Conduct Disorder

Conduct disorder is a set of serious emotional and behavior problems in children and adolescents. These problems may include rule-breaking, aggression, disregard for others, lying, drug use or criminal activity. The behaviors associated with conduct disorder often cause significant problems in a child’s social, school and family life.

Conduct disorder refers to a range of problems, and has no clear, single cause. It has been linked to:

• Child abuse and neglect
• Drug or alcohol abuse by parents
• Family conflict
• Harsh or inconsistent discipline
• Social problems and rejection by peers
• Exposure to violence or other trauma
• Genetic factors, including antisocial personality disorder in parents
• Poverty

Because many of the individual signs, such as rule-breaking and aggression, can be within the range of normal childhood behavior, these must be shown to an extreme degree to be considered conduct disorder.

Signs of conduct disorder include:

Aggression and violence

• Bullying and threatening others
• Starting fights
• Physical cruelty to peers, siblings and animals
• Using dangerous weapons (such as a bat, broken bottle, knife or gun)
• Forced sexual activity

Breaking rules

• Not going to school (frequently, starting before age 13)
• Staying out late often, in violation of parental limits
• Heavy drinking / drug use
• Running away from home overnight more than once

Destruction of property

• Setting fires intentionally to cause serious damage
• Deliberately vandalizing or destroying property

Lying or stealing

• Lying frequently to manipulate others, in order to obtain a positive goal or avoid a negative outcomes
• Breaking into homes, buildings or cars
• Stealing items of value

Conduct disorder can include different behaviors in boys and girls. Boys with conduct disorder tend to fight, steal and vandalize. Girls are more likely to run away from home, lie or abuse drugs or alcohol. Law-breaking behavior for boys may include violence or arson. For girls, it may include sexual behavior at a young age and prostitution.

Conduct disorder is diagnosed by a child and adolescent psychiatrist or an adolescent medical physician based on a detailed history of behavior. This history generally come from parents, teachers and other adults, including law enforcement personnel, observing a pattern of aggressive, dishonest, destructive or illegal activity. Psychological testing may also be done as part of the diagnostic process. In some cases, other testing  may be used to determine if a neurological problem is contributing to the disorder.

Conduct disorder is sometimes linked to attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) or learning problems. It can also be associated with or be an early sign of depression or bipolar disorder. These associated conditions can be diagnosed with psychological tests and interviews.

Treatment for conduct disorder is determined by the child’s age and the nature of the behaviors. Treatment for conduct disorder can be especially challenging because of the child’s negative attitude toward and distrust of adults and a lack of guilt about the behaviors. In addition to direct treatment of the child or teen, treatment generally involves parents, teachers and other adults in the child’s life  in order to reset the environment in which the misbehavior is occurring.

Treatment may include:

Cognitive behavioral therapy - to improve problem-solving and communication skills, and to help with impulse control and anger management.

Family therapy – to help parents learn effective ways to set and enforce healthy limits on the child’s behavior. Parents often need expert help in changing established patterns of interaction in the family. They may also need help in working with the child’s school and teachers to reinforce the treatment plan. Changing the dynamics of family behavior may require the involvement of other siblings and extended family.

Medication – may be used to treat comorbid issues such as ADHD, anxiety, depression or bipolar disorder.

If abuse is a factor, the child may need to be removed from the family and placed in a safer and more orderly home.

Children who are diagnosed and treated early usually overcome their behavioral problems.

In cases where the behavior problems are extreme and the child is not able to complete treatment, youth with conduct disorder can grow into adults who have problems with relationships, have difficulty holding a job, regularly break laws and engage in drug abuse. Conduct disorder in a child or adolescent can evolve into antisocial personality disorder in an adult.

Treatment for conduct disorder is not easy or fast. It requires a long-term commitment from the adults in the child’s life to set firm, fair and consistent limits and to enforce them in a positive way. It also requires a long-term commitment from the child or teen to continue to work on impulse control and anger management, and to improve social skills.

Parents of a child or teen with conduct disorder will need to work with the changing set of teachers and other adults in the child’s life to ensure that any recurring behavior problems are noticed and dealt with effectively.

A long-term team approach to treatment, involving parents, teachers, the child or teen and mental health professionals is critical to ensuring a positive outcome.

Children’s Hospital of Philadelphia (CHOP) has a skilled team of child and adolescent psychiatrists who work with other medical experts and social workers to diagnose, understand the causes of and treat problems such as conduct disorder.

The team of professionals who work with your child and your family is committed to a successful outcome, and realize that success takes time and ongoing treatment and support.