Conduct Disorder

Conduct Disorder is a mental health disorder that can affect children and teenagers. Kids who have Conduct Disorder often hurt people and do bad things. They are unkind and can be violent, and they do not care about other people’s feelings. This behavior is much worse than normal teasing or acting out.

Bullying, hurting animals, and lying for no reason are all signs of Conduct Disorder. In younger kids, it starts with pushing, hitting, and biting. In older kids, it can include more extreme violent behavior and/or crimes like stealing, destroying things, and setting fires.

All kids act out sometimes, so Conduct Disorder is only diagnosed when this extreme behavior shows up over a long time and is not linked to the child’s environment.

What are the symptoms of Conduct Disorder?

Conduct Disorder is diagnosed when a child shows a persistent, repetitive pattern of behavior where social norms or rules or the basic rights of others are violated. These behaviors cause significant problems in social, academic, or daily life. Specific symptoms of Conduct Disorder are:

Core Symptoms

Aggression toward people or animals:

– Often bullying, threatening, or intimidating others

– Often starting physical fights

– Having used a weapon that can cause serious harm to others

– Being physically cruel to others

– Being physically cruel to animals

– Having stolen during a confrontation (e.g., mugging, robbery, extortion)

– Having forced another into sexual activity

Destruction of property:

– Deliberately setting fires to cause damage

– Destroying others’ property on purpose

Deceitfulness or theft:

– Breaking into another’s home or car

– Often lying to get goods, favors, or to avoid obligations

– Stealing items without confronting the victim (e.g., shoplifting, breaking-and-entering, forgery)

Serious violations of rules:

– Often staying out at night despite parents’ rules, starting before age 13

– Has run away from home at least twice, once without returning for a long time

– Often skipping school, starting before age 13

How is Conduct Disorder Diagnosed?

Conduct Disorder is different from just bad behavior or acting out, which most kids do at some point. Kids and teens must show symptoms of Conduct Disorder for several months to be diagnosed. Before diagnosing someone, a child-adolescent psychiatrist will try to see if their extreme behavior could be a reaction to problems at home or elsewhere. To be diagnosed, the child’s enjoyment of causing pain must seem to come from something inside them.

A child-adolescent psychiatrist will diagnose a child with Conduct Disorder after determining whether the symptoms meet the diagnostic criteria and that the symptoms are having a significant impact on daily life. This may be done through interviews with caregivers, teachers, and the child, as well as using behavior and emotion rating forms to support the diagnosis.

Conduct Disorder facts

Worldwide frequency of the condition:

Estimates for Conduct Disorder range from 2% to 10%. For children and adolescents, the prevalence is around 2%.

Impact of the condition in Brazil:

Despite limited data, the estimated prevalence of conduct disorders in Brazil is 1.2% in children (5-9 years) and 2.9% in adolescents (10-19 years).

Gender ratio:

Data suggest that boys are more likely to be diagnosed with Conduct Disorder than girls, with a ratio between 1.5:1 and 2:1.

Peak age of onset:

There is no recent data specifically on the onset of Conduct Disorder. However, adolescents who did not show symptoms before age 10 and who received a diagnosis of “adolescent-onset” are more common than children who receive a diagnosis of “childhood-onset.”

Proportion of the condition that emerges before age 18:

Conduct Disorder is not diagnosed in adults. Therefore, almost 100% of people with Conduct Disorder will be diagnosed before they turn 18.

What are the associated factors for Conduct Disorder?

Several things put individuals at higher risk of developing Conduct Disorder:

– Genetic and familial factors: A tendency toward Conduct Disorder most likely results from a combination of multiple genes interacting with environmental factors. Having a close family member, like a parent or sibling, with Conduct Disorder puts an individual at higher risk. Also, having a biological parent who abuses alcohol or has depression, ADHD, bipolar disorder, or schizophrenia.

– Birth complications.

– Temperament.

– Emerging personality traits.

– Environmental factors: Maternal stress, smoking, or alcohol/substance abuse. Harsh or inconsistent discipline, parent-child conflict, as well as community violence, low socioeconomic status, or poverty, may also contribute. Experiencing abuse or neglect, including malnutrition, being bullied, or having friends who encourage negative behavior.

What other disorders co-occur with Conduct Disorder?

ADHD and ODD are commonly found with Conduct Disorder. It may also occur with learning disabilities, anxiety disorders, depressive disorders, bipolar disorders, and/or substance-abuse disorders.

How is Conduct Disorder treated?

Conduct Disorder is hard to treat, but treatment can work if the child’s family, friends, and teachers get involved. Treatment works better if it starts when the child is young.

In therapy for Conduct Disorder, the child learns healthier ways to interact with others. At the same time, their family and support system learn ways to communicate with them. Children or teens with Conduct Disorder usually stay in psychotherapy or behavioral therapy for a long time.

In younger children, therapy usually involves teaching parents how to encourage good behavior. In teens, therapy may also focus on the teen’s relationships with friends, other kids, and adults at school (i.e., teachers and principals).

