Conduct Disorder

Symptoms of conduct disorder

DSM-5-TR lists 15 behaviors in four groups. A diagnosis needs at least 3 in the past 12 months, with at least 1 in the past 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 harm
• Has been physically cruel to people
• Has been physically cruel to animals
• Has stolen while confronting a victim (for example mugging)
• Has forced someone into sexual activity

Destruction of property

• Has deliberately set fires intending to cause serious damage
• Has deliberately destroyed others' property

Deceitfulness or theft

• Has broken into a house, building or car
• Often lies to obtain goods or favors or to avoid obligations ("cons" others)
• Has stolen items of value without confronting a victim, such as shoplifting

Serious violations of rules

• Often stays out at night despite parental rules, starting before age 13
• Has run away from home overnight at least twice, or once for a long period
• Is often truant from school, starting before age 13

Specifiers

• Childhood-onset type: at least one symptom before age 10. Often more aggressive and more likely to persist into adulthood.
• Adolescent-onset type: no symptoms before age 10. Often more linked to peer groups, with better outcomes.
• With limited prosocial emotions: lack of remorse or guilt, lack of empathy, unconcern about performance, and shallow emotions. Also called callous-unemotional traits, linked to more severe and persistent problems.

Conduct disorder vs ODD and other conditions

Causes and risk factors

Conduct disorder develops from a mix of factors:

• Genetic and temperament factors: a family history of conduct problems, antisocial behavior or substance use; a difficult, fearless or low-empathy temperament.
• Brain and learning factors: differences in emotional processing and impulse control, low verbal IQ, learning disabilities and language problems.
• Family factors: harsh, inconsistent or neglectful parenting, abuse, family conflict and violence, parental mental illness or substance use, and frequent changes of caregivers.
• Social factors: poverty, community violence, rejection by peers and association with delinquent peers.
• Prenatal exposures: maternal smoking, alcohol or drug use during pregnancy.

None of these is a single cause. Many children with risk factors do not develop conduct disorder.

Diagnosis

A child and adolescent psychiatrist, psychologist or pediatrician makes the diagnosis after a full assessment, including:

• interviews with the young person and caregivers
• reports from teachers and other adults
• standardized rating scales
• screening for ADHD, learning difficulties, language problems, depression, anxiety, trauma and substance use
• assessment of safety risks and family circumstances

Treatment

Treatment works best when it is started early, involves the family and addresses multiple settings.

• Parent management training: for younger children, programs teach parents consistent, positive discipline, praise, clear limits and calm consequences. Examples include Parent-Child Interaction Therapy, Incredible Years and Triple P.
• Cognitive behavioral therapy and problem-solving skills training: help young people manage anger, solve problems and understand others' perspectives.
• Multisystemic therapy (MST) and functional family therapy: intensive, home- and community-based programs for adolescents, addressing family, school and peers. They reduce reoffending.
• School support: behavior plans, special education services for learning problems.
• Treating coexisting conditions: ADHD medication can reduce impulsive aggression. Depression, anxiety and substance use also need treatment.
• Medicines are not a primary treatment for conduct disorder itself. They are sometimes used short term for severe aggression alongside therapy.

Punitive approaches alone, such as boot camps, tend to be ineffective or make behavior worse.

Outlook

Many young people, especially with adolescent-onset conduct disorder, improve by adulthood. Childhood onset, callous-unemotional traits and severe aggression are linked to a higher risk of persistent problems, including antisocial personality disorder, substance use, school dropout, legal problems and mental health difficulties. Early, family-focused treatment improves outcomes.

Frequently asked questions

What are the signs of conduct disorder?

Signs include repeated aggression such as fighting, bullying or cruelty to people or animals, deliberately destroying property or setting fires, lying, stealing and breaking into places, and serious rule-breaking like running away, staying out all night or skipping school. The pattern lasts at least a year.

What is the difference between ODD and conduct disorder?

ODD involves an angry, irritable mood and defiance toward adults, such as arguing and refusing rules. Conduct disorder is more serious, involving violating others' rights through aggression, theft, destruction or deceit. Some children with ODD go on to develop conduct disorder.

What causes conduct disorder?

It results from a combination of genetic, temperament, brain development and environmental factors. Risk is higher with harsh or inconsistent parenting, abuse or neglect, family conflict, ADHD, learning problems, and exposure to violence or delinquent peers. No single factor causes it.

Can conduct disorder be treated?

Yes. Parent management training for younger children, and family-based programs such as multisystemic therapy for teens, have the best evidence. CBT, school support and treatment of ADHD, depression or substance use also help. Earlier treatment generally leads to better outcomes.

Does conduct disorder turn into antisocial personality disorder?

Not always. Many young people with conduct disorder do not go on to have antisocial personality disorder. The risk is higher with early onset, severe aggression and callous-unemotional traits. Antisocial personality disorder can only be diagnosed at 18 or older.