Conduct disorder is a mental health condition that usually develops in childhood or adolescence and is characterised by a pattern of disruptive and antisocial behaviour. Children with conduct disorder often display a persistent pattern of aggressive and destructive behaviour towards others, animals, and property. They may engage in behaviours such as bullying, fighting, stealing, lying, truancy, and vandalism. These behaviours may violate the rights of others, go against societal norms, and can lead to legal problems.
Children with conduct disorder often have difficulty following rules and authority and may show little empathy or concern for others. They may also have difficulty regulating their emotions, leading to outbursts of anger or frustration. Conduct disorder can interfere with a child’s academic and social development and lead to problems with relationships, substance abuse, and adult criminal behaviour.
Conduct disorder is a relatively common mental health condition that affects children and adolescents. According to the American Psychiatric Association, the prevalence of conduct disorder in children under the age of 18 is estimated to be between 1-4% in the general population.
However, the prevalence of conduct disorder varies depending on several factors such as age, gender, and other demographic characteristics. For instance, conduct disorder is more common in boys than girls, and the condition is more prevalent in children and adolescents from low-income families or families with a history of mental health disorders, substance abuse, or criminal behaviour.
Conduct disorder can also co-occur with other mental health disorders, such as attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and depression. Children with conduct disorder who have comorbid mental health conditions may have a more severe presentation of symptoms and require specialised treatment interventions.
Conduct disorder is characterised by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.
If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.
The causes of conduct disorder are complex and multifactorial, with a combination of temperamental, environmental, genetic, and physiological factors contributing to its development.
Temperamental factors are a key contributor to the development of conduct disorder. Children who exhibit high levels of impulsivity, aggression, and low levels of empathy are more likely to develop conduct disorder. These traits can be genetically inherited or influenced by early environmental experiences such as trauma, neglect, or abuse. For example, children who experience early life stressors, such as poverty, family conflict, or exposure to violence, are at greater risk of developing conduct disorder.
Environmental factors, such as family and peer influences, also play a critical role in the development of conduct disorder. Children who grow up in families that have a history of criminal behaviour, substance abuse, or mental illness are more likely to develop conduct disorder. Moreover, children who are exposed to deviant peers or engage in antisocial activities are also at increased risk of developing conduct disorder. Poor parenting practices, such as inconsistent discipline, harsh punishment, and neglect, can also contribute to the development of conduct disorder.
Genetic factors are also thought to contribute to the development of conduct disorder. Studies have shown that children who have parents or siblings with conduct disorder are more likely to develop the condition themselves. Genetic factors may influence the development of brain regions involved in emotion regulation, impulse control, and reward processing, all of which are thought to be disrupted in conduct disorder.
Physiological factors, such as alterations in brain structure and function, have also been implicated in the development of conduct disorder. Studies have shown that children with conduct disorder exhibit differences in brain structure and function compared to typically developing children. These differences may be related to disruptions in the development of key brain regions involved in social and emotional processing, such as the prefrontal cortex and amygdala.
In conclusion, the causes of conduct disorder are multifactorial and involve a combination of temperamental, environmental, genetic, and physiological factors. Children who exhibit traits such as impulsivity, aggression, and low empathy, and who are exposed to early life stressors, poor parenting, and deviant peers, are at increased risk of developing conduct disorder. Genetic factors and alterations in brain structure and function may also contribute to the development of the disorder. Understanding the complex interplay of these factors is critical for developing effective prevention and treatment strategies for conduct disorder.
The diagnosis of conduct disorder is typically made by a mental health professional, such as a psychiatrist or psychologist, based on a comprehensive evaluation of the child or adolescent’s symptoms, behaviour, and history.
The diagnostic process for conduct disorder may involve several steps, such as:
To meet the diagnostic criteria for conduct disorder, the child or adolescent must exhibit a persistent pattern of disruptive and antisocial behaviour for at least six months. The behaviour must violate the rights of others or societal norms and may include behaviours such as bullying, fighting, stealing, lying, truancy, and vandalism.
