Definition Conduct disorder is characterised by repeated bouts of disruptive behaviour. The child or adolescent is a rule-breaker who ignores the basic rights of other people, causes physical harm to others or animals, steals, lies and shows other "bad" behaviours.
What is going on in the body? Most children have some conduct-related problems at some time. But a conduct disorder is diagnosed when those behaviours become:
persistent and impinge on the basic rights of others
major violations of accepted norm
significant enough to impair everyday life
Conduct disorder most often begins in late childhood or the early teen years, which is known as adolescent conduct disorder. But it may occur in children as young as 5 or 6 years.
What are the signs and symptoms of the condition? Children with the disorder may exhibit any of these behaviours:
stealing
running away
lying
skipping school
deliberate destruction of property
physical cruelty to animals or people
forcing sexual activity on others
frequent physical fights, bullying, threatening, or intimidating others
violating rules set by parents or other authority figures
What are the causes and risks of the condition? The causes of conduct disorders are unknown. Theories include:
chemical imbalance in the brain
physical causes
genetic or inherited traits
chaotic home environments with little structure or predictability
the child's temperament or the family's response to it
The major risk of conduct disorder in childhood is that the child may develop antisocial personality disorder, mood or anxiety disorders, or substance abuse disorders as an adult.
What can be done to prevent the condition? A nurturing and consistent home environment is the best prevention. Children from homes with a balance of love and discipline are less likely to develop this disorder than are children from abusive, permissive, or neglectful home environments. Prevention focuses on skill development not only for the child, but also for others involved with the child. This includes the family and the school.
How is the condition diagnosed? A conduct disorder is diagnosed when a child displays the symptoms. At least three of these behaviours must have been present during the past year. Typically, a complete psychological and social history will be obtained, either by a doctor or by a mental health professional. Also, a complete medical and physical examination should be done. This is to determine if any medical conditions are causing the child to act out.
What are the long-term effects of the condition? If left untreated, conduct disorder can lead to:
What are the risks to others? Children with conduct disorder tend to have aggressive behaviour. They can cause intentional or unintentional harm to others, to themselves, and to animals.
What are the treatments for the condition? Treatment of conduct disorder may include group, individual, or family therapy or a combination. Psychotherapy is aimed at helping the child learn methods to effectively deal with his or her emotions and impulses in more socially appropriate ways.
Counselling is essential to help the child with self-esteem, mood, anger control, and interpersonal problems. Providing support and sensitive acceptance of the child is important. This will include helping the child understand the various sources of the problems. Counselling will also focus on the development of appropriate behaviour and coping skills.
A predictable and nurturing home environment is important as well. A balance in diet, rest, play, and study should be maintained. Solid discipline, coupled with nurturing, consistent, and fair expectations is important for children with a conduct disorder.
Special education services with an individualised plan for the child may be developed at school. This will specify additional services to be provided to the child. Parents need to work closely with the school and educational services team.
In come cases, medication for mood disorders may be used.
What are the side effects of the treatments? There are no side effects of the behavioural treatments. Side effects may occur if medications are used.
What happens after treatment for the condition? Mild forms of conduct disorder tend to improve as the child ages. Those who received adequate social and work adjustments, show progress. For others, the behaviours continue into adulthood and may develop into antisocial personality disorder. A plan should be in place with the child, family, and therapist for what steps to take if signs of relapse appear. An agreement should be made to call the therapist when those symptoms occur.
How is the condition monitored? Conduct disorder is monitored by the family, the school, and the therapist.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 31/1/2005 Contributors Potential conflict of interest information for reviewers available on request
