Conduct Disorder In Children:
Learn the Most Common Signs and Treatments Based on DSM-5 Criteria
Conduct Disorder is a serious behavioral and emotional disorder that can occur in children and adolescents. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it involves a consistent pattern of violating societal norms and the rights of others. Children with conduct disorder often engage in aggressive, deceitful, or destructive behaviors that go far beyond ordinary mischief or disobedience.
Behavioral disorders such as Conduct Disorder and Attention-Deficit/Hyperactivity Disorder (ADHD) are among the most frequently diagnosed mental health conditions in children. These conditions are also the top reasons children are referred for psychological or psychiatric evaluation. Unfortunately, many families struggle to access the proper care and resources necessary for these complex behavioral challenges.
What is Conduct Disorder?
Conduct Disorder is a mental health diagnosis used to describe a persistent pattern of disruptive and violent behaviors. The DSM-5 defines it as a "repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated." These behaviors must cause significant impairment in social, academic, or occupational functioning.
Conduct Disorder is typically diagnosed in childhood or adolescence and can range in severity. While some children may outgrow these behaviors, untreated Conduct Disorder can lead to more severe outcomes in adulthood, including the development of Antisocial Personality Disorder.
Common Signs and Symptoms of Conduct Disorder (Based on DSM-5)
To be diagnosed with Conduct Disorder, the DSM-5 states that the child must show at least three of the following 15 criteria in the past 12 months, with at least one occurring in the past 6 months:
Aggression to People and Animals
- Often bullies, threatens, or intimidates others.
- Often initiates physical fights.
- Has used a weapon that can cause serious harm (e.g., bat, brick, broken bottle, knife, gun).
- Has been physically cruel to people.
- Has been physically cruel to animals.
- Has stolen while confronting a victim (e.g., mugging, extortion).
- Has forced someone into sexual activity.
Destruction of Property
- Has deliberately engaged in fire setting with the intent to cause serious damage.
- Has deliberately destroyed others' property through other means.
Deceitfulness or Theft
- Has broken into someone else’s house, building, or car.
- Often lies to obtain goods or avoid obligations (e.g., “cons” others).
- Has stolen items of nontrivial value without confronting the victim (e.g., shoplifting, forgery).
Serious Violations of Rules
- Often stays out at night despite parental prohibitions, beginning before age 13.
- Has run away from home overnight at least twice or once for an extended time.
- Is often truant from school, starting before age 13.
In addition to these behavioral patterns, the disorder must cause clinically significant impairment in daily functioning. If the individual is 18 years or older, they must not meet the criteria for Antisocial Personality Disorder.
Subtypes and Severity Levels of Conduct Disorder
The DSM-5 also classifies Conduct Disorder based on the age of onset and severity:
Types by Onset
- Childhood-Onset Type: At least one symptom before age 10.
- Adolescent-Onset Type: No symptoms before age 10.
- Unspecified Onset: Age of onset is unknown.
Severity Levels
- Mild: Few problems beyond what is required for diagnosis; causes minor harm.
- Moderate: Intermediate number and impact of symptoms.
- Severe: Many symptoms and/or significant harm to others.
Conduct Disorder vs. ADHD and ODD
Many children diagnosed with Conduct Disorder also exhibit symptoms of ADHD (Attention-Deficit/Hyperactivity Disorder) and Oppositional Defiant Disorder (ODD). These conditions are often considered precursors to Conduct Disorder, especially when early symptoms are left unaddressed.
- ADHD is characterized by impulsivity, hyperactivity, and difficulty maintaining attention.
- ODD involves a pattern of angry, defiant, and vindictive behavior toward authority figures.
Children with co-occurring ADHD and Conduct Disorder often face even greater difficulties at school and home. Early intervention is key to preventing the escalation of these behaviors into more serious issues.
When to Seek Help for Conduct Disorder
For many parents, watching a child develop symptoms of Conduct Disorder is extremely distressing. If your child displays aggressive behavior, frequent rule-breaking, or other concerning behaviors, seeking professional help is essential. Early diagnosis and treatment can prevent future complications, including legal trouble, academic failure, and social isolation.
It’s especially important to take action if your child also struggles with ADHD symptoms, as the combination can lead to more severe outcomes.
Treatment for Conduct Disorder
Treating Conduct Disorder typically requires a comprehensive, multi-modal approach. Because every child is different, treatment plans are customized to address each child's specific symptoms, environment, and needs.
Evidence-Based Treatments Include:
- Cognitive Behavioral Therapy (CBT): Helps children understand how their thoughts influence behaviors and teaches healthier ways to manage anger and impulses.
- Parent Management Training (PMT): Equips parents with strategies to reinforce positive behavior and reduce problem behaviors at home.
- Family Therapy: Addresses dynamics that may be contributing to the child's behavior.
- Behavioral Therapy: Uses reinforcement to increase desirable behaviors and decrease problem behaviors.
- Medication: In cases where symptoms of ADHD or mood disorders are also present, medication may be used as part of a broader treatment plan.
Working with a team of qualified professionals, including child psychologists, psychiatrists, behavior analysts, and social workers, is critical for successful treatment.
Resources and Support for Families
Families often feel overwhelmed when facing a Conduct Disorder diagnosis. Fortunately, there are resources available. Community mental health centers, school psychologists, and specialized treatment programs can provide access to diagnosis, counseling, and family support services.
Here are a few steps you can take:
- Schedule an evaluation with a licensed child psychologist or psychiatrist.
- Reach out to your local community mental health clinic.
- Consult your child’s school for academic support services.
- Join support groups for parents dealing with Conduct Disorder and ADHD.
Final Thoughts
Conduct Disorder is a serious mental health condition, but with early intervention, professional treatment, and consistent support, children can improve their behavior and overall functioning. If your child is showing signs of Conduct Disorder, don’t wait—get help today.
Addressing Conduct Disorder early can help your child develop the emotional, social, and academic skills needed to thrive. It’s never too late to make a positive change.
References
1. Barkoukis, A., Reiss, N. S., Dombeck, M. (2008). Childhood Mental Disorders and Illnesses. Disorders of Childhood: Attention-Deficit and Disruptive Behavior Disorders. www.mentalhelp.net. 11-30-09.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC. Bonin, E.M., Stevens, M