The diagnosis of conduct disorder is important as it guides the selection of appropriate treatment interventions for the child or adolescent. Treatment for conduct disorder often involves a combination of behavioural therapies, family interventions, and medication, depending on the severity of symptoms and any co-occurring mental health conditions. Early intervention and treatment can help prevent further complications later in life.
Conduct disorder typically develops in childhood or adolescence, and the diagnosis is primarily focused on evaluating behaviours and symptoms that occur during those developmental stages. While the diagnosis of conduct disorder is not typically made in adults, some individuals who had conduct disorder in childhood may continue to exhibit similar behaviours and symptoms into adulthood.
In such cases, a mental health professional may evaluate the individual’s history of disruptive and antisocial behaviour, along with their current symptoms and behaviour, to determine whether they are experiencing persistent conduct disorder symptoms or have developed other mental health conditions, such as antisocial personality disorder.
The diagnostic criteria for conduct disorder are not used for adults, but mental health professionals may use similar assessment tools to evaluate adults for disruptive and antisocial behaviour, such as the Antisocial Personality Disorder module of the Structured Clinical Interview for DSM-5 (SCID-5).
It is important to note that the assessment and diagnosis of behavioural and mental health disorders in adults can be complex, and the evaluation process may involve multiple assessments and observations.
Differential diagnosis can include:
The treatment for conduct disorder in Australia typically involves a range of interventions tailored to the individual needs of the child or adolescent, including behavioural therapies, family interventions, and medication. The treatment may involve a multidisciplinary team of healthcare professionals, including psychiatrists, psychologists, social workers, and counsellors.
Some of the common treatment options for conduct disorder in Australia include:
It is important to note that the treatment for conduct disorder should be tailored to the individual needs of the child or adolescent, and treatment may need to be adjusted over time as the child’s needs and symptoms change. Early intervention and treatment can help prevent the development of more serious problems later in life.
ADHD and oppositional defiant disorder are both common in individuals with conduct disorder, and this comorbid presentation predicts worse outcomes. Individuals who show the personality features associated with antisocial personality disorder often violate the basic rights of others or violate major age-appropriate societal norms, and as a result their pattern of behaviour often meets criteria for conduct disorder.
Conduct disorder may also co-occur with one or more of the following mental disorders:
Academic achievement, particularly in reading and other verbal skills, is often below the level expected on the basis of age and intelligence and may justify the additional diagnosis of specific learning disorder or a communication disorder.
The prognosis for conduct disorder can vary widely depending on a range of factors, including the severity of symptoms, the presence of co-occurring mental health conditions, and the quality of treatment and support received. Some children and adolescents with conduct disorder may experience significant improvement in their behaviour and symptoms with appropriate treatment, while others may continue to struggle with their behaviour and experience negative consequences into adulthood.
Research suggests that the earlier the intervention and treatment for conduct disorder, the better the prognosis. Children and adolescents who receive early intervention and treatment have a better chance of developing healthy coping skills, improving their behaviour, and avoiding negative outcomes such as substance abuse, academic failure, and involvement with the criminal justice system.
Children and adolescents with conduct disorder who also have co-occurring mental health conditions, such as ADHD or depression, may have a more challenging prognosis as these conditions can exacerbate conduct disorder symptoms and make treatment more difficult.
It is also important to note that the long-term outcomes of conduct disorder can be influenced by environmental and social factors, such as poverty, family dysfunction, and exposure to violence. Children and adolescents who experience chronic stress and trauma may be more likely to experience negative outcomes, regardless of the quality of treatment received.
Living with conduct disorder can be challenging, both for the individual with the disorder and for their family members and caregivers. However, there are strategies that can help manage the symptoms and improve quality of life.
It is important to remember that living with conduct disorder can be challenging, but with the right support and interventions, individuals with this disorder can lead fulfilling and successful lives. Seeking professional help, building a support system, and practicing self-care and coping skills can all be helpful in managing symptoms and improving quality of life.
American Psychiatric Association
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
