Conduct Disorder (CD)

Conduct disorder is one of the most common disorders in children and adolescents in general population. Conduct disorder or CD involves a number of persistent patterns of problematic behaviors, including oppositional and defiant behaviors and antisocial activities including lying, stealing, destruction of property, deceitful, running away, physical violence and sexually coercive behaviors.

A child is diagnosed with conduct disorder when the symptoms continue for 6 months or more. CD is also known as a "disruptive behavior disorder" due to its impact on a child or adolescents family, school and people around them.

Another disruptive behavior disorder is Oppositional defiant disorder (ODD) which may be a precursor of conduct disorder. A child is diagnosed with oppositional defiant disorder when he or she shows signs of being hostile, negative and defiant behavior for at least 6 months or more.

Treatment of children with CD can be complex and challenging but early intervention and treatment is very important. If not treated on time, children with conduct disorder will be at higher risk of developing a range of problems later in their life such as substance use, law-breaking lifestyle, personality disorders and mental illnesses. Treatment must include medical, mental health and educational components as well as support from the family.

How common is conduct disorder?

Approximately 2 to 16 percent of children in the United States alone have conduct disorder. The average age of onset of CD is younger in boys as compared to girls. While boys most commonly meet the diagnostic criteria by 10 to 12 years of age on the other hand girls often reach 14 to 16 years of age before the criteria is met.

What are the signs of conduct disorder?

A child with conduct disorder will show following symptoms:

Stealing or lying,
Aggression to people or animals such as often bullies, threatens, physically cruel to animals,
Get involved in physical fights,
Verbally abusive,
Using weapons in physical fights,
Forces someone into physical activity,
Early alcohol, tobacco and substance abuse,
Destructive behavior that damages or destroys property,
Serious violations of rules,
Spiteful and vengeful behavior,
Running away from home,
Often truant from school, beginning before age 13 years.

A child with CD or ODD also may experience:

Poor peer and adult relationship,
Low self esteem,
Face problems with law,
Get expelled from school,
Learning difficulties,
Higher rate of depressiondefine,
Suicidal thoughts, gestures and suicide,
Increased rates of injuries.

ODD and conduct disorder Often Coexist

Children who develop conduct disorder are more irritable; throw more “temper tantrums” and are more “fussy” during babyhood, although most difficult babies do not develop conduct disorder. The milder oppositional defiant disorder (ODD) usually develops before CD. Losing temper easily, often arguing with adults, constant defiance and hostility are few common characteristics of ODD.

Nearly fifty percent of children with early oppositional defiant behavior have an affective disorder, CD or both by adolescence. And approximately one-third of children with conduct disorder often also meet criteria for attention deficit/hyperactivity disorder (ADHD). ADHD and learning difficulties commonly accompany ODD and CD. 1 in five children with CD are depressed.

Who is at risk for conduct disorder?

A single factor cannot be accounted for CD or antisocial behavior. Instead a variety of factors can contribute to the development of disorder. Previous studies show that some cases of conduct disorder begin in early childhood, often by the preschool years. Factors which make a child more likely to develop conduct disorder include:

• Chaotic home conditions
• Large family size
• Child abuse/violence and negligence
• Early maternal rejection
• Separation from parents
• Poverty
• Early institutionalization;
• Family neglect;
• Domestic violence
• Mentally ill parents
• Parents who are involved in law-breaking behaviour
• Crowding in home
• Alcoholic parents

Other factors which co-exist with conduct disorder are such as

Mood disorders,
Post-traumatic stress disorder (PTSD),
substance misuse,
Anxiety,
Learning problems,
Oppositional defiant disorder (ODD),
Attention deficit hyperactivity disorder (ADHD).

How is diagnosis of conduct disorder made?

Just like any other clinical diagnosis, a broad-based, behavioral evaluation is carried out by an expert (child or adolescent psychologist, child psychiatrist or paediatrician) so that he/she rule out other diagnostic categories with overlapping symptoms and can confirm the actual diagnosis. A diagnosis of CD is made when the child shows persistent, non-transitory antisocial and aggressive behaviour for more than 6 months to one year.

The expert will make their assessment on the basis of observation and detailed interview with the child, family and teachers. The child or adolescent psychologist, child psychiatrist or paediatrician can use Behavioural checklists. The Diagnostic and Statistical Manual of Mental Disorders (DSM-1V) from the American Psychiatric Association provides the criteria for diagnosing disruptive behaviour disorders.

What are the treatments for conduct disorder?

# Medication can be prescribed to a child with ADHD and depression which coexist with conduct disorder.

# Behavioral therapy and psychotherapy – Both helps a child with CD for developing anger management skills.

# Family group therapy – The parents can learn techniques to help manage their child's problem behavior, improve communication skills and interactions.

# Counseling – Parents must be counseled on how to set clear limits with their child and be consistent and realistic when disciplining them.

# If there is abuse in a family, all steps must be taken to remove the child from the situation and placed in a safe environment.

# Parent management training or PMT is one of the methods which have the most impact on the child's coercive pattern of behavior.

# Mood stabilizing medication such as lithium (Cibalith-S, Eskalith, Lithane, Lithobid, Lithonate, Lithotabs), carbamazepine (Tegretol, Atretol), and propranolol (Inderal) can be given to a child with CD in case he shows severe aggressive behaviour.

# Peer-group therapy is focused on developing social skills and interpersonal skills.