What Is Conduct Disorder?

Conduct disorder is a type of mental illness diagnosed in children where they demonstrate persistent or repeated violent, threatening, or intimidating behavior that goes outside of social norms. This behavior can be toward other people, animals, or property or could be in direct violation of rules, such as ignoring parental or school requirements.

Conduct disorder can be diagnosed as early-onset if the behaviors emerge before the age of 10 or as adolescent-onset if the behaviors occur after.

This article will present the symptoms, causes and risk factors, diagnostic criteria, and treatment options for children with conduct disorder.

Signs and Symptoms of Conduct Disorder

Some of the signs that a child may have, or be at risk of developing, conduct disorder include:

• Increasing difficulty with peers over time
  
• Increasing struggles with academics over time or absences from school
• Aggression toward people and/or animals
• Causing physical or sexual violence
• Having disregard for social norms or rules
• Destruction of property
• Deceitfulness or theft

These symptoms will usually emerge over time, and the child could display some or many of them. It's important to note that difficulty at school or with peers, aggressive behaviors, and other oppositional challenges alone does not mean a child has conduct disorder or even that an evaluation is needed. It's when these behaviors continue, increase in severity, or become violent that a professional diagnosis is needed.

Causes and Risk Factors

There are many factors that can contribute to the development of conduct disorder in children. These include:

• Genetic factors (traits passed down from parent to child)
• Neurocognitive factors (problems with the brain)
• Temperament (biological differences in behavior; someone's nature)
• Peer influence
• Family influence

Though contributing factors are broad, there are some concrete signs that a child may be at higher risk of developing conduct disorder. Those who develop early-onset conduct disorder often had symptoms consistent with attention-deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) prior to being diagnosed with conduct disorder.

The shift from these common childhood disorders to conduct disorder is based on certain conditions that occur in the brain, like not being able to control inhibitions or having poor verbal abilities. These can lead to a child having difficulty solving problems within their peer groups and controlling their emotions and impulses.

Children at risk for conduct disorder might also be using drugs or alcohol or struggling with another mental illness that affects their ability to be rational, such as post-traumatic stress disorder or depression.

For adolescents over the age of 10, the risk does not come as much from brain conditions as it does for younger children. Instead, behaviors consistent with conduct disorder usually emerge because the teenagers start to exhibit rebellious behavior. Oftentimes they associate with similarly behaving friends and are not monitored and managed by parents.

Diagnosis

Conduct disorder is diagnosed by a medical or mental health professional. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), children or adolescents must display at least three symptoms of conduct disorder in the past 12 months, and at least one symptom must have occurred within the last six months.

These symptoms also must cause difficulties and have a significant impact on the child's school, work, or social life. The healthcare provider providing the diagnosis will also determine whether the disorder is considered child-onset, adolescent-onset, or unspecified if the exact time when symptoms began is unclear.

Additionally, a diagnosis will include the severity (mild, moderate, or severe) and whether the child is showing limited prosocial emotions, which means a lack of guilt, remorse, empathy, or other expected emotion.

Treating Conduct Disorder

A good treatment plan is extremely important to help a child with conduct disorder. Without treatment, conduct disorder symptoms will not improve. There are different options for treatment, including medication and therapy, and a healthcare provider can help determine the best approach for each child.

Therapy Approaches

There are different treatment options that may be suggested by the medical or mental health professional who provides a conduct disorder diagnosis. Interventions including psychosocial supports, which involve both the child and the family, are most effective.

Treatment is also likely to vary based on the ways the disorder is presented in each specific child. For example, children with higher levels of aggression would probably work on anger management and reduction in harsh punishments from family members. Some of the most common interventions include:

• Contingency management programs: These programs help parents and children learn how to slowly change a child's behavior over time by setting goals and rewarding good behavior while providing consequences for undesired behaviors.
• Cognitive behavioral training: This type of intervention is focused on skills training. It teaches children how to problem solve and make positive decisions.
• Parent management training: This kind of training teaches parents how to develop a child's skills and improve behaviors while at home. It focuses on positive reinforcement and teaches appropriate discipline for undesired behaviors.

Often, treatment programs will include parts of multiple interventions. Here are some examples of types of programs that combine approaches:

• Mentalization-based treatment for children and adolescents with conduct disorder (MBT-CD): This is a structured program that lasts 12 months and includes a combination of individual and family therapy. Sessions are organized in a specific way and include assessments, practicing mentalizing (the ability to reflect on their behavior), the child's personal story, efforts to build trust with their therapist, and efforts to break unhealthy loops within the family (e.g., using aggressive forms of punishment that lead to aggressive behaviors in the child).
• Positive Parenting Program (PPP): This treatment approach includes the entire family and works with the child's behavioral, emotional, and developmental problems. Working with the parents to adopt positive discipline styles, improve their confidence, and develop their parenting skills is central to this approach.
  

Pharmacological Interventions

Though research shows that medication alone is not enough to treat conduct disorder, some medication can be helpful alongside therapy and other support programs, especially during crisis situations. These medications are not FDA approved for conduct disorder specifically, but healthcare providers sometimes use them to target specific symptoms and behaviors or to treat an underlying mood disorder.

Some medications that may be prescribed include:

• Risperdal (risperidone) for reducing aggressive behaviors
• Lithium for reducing aggressive behaviors
• Strattera (atomoxetine) for reducing oppositional behaviors in children with ADHD
• Intuniv ER (guanfacine) for reducing oppositional behaviors in children with ADHD

Summary

Conduct disorder is a mental illness that is diagnosed in children and adolescents. The key features of conduct disorder include aggression toward people and animals, destruction of property, a disregard for rules and authority, difficulty with school and peers, and deception or theft. Each of these symptoms alone are not necessarily indicative of conduct disorder, but concerning behavior that continues over time should be taken seriously.

A mental health professional can provide a diagnosis and recommend an effective treatment plan based on the behaviors that are most concerning.

A Word From Verywell

Children often behave in ways that challenge rules and test boundaries. A single concern or one-time incident doesn't necessarily mean there is cause for greater concern. But, if a child or adolescent becomes violent toward others or animals, consistently demonstrates concerning behaviors like stealing or damaging property, or has increasing difficulty with friends and academics, it's important to talk to a healthcare provider to receive an assessment.

It can be scary to think about a child potentially having a mental illness, but early interventions can have a big impact on a child's ability to make behavioral changes and ultimately find success through treatment.