Conduct disorder is characterized by the intentional violation of others’ rights and disregard for societal norms. Symptoms of conduct disorder in children vary but generally include aggression or violence, pathological lying, and manipulating others for personal gain. Typically, childhood conduct disorder is a precursor for a diagnosis of antisocial personality disorder in adulthood.
What Is Conduct Disorder?
Conduct disorder is classified as a combination of disruptive behaviors including aggression, property destruction, deceitfulness, and violation of rules. While there is no age limitation for receiving a conduct disorder diagnosis, the condition is rarely diagnosed after the age of 16. Typically, if similar symptoms present after the age of 18, a person may meet the criteria for antisocial personality disorder (ASPD).
How Common Is Conduct Disorder?
According to recent statistics, conduct disorder affects between 2% and 10% of children in the United States. Other research suggests that this rate may be as high as 16%. Furthermore, conduct disorder is more common in males than females, as prevalence rates for males vary from 6% to 16% while only between 2% and 9% of females meet the diagnosis.1,10
Symptoms of Conduct Disorder
Conduct disorder symptoms vary depending on the child’s age and the severity of their condition. However, there are patterns of behavior that are common across the board, such as anger, rage, low self-esteem, irritability, and difficulty feeling remorse.
Symptoms of conduct disorder may include:
- Tantrums, losing composure easily
- Hostility and aggression
- Pathological lying
- Running away from home
- Sexual abuse/assault
- Manipulation of others for personal gain
- Intentional violation of others’ rights
- Substance abuse1,2
Signs of Conduct Disorder
A child or teen with conduct disorder will exhibit troubling behaviors that draw negative attention from family members, school authorities, and law enforcement. They will frequently experience reoccurring troubles at home, school, and in most aspects of their life. For example, children diagnosed with conduct disorder will display hostility and aggression towards others, commonly resulting in bullying or fighting with peers. Additionally, many will frequently manipulate people for personal gain, exhibiting cunning and deceitful behaviors to do so.
Signs of conduct disorder in children may include:
- Bullying peers or threatening violence
- Cruelty toward animals
- Destroying property
- Arson or purposefully setting fires
- Purposefully breaking rules and curfew
- Trespassing for no apparent reason
- Acts of vandalism
- Obtaining or wielding weapons
What Causes Childhood Conduct Disorder?
Conduct disorder is caused by a combination of biological and environmental factors that differ among individuals. The use of authoritarian parenting (high-discipline, low-affection parenting) or permissive parenting styles correlates with an increased risk of conduct disorder development. Experiencing childhood trauma and generational trauma are also commonly linked with conduct disorders.
Possible causes and risk factors for conduct disorder in children include:1,3,12
- Male gender
- Parents who abuse drugs and alcohol
- Brain injury, impaired frontal lobe, or neurological abnormality
- Co-occurring substance abuse or mental illness
- Genetic factors
- Having a family member diagnosed with a mental illness
- Dysfunctional family life
- Childhood abuse and neglect
- Growing up or living in poverty
- Not being accepted by peer groups, social rejection
- Lack of or difficulty with moral awareness
- Low empathy or callousness
- Experiencing trauma
- Exposure to gang activity or violence
- Delinquency in peers
- Inconsistent discipline
- Authoritarian or permissive parenting styles
How Is Conduct Disorder Diagnosed?
Conduct disorder is diagnosed by a mental health care professional or medical provider. A child or teen will likely be referred for evaluation to seek remedy for any disturbance of conduct or conduct problems by authority figures in their life. A provider will use the DSM criteria for conduct disorder and clinical interviews to assess if a child’s behavior meets the diagnosis.
A diagnosis may also include observing the child in their natural environment as well as interviewing parents, family members, and teachers. They will review the child’s behavior across different settings and contexts to look for variations in behavior.8
Treatment for Conduct Disorder
Common treatment modalities for conduct disorder include cognitive behavioral therapy (CBT) for kids, parent management training (PMT), individual therapy, family therapy, and social skills training. School-based treatment programs, including residential treatment, may help improve academic performance and build the child’s self-esteem. Ongoing medical, emotional, educational, and social support is required for many years for severe forms of conduct disorder in order to help the child become a productive adult.
If the youth is incarcerated, there may be group and individual therapy treatments included as part of the rehabilitation process, often targeting interpersonal skills training, emotion regulation, and substance abuse treatment. In these cases, common modalities used may include multisystemic therapy (MST), multidimensional family therapy (MDFT), and functional family therapy (FFT). These interventions have been shown effective in reducing delinquency and substance abuse in juveniles.
There are currently no FDA-approved medications for conduct disorder. However, treating any co-occurring disorders, such as mood disorders and ADHD, is common practice. Without seeking treatment, escalations of violent and aggressive behaviors are probable.
Helping Your Child Cope With Conduct Disorder
Supporting your child or teen with conduct disorder can be challenging and exhausting. However, there are strategies that can help improve daily life for the child and family members and improve long-term positive outcomes.
Below are tips for helping your child if they have been diagnosed with conduct disorder:9
- Praise positive behavior: Telling your child something as simple as, “Thank you for making your bed today,” reinforces positive behavior and lets them know you are paying attention to their efforts in improving.
- Set and maintain boundaries: Once boundaries are set, stick to them. Be clear and consistent with rules in your home and avoid power struggles.
- Assign chores to teach responsibility: Assign chores and age-appropriate tasks to your child. This will help them feel responsible and develop a sense of agency.
- Set a positive example for your child: Model the behaviors you want to see in your child. Interacting and behaving in a pro-social is one way to start. Modeling is a powerful form of learning, especially in your child’s formative years.
- Establish a routine: Creating a consistent schedule for your child or teen will help foster stability and structure in the household and in their daily life.
- Spend time with your child: Spend meaningful time together. Engage your child in conversations. Listen to your child and engage in activities with them. Show them that they matter!
- Focus on communication: Get everyone in the family on the same page. As the restructuring of your household occurs, make sure everyone participates to avoid reverting back to prior ineffective family dynamics.
- Remember to stay patient: The process of change won’t happen overnight. Think of this process as a marathon and not a sprint.
Conduct disorder in children predicts an increased rate of psychiatric disorders throughout their lifespan. Because of this, the importance of early identification and treatment of conduct disorder, in conjunction with protective factors, is important in predicting better long-term outcomes for youth diagnosed.4,17,19