Conduct disorder is a personality disorder seen in children or adolescents where there are repeated bouts of disruptive behavior. These children or adolescents frequently break rules and ignore the basic rights of other people. They also cause physical harm to others or animals, steal, lie, and show other unacceptable behaviors.
More research needs to be done before experts fully understand the mechanisms at work in this disorder.
Conduct disorder most often begins in late childhood, but it may occur in children as young as 5 or 6. If it begins in the early teen years, it is known as adolescent conduct disorder.
Children with the disorder may exhibit any of these behaviors: abusing drugs or alcohol dependencephysical cruelty to animals or peoplecheating in games or at schooldeliberately destroying propertyforcing sexual activity on othershaving frequent physical fights, bullying, threatening, or intimidating othershaving difficulty interacting with others or behaving in social or school settingslyingmanipulating or taking advantage of othersrunning awayskipping schoolstealingviolating rules set by parents or other authority figures
The causes of conduct disorders are unknown. Theories include: chemical imbalance in the brainphysical causesgenetic or inherited traitschaotic home environments with little structure or predictabilitythe child's temperament or the family's response to it
The major risk of conduct disorder in childhood is that the child may develop one of the following conditions as an adult: antisocial personality disordermood or anxiety disorderssubstance abuse disorder
A nurturing and stable home environment is the best prevention. Children from homes with a balance of love and discipline are less likely to develop this disorder than are children from abusive, overly permissive, or neglectful homes. Prevention focuses on skill development not only for the child but also for others involved with the child. This includes the family and the school.
Most children have some problems related to conduct at some time. But a conduct disorder is diagnosed when those behaviors become: persistent and impinge on the basic rights of othersmajor violations of accepted normssignificant enough to impair everyday life
At least three of these behaviors must have been present during the past year. Typically, a complete psychological and social history will be obtained, either by a healthcare or a mental health care professional. Also, a complete physical exam should be done. This is to find out if any medical conditions are causing the child to act out.
If left untreated, conduct disorder can lead to: school failureschool suspensionlegal problemsinjuries due to fightingaccidentssexually transmitted diseaseteenage pregnancydrug addictionsuicidehomicide
Children with conduct disorder tend to have aggressive behavior. They can cause intentional or unintentional harm to others, to themselves, and to animals.
Treatment of conduct disorder may include group, individual, or family therapy or a combination. Psychotherapy is aimed at helping the child learn methods to deal with his or her emotions and impulses in ways that work better in social settings.
Counseling is essential to help the child with self-esteem, mood, anger control, and interpersonal problems. Providing support and sensitive acceptance of the child is important. This will include helping the child understand the various sources of the problems. Counseling will also focus on developing appropriate behavior and coping skills.
A predictable and nurturing home environment is important as well. A balance in diet, rest, play, and study should be maintained. Solid discipline, coupled with nurturing, consistent, and fair expectations is important for children with a conduct disorder.
Special education services with a plan customized for the child may be developed at school. This plan will help arrange for additional services for the child. Parents need to work closely with the school and educational services team.
Sometimes medications are used, but if so, they are generally aimed at other contributing conditions rather than at the conduct disorder per se.
There are no side effects of the behavioral treatments. Side effects may occur if medicines are used.
Mild forms of conduct disorder tend to improve as the child ages. Those who receive adequate social and work adjustments show progress. For others, the behaviors continue into adulthood and may develop into antisocial personality disorder. A plan should be in place with the child, family, and therapist for what steps to take if signs of relapse appear. An agreement should be made to call the therapist when those symptoms occur.
Conduct disorder is monitored by the family, the school, and the therapist. Any new or worsening symptoms should be reported to the healthcare professional.
Hales, Robert, Textbook of Psychiatry, 2nd edition:1994
The Merck Manual of Medical Information, Home edition, 1997
"Conduct Disorders", http://www.adhd.com.au/conduct.html.
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), American Psychiatric Association, 1994