Conduct Disorder is a severe condition characterized by emotionally and sometimes physically violent behavior and a disregard for others

  • The child with a Conduct Disorder does not respect authority, has little regard for the basic rights of others and breaks major societal rules
  • He or she demonstrates aggressive conduct that threatens physical harm or property damage, deceitfulness, theft, truancy or running away from home.
  • The child with a Conduct Disorder is often vengeful, irascible, and has a chip on his shoulder.
  • Children with Conduct Disorder exhibit cruelty, from early pushing, hitting and biting to, later, more than normal teasing and bullying, hurting animals, picking fights, theft, vandalism, and arson.

The cause of Conduct Disorder is believed to be a combination of genetic vulnerability and environmental factors. Treatment plans might include behavior therapy with the child and parents and pharmacotherapy.

Since childhood and adolescent conduct disorder results in a high risk of adult antisocial personality disorder, it should be addressed with treatment as early as possible; the earlier treatment starts, the better the possible outcome.

Causes

Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse, school failure, and traumatic life experiences.

  • Certain children have a genetic vulnerability to this disorder, the nature of which is unclear.
  • When vulnerability is combined with high-risk environmental factors, such as poverty, parental neglect, marital discord, parental illness, parental alcoholism, and having a parent with antisocial personality disorder, chances of CD increase.
  • Adolescents with CD have been found to have impairment in the frontal lobe of the brain, an area that affects the ability to plan, to avoid harm, and to learn from negative consequences.

A troubled, abusive, or unsupportive home or social environment can result in a child with a naturally but not distressingly difficult temperament spiraling towards conduct disorder, in an increasingly negative cycle of interactions with parents, authority figures, and peers.

Professional understanding of the underlying factors is complicated by the fact that many children with CD go undiagnosed because their symptoms are considered simply bad behavior rather than a psychiatric disorder.  Research based on treatment data suggests 6% of American children may have CD, though the actual prevalence is unknown.

Co-occurring Disorders

Many children with a conduct disorder may have coexisting conditions:

  • Depression
  • Anxiety
  • PTSD
  • Substance Abuse
  • ADHD
  • Learning problems
  • Thought disorders

Prognosis

The earlier the age of onset of Conduct Disorder, the poorer the prognosis

Early onset Conduct Disorder, is most common and occurs in childhood.

Late-onset CD occurs after early adolescence.

The prevalence of Conduct Disorder has increased over recent decades and is higher in urban than in rural settings.

It is estimated that six percent of all children have CD, with a male-female ratio of four to one.

Aggressive children comprise one-third to one-half of the referrals to child and adolescent clinics.

Conduct disorder is difficult to overcome, but it is not hopeless. In situations where an effective support network of parental figures, teachers, and peers can be assembled, the disorder is manageable.

SIgns and Symptoms

One of the hallmarks of conduct disorder is a seemingly callous disregard for societal norms and the rights, feelings, and personal space of other people.

Children and adolescents with CD seem to “get a rise” out of causing harm.

Aggression, deceit, coercion—behaviors that result in a power differential—are gratifying.

Picking fights, trespassing, lying, cheating, stealing, vandalism, and emotionally or physically abusive behavior, including wielding a deadly weapon or forcing sex, are all signs that an older child may have conduct disorder.

Signs of the disorder in younger children may be harder to discern from more normal acting out, but are similarly coercive: relentless bullying, lying for the sake of lying, stealing items of no apparent worth.

Since all kids and adolescents act out from time to time, a persistent pattern of this sort of behaviormust be in evidence before CD is considered. Professionals also attempt to determine if the behavior is a negative adaptation to a troubled environment, a “learned” behavior, or if the gratification that comes from aggression seems to originate from within.

Treatment

  • Early treatment and identification of children with early-onset CD is the key to improving prognosis.
  • Intelligence is another significant factor; a child with a high IQ is easier to work with in treatment.
  • Many children with CD have learning disabilities and lower than average verbal skills.

Various forms of treatment, including medication and family approaches, have been utilized with varying degrees of success. There is no one medication or treatment of choice. A treatment plan might include some or all of the following:

Behavior therapy attempts to set up contingencies that make desirable behavior more likely and attempts to eliminate undesirable behaviors. It provides a high level of structure which is generally needed by children with CD. Behavior therapy helps the child make crucial cause and effect connections that he or she has not been able to do previously, either through lack of experience or inherent lack of capability. Behavioral plans should be coordinated between school and home for maximum effectiveness.

Treatment is often conducted in the context of the family. Therefore the family may require assistance, ranging from education about basic parenting skills to management strategies for the disturbed child.

Treatment may also include medication in some youngsters, such as those with difficulty paying attention, impulse problems, or those with depression.

Multisystemic Therapy is the form of treatment that seems to work best for Conduct Disorder, but few communities have the resources and organization to establish a system of care to within which to provide these services.