Conduct Disorder

A childhood antisocial behavior disorder characterized by aggressive and destructive actions that harm other human beings, animals, or property, and which violate the socially expected behavior for the child's age.

Along with anxiety and depression, conduct disorder is one of the most frequently diagnosed childhood psychological disorders. Depending on the population, rates of the disorder range from 6-16% in males and 2-9% in females and are expected to increase as antisocial behavior increases. Symptoms of conduct disorder include aggression, destruction of property, deceitfulness or theft,

and serious violations of rules. The specific manner in which these activities are carried out may vary with age as cognitive and physical development occur. The child may exhibit opposition to authority (characteristic of oppositional-defiant disorder) during early childhood, gradually adopt the more serious behaviors of lying, shoplifting, and fighting during school age years, and then develop the most extreme behaviors such as burglary, confrontative theft, and rape during puberty and teenage years. Males tend to demonstrate more confrontative behaviors, such as fighting, theft, vandalism, and discipline problems, than females, who are more likely demonstrate lying, truancy, substance abuse, and prostitution.

Depending on the age it first appears, two forms of conduct disorder are identified: childhood-onset type and adolescent-onset type. In childhood-onset conduct disorder, the individual, usually a male, will have exhibited at least one criteria for the disorder before age 10 and will usually have full-blown conduct disorder by puberty. These children are more likely to develop adult antisocial personality disorder. Adolescent-onset conduct disorder tends to be milder, with no exhibiting symptoms before age 10. Adolescents with this type of conduct disorder are only slightly more frequently male than female, have more normal peer relationships, and are less likely to progress to antisocial personality disorder as adults. Their antisocial behaviors may be much more marked when in the presence of others.

Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), conduct disorder is present when a child or adolescent (1) repetitively violates the rights of others or violates age-appropriate social norms and rules, and (2) this pattern of behavior causes significant impairment in social, academic, or occupational functioning. Three or more of the following criteria must have been present within the past 12 months, with one present within the past six months:

Aggression

The child or adolescent:

• bullies, threatens, or intimidates others;
• initiates physical fights;
• uses a weapon with potential to cause serious harm;
• is physically cruel to people;
• is physically cruel to animals;
• steals while confronting the victim (mugging, extortion, robbery);
• forces another person into sexual activity.

Destruction of property

The child or adolescent:

• deliberately engages in fire-setting with the intention of doing serious damage;
• deliberately destroys others' property (other than by fire).

Deceitfulness or theft

The child or adolescent:

• breaks into someone else's house, building, or car;
• lies to obtain goods, favors, or to avoid obligations;
• steals objects of non-trivial value without confronting the victim.

Serious violations of rules

The child or adolescent:

• stays out late at night against parental prohibition before age 13;
• runs away once for a lengthy period of time or twice overnight;
• is truant from school before age 13.

Because children and adolescents with conduct disorder often attempt to minimize the seriousness of their behavior, diagnosis is based on observations by parents, teachers, other authorities, peers, and by victims of the child's abuse. Generally, the child will present an exterior of toughness which actually conceals low self-esteem, and will demonstrate little empathy for the feelings of others or remorse for his or her actions. The disorder is associated with early sexual activity, substance abuse, reckless acts, and suicidal ideation. Chronic health problems, attention deficit/hyperactivity disorder, poverty, family conflict or a family history of alcohol dependence, mood disorders, antisocial disorders, and schizophrenia are also linked to the disorder.

There is some concern that the behaviors associated with conduct disorder may potentially be considered "normal" responses in the context of certain highly violent social conditions, for example war-zones (a concern when treating some immigrants) and high-crime urban neighborhoods. In these areas, the routine threats posed to life and property may encourage aggressive and deceptive behaviors as protective responses. Thus, the social and economic context in which the behaviors occurred should be taken into account, and in some cases a model based on trauma may be helpful.

A majority of children with conduct disorder no longer exhibit the extreme behaviors by the time they reach adulthood, but a substantial number do go on to develop antisocial personality disorder. For information about treatment, see entry on antisocial behavior.