What are the other Names for this Condition? (Also known as/Synonyms)

• CD (Conduct Disorder)

What is Conduct Disorder? (Definition/Background Information)

• Conduct Disorder (CD) is characterized by rebellious behavior and a severe defiance against established social standards and norms. The hostile behavior is usually directed at authority figures such as parents, teachers, or law enforcement agents
• This antisocial behavior that occurs from Conduct Disorder is often persistent; repetitive flouting of age-appropriate rules and violation of others basic rights is observed
• Conduct Disorder falls under the category of disruptive behavior disorders (DBDs) that is characterized by aggressive and defiant behaviors, usually by children and teens, such that it severely impacts their daily life (and of those around them)
• Conduct Disorder is caused by a combination of both biological and environmental factors, such as neurological damage at birth, as well as psychological problems within their families
• Often, many children display symptoms associated with Conduct Disorder, such as temper tantrums, physical aggression, and argumentativeness, during their growing years. However, it is not considered a disorder unless it is long-lasting and disrupts one’s daily (normal) function and of the people around them
• A treatment for Conduct Disorder primarily involves behavioral therapy, so that the affected individuals are able to identify anger cues and effectively use strategies to cope with them. A treatment of any underlying or coexisting disorder is also undertaken
• The prognosis of Conduct Disorder is usually good. However, it is important to detect and treat the condition in the early stages to prevent it from progressing into a more serious disorder

Who gets Conduct Disorder? (Age and Sex Distribution)

• Conduct Disorder most commonly onsets in children and adolescents. However, individuals of all age categories are prone to the disorder
• Males are more likely to be affected than females
• Worldwide, individuals of all racial and ethnic groups may be affected. The condition reportedly affects up to 16% of the youth in the United States

What are the Risk Factors for Conduct Disorder? (Predisposing Factors)

Some known risk factors for Conduct Disorder may include:

• Birth injuries that occur during childbirth
• Personal history of anxiety and depression
• Attention-deficit hyperactivity disorder (ADHD)
• Family history of Conduct Disorder (or any other type of disruptive behavior disorder), ADHD, anxiety, and depression
• Psychological stress caused by familial or other domestic circumstances

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Conduct Disorder? (Etiology)

Conduct Disorder is generally caused by a combination of biological and environmental factors.

• Biological factors:
  • Neurological damage at birth
  • Low birth weight
  • Personal history of anxiety and depression
  • Attention-deficit hyperactivity disorder (or ADHD); a neurodevelopmental disorder affecting young children. Around 1 in 4 children and up to 1 in 2 adolescents with ADHD may develop Conduct Disorder
  • A family history of Conduct Disorder (or any other types of disruptive behavior disorder), anxiety, and depression
• Environmental factors, such as stressors from family situations and dynamics, which could arise from:
  • Divorce and separation
  • Substance abuse
  • Physical/emotional/sexual abuse
  • Criminal activity
  • Serious conflict

What are the Signs and Symptoms of Conduct Disorder?

Some signs and symptoms of Conduct Disorder include the following:

• Antisocial behavior - it may be described as defining Conduct Disorder
• Aggressive and intimidating behavior that may include:
  • Cruelty to animals
  • Fighting 
  • Bullying 
• Short-temperedness
• Constantly arguing and conflicting with adults or people of authority
• Constant defiance of rules and denial of requests
• Tendency to cause harm
• Tendency to blame others for one’s own shortcomings
• Tendency to lie
• Tendency to steal
• Destructive behavior - the individual may indulge in:
  • Arson
  • Vandalism

It is reported that the level of physical aggression and violent behavior may reduce as the child grows, but non-physical conflicts and verbal duels tend to increase.

How is Conduct Disorder Diagnosed?

A diagnosis of Conduct Disorder is made based on the information gathered from the following tools:

• Complete physical evaluation
• Comprehensive analysis of medical history
• Thorough psychiatric assessment by a child psychiatrist; speaking to the child, his/her parents and teachers, etc.
• Assessment of symptoms based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
• Differential diagnosis to rule out other disorders that may present similar signs and symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Conduct Disorder?

The following complications for Conduct Disorder may be observed:

• Lack of friends
• Difficulty in academic and occupational life
• Feelings of isolation and loneliness
• Substance use and abuse
• Homelessness and poverty
• Perpetration of domestic violence and child abuse
• Animal cruelty
• Involvement in criminal activities
• Suicidal thoughts and behaviors

How is Conduct Disorder Treated?

The treatment methods for Conduct Disorder may involve the following techniques that may be used either in isolation or as a combination to treat the condition:

• Behavioral therapy:
  • Collaborative problem solving (CPS) to help teach affected individuals how to be aware of their frustration and handle it in a healthy manner 
  • School-wide positive behavioral support (SWPB): It is a program in place in many schools that fosters positive social behaviors and provides a service for extreme behavioral needs
  • Peer group therapy - in order to develop better social and interpersonal skills
• Parent training (PT) is an intervention-style training program set for parents of the affected children/individuals to help them be educated about the disorder and how to manage it at home and other social places
• Meditation and relaxing techniques including hypnosis
• Medication and other measures to treat simultaneously occurring ADHD and/or any associated anxiety and depression

How can Conduct Disorder be Prevented?

Presently, there are no methods or guidelines available for the prevention of Conduct Disorder.

• Seeking early intervention including professional treatment soon after the onset of symptoms may help prevent progression of Conduct Disorder into a more severe condition
• Undertaking timely and appropriate treatment for ADHD, anxiety, and depression, can be beneficial in lowering one’s risk for the condition
• Since it has been determined that psychological stress is a key risk factor, seeking professional help after psychologically stressful events may help prevent Conduct Disorder

What is the Prognosis of Conduct Disorder? (Outcomes/Resolutions)

• The prognosis for Conduct Disorder is generally good in a majority of individuals. Most of the affected individuals are reported to improve their symptoms through adequate treatment
• However, failure to diagnose and treat Conduct Disorder during its early stages may result in its progression to a more serious and disruptive disorder. Also, children with co-existing attention deficit hyperactivity disorders are known to typically have poorer outcomes

Additions and Relevant Useful Information for Conduct Disorder:

Intermittent explosive disorder (IED) is another type of disruptive behavior disorder, wherein the affected individuals display sudden unwarranted hostility and aggression.