Conduct Disorder In Children: Causes, Symptoms And Treatment

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Conduct disorders in children are mental health disorders that commonly occur in childhood or early adulthood. Unlike their peers, children with this disorder illustrate constant inappropriate or repetitive behaviors.

This disorder has a 2–5% occurrence in children aged between five to 12 and 5–9% in those between 13 to 18, respectively. Moreover, boys are at a higher risk of developing this disorder than girls (1).

Some common signs of conduct disorder in children are difficulty following rules, undesirable social behaviors, a sense of content while hurting others, and a lack of empathy and respect toward people.

In this post, you can learn more about the various types, causes, signs, diagnoses, complications, and management options for conduct disorder in children.

Types Of Conduct Disorder

Conduct disorder in children is divided into the following subtypes based on the onset (2) (3).

  • Childhood-onset: Children with childhood conduct disorder show at least one symptom before ten years of age. They may have difficulty following rules and behaving in socially acceptable ways. Property destruction, such as setting fires and breaking things, aggression, and poor peer relationships are typical symptoms of childhood-onset conduct disorder.
  • Adolescent onset: Adolescent conduct disorder is often considered in social contexts. Conduct disorders in adolescents can often be linked to basic survival needs such as stealing food or being part of gang culture. Adolescents may be less psychologically disturbed than those children with childhood-onset conduct disorder as their behavior is situational.
  • Unspecified onset: Children are included in this group if the age at onset is unknown and the diagnostic criteria for conduct disorder are met.

Sometimes, children or teens may also develop new-onset conduct disorder behaviors such as running away from home, skipping school, and shoplifting as a result of family stressors. These behaviors can often be corrected with appropriate support and care.

Causes Of Conduct Disorder

Multiple factors may contribute to the development of conduct disorder in children. These may include the following (4).

Parental and family factors

  • Exposure to frequent domestic violence episodes
  • Disruptive or criminal behaviors of caregivers and parents
  • Lack of adequate supervision and structure in the family due to marital conflicts between parents
  • Harsh parental behavior and verbal aggression
  • Substance abuse, such as alcohol dependence or use of illicit drugs, in parents
  • Poor living conditions and neglect

Biological factors

  • Studies show that heritability could be responsible for antisocial behavior, temperament, and aggression.
  • Low levels of 5-HIAA (5-hydroxyindoleacetic acid) in cerebrospinal fluid (CSF) are seen in some adolescents with aggressive and violent behaviors. 5-HIAA forms when serotonin is metabolized.
  • High testosterone levels may contribute to aggressive behavior.
  • Low plasma dopamine beta-hydroxylase is associated with behavioral disturbances and conduct disorder in some children.

Neurological factors

School and social factors

  • Exposure to frequent gang violence in the community
  • Lack of positive feedback from teachers
  • Lack of counseling and supportive staff in the school setting
  • Large classroom size and increased student-teacher ratio
  • Past failure in school

Not all children with these risk factors develop conductive disorder. Protective factors include self-soothing ability, affectionate parenting, and positive role models around them.

Risk Factors For Conduct Disorders

The following factors and events may increase children’s risk of developing conduct disorders in children (5).

  • Parental abuse, neglect, and rejection
  • Poor nutrition
  • Poor parenting
  • Poverty and lack of adequate care
  • Residing in an urban area as opposed to a rural area
  • Maternal psychopathology or mental illness
  • Lack of discipline in the family
  • Psychological disorders
  • Parents with depression, bipolar disorder, ADHD, alcohol use disorder, or schizophrenia
  • History of emotional, physical, or sexual abuse
  • Exposure to violence

Children need affection and care from their parents and the people around them as childhood experiences play a significant role in shaping one’s personality.

Symptoms And Signs Of Conduct Disorder

Clinical features of conduct disorder can be classified into four types (6) (7).

1. Aggressive behavior

Children with conduct disorder often exhibit aggression toward people and animals. The following aggressive behaviors are signs of conduct disorder in children.

  • Intimidating, threatening, or bullying other children and elders
  • Harming people or animals
  • Not showing genuine regret after being aggressive with someone
  • Initiating physical fight with others
  • Stealing and theft

2. Destructive behavior

Children with conduct disorder may find delight in destroying others’ property. Common destructive behaviors may include

  • Arson: Deliberately setting fire to damage property
  • Vandalism: Destroying property

Vehicle vandalism is common in children with conduct disorder. They may deliberately scratch, break windows, or cause other damages to vehicles.

3. Deceitful behavior

Lying, stealing, and deceitfulness are characteristics of children with conduct disorder. They may show the following deceitful behaviors.

  • Breaking into another’s car, house, or property
  • Lying to avoid obligations and seeking goods or favors
  • Stealing and shoplifting

4. Violations of rules

The following rule-violations behaviors are typically seen in children, primarily those below 13 years, with conduct disorder.

