Conduct disorder

Definition 

Conduct disorder, which is a disorder of childhood and adolescence, involves longstanding behavior problems, such as defiant, impulsive, or antisocial behavior; drug use; or criminal activity.

Causes, incidence, and risk factors 

Conduct disorder has been associated with family conflicts, child abuse, poverty, genetic defects, and parental drug addiction or alcoholism. The diagnosis is more common among boys and is estimated to be as high as 10%.

However, because many of the qualities necessary to make the diagnosis (such as “defiance” and “rule breaking”) can be subjective, it is hard to know how common the disorder really is. For accurate diagnosis, the behavior must be far more extreme than simple adolescent rebellion or boyish exuberance.

Conduct disorder is often associated with attention-deficit disorder, and the two together carry a major risk for alcohol and/or other drug dependence.

Children with conduct disorder tend to be impulsive, difficult to control, and unconcerned about the feelings of others. They often lie and break rules without apparent reasons and engage in antisocial behavior like bullying and fighting.

Symptoms 

     
  • Cruel or aggressive behavior towards people and animals  
  • Destruction of property, including fire setting  
  • Lying, truancy, running away  
  • Vandalism, theft  
  • Heavy drinking and/or heavy illicit drug use

Signs and tests 

Some of the common signs of conduct disorder are bullying, fighting and staying out at night without concern for curfew or other limits. These children often make no effort to hide their aggressive behaviors and have difficulty making close friends. The diagnosis is made on the basis of a history of these kinds of behaviors.

Treatment 

Successful treatment requires close involvement of the child’s family. Parents can learn techniques to help manage their child’s problem behavior. In cases of abuse, the child may need to be removed from the family and placed in a less chaotic environment. Treatment, such as medications or talk therapy, may be used for depression and attention-deficit disorder, which commonly accompany conduct disorder.

Many “behavioral modification” schools, “wilderness programs”, and “boot camps” are sold to parents as solutions for conduct disorder. These may use a form of “attack therapy” or “confrontation” that can actually be harmful. There is no research support for such techniques. Research suggests that treating children at home, along with their families, is more effective.

If you are considering an inpatient program, be sure to thoroughly check it out. There have been serious injuries and deaths associated with some of them, and in many states they are not regulated.

Expectations (prognosis) 

Those children who have severe or frequent symptoms tend to have the poorest prognosis. Expectations are also worse for individuals who have other illnesses, such as mood and drug abuse disorders.

Complications 

Children with conduct disorder may go on to develop personality disorders as adults, particularly antisocial personality disorder. As their behaviors worsen, these individuals may also develop significant drug and legal problems.

Calling your health care provider 

See your health care provider if your child seems to be overly aggressive, is bullying others, is being victimized, or continually gets in trouble. Early treatment may help.

Prevention 

The sooner the treatment for conduct disorder is started, the more likely the child will learn adaptive behaviors and prevent some of the potential complications.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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