Conduct disorder is a behaviour disorder which develops during childhood or adolescence. An individual with conduct disorder experiences behavioural and emotional difficulties. These may include engaging in antisocial behaviour, harming other people or animals, impulsivity, anger, stealing, skipping school, and behaving in other socially inappropriate ways.
The symptoms of conduct disorder fall into four main categories; aggressive conduct, deceitful behaviour, violation of rules, and destructive behaviour. To diagnose conduct disorder at least 3 common symptoms must be present for at least 6 months and these symptoms must significantly impair daily functioning. Conduct disorder can be classified as mild, moderate, or severe depending on the level of harm their behaviours cause others and the severity of behavioural problems. Some will be diagnosed with “conduct disorder with limited prosocial emotions” meaning they do not feel remorse or guilt following their behaviours.
There are three types of conduct disorder defined by the age at which symptoms first appear. ‘Childhood onset’ is diagnosed when symptoms appear before age 10, ‘adolescent onset’ is when symptoms appear over adolescence, and ‘unspecified onset’ means it is unknown when symptoms started. Conduct disorder is most commonly diagnosed in adolescence but the childhood onset form is associated with poorer outcomes.
Conduct disorder is thought to be caused by a mix of genetic and environmental factors. Risk factors include a family history of mental illness, having a difficult temperament, experiencing abuse or trauma, harsh or inconsistent parenting, coming from a disadvantaged or dysfunctional family, and having a parent with a mental illness.
Conduct disorder can impair a person’s ability to learn, form friendships and relationships, and do well academically and socially. Those with conduct disorder are at an increased risk of substance abuse, getting in trouble with the law, and developing other mental health conditions later in life such as antisocial personality disorder.
- Aggressive conduct - e.g. aggression toward people or animals, bullying, intimidating others, use of weapons, involvement in fights.
- Deceitful behaviour - e.g. stealing, lying, delinquency.
- Violation of rules - e.g. use of drugs/alcohol, running away, skipping school.
- Destructive behaviour - e.g. destruction of property, vandalism, arson.
- Impulsive behaviour.
- Does not consider the emotions/ feelings of others or the consequences of their behaviour.
- Does not follow rules.
- Difficult to control.
Treatment for conduct disorder usually involves a combination of individual talk therapy and behavioural therapy, family therapy, and parent training. Treatment aims to improve interpersonal skills and relationships, and help the individual learn how to control and manage their emotions. It is important to identify and treat any other co-occurring mental health conditions (e.g. ADHD, depression).
Psychological Therapy:
Cognitive behavioural therapy (CBT) is a form of structured talk therapy which can help those with conduct disorder learn how to control and manage their emotions. CBT can also help the individual learn how to deal with stress, improve their problem solving abilities, and improve their interpersonal and communication skills.
Behavioural Therapy - Social skills training:
Social skills training, such as in peer group therapy, can help the individual develop their interpersonal skills. This can help them to improve their relationships and interactions with others.
Parent Training and Family Therapy:
Parent training helps parents learn how to better manage and respond to their child’s behaviour, and how to effectively communicate with their child. Having consistent expectations and consequences, and using positive reinforcement for good behaviour has been shown to help those with conduct disorder.
Family therapy can help to improve relationships and communication, and improve the home environment which can have a positive effect on behaviour. This can also be a chance to address any other issues in the family.
Medication:
Medication is not used to treat conduct disorder directly but it may be prescribed to treat other co-occurring conditions (e.g. ADHD, depression).
This video created by ‘Demystifying Medicine’ takes a look at conduct disorder. It explains the DSM-5 definition, symptoms, potential causes, subtypes of the disorder, differences in brain structure and function, and treatment options.
In this TEDx video Kalina Michalska, a university professor of neuroscience and psychology, explains her research which uses neuroimaging and observational tools to study empathy in children. She focuses on children with conduct problems and wants to develop an understanding of emotional and social development, and how differences in development occur. Research has identified neurobiological factors associated with aggression and differences in the brains of children with conduct problems. We can use this understanding to develop treatments for aggressive behaviour.
This Osmosis video outlines the different disorders under the ‘Disruptive, impulse control, and conduct disorders’ chapter of DSM-5. It provides an overview of conduct disorder and other disorders in this category, such as oppositional defiant disorder and antisocial personality disorder, and how we can treat these conditions.