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Conduct disorder
Definition
Conduct disorder is a disorder of childhood and adolescence that involves long-term (chronic) behavior problems, such as:
- Defiant or impulsive behavior
- Drug use
- Criminal activity
Causes
Conduct disorder has been associated with:
- Child abuse
- Drug addiction or alcoholism in the parents
- Family conflicts
- Genetic defects
- Poverty
The diagnosis is more common among boys.
It is hard to know how common the disorder is, because many of the qualities needed to make the diagnosis (such as "defiance" and "rule breaking") can be hard to define. For an accurate diagnosis, the behavior must be far more extreme than simple adolescent rebellion or boyish enthusiasm.
Conduct disorder is often associated with attention-deficit disorder. Both conditions carry a risk for alcohol or other drug addiction.
Conduct disorder also can be an early sign of depression or bipolar disorder.
Symptoms
Children with conduct disorder tend to be impulsive, hard to control, and not concerned about the feelings of other people.
Symptoms may include:
- Breaking rules without obvious reason
- Cruel or aggressive behavior toward people or animals (for example: bullying, fighting, using dangerous weapons, forcing sexual activity, and stealing)
- Failure to attend school (truancy -- beginning before age 13)
- Heavy drinking and/or heavy illicit drug use
- Intentionally setting fires
- Lying to get a favor or avoid things they have to do
- Running away
- Vandalizing or destroying property
These children often make no effort to hide their aggressive behaviors. They may have a hard time making real friends.
Exams and Tests
There is no real test for diagnosing conduct disorder. The diagnosis is made when a child or adolescent has a history of conduct disorder behaviors.
A physical examination and blood tests can help rule out medical conditions that are similar to conduct disorder. Rarely, a brain scan may also help rule out other disorders.
Treatment
For treatment to be successful, the child's family needs to be closely involved. 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 home. Treatment with medications or talk therapy may be used for depression and attention-deficit disorder, which commonly occur with conduct disorder.
Many "behavioral modification" schools, "wilderness programs," and "boot camps" are sold to parents as solutions for conduct disorder. These programs may use a form of "attack therapy" or "confrontation," which can actually be harmful. There is no research to support these 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 check it out thoroughly. Serious injuries and deaths have occurred with some programs. They are not regulated in many states.
Outlook (Prognosis)
Children who have severe or frequent symptoms tend to have the poorest outlook. Expectations are also worse for those who have other illnesses, such as mood and drug abuse disorders.
Possible 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 drug and legal problems.
Depression and bipolar disorder may develop in adolescence and early adulthood. Suicide and violence toward others are also possible complications of this disorder.
When to Contact a Medical Professional
See your health care provider if your child:
- Regularly gets in trouble
- Has mood swings
- Is bullying others or cruel to animals
- Is being victimized
- Seems to be overly aggressive
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.
References
Nurcombe B. Oppositional defiant disorder and conduct disorder. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF, eds. Current Diagnosis & Treatment Psychiatry. 2nd ed. New York, NY: McGraw Hill; 2008:chap 36.
Thomas CR. Evidence-based practice for conduct disorder symptoms. J Am Acad Child Adolesc Psychiatry. 2006;45:109-114.
Whittinger NS. Clinical precursors of adolescent conduct disorder in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:179-187.
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
