Children and Adolescents with Conduct Disorder What is conduct disorder? Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools. Another disruptive behavior disorder, called oppositional defiant disorder, may be a precursor of conduct disorder. A child is diagnosed with oppositional defiant disorder when he or she shows signs of being hostile and defiant for at least 6 months. Oppositional defiant disorder may start as early as the preschool years, while conduct disorder generally appears when children are older. Oppositional defiant disorder and conduct disorder are not co-occurring conditions. What are the signs of conduct disorder? Symptoms of conduct disorder include: Aggressive behavior that harms or threatens other people or animals; Destructive behavior that damages or destroys property; Lying or theft; Truancy or other serious violations of rules; Early tobacco, alcohol, and substance use and abuse; and Precocious sexual activity. Children with conduct disorder or oppositional defiant disorder also may experience: Higher rates of depression, suicidal thoughts, suicide attempts, and suicide; Academic difficulties; Poor relationships with peers or adults; Sexually transmitted diseases; Difficulty staying in adoptive, foster, or group homes; and Higher rates of injuries, school expulsions, and problems with the law. How common is conduct disorder? Conduct disorder affects 1 to 4 percent of 9- to 17-year-olds, depending on exactly how the disorder is defined (U.S. Department of Health and Human Services, 1999). The disorder appears to be more common in boys than in girls and more common in cities than in rural areas Who is at risk for conduct disorder? Research shows that some cases of conduct disorder begin in early childhood, often by the preschool years. In fact, some infants who are especially "fussy" appear to be at risk for developing conduct disorder. Other factors that may make a child more likely to develop conduct disorder include: Early maternal rejection; Separation from parents, without an adequate alternative caregiver; Early institutionalization; Family neglect; Abuse or violence; Parental mental illness; Parental marital discord; Large family size; Crowding; and Poverty. What help is available for families? Although conduct disorder is one of the most difficult behavior disorders to treat, young people often benefit from a range of services that include: Training for parents on how to handle child or adolescent behavior. Family therapy. Training in problem solving skills for children or adolescents. Community-based services that focus on the young person within the context of family and community influences. What can parents do? Some child and adolescent behaviors are hard to change after they have become ingrained. Therefore, the earlier the conduct disorder is identified and treated, the better the chance for success. Most children or adolescents with conduct disorder are probably reacting to events and situations in their lives. Some recent studies have focused on promising ways to prevent conduct disorder among at-risk children and adolescents. In addition, more research is needed to determine if biology is a factor in conduct disorder. Parents or other caregivers who notice signs of conduct disorder or oppositional defiant disorder in a child or adolescent should: Pay careful attention to the signs, try to understand the underlying reasons, and then try to improve the situation. If necessary, talk with a mental health or social services professional, such as a teacher, counselor, psychiatrist, or psychologist specializing in childhood and adolescent disorders. Get accurate information from libraries, hotlines, or other sources. Talk to other families in their communities. Find family network organizations. People who are not satisfied with the mental health services they receive should discuss their concerns with their provider, ask for more information, and/or seek help from other sources. This is one of many fact sheets in a series on children's mental health disorders. All the fact sheets listed below are written in an easy-to-read style. Families, caretakers, and media professionals may find them helpful when researching particular mental health disorders. To obtain free copies, call 1-800-789-2647 or visit http://mentalhealth.samhsa.gov/child. About Conduct Disorder Author: Robin F. Goodman, Ph.D. Source: NYU Child Study Center Introduction The child with a Conduct Disorder does not respect authority, has little regard for the basic rights of others and breaks major societal rules; he or she demonstrates aggressive conduct that threatens physical harm or property damage, deceitfulness, theft, truancy or running away from home. The child with a Conduct Disorder is often vengeful, irascible, and has a chip on his shoulder. The cause of Conduct Disorder is believed to be a combination of genetic vulnerability and environmental factors. Treatment plans might include behavior therapy with the child and parents and pharmacotherapy. Real Life Stories Brandon's teachers in the daycare center report that he is the "terrorist of the 4- year- olds." He punches or bites children and pushes them off the swings in the playground without provocation. He swings the class pet rabbit by the tail in spite of being told how it hurts the animal. His parents report that he has been difficult to manage since he was an infant. Eleven-year-old Paul, known as The Prankster in his family, was suspended from school after leaving half-eaten candy bars in all the girls' lockers. He had previously been suspended for leaving poison pills for the frogs in the biology class lab. Robin, l6: "When I was 13, that summer was a blast. One time we picked up some older guys in a bar and tried a new kind of speed. We got really wild and we smashed in some car windows and somebody called the police. My mother freaked out and tried to punish me by locking me in my room, but I would just skip out on her through the window." What are the symptoms? A child or adolescent who has