How Conduct Disorder In Children Can Affect Mental Health
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Conduct disorder (CD) is part of a category of disruptive, impulse-control, and conduct disorders that also includes oppositional defiant disorder, kleptomania and pyromania, and intermittent explosive disorder. It is typically diagnosed in children and adolescents. Due to CD’s connection with adult antisocial behavior and long-term mental health issues, early diagnosis and treatment may be crucial.
What is conduct disorder in children?
CD comprises a category of disruptive behavior disorders in which a child or adolescent expresses serious defiance of or disregard for interpersonal boundaries and social norms, potentially acting out with antisocial behaviors that are harmful to the self and to others. Estimations project that up to 3% of children and teens in the U.S. have CD.
While CD can appear in children of all backgrounds, it is more prevalent in boys. Children with CD often live with comorbid mental health conditions, such as bipolar disorder, that may contribute to its development.
CD is diagnosed in adolescents and younger children aged 18 and under. Adults who display similar behaviors may be diagnosed with another mental health condition, such as antisocial personality disorder (ASPD).
Symptoms of conduct disorder in children
At times, it can be difficult to differentiate CD from other more typical forms of acting out that can be a normal part of childhood expression, especially in younger children. CD differs in the intensity, duration, and frequency of these episodes. CD will also likely affect a child’s ability to function in daily life.
This condition is often characterized by rule-breaking, physical aggression against other children or adults, and deceitful behaviors such as lying and manipulation. Adolescents’ behavior may intensify, potentially moving on to bullying, hurting animals, theft, picking fights with others, vandalism, and arson.
- Breaking curfews
- Being truant from school
- Trespassing
- Destroying property
- Cheating
- Running away from home
- Physical violence
- Forcing sex
- Taking risks
- Having difficulty in school
- Using substances
Children with conduct disorder tend to have trouble feeling empathy or remorse or have difficulty expressing emotions in general. If they don’t do well in school, they may blame others for their poor performance.
Causes of CD in children
A combination of psychological, genetic, neurodevelopmental, socioeconomic, interpersonal, and environmental factors can contribute to the development of conduct disorder in children.
Contributing factors to developing conduct disorder may include:
- Living with parents who have a hostile or ineffective disciplinary style
- Experiencing poverty
- Maintaining a poor diet
- Being exposed to alcohol or tobacco in utero
- Atypical neurodevelopment, possibly caused by abnormal brain activity due to traumatic brain injury or seizures
- Being physically, sexually, or emotionally abused
- Growing up in an abusive or neglectful home environment
- Having parents who exhibit mental health issues or a family history of mental disorders
- Being diagnosed with other psychiatric or personality disorders
CD may also be a progression of other untreated disruptive behavior disorders, like oppositional defiant disorder (ODD).
Impact of CD on children’s mental health
Research suggests that CD shares genetic influences with depression. Children and adolescents with CD often also live with:
- Other mood disorders
- Autism spectrum disorder
- Anxiety disorders
- Attention-deficit/hyperactivity disorder
- Poor self-esteem
- Emotional regulation difficulties
- Social isolation
- Strained interpersonal relationships
- A higher likelihood of engaging in substance misuse
Without intervention from a mental health professional, these concerns can persist in individuals with CD into adulthood, potentially impacting their overall mental health severely.
Long-term mental health effects of CD
CD is a diagnosis that is reserved for children aged 18 and under and can first be observed in preschool. However, symptoms of this condition may persist into adulthood. At that point, research suggests that a CD diagnosis may be updated to another personality disorder—often antisocial personality disorder (ASPD).
One 2010 study analyzing the psychosocial outcomes of early adults who were diagnosed with CD concluded that most areas of adult life were affected by having childhood CD, saying, “Adult antisocial behavior appeared to mediate the relationship between CD and marital status, life satisfaction, and being in jail and partially mediated the relationship between CD and family support and global functioning.”
Antisocial behavior in adults is associated with unemployment, low educational achievement, early marriage, low income, and intimate relationship problems. Childhood intervention can help prevent adult antisocial behavior.
CD versus oppositional defiant disorder in children
CD is often conflated with oppositional defiant disorder (ODD). While they are both categorized as disruptive behavioral disorders, they are listed as distinct diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
These two disorders have a significant overlap in symptoms, including engaging in risky, aggressive, and harmful behaviors. Both may significantly affect an individual’s life at school, at home, and in the larger community. An individual with either of these conditions may get into severe trouble due to rule-breaking tendencies. They are connected in that untreated oppositional defiant disorder may develop into CD.
A key difference between oppositional defiant disorder and CD is that those with ODD typically engage in disruptive, spiteful, or vindictive behaviors in direct opposition to the demands or expectations of an authority figure, whereas those with CD push the limits of risky behaviors independent of others’ expectations.
Rule-breaking behaviors of CD are also typically much more severe than those of ODD. A child with ODD may become verbally defiant with an authority figure or break their rules, but they likely won’t physically harm animals or engage in other illegal activities like arson, theft, or sexual assault.
