Conduct Disorders in Children and Adolescents

A Conduct Disorder in children or adolescents is characterized by a repetitive and persistent pattern of behavior where the basic rights of others or major age appropriate or social norms or rules are violated.  Three or more of the following would be present in the last year, with at least one in the most recent 6 months:

Aggression to people and animals

  • Often bullies, threatens, or intimidates others
  • Often starts physical fights
  • Has used a weapon that can cause serious physical harm to others
  • Has been physically cruel to people
  • Has been physically cruel to animals
  • Has stolen while confronting a victim
  • Has forced someone into sexual activity

Destruction of property

  • Has deliberately engaged in fire setting with the intention of causing serious damage
  • Has deliberately destroyed other's property (other than by fire)

Deceitfulness or theft

  • Has broken into someone else's house, building, or car
  • Often lies to obtain goods or favors, or to avoid obligations
  • Has stolen items of nontrivial value without confronting a victim

Serious violations of rules

  • Often stays out late at night despite parental prohibitions, starting before age 13
  • Has run away from home overnight at least twice while living with parents or guardians
  • Is often truant from school, starting before age 13

These criteria are the signs and symptoms currently designated by the American Psychiatric Association for this disorder.  They are published in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994), and available in the public domain.  Diagnoses for mental health remain dominated by the medical model in this country.  A diagnosis is necessary for insurance coverage for services, and for determining a proper treatment plan.

These behaviors of conduct should cause a significant impairment in social or academic functioning in the child's or adolescent's life.  The onset can be detemined to be Childhood Onset, with at least one symptom present prior to age 10, or Adolescent Onset, with a lack of symptoms before age 10.  The severity of the disorder may be Mild, if there is only minor harm to others; Moderate, if the effect on others is between mild and severe; or Severe, where behavior causes considerable harm to others.

The patterns of behavior are usually found in a variety of settings.  Children or adolescents with a Conduct Disorder may display bullying, threatening behaivor, or intimidate others.  They frequently start fights.  They may use a weapon such as a bat, brick, broken bottle, knife or gun.  They may engage in mugging, purse snatching,  armed robbery, or rape, assault or murder.  They may smash car windows, or vandalize schools, homes or public property.  They may break into homes or cars.  They may frequently lie or break promises for personal gain or favors, or to avoid debts or obligations.  They may engage in shoplifting or forgery.

Usually children before the age of 13 with this disorder stay out late at night in violation of parental rules.  They may run away overnight, or for extended periods of time.  (Running away due to physical or sexual abuse does not qualify for this criterion.)  They are often truant from school.

The Childhood onset type is usually a male.  They have highly conflicted peer relationships.  They are more likely to develop an Antisocial Personality Disorder than those with the Adolescent onset.  Those with the Adolescent onset type tend to have more normal peer relationships, although their disruptive behavior is often in the company of others.  Females are more frequently diagnosed with the later onset type than males.

Children and adolescents with a Conduct Disorder may have little empathy or concern for others.  The more aggressive individuals may misperceive the intentions of others as hostile and more threatening than is the case, which prompts them to respond with aggression they feel is justified.  They may lack guilt or remorse.  If they do exibit remorse, it is hard to tell if it is sincere since it may be to avoid punishment.  They may easily inform on others, or blame others for their behavior.  Like most bullies, their self esteem is usually low, though they act tough.  They have poor frustration tolerance, are easily irritated, have temper outbursts, and are frequently reckless.  They may have more accidents.

A Conduct Disorder is often associated with early sexual behavior, smoking, drug use, and risk taking.  These individuals are often suspended or expelled from school and have legal problems.  Sexually transmitted diseases, unplanned pregnancies, and physical injuries from accidents or fights are more frequent.  Many will require placement in foster homes or residential schools and treatment centers.  Intelligence and academic achievement are often lower than average, particularly with reading and verbal skills.  Learning Disabilities, Attention Deficit Hyperactivity Disorders, Mood Disorders, and Substance Abuse Disorders are often associated with this condition.

Common elements of the environment predispose children or adolescents to having a CD.  These include: parental rejection, inconsistent parenting with harsh discipline, physical or sexual abuse, lack of supervision, living in an institution at a young age, large family size, or belonging to a delinquent peer group or gang.

A Conduct Disorder is not simply a reaction to a social context, where the behavior may be protective, such as in a threatening, impoverished, or high crime environment.  It is not applied to immigrant youth from war ravaged countries, where aggressive behaviors may have been necessary for survival.

Less severe behaviors tend to emerge first, and the more severe later, although this can vary by individual.  This condition is much more common in males.  Males engage in more confrontational aggression.  Rates of this disorder are between 6 to 16% for males, and between 2 to 9% for females.  It can occur as early as age 5, and onset is rare after age 16.  A majority of children and adolescents stop this disruptive behavior by adulthood.  Early onset predicts a worse prognosis.  There is evidence of both genetic and environmental components in this disorder.  It seems to be more common with a parent with Antisocial Personality Disorder or a sibling with a CD.  It is also more common with a parent with Alcohol Dependence, Mood Disorders, Schizophrenia, or ADHD.

Children and adolescents with a Conduct Disorder receive early attention from authority figures and agencies due to the aggressiveness and severity of their disruptive behaviors.  They usually require court ordered and supervised treatment in individual or group settings.  Residential treatment is common.  Counseling at the first signs of these behaviors has the best chance of being effective and of minimizing the course of the disorder.  Family treatment is almost always indicated, but seldom started or followed through on.  Outpatient psychotherapy should be considered when possible.  If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions or to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family.  See the Cranberry Counseling, P.C. page of this web site for more information, or use the Contact Us form.