Definition

Conduct disorder in children is a group of behavioral and emotional problems that begin during childhood or adolescence. Children and adolescents with this disorder have difficulty following rules and behave in ways that are not socially acceptable. They may exhibit aggressive and destructive behaviors (causing damage) and may deceive others or violate others' rights.

People may perceive them as simply being "naughty," rarely understanding that this is a mental disorder. If a child has this disorder, they often appear tough and confident, but in reality, they frequently feel insecure and believe others will threaten or act aggressively toward them.

Based on the age at which symptoms first appear, conduct disorder can be categorized into three types:

• Childhood-onset: Symptoms of conduct disorder appear before age 10.
• Adolescent-onset: Symptoms of conduct disorder appear during adolescence.
• Unspecified onset: The age at which symptoms first appear is unknown.

Causes

The development of conduct disorder in children can result from a combination of genetic and environmental factors.

Genetic Factors

A disruption in the frontal lobe of the brain is thought to be associated with conduct disorder. The frontal lobe is responsible for important cognitive functions such as problem-solving, memory, and emotional expression. An injury or disturbance to the brain early in a child's life can result in:

• Deficits in language skills, memory, and executive functions
• Difficulty making good decisions
• Reduced ability to solve problems in critical situations
• Impulsivity and reduced impulse control
• Impaired ability to plan for future actions
• Difficulty learning from past negative experiences

Additionally, developmental disorders can impact a child's learning and socialization abilities. High levels of testosterone have also been associated with aggressive behavior, making a child more prone to engage in aggressive conduct.

Environmental Factors

Environmental factors linked to conduct disorder include:

• A history of child abuse
• Dysfunctional family environments, such as those with parental substance abuse or alcoholism
• Poverty
• Frequent exposure to violence, whether physical or verbal
• A non-conducive school environment

Risk Factor

The following factors can increase a child's risk of developing conduct disorder:

• Male
• Living in urban areas
• Growing up in poverty
• Family history of conduct disorder or other mental health disorders
• Presence of co-occurring psychiatric conditions (e.g., ADHD, PTSD, mood disorders)
• Parental substance abuse
• Dysfunctional or conflict-ridden home and family environment
• A history of traumatic events, violence, or neglect

Symptoms

Children with conduct disorder are often challenging to control and do not adhere to rules. They act impulsively without considering the consequences of their actions and behavior. They are also indifferent to the feelings of others. Boys with this disorder are more likely to display aggressive and destructive behavior than girls, who are more prone to deceptive behaviors and rule-breaking.

A child might have conduct disorder if they consistently exhibit one or more of the following behaviors:

• Aggressive or attacking behavior
• Intimidating or bullying others
• Deliberately attacking people or animals
• Forcing someone into sexual activity
• Using weapons
• Deceptive Behavior
• Lying
• Breaking and entering
• Stealing
• Forgery
• Destructive Behavior
• Arson
• Intentional property destruction
• Rule Violation
• Skipping school
• Running away from home
• Drug and alcohol use
• Engaging in sexual activity at a very young age

Symptoms of conduct disorder can be mild, moderate, or severe. If a child exhibits mild symptoms, they display a few of the behaviors listed above, causing relatively minor harm to others. Such behaviors are often similar to typical delinquency for their age, such as lying, skipping school, and staying out late without parental permission.

A child with moderate symptoms shows multiple behavioral issues that can have a mild to severe impact on others. Moderate behaviors may include vandalism and theft.

Children with severe symptoms display all the behaviors mentioned above, significantly harming others. Severe conduct disorder behaviors include rape, using weapons, and burglary.

Diagnosis

If a child begins to exhibit symptoms that suggest conduct disorder, including patterns of behavior that violate others' rights and disregard social norms, consulting a psychiatrist or mental health specialist is crucial. The doctor will inquire about the child's behavior patterns, conduct at school, academic performance, and health history to diagnose the condition. The doctor will also check for signs of other mental disorders that may co-occur with conduct disorder.

To diagnose conduct disorder, a child must consistently display at least three general behaviors of the disorder, with at least one behavior occurring in the past six months. The behavioral issues must significantly interfere with the child's social life.

Management

For children with conduct disorder who live in homes filled with violence or other non-supportive environments, they may be placed in a different home setting. If the environment is supportive, a psychiatrist will use behavioral therapy or talk therapy to help the child learn to express or control their emotions appropriately.

The psychiatrist will also teach parents how to manage their child's behavior. If the child has another mental health condition, such as depression or attention-deficit/hyperactivity disorder (ADHD), the psychiatrist may prescribe medication to treat these conditions.

Since it takes time to develop new attitudes and behavioral patterns, children with conduct disorder usually require long-term treatment. Early intervention can slow the progression of the disorder and reduce the severity of negative behaviors.

Complications

If a child exhibits symptoms of conduct disorder, it is essential to consult a specialist, such as a psychiatrist. Untreated conduct disorder increases the risk of developing other mental health issues in adulthood, such as personality disorders, mood disorders, anxiety disorders, and substance use disorders.

Children with conduct disorder are also at risk of academic failure or dropping out of school, substance abuse, legal problems, self-harm, violence toward others, sexually transmitted infections, and even suicide.

Treatment outcomes can vary widely. However, early intervention can help reduce the risk of incarceration due to aggressive and destructive behaviors and prevent the development of other mental disorders.

Prevention

Although preventing the onset of conduct disorder is nearly impossible, recognizing symptoms and addressing them early can minimize the adverse effects on the child, family, and others. Creating a balanced home environment characterized by love, support, discipline, and serving as a positive adult role model can help reduce symptoms and prevent disruptive behaviors in children.

When to See a Doctor? 

If your child exhibits rule-breaking behavior or appears increasingly "naughty," be aware of the possibility of conduct disorder. If such behavior persists and becomes more pronounced as described above, and causes disruption in the child's environment, consult a psychiatrist for an evaluation and treatment. Timely and appropriate therapy can benefit the child's growth and development.