Conduct Disorder

Conduct Disorder affects children and adolescents. Patients have trouble following rules and usually don’t follow the rules of socially accepted behavior They may be labeled as ‘bad’ children or called delinquent, but in fact they suffer from a treatable disorder. These children are defiant, impulsive, and can exhibit extreme antisocial behavior including drug use and criminal acts. Conduct Disorder patients are often the ones who are labeled as bullies and trouble makers. They don’t listen to direction, and are likely to have trouble with peer relationships and with school in general. Oppositional Defiant Disorder is often the precursor to Conduct Disorder. A child with oppositional defiant disorder will show signs of hostile and defiant behavior for at least six months, starting as early as preschool. Whereas Conduct Disorder typically appears in older children, as a persistent pattern of repetitive behavior at home, at school, and in social gatherings, causing significant impairment in every area of family, school and social function. Research on Conduct Disorder shows that most patients do not have behavioral problems as adults. In fact, most do well socially and in their career and family life. Conduct disorder has genetic and environmental roots. The disorder is more common in children whose parents had conduct problems when they were young, but there are other factors that contribute to this disorder. Patients typically have problems processing social information or cues, which may make it more difficult for them to understand and display appropriate behavior. Other facts that contribute to the development of this disorder are rejection by peers, brain damage, child abuse, and traumatic childhood experiences. Conduct Disorder often co-exists with Attention Deficit-Hyperactive Disorder, and together these conditions carry significant risk for patients to develop alcohol or drug dependence.

What are the symptoms?

There are various primary and secondary symptoms associated with Conduct Disorder.

• Aggression, serious threats of harm to people or animals
• Repeatedly violating of family and school rules, breaking laws
• Lying to avoid consequences or to get favors, prizes or privileges
• Bullying, threatening or injuring others
• Precocious sexual activity or forcing others to have sex
• Secondary symptoms can include: depression, drug or alcohol abuse, suicidal thoughts or attempts, sexually transmitted diseases (STDs)
• Deliberate damage or destruction to property, setting fires, vandalism, theft
• Behavioral and academic problems in school, cutting school, running away
• Heavy drinking, tobacco or illicit drug use
• Persistent fighting, school expulsion
• Use of weapons to threaten others
• Breaks curfews, has difficulty staying in foster homes or adoptive homes, difficulty following rules dictated by parents and teachers
• Poor peer relationships

How is it diagnosed and treated?

Doctors usually perform a physical exam to rule out other health or mental disorders. They will look for a repetitive, persistent pattern whereby the patient violates the basic rights of others or consistently breaks rules, along with the presence of at least three of the following criteria over a twelve-month period, and at least one of the following over the past six months:

• Aggressive toward people and/or animals
• Initiates fighting and has used a weapon
• Deliberate destruction of other people’s property
• Has run away from home, is often truant from school (prior to age 13)
• Behavior causes impaired social, school and family function
• Bullying, threatening or intimidation of others
• Forced sexual activity
• Stolen items from others, either in person or by breaking and entering
• Breaks rules, curfews, etc.
• The patient is a child or adolescent (under 18). If over 18, the patient does not meet the criteria for Conduct Disorder

Successful treatment requires family involvement. In cases of child abuse, the child may need to be placed in a less threatening environment. Treatment(s) can include:

• Psychotherapy
• Problem Solving and Coping Skills for Parents and Patient to handle behavioral problems
• Family Therapy
• Behavioral Modification Programs (wilderness program, boot camps, etc) If you are considering these inpatient programs, do your homework! There have been serious injuries and fatalities associated with some of them, and not all states regulate these programs
• Cognitive Behavioral Therapy
• Special Education for learning disabled patients
• Medication as appropriate including lithium, anti-convulsants, stimulants, SSRIs

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