Conduct Disorder: Symptoms, Causes, and Treatment

Conduct Disorder (CD) is a mental condition diagnosed primarily in children and adolescents marked by a pattern of behavior that violates the rights of others or major age-appropriate societal norms and rules. The disorder is characterized by aggressive behavior, deceitfulness, theft, and serious rules violations.

Symptoms of CD include bullying, stealing, starting fights, using weapons, lying, and truancy.

Conduct disorder is diagnosed using DSM-5 criteria. If the individual has exhibited three of the behaviors outlined in the manual in the last 12 months, they are deemed to have conduct disorder.

Conduct disorder has no single cause; rather, it is the result of a combination of factors such as genetic (family history of mental disorders), biological (abnormalities in the brain), and environmental (dysfunctional families).

Treatment for conduct disorder requires a combination of approaches, including psychotherapy (cognitive behavioral therapy, family therapy, parental management training), and pharmacotherapy (antidepressants, anticonvulsants).

What Is Conduct Disorder?

Conduct Disorder (CD) is a serious behavioral and emotional disorder diagnosed in children and adolescents characterized by a repetitive and persistent pattern of behavior that violates societal norms and the rights of others. Children and adolescents with CD exhibit aggressive, deceitful, or destructive behaviors. They also lack empathy and disregard rules and social norms. The American Psychiatric Association’s DSM-5 outlines specific criteria for diagnosing conduct disorder, which includes various behavioral patterns observed over at least 12 months.

What Are The Symptoms Of Conduct Disorder?

Symptoms of CD include bullying, stealing, starting fights, using weapons, lying, and truancy.

According to the 2019 article “Conduct Disorder” from the American Academy of Child and Adolescent Psychiatry Conduct Disorder Resource Center (AACAP), “Children and adolescents with conduct disorder exhibit behaviors like bullying, threatening, initiating physical fights, using weapons, and being physically cruel to people and animals”. Additionally, these individuals engage in activities such as lying, stealing, truancy, and running away from home.

Children and adolescents with conduct disorder often display a range of symptoms that are categorized into four main types:

  1. Aggression to People and Animals: This includes bullying, threatening or intimidating others, initiating physical fights, using weapons to cause serious harm, physical cruelty to people and animals, stealing while confronting a victim, and forcing someone into sexual activity.
  2. Destruction of Property: This involves deliberate fire-setting to cause damage and other intentional destruction of property.
  3. Deceitfulness or Theft: This includes breaking into someone’s house, building, or car, lying to obtain goods or favors, avoiding obligations (i.e., “conning” others), and stealing items of nontrivial value without confronting the victim.
  4. Serious Violations of Rules: This involves staying out at night despite parental prohibitions, running away from home overnight at least twice, and being truant from school starting before age 13​.

What Are The Causes Of Conduct Disorder?

Conduct disorder has no single cause; rather, it is the result of a combination of factors such as genetic (family history of mental disorders), biological (abnormalities in the brain), and environmental (dysfunctional families).

According to a 2023 study by Mohan L et al., “Conduct Disorder,” causes of CD include heritability, brain chemical imbalances, dysfunctional families, and developmental delays.

  1. Genetic Factors: A family history of mental health disorders such as personality disorders, mood disorders, and anxiety disorders increases the risk of developing CD.
  2. Biological Factors: Abnormalities in the brain regions that regulate behavior and impulse control and deficits in cognitive processing and social cognition contribute to the development of CD.
  3. Environmental Factors: Factors such as child abuse, family conflicts, exposure to violence, and peer rejection play a significant role in the onset of CD. Socioeconomic disadvantages, lack of supervision, inconsistent discipline, and parental substance abuse also contribute to the disorder.

How Is Conduct Disorder Diagnosed?

Conduct disorder is diagnosed using DSM-5 criteria for Conduct Disorder. If the individual has exhibited three of the behaviors outlined in the manual in the last 12 months, they are deemed to have the condition.

The diagnosis of Conduct Disorder is primarily based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association. According to the DSM-5, the essential feature of Conduct Disorder is a repetitive and persistent pattern of behavior where the basic rights of others or major societal norms or rules are violated. These behaviors are categorized into four main groups:

  1. Aggression to People and Animals: This includes bullying, threatening or intimidating others, physical fights, use of a weapon that causes serious harm, cruelty to people or animals, stealing while confronting a victim, and forcing someone into sexual activity.
  2. Destruction of Property: Engaging in deliberate fire-setting to cause serious damage or deliberately destroying others’ property.
  3. Deceitfulness or Theft: This involves breaking into someone else’s house, building, or car, lying to obtain goods or favors or to avoid obligations, and stealing items of nontrivial value without confronting a victim.
  4. Serious Violations of Rules: This includes staying out at night despite parental prohibitions (beginning before age 13), running away from home overnight at least twice while living in the parental or parental surrogate home, and being truant from school, beginning before age 13.

