What Are the Signs of Conduct Disorder in Children?

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Conduct disorder in children is characterized by patterns of violating societal norms and the rights of others. It is found in an estimated 1 to 4 percent of 9 to 17-year-olds, and more prevalent in boys than girls. It's actually a diagnosable mental health condition with available treatments. As a parent, recognizing the signs can help take appropriate action.

Conduct Disorder Impairs a Child’s Functioning

The challenging behaviors that are characteristic of conduct disorder impair children’s education.

Children with conduct disorder may be at a higher risk of failure or dropping out of school. They usually receive frequent disciplinary action from teachers and may be truant.

Children with conduct disorder also tend to have poor relationships. They struggle to develop and maintain friendships. Their relationships with family members usually suffer due to the severity of their behavior.

Adolescents with conduct disorder are also more likely to have legal problems. Substance abuse, violent behavior, and a disregard for the law may lead to incarceration.

They may also be at a higher risk of sexually transmitted infections. Studies show teens with conduct disorder are more likely to have multiple sexual partners and they are less likely to use protection.

Signs of Conduct Disorder

Conduct disorder extends beyond normal teenage rebellion. It involves serious behavior problems that are likely to raise alarm among teachers, parents, peers, and other adults.

In order to qualify for a diagnosis of conduct disorder, children must exhibit at least three symptoms in the past year and at least one symptom in the past six months:

Aggression Toward People and Animals

  • Often bullies, threatens, or intimidates others
  • Often initiates physical fights
  • Has used a weapon that could cause serious harm
  • Physical cruelty to people
  • Physical cruelty to animals
  • Stealing while confronting a victim
  • Forced sexual activity

Property Destruction

  • Deliberate fire setting
  • Other destruction of property

Deceptiveness or Theft

  • Breaking or entering a house, car or building
  • Lying for personal gain
  • Stealing without confronting the victim (such as shoplifting)

Serious Rule Violation

  • Staying out at night or being truant before the age of 13 years
  • Has run away from home overnight at least twice
  • Is often truant from school, beginning before the age of 13

Types of Conduct Disorder

The DSM-V, which is used to diagnose mental illnesses, distinguishes between conduct disorder with or without limited prosocial emotions. Individuals with limited prosocial emotions are characterized by a lack of remorse, are callous, and lack empathy.

They are unconcerned about their performance at school or work, and have shallow emotions. When present, their emotional expressions may be used to manipulate others.

Potential Causes of Conduct Disorder

Researchers aren’t exactly sure why some children develop conduct disorder.

There are likely a variety of biological, psychological and social factors involved. Quite often, those factors overlap.

Here are several factors that may play a role:

  • Brain abnormalities – Neuroimaging studies suggest children with conduct disorder may have some functional abnormalities in certain regions of the brain. The pre-frontal cortex—which affects judgment—and the limbic system—which affects emotional responses—may be impaired.
  • Genetics – Studies suggest anti-social behavior is about 50 percent inheritable. Researchers aren’t sure what genetic components contribute to conduct disorder.
  • Social issues – Poverty, disorganized neighborhoods, poor schools, family breakdown, parental psychopathology, harsh parenting, and inadequate supervision are all strongly correlates of conduct disorder.
  • Cognitive deficits – Low IQ, poor verbal skills, and impairment in executive functioning may make children more vulnerable to conduct disorder.

Oppositional Defiant Disorder Could Be a Precursor to Conduct Disorder

Some children with oppositional defiant disorder go on to develop conduct disorder. Oppositional defiant disorder is a behavior disorder that involves a pattern of angry or irritable mood, argumentativeness and defiance, and vindictiveness.

Without effective treatment, it’s thought that oppositional defiant disorder may progress into conduct disorder as a child ages.

Children with conduct disorder may be more likely to develop antisocial personality disorder later in life.

Common Comorbid Conditions

Many children with conduct disorder have other mental health issues or cognitive impairments. Here are the most common comorbid conditions:

  • ADHD
  • Self-harm
  • Substance misuse
  • Depression and anxiety
  • Posttraumatic stress disorder
  • Learning disability

How Conduct Disorder Is Diagnosed

Conduct disorder in children is often diagnosed by a mental health professional or a physician. Often, a diagnosis is made after attempts to remedy behavior problems at school and at home are ineffective.

A professional may interview the child, review records, and request parents and teacher complete questionnaires about the child’s behavior. Psychological testing and other assessment tools may be used to evaluate a child for conduct disorder.

Treatment for Children With Conduct Disorder

Treatment for conduct disorder depends on several factors, such as a child’s age and the severity of behavior problems.

  • Psychotherapy may be helpful when a child could benefit from learning new skills, such as anger management and impulse control.
  • Parent training is often used to address conduct disorder. Parents may be taught behavior management strategies and techniques to increase safety in the home if a child is aggressive or violent.
  • Family therapy may also be an option. Sometimes, improving the relationship between parents and a child may improve family interactions.
  • In cases where a child or adolescent's behavior has become out of control, a residential placement may be necessary. A therapeutic environment may address substance abuse issues, sexualized behavior, or violence.
  • There isn’t a medication that treats conduct disorder. But, sometimes a doctor may prescribe medication to treat some of the symptoms or to address other underlying mental illness.

Early intervention is the key to getting the most effective treatment, so it’s important for parents, educators, and physicians to be aware of the signs of conduct disorder in children so that appropriate referrals and interventions can be put into place.

Sources:

American Academy of Child & Adolescent Psychiatry. Child and Adolescent Mental Illness and Drug Abuse Statistics.

Baker K. Conduct disorders in children and adolescents. Paediatrics and Child Health. 2016;26(12):534-539.

Balia C, Carucci S, Coghill D, Zuddas A. The pharmacological treatment of aggression in children and adolescents with conduct disorder. Do callous–unemotional traits modulate the efficacy of medication? Neuroscience & Biobehavioral Reviews. January 2017.

Holliday SB, Ewing BA, Storholm ED, Parast L, D'amico EJ. Gender differences in the association between conduct disorder and risky sexual behavior. Journal of Adolescence. 2017;56:75-83.

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