A conduct disorder refers to any of a group of serious emotional and behavioral problems in children and adolescents. Children with conduct disorders frequently behave in extremely troubling, socially unacceptable, and often illegal ways, though they feel justified in their actions and show little to no empathy for their victims. Others may view these children as simply “bad kids,” without realizing they have a disorder. Conduct disorder may be diagnosed in adulthood, but symptoms most commonly appear around ages 8 to 16. Some children who have conduct disorder go on to develop a similar condition known as antisocial personality disorder in adults.
Symptoms of conduct disorder generally fall into four categories:
- Aggressive behavior toward people and animals. This includes bullying, threatening, physical violence, use of a weapon, physical cruelty to people or animals, and forcing someone to perform a sexual act.
- Property destruction, including setting fires and purposefully destroying property.
- Deceit or theft, including lying, shoplifting, and breaking into someone else’s property with the intent to steal.
- Serious violations of rules, including breaking family rules, running away from home, and frequently skipping school before the age of 13.
For a diagnosis of conduct disorder, at least three of these behaviors must have occurred within the past year, with at least one occurring within the past six months. The number of symptoms exhibited, and the degree of injury or damage done, determines whether it is a case of mild, moderate, or severe conduct disorder.
Gender can play a role in the symptoms and diagnosis of conduct disorder, according to the DSM-5. Boys with the condition are more likely to fight, steal, vandalize, and have disciplinary problems at school. Girls are more likely to lie, skip school, run away, and use substances. Boys show physical aggression and aggression in relationships, while girls show more relational than physical aggression.
While the cause is unclear, many possible factors can put a child at risk of developing conduct disorder. In addition to genetics, these include child abuse, impulsive behavior, low academic achievement, poor parental supervision, callous or unemotional parental attitude, antisocial parents or peers, trauma, poverty, and living in a high-crime neighborhood or attending a school with a high delinquency rate.
Conduct disorder occurs in around 4 percent of the population, although prevalence estimates range from 2 percent to 10 percent, according to the DSM-5. The condition becomes more prevalent in adolescence, and tends to affect boys more often than girls.
Conduct disorder often emerges between middle childhood and middle adolescence, around ages 8 to 16, according to the DSM-5. Although that is the most common trajectory, symptoms can also occasionally emerge in children as young as 3 and individuals older than 16.
With the right care, and a good support system in place, conduct disorder can be managed. The earlier the diagnosis, the more successful the treatment will be. Treatment is often long-term psychotherapy and behavior therapy to help the child learn healthier and more acceptable ways of thinking and behaving. In some cases, medication may be used to treat both the conduct disorder and any co-existing conditions that may be diagnosed. Additionally, shorter-term parent management training can help the family understand the problem, learn new ways of responding to the child, and rebuild the child-parent relationship.
A few different forms of therapy can help those with conduct disorder. Cognitive behavioral therapy helps children recognize and change their thought patterns, develop skills to solve problems, cope with difficult emotions like stress and anger, and exercise self-control. Family therapy helps improve relationships and communication between children and parents.
Harsh discipline often backfires when it comes to a pathologically defiant child. Programs that help kids develop coping skills and impulse control with compassion rather than punishment are more effective. One such treatment is a form of cognitive behavioral therapy called Collaborative and Proactive Solutions, which has proven to reduce challenging behaviors.