For a diagnosis, at least three of these behaviors must have been present in the past 12 months, with at least one behavior occurring in the past six months. Additionally, the behavior must cause significant impairment in social, academic, or occupational functioning.

How Is Conduct Disorder Treated?

Treatment for conduct disorder requires a combination of approaches, including psychotherapy (cognitive behavioral therapy, family therapy, parental management training), and pharmacotherapy (antidepressants, anticonvulsants).

According to a 2006 article “Diagnosis and Treatment of Conduct Disorder” from the American Medical Association (AMA), conduct disorder is treated using a combination of psychotherapy and pharmacotherapy.

Psychotherapy

According to the 2018 article “ Conduct Disorder” from the American Academy of Child & Adolescent Psychiatry (AACAP), psychotherapy is essential when treating CD as it helps the child identify better ways of expressing and controlling their anger. 

  1. Cognitive-behavioral Therapy (CBT): Psychotherapy, particularly cognitive-behavioral therapy (CBT), is often the cornerstone of treatment for CD. CBT helps individuals recognize and change problematic behaviors and thought patterns. CBT assists in managing anger, improving problem-solving skills, and developing better-coping mechanisms. Other forms of therapy, such as Dialectical Behavior Therapy (DBT) and Multisystemic Therapy (MST), are also beneficial. MST, in particular, involves intensive family and community-based treatment, focusing on the child’s environment and support systems to reduce problematic behaviors.
  2. Family Therapy: Family therapy aims to improve communication and relationships within the family unit. It addresses dysfunctional family dynamics that contribute to the child’s conduct issues. The National Institute of Mental Health (NIMH) notes that involving family members in treatment helps address broader systemic issues and provides a support network for the child.
  3. Parent Management Training (PMT): PMT involves training parents in effective discipline strategies, communication skills, and ways to reinforce positive behaviors. The Centers for Disease Control and Prevention (CDC) highlights that PMT can significantly reduce behavioral problems by enhancing parenting skills and providing consistent and constructive responses to the child’s behavior.

Pharmacotherapy

While there is no specific medication approved for treating conduct disorder, medications are prescribed to address comorbid conditions such as ADHD, depression, or anxiety. The 2006 article from AMA indicates that medications like stimulants, antidepressants (selective serotonin reuptake inhibitors, or SSRIs such as fluoxetine), or antipsychotics such as risperidone are used in conjunction with other treatments to manage symptoms such as aggression, depression, and impulsivity more effectively.

Are There Any Effective Community Programs For Conduct Disorder?

Community programs that focus on youth development, mentorship, and social skills training can be effective in managing conduct disorder. These programs provide positive role models, opportunities for skill-building, and a supportive environment that helps reduce the risk of antisocial behavior and improve overall functioning. According to a 2015 study by Gonzalez ML, “Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards,” psychosocial interventions, such as community-based treatment, are ideal for managing conduct disorder.

What Role Do Schools Play In Managing Conduct Disorder?

Schools play a crucial role in managing conduct disorder by providing supportive and structured environments, implementing behavior management programs, offering social skills training, and coordinating with mental health professionals to ensure a comprehensive approach to treatment. Teachers and school counselors using the techniques recommended by the 2015 study by Gonzale, work together to create individualized plans that address the specific needs of students with conduct disorder.

How Can Parents Support A Child Diagnosed With Conduct Disorder?

According to the 2018 AACAP article, parents should support their children by participating in parent management training to learn effective behavior management strategies, providing consistent and structured discipline, reinforcing positive behaviors, and seeking professional help for both the child and the family. Family therapy also improves communication and reduces conflicts within the family.

Can Conduct Disorder Be Outgrown, Or Does It Persist Into Adulthood?

The DSM-5 indicates that most children outgrow conduct disorder. However, others continue to exhibit symptoms into adulthood. Without proper treatment, individuals with conduct disorder are at an increased risk of developing antisocial personality disorder and other mental health issues. Early intervention and comprehensive treatment improve the chances of better outcomes.

What Is The Primary Difference Between Conduct Disorder And Oppositional Defiant Disorder (ODD)?

Conduct disorder is more severe than oppositional defiant disorder (ODD). According to DSM-5, ODD involves a pattern of angry or irritable mood, argumentative or defiant behavior, and vindictiveness. On the other hand, conduct disorder includes more aggressive and destructive behaviors that violate the rights of others and societal norms. Children with CD exhibit behaviors such as physical aggression, cruelty to animals, and serious violations of rules, which are not typical of ODD.

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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