Conduct Disorder Resource Center

Conduct disorder describes serious behavioral and emotional problems in a child that demonstrate little or no concern for the rights or needs of others. The behavior is clearly outside of what is considered normal or acceptable and is consistently dangerous or troubling to others. Many teens with conduct disorder little regret, guilt or understanding of the damage and pain caused by their behavior. It is among the most frequently diagnosed childhood disorders in outpatient and inpatient mental health facilities. It is seen in 1-4% of the 9-17 year old population and is more common in boys. However, adolescent girls are increasingly being diagnosed with the disorder.

The earlier a child shows extremely disturbed behavior, the more difficult it can be to successfully treat. The teen with a conduct disorder has moved from being disobedient and disrespectful (behaviors seen in oppositional defiant disorder) to violating the rights of others through violence and illegal activity. The behaviors are are seen often and seen in many settings such as home, church or community activities and school.

Symptoms of conduct disorder are divided into four major categories:

• Aggression toward people and animals - bullying, threatening, intimidating, fighting, animal cruelty, threatening others with a weapon, confronting someone to steal from them
• Deliberate destruction of property – causing costly or serious damage to others’ property, setting fires
• Lying and theft
• Serious rule violations like running away from home, skipping many days of school and breaking curfew before the age of thirteen.

Very different underlying problems can lead to conduct disorder behaviors. Genes, environment and individual personality traits can put a child at risk for conduct disorder behaviors. Brain development delays, memory problems, language difficulties and other learning disabilities can increase the risk. These differences, especially when missed can lead to problems with judgment, difficulty expressing feelings, frustration, low self-esteem and severe loneliness, increasing the chance of conduct disorder.

Physical, sexual and emotional abuse can also contribute to the developing conduct disorder. Difficult or distant relationships with caregivers is also a risk factor. Conduct disorder is often associated with attention-deficit hyperactivity disorder (ADHD), depression, bipolar disorder, anxiety, post-traumatic stress disorder (PTSD), and substance abuse, though having these disorders does not mean a child will necessarily develop conduct disorder. Suicidal behavior and self-injury can be common in teenagers who have conduct disorder.

Conduct disorders can be caused by many factors. Because of this, a combination of treatment methods is most effective. Recognizing the risk and early treatment is most helpful. The comprehensive evaluation for severe behavior problems includes interviews with the child, the family, and often interviews with the pediatrician and testing of the child’s learning. Sometimes learning problems are discovered that can lead to frustration and a mistaken belief that the child isn’t smart, leading to low self-esteem, frustration. contribute to academic issues, in turn putting put the adolescent at risk for skipping school and being disruptive.

Many treatment methods are available. Effective therapies include parent management training, individual therapy, family therapy and social skills training. Through such programs, a child can learn to identify problems, recognize causes and consequences, learn to talk about feelings, and consider other ways of handling difficult situations.

School based treatment programs, including residential therapy programs, can be helpful in trying to help a teen achieve academic success and improve their self-esteem.

Medications can be helpful to treat underlying and associated medical conditions such as ADHD, depression, bipolar disorder, and anxiety.

While not all children or teens with conduct disorder symptoms go on to become criminal adults, ongoing adequate medical, emotional, educational and social supports are needed for many years for teenagers with this disorder to go on to live meaningful, productive lives.