Conduct disorder (CD)

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Conduct disorder (CD) is a behavior disorder, sometimes diagnosed in childhood, that is characterized by antisocial behaviors which violate the rights of others and age-appropriate social standards and rules. Antisocial behaviors may include irresponsibility, delinquent behaviors (such as truancy or running away), violating the rights of others (such as theft) and physical aggression toward others (such as assault or rape). These behaviors sometimes occur together, however, one or several may occur without the other(s).

Causes

The conditions that contribute to the development of conduct disorder are considered to be multi-factorial, with many factors (multi-factorial) contributing to the cause. Neuropsychological testing has shown that children and adolescents with conduct disorders seem to have an impairment in the frontal lobe of the brain that interferes with their ability to plan, avoid harm and learn from negative experiences. Childhood temperament is considered to have a genetic basis. Children or adolescents who are considered to have a difficult temperament are more likely to develop behavior problems. Children or adolescents from disadvantaged, dysfunctional and disorganized home environments are more likely to develop conduct disorders. Social problems and peer group rejection have been found to contribute to delinquency. Low socioeconomic status has been associated with conduct disorders. Children and adolescents exhibiting delinquent and aggressive behaviors have distinctive cognitive and psychological profiles when compared to children with other mental health problems and control groups. All of the possible contributing factors influence how children and adolescents interact with other people.

Whose affected

Rates of CD in children vary widely, with reported ranges of 6 to 16 percent for males and 2 to 9 percent for females. The disorder is more common in boys than in girls by a 4:1 ratio and is believed to be more prevalent in urban rather than in rural settings. Children and adolescents with conduct disorders often have other psychiatric problems as well that may be a contributing factor to the development of the conduct disorder. The prevalence of conduct disorders has increased over recent decades. Aggressive behavior is the reason for one-third to one-half of the referrals made to child and adolescent mental health services.

Symptoms

Most symptoms seen in children with conduct disorder also occur at times in children without this disorder. However, in children with conduct disorder, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the child's relationships with others.

The following are the most common symptoms of conduct disorder. However, each child may experience symptoms differently. The four main groups of behaviors include the following:

• Aggressive conduct
  Aggressive conduct causes or threatens physical harm to others and may include the following:
  • Intimidating behavior
  • Bullying
  • Physical fights
  • Cruelty to others or animals
  • Use of a weapon(s)
  • Forcing someone into sexual activity, rape, molestation
• Destructive conduct
  Destructive conduct may include the following:
  • Vandalism; intentional destruction to property
  • Arson
• Deceitfulness
  Deceitful behavior may include the following:
  • Lying
  • Theft
  • Shoplifting
  • Delinquency
• Violation of rules
  Violation of ordinary rules of conduct or age-appropriate norms which may include the following:
  • Truancy (failure to attend school)
  • Running away
  • Pranks
  • Mischief
  • Very early sexual activity

The symptoms of conduct disorder may resemble other medical conditions or behavioral problems. Always consult your child's physician for a diagnosis.

Diagnosis

A child psychiatrist or a qualified mental health professional usually diagnoses conduct disorders in children and adolescents. A detailed history of the child's behavior from parents and teachers, observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of conduct disorder in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, conduct disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, post-traumatic stress disorder, substance abuse, attention-deficit/hyperactivity disorder and learning disorders, increasing the need for early diagnosis and treatment. Consult your child's physician for more information.

Treatment for conduct disorder:

Specific treatment for children with conduct disorders will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of your child's symptoms
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment may include:

• Cognitive-behavioral approaches - The goal of cognitive-behavioral therapy is to improve problem solving skills, communication skills, impulse control and anger management skills.
• Family therapy - Family therapy is often focused on making changes within the family system, such as improving communication skills and family interactions.
• Peer group therapy - Peer group therapy is often focused on developing social skills and interpersonal skills.
• Medication - While not considered effective in treating conduct disorder, medication may be used if other symptoms or disorders are present and responsive to medication.

Prevention of conduct disorder in childhood:

As with oppositional defiant disorder (ODD), some experts believe that a developmental sequence of experiences occurs in the development of conduct disorder. This sequence may start with ineffective parenting practices, followed by academic failure and poor peer interactions. These experiences then often lead to depressed mood and involvement in a deviant peer group. Other experts, however, believe that many factors, including child abuse, genetic susceptibility, history of academic failure, brain damage or a traumatic experience influence the expression of conduct disorder. Early detection and intervention into negative family and social experiences may be helpful in disrupting the development of the sequence of experiences that lead to more disruptive and aggressive behaviors.