Conduct Disorder

Oppositional Defiant Disorder	Conduct Disorder
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Children with conduct disorder repeatedly violate the basic rights of others. They are often aggressive and may be physically cruel to people or animals, deliberately destroy other people's property, lie and cheat, skip school, or run away from home. Many steal from, threaten, or harm their victims, committing such crimes as shoplifting, forgery, breaking into buildings or cars, mugging, and armed robbery. As they get older, their acts of physical violence may escalate to rape or even homicide.

Conduct disorder usually begins between 7 and 15 years of age. Between 1 and 10 percent of children display this pattern, boys more than girls. Children with a mild conduct disorder may improve over time, but severe cases frequently continue into adulthood and may develop into antisocial personality disorder.

Many children with conduct disorder are suspended from school, placed in foster homes, or incarcerated. Substance abuse is very high in individuals with this diagnosis and in family members of children with this disorder.

Cases of conduct disorder have been linked to genetic and biological factors, drug abuse, poverty, and exposure to community violence. However, they have most often been tied to troubled parent-child relationships, family conflict, and family hostility. Children whose parents reject them, or fail to provide consistent discipline and supervision, are more likely to develop a conduct disorder.

Symptoms of Conduct Disorder:

Children with conduct disorder seem to lack the inability to correctly "read" other people, and often misunderstand the intentions of others. They tend to believe that others are threatening them or putting them down, and to react to these supposed threats or put-downs in an aggressive manner. They do not tolerate frustration well, and generally show little feeling or remorse. They also tend to behave in a reckless manner, without regard for the safety of themselves or others.

Boys with conduct disorder appear to be more inclined to fight, steal, and participate in acts of vandalism. They are often even more aggressive and violent than girls with this disorder. Girls with conduct disorder are more likely to lie, run away from home, and become involved in severe sexual acting-out behavior, including prostitution. Both genders are at an extremely high risk of developing substance abuse problems, and typically have severe difficulties getting along in school and at home.

Repeated violations of the law are common, and many individuals with conduct disorder spend a great amount of time in jail, in court ordered treatment centers, or in foster homes.

Diagnostic Criteria for Conduct Disorder:

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

Aggression to people and animals

(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else's house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Specify type based on age at onset:

Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years

Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others

Moderate: number of conduct problems and effect on others intermediate between "mild" and "severe"

Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

Treatment of Conduct Disorder:

Disruptive behavior patterns become more difficult to treat with age, and treatment for conduct disorder is generally most effective with children younger than 13 years. Given the importance of family factors in this disorder, therapists often use family interventions.

Looking for comorbid disorders in every child with conduct disorder is absolutely essential. Treatment of other disorders can make a very noticeable difference in the behavior and prognosis of those with conduct disorder.