There is no medication specifically for Conduct Disorder. But kids sometimes have other disorders too, like depression or ADHD. Treating those other disorders with medication can help therapy for Conduct Disorder work better.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Child Mind Institute. (2021, September 7). Quick guide to Conduct Disorder. _https://childmind.org/guide/quick-guide-to-conduct-disorder/_

– Miller, G. (2021, October 5). What Is Conduct Disorder? _https://childmind.org/article/what-is-conduct-disorder/_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6C91 Conduct-Dissocial Disorder. _https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f719572464_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Konrad, K., Kohls, G., Baumann, S., et al. (2022). Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. Journal of Child Psychology and Psychiatry, 63(2), 218–228. _https://doi.org/10.1111/jcpp.13428_

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington. Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– Kerekes, N., Lundström, S., Chang, Z., et al. (2014). Oppositional defiant- and conduct disorder-like problems: Neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study. PeerJ, 2, e359. _https://doi.org/10.7717/peerj.359_

– Mohammadi, M.-R., Salmanian, M., & Keshavarzi, Z. (2021). The Global Prevalence of Conduct Disorder: A Systematic Review and Meta-Analysis. Iranian Journal of Psychiatry. _https://doi.org/10.18502/ijps.v16i2.5822_

– Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. _https://doi.org/10.1111/jcpp.12381_

– Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. _https://doi.org/10.1007/s00787-022-02131-2_

– Wu, J., Chen, L., Li, X., et al. (2022). Trends in the prevalence of conduct disorder from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. Psychiatry Research, 317, 114907. _https://doi.org/10.1016/j.psychres.2022.114907_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Azeredo, A., Moreira, D., & Barbosa, F. (2018). ADHD, CD, and ODD: Systematic review of genetic and environmental risk factors. Research in Developmental Disabilities, 82, 10–19. _https://doi.org/10.1016/j.ridd.2017.12.010_

– Karwatowska, L., Russell, S., Solmi, F., et al. (2020). Risk factors for disruptive behaviours: Protocol for a systematic review and meta-analysis of quasi-experimental evidence. BMJ Open, 10(9), e038258. _https://doi.org/10.1136/bmjopen-2020-038258_

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. _https://doi.org/10.1038/mp.2013.50_

– Maniglio, R. (2015). Significance, Nature, and Direction of the Association Between Child Sexual Abuse and Conduct Disorder: A Systematic Review. Trauma, Violence, & Abuse, 16(3), 241–257. _https://doi.org/10.1177/1524838014526068_

– Maniglio, R. (2014). Prevalence of Sexual Abuse Among Children with Conduct Disorder: A Systematic Review. Clinical Child and Family Psychology Review, 17(3), 268–282. _https://doi.org/10.1007/s10567-013-0161-z_

– Yockey, R. A., King, K. A., & Vidourek, R. A. (2021). Family factors and parental correlates to adolescent conduct disorder. Journal of Family Studies, 27(3), 356–365. _https://doi.org/10.1080/13229400.2019.1604402_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Bevilacqua, L., Hale, D., Barker, E. D., & Viner, R. (2018). Conduct problems trajectories and psychosocial outcomes: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 27(10), 1239–1260. _https://doi.org/10.1007/s00787-017-1053-4_

– Zavaglia, E., & Bergeron, L. (2017). Systematic review of comorbidity between DSM disorders and depression according to age and sex in youth. Canadian Psychology / Psychologie Canadienne, 58(2), 124–139. _https://doi.org/10.1037/cap0000085_

Interventions

– Bakker, M. J., Greven, C. U., Buitelaar, J. K., & Glennon, J. C. (2017). Practitioner Review: Psychological treatments for children and adolescents with conduct disorder problems – a systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 58(1), 4–18. _https://doi.org/10.1111/jcpp.12590_

– Battagliese, G., Caccetta, M., Luppino, O. I., Baglioni, C., Cardi, V., Mancini, F., & Buonanno, C. (2015). Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness. Behaviour Research and Therapy, 75, 60–71. _https://doi.org/10.1016/j.brat.2015.10.008_

– Boldrini, T., Ghiandoni, V., Mancinelli, E., Salcuni, S., & Solmi, M. (2023). Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 62(2), 169–189. _https://doi.org/10.1016/j.jaac.2022.05.002_

– Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., Freitag, C. M., & De Brito, S. A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 43. _https://doi.org/10.1038/s41572-019-0095-y_

– Karukivi, J., Herrala, O., Säteri, E., Tornivuori, A., Salanterä, S., Aromaa, M., Kronström, K., & Karukivi, M. (2021). The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12–18—A Systematic Review. Frontiers in Psychiatry, 12, 779933. _https://doi.org/10.3389/fpsyt.2021.779933_

– Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A systematic review and meta-analysis. Part 1: Psychostimulants, alpha-2 agonists, and atomoxetine. The Canadian Journal of Psychiatry, 60(2), 42–51. _https://doi.org/10.1177/070674371506000202_

– Riise, E. N., Wergeland, G. J. H., 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_