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Conduct Disorder

By

Josephine Elia

, MD, Nemours/A.I. duPont Hospital for Children

Reviewed/Revised May 2023
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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 an at-risk environment and providing a strictly structured setting, as in a mental health facility, may be the most effective treatment.

Normal behavior in children 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 a substance use disorder Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more , attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and impulsiveness inappropriate for the child’s age that interferes with functioning... read more , a mood disorder Overview of Mood Disorders Mood disorders are mental health conditions that involve long periods of excessive sadness (depression), excessive elation (mania), or both. Depression and mania represent the 2 emotional extremes... read more , schizophrenia Schizophrenia Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually, hearing voices), firmly held false beliefs (delusions), abnormal thinking... read more , or antisocial personality disorder Antisocial Personality Disorder Antisocial personality disorder is a mental health condition that is characterized by a pervasive pattern of disregard for consequences and for the rights of others. People with antisocial personality... read more . However, children from healthy families that function well may also develop conduct disorder.

Symptoms of Conduct Disorder

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.

Seriously violating rules is common and includes running away from home and frequently being truant from school. Children are likely to use illicit drugs and have difficulties in school. Suicidal thoughts Suicidal Behavior in Children and Adolescents Suicidal behavior is an action intended to harm oneself and includes suicidal gestures, suicide attempts, and completed suicide. Suicidal ideation is thoughts and plans about suicide. Suicide... read more may occur and must be taken seriously to protect a child's safety.

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 Antisocial Personality Disorder Antisocial personality disorder is a mental health condition that is characterized by a pervasive pattern of disregard for consequences and for the rights of others. People with antisocial personality... read more . Some of these adults develop mood, anxiety, or other mental health disorders.

Diagnosis of Conduct Disorder

  • A visit with a doctor or behavioral health specialist

  • Description of child's behavior (often by a parent or teacher)

    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 of Conduct Disorder

    • Often, moving children from an at-risk 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 at-risk environment and to provide a strictly structured setting, such as a mental health or a juvenile justice facility.

    NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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