  • Staying out at night regardless of parental objections
  • Running away from home
  • Skipping school
  • Very early sexual activity

Children with any of these symptoms require a comprehensive evaluation by a mental health professional since conduct disorder may often coexist with other mental health disorders such as anxiety, ADHD, mood disorders, substance abuse, and learning problems.

Diagnosis Of Conduct Disorder

A pediatric or adolescent psychiatrist may diagnose conduct disorder by observing a child and asking parents and teachers about the child’s behavior. There are specific mental health tests used to identify coexisting mental health disorders (8).

Diagnostic tests, such as imaging, might be often ordered in suspected cases of brain damage. It is essential to seek help from a mental health professional to diagnose conduct disorder children since early treatment can improve outcomes.

Treatment For Conduct Disorder

Although there is no specific cure for this disorder, certain therapies can improve outcomes and positively change a child’s behavior. Treatments are chosen based on age, symptoms, severity, and health status of the child.

Pediatric psychologists may recommend certain psychosocial interventions to children with conduct disorders. These therapies may take years to show results and are often done by certified professionals under the supervision of psychiatrists.

The following types of therapy are often used to manage children with conduct disorder (9).

  • Cognitive-behavioral therapy (CBT) may help children handle stress, control anger, solve issues, and communicate well.
  • Family therapy is beneficial for families to understand their child’s condition and improve their communication and interaction with their child.
  • Peer group therapy helps children develop interpersonal and social skills.
  • Medications are not recommended for treating conduct disorder in the US and many other countries. In some cases where a child shows symptoms of other disorders, such as ADHD, which may occur along with conduct disorder, doctors may prescribe medications for treating the accompanying disorder(s). Some countries, such as Canada, do allow the use of psychostimulants to treat conduct disorder.

Stress reduction in the home can be beneficial for managing conduct disorder in children. Avoiding harsh punishments and practicing warm parental interaction can help your child. Parents should modulate their emotional expressions and be empathetic while communicating with their child who has conduct disorder.

Complications Of Conduct Disorder

Mismanaged or untreated conduct disorder may worsen over time and can result in devastating outcomes, including (10)

  • Poor educational outcome or academic failure
  • Legal troubles and imprisonment
  • Injuries to others or self
  • Substance abuse and addiction
  • Occupational and relationship problems
  • Antisocial personality disorder
  • Suicidal ideas

Conduct disorder in children might lead to life-threatening behaviors and the development of antisocial personalities in adulthood.
Firstly, you must consider attending training from several support services available to manage your child’s symptoms. The second step is enrolling your child in a school-based program that aims to reduce aggression and impulsive nature. Additionally, the triple P (positive parenting program) improves parenteral skills and promotes reducing behavioral and emotional troubles in children.
Furthermore, you may seek support from organizations, such as school or church groups. For instance, The National Alliance on Mental Illness and Big Brothers Big Sisters of America are popular organizations that help the families of children with conduct disorders and other behavioral and mental health disorders.

Key Pointers

  • Conduct disorder in children is a mental illness characterized by constant inappropriate behavior.
  • Domestic violence, high testosterone levels, brain damage, and lack of supportive teachers are a few causes of conduct disorder.
  • Poor nutrition, lack of discipline in the family, sexual abuse, and many other factors increase the risk of this condition.
  • Common symptoms of conduct disorder may be aggressive behavior, breaking laws, running away from home, destroying properties, and others.
  • Treatment includes medications and different types of therapies

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Understanding the Demographic Predictors and Associated Comorbidities in Children Hospitalized with Conduct Disorder; U.S. National Library of Medicine
2. H. Russell Searight, Fred Rottnek, and Stacey L. Abby; Conduct Disorder: Diagnosis and Treatment in Primary Care; American Family Physician (2001).
3. DSM-5 Changes: Implications for Child Serious Emotional Disturbance; U.S. National Library of Medicine
4. Conduct Disorder; U.S. National Library of Medicine
5. What are conduct disorders?; Nationwide Children’s Hospital
6. Conduct Disorder in Children; Stanford Children’s Health
7. Conduct Disorder Basics; Child Mind Institute
8. Conduct Disorder; Johns Hopkins Medicine
9. Conduct Disorder In Childrent; Lucile Packard Children’s Hospital Stanford
10. Conduct Disorder Causes and Effects; Piney Ridge Treatment Center
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Dr. Jessica Madden

(MD, FAAP, IBCLC)
Jessica Madden is a pediatrician, neonatologist, lactation consultant, and mother of four, who has been taking care of newborns since 2001. She works as a neonatologist in the NICU at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and founded Primrose Newborn Care, a newborn medicine and “4th trimester” home-visiting and telemedicine practice, in 2018.  Dr. Madden is a Fellow... more

Dr Bisny T. Joseph

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has 3+ years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education made... more