Intervention strategies for CD in children
Early diagnosis can be instrumental in preventing oppositional defiant disorder from escalating into conduct disorder and in preventing CD from progressing into antisocial personality disorder, reducing long-term mental and physical health consequences.
Treating conduct disorder effectively often includes a multi-pronged approach that addresses home life, school life, and social life to improve a child’s behavior and environment holistically. This approach may involve family therapy, parent management training, school-based programs, and medication.
How parents can support children with CD
Parents and caregivers may play a significant role in their child’s mental well-being. In the case of CD, caregivers may complete parent management training (PMT), which teaches them how to adjust their parenting styles to be healthier for their child; this often includes providing positive reinforcement and consistent discipline strategies. Caregivers who participate in PMT are often encouraged to give appropriate punishments, when necessary, that are proportionate to the circumstances at hand.
How schools can help children with CD
Classroom accommodations and individualized behavioral support plans can be put in place to support a child with CD. These support plans may include training teachers and staff to recognize and respond appropriately and effectively to a child’s disruptive behavior. A school counselor or peer support group can be a helpful contact point for collaborating with caregivers and mental health professionals.
Other adults’ roles in a child’s treatment
An early diagnosis and complete treatment can help individuals with CD overcome their condition. Caregivers can support people with CD by providing access to multi-systemic therapy, which can provide solutions and coping mechanisms that are tailored to the child’s unique needs.
How family and community aid CD and oppositional defiant disorder
When getting conduct disorder diagnosed, the input and observations of others may offer relevant insights into the child’s history of behaviors. They may also encourage a stable and nurturing home and school environment by strengthening family relationships to support the child’s mental health and reducing stressors that contribute to CD.
Benefits of online therapy for CD in children
Online therapy can be helpful to children with CD and their families by delivering structured therapy sessions remotely, allowing attendance from anywhere with a secure internet connection. This can be beneficial for families that have difficulty commuting to an office space and for caregivers who would otherwise have to wait nearby for their child’s sessions to end. Internet-based therapy also eliminates geographical boundaries, allowing families to work with specialists who are not locally available.
Using online therapy for CD
According to research published in 2019, online parenting interventions with a therapist yielded similar results as face-to-face interventions. This suggests that online therapy can be an effective tool in supporting children with CD and their families.
Takeaway
At what age does conduct disorder usually begin?
Conduct disorder most frequently develops between the ages of 10 and 19. On average, male children develop this disorder at a younger age than female children. Many factors impact whether a child develops conduct disorder. A combination of environment and biological factors typically determine whether a mental health disorder affects children.
What are the three types of conduct disorders?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association, conduct disorder can be categorized into three subtypes based on the age of onset. These subtypes include childhood-onset conduct disorder, adolescent-onset conduct disorder, and unspecified-onset conduct disorder. Childhood-onset conduct disorder, sometimes called early-onset conduct disorder, arises before age 10.
What are the long-term effects of conduct disorder?
The long-term effects of unaddressed conduct disorder can include the following:
- Criminal behavior
- Substance use disorder
- Suicidal thoughts or behaviors
How can you discipline a child with conduct disorder?
Consistency and structure can be crucial when disciplining a child with conduct disorder. Rewarding positive behaviors and addressing behavior problems with appropriate consequences may be helpful. Getting conduct disorder treated through various types of therapy, some of which require parental involvement, can lead to better outcomes.
Is conduct disorder a type of ADHD?
Conduct disorder and attention-deficit/hyperactivity disorder (ADHD) are two separate disorders. However, these two psychiatric disorders can co-occur.
Do kids outgrow conduct disorder?
Many children diagnosed with conduct disorder grow up to do well socially and occupationally, especially if they receive treatment. A smaller percentage of children with conduct disorder may develop antisocial personality disorder as adults.
How do you assess children with conduct disorder?
The American Academy of Family Physicians recommends the following rating scales for professionals assessing children suspected to have conduct disorder:
- The Child Behavior Checklist
- The Disruptive Behavior Disorders Rating Scale
- The National Institute for Children's Health Quality Vanderbilt Assessment Scales
Is conduct disorder on the spectrum?
Conduct disorder and autism spectrum disorder (ASD) are distinct diagnoses. Some research suggests the two disorders can occur together. A mental health provider, such as a child psychiatrist who is familiar with child development, can provide an accurate diagnosis.
Which behavior is typical of children with conduct disorder?
Children with conduct disorder often behave in a way that displays a sense of disregard for others. They may display aggressive behavior and defiant behavior, bully others, cause serious physical harm to animals or people, and engage in theft or arson, among other behaviors involving serious violations of others’ rights. Adolescents with conduct disorder tend to be more likely than others to engage in risky behaviors, such as unsafe sexual activity.
What is the best treatment for conduct disorder?
Efforts to prevent conduct disorder, especially for those with existing risk factors, can be helpful. Treatment options include contingency management programs, cognitive behavioral skill training (such as anger management training), and parent management training, sometimes in conjunction with prescription medication.
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