What is Conduct Disorder? Causes, Symptoms, and Treatment
Has your child been repeatedly pushing, hitting, or biting classmates? Do you have an adolescent son who has been picking fights, vandalizing property, stealing, or even starting fires? Has your teen daughter been staying out late, disobeying your rules, and failing to show up for school?
Conduct disorder is characterized by a disregard for others, a lack of empathy, difficulty following rules and acting in a socially acceptable manner, and sometimes hostile and/or physically violent behavior.
If you recognize any of these behaviors in your child or adolescent, it’s possible they may have conduct disorder (CD)—one the most common disruptive behavior disorders.
Unfortunately, children and adolescents with conduct disorder are often misunderstood by peers, adults, and social agencies as delinquent or “bad.” In truth, they are dealing with a challenging mental health condition. The good news is there’s help available.
Here’s what you need to know about conduct disorders, including causes, symptoms, and treatments.
WHAT IS CONDUCT DISORDER?
Conduct disorder refers to a group of persistent, repetitive emotional and behavioral problems in children and adolescents up to the age of 18. These disruptive behavior disorders also include oppositional defiant disorder. CD is characterized by a disregard for others, a lack of empathy, difficulty following rules and acting in a socially acceptable manner, and sometimes hostile and/or physically violent behavior. Children with CD tend to be impulsive and difficult to manage. Early signs of aggression in younger children with conduct disorder may include pushing, hitting, and biting others. When a child with CD enters adolescence and early teens, they may exhibit more serious behaviors such as picking fights, bullying, hurting animals, vandalism, theft, and arson. In the U.S., conduct disorder is estimated to affect 6-16% of males, and 2- 9% of females, according to data. It’s more common among adolescents than in younger children, researchers report. The average age when symptoms appear is 10-12 years for boys and 14-16 for girls. Early-onset conduct disorder—before age 10—is associated with a greater risk of persistent difficulties, academic problems, and troubled relationships with peers. According to recent data, young people with CD often have co-occurring mental health conditions, such as:- Clinical depression
- ADD/ADHD (attention-deficit disorder, also known as attention-deficit/hyperactivity disorder)
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Learning disorders
CONDUCT DISORDER SYMPTOMS
There are four basic types of behavior seen with conduct disorder:- Physical aggression
- Violating the rights of others/destruction of property
- Lying, manipulating, and/or stealing
- Delinquent behaviors
- Threatens, intimidates, or bullies others
- Finds delight in being mean and cruel to others
- Initiates physical fights
- Uses a weapon (e.g., a knife, bat, gun, or broken bottle) that could seriously harm others
- Engages in physical cruelty to people or animals
- Steals while confronting a victim
- Forces another person into sexual activity
- Shows no real remorse after an aggressive incident
- Sets fires to intentionally cause damage
- Vandalizes or destroys other people’s property deliberately
- Lies to obtain favors or to avoid obligations
- Steals from individual people or stores
- Breaks into cars, houses, or businesses
- Often stays out at night despite parental objections
- Trespasses
- Breaks rules without clear reason
- Skips school (truancy)
- Runs away
- Doesn’t follow household rules
- Heavy alcohol consumption and/or substance use
- Reckless and frequent sexual activity
- Trouble forming and maintaining friendships
- Getting frustrated easily
- Making no effort to conceal aggressive behaviors
- Lacking remorse for harmful behavior
WHAT CAUSES CONDUCT DISORDER?
Conduct disorder develops from a host of factors, such as genetic vulnerability, child abuse or neglect, brain injuries, school failure, and traumatic life experiences. Structural brain differences may play a role as well. Additionally, the following factors put children and teens at a higher risk for developing CD:- Parental rejection or neglect, or abuse
- Having one or more other mental health disorders
- Having a parent diagnosed with ADD/ADHD, depression, alcohol use disorder, bipolar disorder, or schizophrenia
- Poor diet
- Poverty
- Maternal psychopathology
- Poor parenting or lack of parental involvement
- Discipline that’s inconsistent, overly harsh, or otherwise ineffective
- Exposure to violence
- Peer delinquency
- Having experienced physical, sexual, and/or emotional abuse
- Lack of adequate adult or parental supervision
CONDUCT DISORDER AND THE BRAIN
Brain differences have been found in young people with CD. One brain-imaging study on children and another study on teens with conduct disorder observed reduced volume in the temporal lobes and prefrontal lobes. The brain-imaging work at Amen Clinics using SPECT scans has found that deficits in the frontal lobes can potentially interfere with an individual’s ability to plan, avoid harm, and learn from difficult experiences. SPECT scans also show that abnormal activity in the temporal lobes may be associated with increases in aggression, mood instability, and learning problems. Another more recent study that analyzed brain scans of children with CD noted differences in their brain’s wiring that link the brain’s emotional centers together. The differences were found in the brain’s corpus callosum, an area linked to callous behavior, a lack of empathy, and disregard for other people’s feelings. However, more research is needed to fully understand how brain differences might play a role in the development of CD.CONDUCT DISORDER TREATMENT
Accurate and early diagnosis of CD are critical, especially if there are co-occurring mental health disorders involved. With treatment, the condition can be managed and symptoms improved. One overview study found, in general terms, that in younger children (under age 11) with CD, parent-focused interventions appear to be the most effective treatment. With adolescents (age 11 and older), child-focused interventions seem to be more effective. Different types of psychotherapy have proved most effective in treatment, which is usually an intensive process that may last for months. In some cases, medications may also be helpful. Some nutritional interventions with diet and nutritional supplements can be beneficial as well. Therapy may include a combination of the following:- Parent management training, designed to train the child’s parents to set consistent discipline and appropriate rewarding of positive behaviors.
- Multisystemic therapy is an intense, family-focused, and community-based treatment program for adolescents with serious criminal offenses and who may be abusing substances. It is also designed to teach their families how to best support their success in therapy.
- Individual psychotherapy is aimed at helping the adolescent change troubling thoughts, emotions, and behavior. To treat CD, it is heavily focused on improving family dynamics, academic performance, and working on improved behavior.
- Anger management training is designed to reduce both your child’s emotional feelings and the physiological arousal that anger causes, helping to improve emotional regulation.
- Community-based treatment, aimed at minimizing disruptive behaviors, typically involves more structed programs in residential treatment centers or therapeutic schools.