a Conduct Disorder behaves in a manner that violates the basic rights of others and/or major age-appropriate societal rules. These behaviors fall into four main groupings: aggressive conduct that causes or threatens physical harm to other people or animals. Examples of such behaviors are bullying or intimidating behavior, physical fights or cruelty, use of a weapon, forcing someone into sexual activity conduct that causes property loss or damage, such as firesetting, vandalism deceitfulness or theft, such as breaking into stores or homes, shoplifting serious violations of rules, such as truancy or repeated running away overnight The behavioral disturbances can cause deficits in social, academic or occupational functioning. The behavior usually occurs in a variety of settings, such as home, school and community. Other manifestations of Conduct Disorder: Oppositional Defiant Disorder (ODD) - a recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward authority figures that persists for at least six months. To warrant a diagnosis of ODD, the child must show frequent occurrence of at least four behaviors such as losing temper, arguing with and defying adults, deliberately doing things that will annoy other people. Children and adolescents with ODD are usually angry and resentful and quick to blame others for their misbehaviors. Who is likely to have it? The age of onset of CD is critical. The earlier the age of onset the worse the prognosis. Early onset CD, which occurs before adolescence, is the most common. Late-onset CD occurs after early adolescence. The prevalence of CD has increased over recent decades and is higher in urban than in rural settings. It is estimated that six percent of all children have CD, with a male-female ratio of four to one. Aggressive children comprise one-third to one-half of the referrals to child and adolescent clinics. Why does it happen? Certain children have a genetic vulnerability to this disorder, the nature of which is unclear. When that vulnerability is combined with certain high-risk environmental factors, such as poverty, parental neglect, marital discord, parental illness, parental alcoholism, and having a parent with antisocial personality disorder, chances of CD increase. Adolescents with CD have been found to have impairment in the frontal lobe of the brain, an area that affects the ability to plan, to avoid harm, and to learn from negative consequences. How is it treated? Early treatment and identification of children with early-onset CD is vital. Intelligence is another significant factor; a child with a high IQ is easier to work with in treatment. Many children with CD have learning disabilities and lower than average verbal skills. Various forms of treatment, including medication and family approaches, have been utilized with varying degrees of success. There is no one medication or treatment of choice. A treatment plan might include some or all of the following: Behavior therapy attempts to set up contingencies that make desirable behavior more likely and attempts to eliminate undesirable behaviors. It provides a high level of structure which is generally needed by children with CD. Behavior therapy helps the child make crucial cause and effect connections that he or she has not been able to do previously, either through lack of experience or inherent lack of capability. Behavioral plans should be coordinated between school and home for maximum effectiveness. Treatment is often conducted in the context of the family. Therefore the family may require assistance, ranging from education about basic parenting skills to management strategies for the disturbed child. Questions & answers I have a hard time disciplining my child. Does that mean he will develop a conduct disorder? All children misbehave at some time. Only those children and adolescents who have more serious and consistent behavioral problems may develop a Conduct Disorder. If an 8-year-old defies her parents and refuses to do what they ask her to do does that mean she has a Conduct Disorder? CD is manifested in different ways at different ages. Preschoolers may be aggressive, oppositional, and defiant and have tantrums. School-aged children may challenge classroom and adult authority, lie and steal. Adolescents may violate the law and community authority; they fight, steal, vandalize, are accident-prone and commit crimes against persons and property. An eight-year-old who has tantrums is not displaying age- appropriate behavior, and consultation with a professional would help pinpoint ways to help her change her behavior. My adolescent son stays out late and doesn't tell us where he is. We don't like the friends he chooses, and his school work is beginning to suffer. Is that part of a Conduct Disorder? It might be. A Conduct Disorder can cause problems in the academic and social life of adolescents. It's important to remember that the behavior usually occurs in a variety of settings, such as home, school and in the community. My 10-year-old can be mean or bullying with his friends, and then he won't agree to say he's sorry. He usually says the argument was started by somebody else. I'm afraid that he's just like his father who never accepts responsibility for what he does. Are kids with Conduct Disorder like that? Children and adolescents with Conduct Disorder may have little empathy and little concern for the feelings and well-being of others. They may misperceive the intentions of others as more hostile and threatening than is the case and respond with aggression that they then feel is reasonable and justified. They may lack appropriate feelings of guilt or remorse. My 12-year old acts like a big shot after he's done something obnoxious, like hitting our dog. Does that mean he has good self-esteem? Although a child with CD may have an air of bravado, his self-esteem is usually low, and he has little tolerance for frustration; irritability, temper outbursts and recklessness are frequent. About the Author Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.