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Conduct Disorder

By Josephine Elia, MD, Professor of Psychiatry and Human Behavior, Professor of Pediatrics;Attending Physician, Sidney Kimmel Medical College of Thomas Jefferson University;Nemours/A.I. duPont Hospital for Children

A conduct disorder involves a repetitive pattern of behavior that violates the basic rights of others.

  • Children with a conduct disorder are selfish and insensitive to the feelings of others and may bully, damage property, lie, or steal without guilt.

  • Doctors base the diagnosis on the history of the child’s behavior.

  • Psychotherapy may help, but separating children from a troubled environment and providing a strictly structured setting, as in a mental health facility, may be the most effective treatment.

How well children behave varies. Some children are better behaved than others. Conduct disorder is diagnosed only when children repeatedly and persistently violate rules and the rights of others in ways inappropriate for their age.

Conduct disorder usually begins during late childhood or early adolescence and is much more common among boys than girls.

Heredity and the environment probably influence the development of a conduct disorder. Children often have parents who have a mental health disorder, such as substance abuse, attention-deficit/hyperactivity disorder, a mood disorder, schizophrenia, or antisocial personality disorder. However, affected children may come from healthy families that function well.

Symptoms

In general, children with a conduct disorder have the following characteristics:

  • They are selfish.

  • They do not relate well to others.

  • They lack an appropriate sense of guilt.

  • They are insensitive to the feelings and well-being of others.

  • They tend to misperceive the behavior of others as threatening and react aggressively.

  • They may engage in bullying, threatening, and frequent fights.

  • They may be cruel to animals.

  • They may damage property, especially by setting fires.

  • They may lie or steal.

Conduct disorder affects boys and girls differently. Girls are less likely to be physically aggressive. Instead, girls typically run away, lie, abuse substances, and sometimes engage in prostitution. Boys tend to fight, steal, and vandalize.

Seriously violating rules is common and includes running away from home and frequently being truant from school. Children are likely to use and abuse illicit drugs and have difficulties in school. Suicidal thoughts may occur and must be taken seriously.

Children with conduct disorders may have other disorders, such as depression, attention-deficit/hyperactivity disorder, or a learning disorder.

About two thirds of the children stop the inappropriate behaviors by adulthood. The younger a child is when conduct disorder begins, the more likely the behavior is to continue. If the behavior continues into adulthood, people often encounter legal trouble, chronically violate the rights of others, and are often diagnosed with antisocial personality disorder. Some of these adults develop mood, anxiety, or other mental health disorders.

Diagnosis

  • Description of behavior

Doctors base the diagnosis of conduct disorder on the child’s behavior. The symptoms or behavior must be troubling enough to impair functioning in relationships, at school, or at work.

The social environment is also considered. If misconduct develops as an adaptation to a very stressful environment (such as a war-torn area or area of civil unrest), it is not considered a conduct disorder.

Doctors also try to identify any other mental health or learning disorder children may have.

Treatment

  • Often, moving children from their troubled environment to a strictly structured setting

  • Psychotherapy

Treatment of conduct disorder is very difficult because children and adolescents with conduct disorder rarely perceive anything wrong with their behavior. Thus, scolding them and urging them to behave better do not help and should be avoided. Often, the most successful treatment for seriously disturbed children or adolescents is to separate them from the troubled environment and to provide a strictly structured setting, such as a mental health or a juvenile justice facility.

Psychotherapy may improve the child's self-esteem and self-control, thus enabling them to control their behavior better.

Other disorders, if present, are treated. Certain drugs may be somewhat effective, especially if children also have certain other disorders, such as attention-deficit/hyperactivity disorder or depression. Treatment of such disorders can help lessen the symptoms of conduct disorder. For learning disorders, the most useful treatment is education that is carefully tailored to the individual child.