Conduct Disorder in Children

Know the Critical Signs – and How to Get the Right Help

All children – on occasion - misbehave. It’s a natural part of growing up. Finding out where the behavior boundaries are. And which ones really matter.

But some children never really find those boundaries. Or repeatedly ignore them. Misbehaving becomes chronic. Testing the boundaries turns into outright defiance of them.

When misbehavior consistently involves violence, hostility and even cruelty, it reaches the level of antisocial behavior. Then it becomes more than a developmental issue. A child whose behavior consistently shows no regard for the rights of others or the rules of society may be diagnosed with a mental illness. It’s called conduct disorder.

What is conduct disorder?

Conduct disorder refers to a group of behavioral and emotional problems characterized by a disregard for others. Children with conduct disorder have a difficult time following rules and behaving in a socially acceptable way. Their behavior can be hostile and sometimes physically violent.

As infants, they may show early signs of violence and cruelty, pushing, hitting and even biting others. Adolescents and teens with conduct disorder may move into more serious behaviors, including bullying, hurting animals, picking fights, theft, vandalism, and arson.

Children with conduct disorder can be found across all races, cultures, and socioeconomic groups. They often have other psychiatric problems as well that may contribute to the development of the conduct disorder. The disorder is more prevalent in boys than girls.

What symptoms should parents look for?

There are four basic types of behavior that characterize conduct disorder:

•               Irresponsibility.

•               Delinquent behaviors (such as truancy or running away from home).

•               Violating others’ rights (such as theft or vandalism).

•               Physical aggression (such as cruelty toward animals, assault or rape).

Conduct disorder is characterized by aggression toward others and a callous disregard for their rights and needs. Adolescents and teens with conduct disorder find acts of aggression, deceit and coercion to be gratifying. You should suspect conduct disorder if you find them engaging in:

•               Picking fights.

•               Trespassing.

•               Lying.

•               Cheating.

•               Stealing.

•               Vandalism.

•               Emotionally or physically abusive behaviors (such as wielding a deadly weapon or forcing sex).

Many young people with conduct disorder will have trouble

•               Feeling and expressing empathy or remorse.

•               Reading social cues.

They often misinterpret the actions of others as being hostile or aggressive. They respond by escalating the situation into verbal or physical conflict.

In adolescents and teens, conduct disorder may be associated with other difficulties, including:

•               Substance use.

•               Risk-taking behavior.

•               School problems.

•               Physical injury from accidents or fights.

In younger children, it can be more of a challenge to distinguish signs of conduct disorder from more normal “acting out.” You should suspect conduct disorder in young children if you find them engaging in:

•               Bullying.

•               Lying for its own sake.

•               Stealing items of no apparent worth.

At times, these same symptoms can be seen in children without the disorder. The difference is frequency. In children with conduct disorder, these behaviors happen much more often.

What causes conduct disorder in children?

Many factors seem to contribute to this disorder. Research has found that children and teens with conduct disorder seem to have an impairment in the frontal lobe of the brain. This interferes with their ability to plan, avoid harm, and learn from negative experiences.

In addition, these factors seem to put children and teens are at a higher risk to develop conduct disorder:

•               Having experienced abuse, parental rejection or neglect.

•               Living in a city as a opposed to a rural area.

•               Having other psychiatric disorders.

•               Biological parents with ADHD, alcohol use disorder, depression, bipolar disorder, or schizophrenia.

•               Poor nutrition.

•               Living in poverty.

•               Maternal psychopathology.

•               Poor parenting / lack of parental involvement.

•               Lack of appropriate methods of discipline.

•               Exposure to violence.

•               Peer delinquency.

•               Having been subjected to physical, sexual, and/or emotional abuse.

How is conduct disorder diagnosed and treated?

A child psychiatrist or other qualified mental health professional usually diagnoses conduct disorders in children and teens by completing:

•               A detailed history of the child's behavior.

•               Observations of the child's behavior.

•               Psychological testing.

Interviews with family and teachers are a vital part of the diagnostic process.

Treatment can be complex and challenging. And it is rarely brief. Children with conduct disorder tend to be uncooperative. They often fear and distrust adults. And adding to the complication is the fact that conduct disorder is often (but not always) diagnosed along with a number of other psychological conditions.

Treatment for conduct disorder may include:

•               Cognitive-behavioral approaches.

•               Family therapy.

•               Peer group therapy.

•               Medication.

Conduct disorder can be difficult to overcome. But it is manageable.  The earlier the condition is diagnosed, the more successful therapy will be.

If any of the symptoms described above fit your child’s situation, the time to act is now.

Ultimately, you will need to speak with a specialist. Your family physician or pediatrician can help guide you to that person.