorder. They are as follows:

    1. Therapy

    Therapy can go a long way in helping the child to deal with their issues. It will help them to analyze and evaluate their behavior so that they can change for the better. The approaches that are generally used are as follows:

    Read More About Therapy Here

    A. Cognitive Behavioral Therapy (CBT)

    CBT 9 helps the patient to understand the thoughts and patterns that trigger their negative behavior. It ultimately helps to detect and then rectify them with positive thoughts and patterns. The child gradually learns how to handle stress, communicate, and solve problems. They also learn how to control their impulsive behavior and anger issues.

    Read More About Cognitive Behavioral Therapy (CBT) Here

    B. Family Therapy

    This therapy involves family interactions in order to detect which situations are triggering this behavior in the child. It helps to improve communication in family members and to resolve conflicts among them. It works towards nurturing change and development so that they can understand where they are going wrong and make amends accordingly. “Family treatment should focus on enhancing cooperation between parents and children and between parents as co-parents and as a couple. Enhancing parent management skills can undermine the use of coercive, punitive, and impulsive interactions in families,” explains a study 10.

    C. Peer Group Therapy

    This therapy helps teens to change the peer groups that have a negative influence by moving away from them. These sessions can help them to break the negative thought pattern and encourage confidence about their choices. The main motive behind this therapy is to let the child speak about the issues related to their mental health. They usually feel comfortable sharing their issues with the group because all the members have similar kinds of issues.

    Read More About Group Therapy Here

    2. Medications

    There are no specific medications to treat this disorder. However, medications may be used to treat other associated disorders such as anxiety or depression.

    Read More About Anxiety Here

    Prevention Of Conduct Disorder

    The cause of developing this disorder is still unknown. Sometimes traumatic experiences, biological factors, and social problems may be a contributing factor for developing this disorder. In order to reduce the risk of developing this disorder, parents can learn good parenting habits and strategies to make sure their child is growing in a safe and loving environment. This can help to create a closer and loving relationship between the parents and the child.

    Recovering From Conduct Disorder

    Recognizing the symptoms early on can go a long way to treat this disorder. However, providing a nurturing and loving environment for your child may work as a preventive measure. In case your child is already showing signs of conduct disorder, it is wise to consult a doctor to devise the correct treatment plan for your child. A combination of group therapy and counseling may be helpful to build a healthy and normal life.

    Conduct Disorder At A Glance

    1. Conduct disorder is a condition where a child or adolescent displays a group of antisocial behavioral and emotional problems.
    2. The prevalence of this disorder is 6-16% in males and 2-9% in females in the United States.
    3. There are three types of conduct disorder: Childhood onset, Adolescents onset, Unspecified onset.
    4. One can develop this disorder depending on a broad range of biological, neurological, parental factors.
    5. Family history of conduct disorder, being a male, and poverty can play the roles of risk factors for this disorder.
    6. CBT, family and peer group therapy are considered extremely beneficial for the treatment of this mental illness.
    👇 References:
    1. INSERM Collective Expertise Centre. INSERM Collective Expert Reports [Internet]. Paris: Institut national de la santé et de la recherche médicale; 2000-. Conduct: Disorder in children and adolescents. 2005. Available from: https://www.ncbi.nlm.nih.gov/books/NBK7133/ []
    2. Mohan L, Yilanli M, Ray S. Conduct Disorder. [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470238/ []
    3. Global Burden of Disease Study 2013 Collaborators (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England), 386(9995), 743–800. https://doi.org/10.1016/S0140-6736(15)60692-4 []
    4. Moffitt T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychological review, 100(4), 674–701. []
    5. Zoccolillo, M., Pickles, A., Quinton, D., & Rutter, M. (1992). The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder. Psychological medicine, 22(4), 971–986. https://doi.org/10.1017/s003329170003854x []
    6. Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry, 61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18 []
    7. Loeber, R., Keenan, K., Lahey, B.B. et al. Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder. J Abnorm Child Psychol 21, 377–410 (1993). https://doi.org/10.1007/BF01261600 []
    8. Moffitt, T. E., & Caspi, A. (2001). Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Development and psychopathology, 13(2), 355–375. https://doi.org/10.1017/s0954579401002097 []
    9. Riise, E. N., Wergeland, G., Njardvik, U., & Öst, L. G. (2021). Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clinical psychology review, 83, 101954. https://doi.org/10.1016/j.cpr.2020.101954 []
    10. Sholevar G. P. (2001). Family therapy for conduct disorders. Child and adolescent psychiatric clinics of North America, 10(3), 501–517. []