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Conduct disorder

Definition

Conduct disorder is a set of ongoing emotional and behavioral problems that occurs in children and teens. Problems may involve defiant or impulsive behavior, drug use, or criminal activity.

Causes

Conduct disorder has been linked to:

• Child abuse

• Drug or alcohol use in the parents

• Family conflicts

• Gene disorders

• Poverty

The diagnosis is more common among boys.

It is hard to know how many children have the disorder. This is because many of the qualities for diagnosis, such as "defiance" and "rule breaking," are hard to define. For a diagnosis of conduct disorder, the behavior must be much more extreme than is socially acceptable.

Conduct disorder is often linked to attention-deficit disorder. Conduct disorder also can be an early sign of depression or bipolar disorder.

Symptoms

Children with conduct disorder tend to be impulsive, hard to control, and not concerned about the feelings of other people.

Symptoms may include:

• Breaking rules without clear reason

• Cruel or aggressive behavior toward people or animals (for example: bullying, fighting, using dangerous weapons, forcing sexual activity, and stealing)

• Not going to school (truancy, beginning before age 13)

• Heavy drinking or drug use

• Intentionally setting fires

• Lying to get a favor or avoid things they have to do

• Running away

• Vandalizing or destroying property

These children often make no effort to hide their aggressive behaviors. They may have a hard time making real friends.

Exams and Tests

There is no real test for diagnosing conduct disorder. The diagnosis is made when a child or teen has a history of conduct disorder behaviors.

A physical examination and blood tests can help rule out medical conditions that are similar to conduct disorder. In rare cases, a brain scan helps check for other disorders.

Treatment

For treatment to be successful, it must be started early. The child's family also needs to be involved. Parents can learn techniques to help manage their child's problem behavior.

In cases of abuse, the child may need to be removed from the family and placed in a less chaotic home. Treatment with medicines or talk therapy may be used for depression and attention-deficit disorder.

Many "behavioral modification" schools, "wilderness programs," and "boot camps" are sold to parents as solutions for conduct disorder. There is no research to support these programs. Research does suggest that treating children at home, along with their families, is more effective.

Children who are diagnosed and treated early usually overcome their behavioral problems.

Outlook (Prognosis)

Children who have severe or frequent symptoms and who are not able to complete treatment tend to have the poorest outlook.

Possible Complications

Children with conduct disorder may go on to develop personality disorders as adults, particularly antisocial personality disorder. As their behaviors worsen, these individuals may also develop problems with drug abuse and the law.

Depression and bipolar disorder may develop in the teen years and early adulthood. Suicide and violence toward others are also possible complications.

When to Contact a Medical Professional

See a health care provider if your child:

• Regularly gets in trouble

• Has mood swings

• Is bullying others or cruel to animals

• Is being victimized

• Seems to be overly aggressive

Early treatment may help.

If you or someone you know is thinking about suicide or about hurting others, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Always take suicide attempts and threats seriously.

Prevention

The sooner treatment is started, the more likely the child will learn adaptive behaviors and avoid potential complications.

References

American Psychiatric Association. Disruptive, impulse-control, and conduct disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: American Psychiatric Association Publishing; 2022.

Walter HJ, DeMaso DR. Disruptive, impulse-control, and conduct disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 42.

Weissman AR, Gould CM, Sanders KM. Impulse-control disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 23.

Review Date: 2/10/2023

Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.