Conduct Disorder

Medically reviewed by Dr. Samuel Sarmiento, MD, Dr. April Brewer, DBH, LPC, and Julie Dodson, MA

Overview

Conduct disorder is a behavioral and emotional disorder that can occur in children and teens. It involves a range of disruptive and antisocial behaviors that often violate the rights of others and defy societal norms. Symptoms¹ may include aggressive conduct like bullying or cruelty to others, property destruction, deceitfulness or theft, and serious rule violations.

These behaviors cause significant impairments in the child's or teen's social, academic, or occupational functioning. While the exact cause of conduct disorder is unknown, it is believed to be influenced by a combination of genetic, biological, psychological, and environmental factors.

The condition is often associated with other mental health disorders, such as attention deficit hyperactivity disorder (ADHD),² oppositional defiant disorder (ODD),³ anxiety disorders, and mood disorders. Early intervention and comprehensive treatment, often involving the individual and their family, can help manage symptoms and improve outcomes. Adults who were diagnosed with conduct disorder as a child may be at risk of developing antisocial personality disorder (ASPD).⁴

Symptoms

The symptoms of conduct disorder often fall into four broad categories: aggressive behavior, destructive behavior, deceitful behavior, and violation of rules. Each category involves different symptoms.

Aggressive behavior

Below are symptoms associated with aggression in children with conduct disorder:

Frequent physical fights or assaults
Using a weapon in fights
Bullying, intimidating, or threatening others
Cruelty or violence toward animals
Forceful sexual activity (assault)

Destructive behavior

Destructive behavior in children with conduct disorder may involve actions like the following:

Deliberately setting fires with the intention of causing damage
Vandalism or deliberate destruction of property

Deceitful behavior

Deceitful behavior in children with conduct disorder involves the following symptoms:

Lying or deceit for personal gain or pleasure
Shoplifting or theft
Breaking into someone's house, building, or car
Attempting to manipulate others

Violation of rules

Below are some ways children with conduct disorder may violate rules:

Staying out at night despite parental objections, beginning before age 13
Running away from home overnight at least twice while living in a parental or parental surrogate home or once without returning for a lengthy period
Truancy from school, beginning before age 13

Secondary symptoms

Conduct disorder can also present with secondary symptoms associated with the consequences of the disruptive behavior, including:

Problems in school or problems with the law
Drug or alcohol use
Risky sexual behavior
Suicidal thoughts or behaviors

These behaviors must cause significant impairment in the individual's social, academic, or occupational functioning for a provider to diagnose conduct disorder. In addition, experts will look at whether children and teens show few signs of concern or guilt about their harmful behavior, often blaming others.

Children with this condition may have difficulty regulating their emotions, appear irritable, or frequently lose their temper. The behaviors associated with conduct disorder can vary in severity and lead to serious consequences if left untreated.

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Causes

The exact cause of conduct disorder is unknown, but it is believed to be a complex interplay of genetic, biological, psychological, and environmental factors.

Genetic and biological factors

Below are some of the genetic and biological factors that could cause conduct disorder:

A family history of conduct disorder, antisocial personality disorder, or other personality or mood disorders can increase the risk of developing the condition.
Abnormalities in the brain, especially in the frontal cortex, which is responsible for decision-making, impulse control, and judgment, may contribute to conduct disorder.
Exposure to substances while in the womb may influence the development of conduct disorder.

Psychological factors

Below are potential psychological causes of conduct disorder:

An individual's temperament, such as impulsivity or difficulty managing anger, can play a role in the development of the disorder.
Learning disabilities or lower intelligence quotient (IQ) can contribute to the manifestation of conduct disorder.

Environmental factors

Below are potential environmental factors that could cause conduct disorder:

A dysfunctional family environment, such as high family conflict or poor parenting practices, can be a risk factor for conduct disorder.
Exposure to violence or trauma, such as child abuse or community violence, can increase the risk of conduct disorder.
Socioeconomic hardship, including poverty, can also be a risk factor.

Causes of conduct disorder symptoms can vary widely and include stressors such as changes in family structure, school problems, or conflicts with peers. Note that these factors do not cause conduct disorder alone. Instead, they may increase the risk when combined with other factors. Early intervention can often prevent the escalation of symptoms and improve long-term outcomes.

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Treatments

The treatment for conduct disorder aims to reduce or eliminate symptom manifestations, improve social and academic functioning, and cultivate positive family interactions. A comprehensive treatment approach often involves psychotherapy, medication, and supportive services.

Therapy

Psychotherapy is often the primary treatment method for conduct disorder, with several types proving beneficial, including the following:

Cognitive-behavioral therapy (CBT): CBT may help children and teens recognize and change thought patterns leading to problem behaviors. This therapeutic approach teaches them how to manage anger and improve their problem-solving skills.
Family therapy: Conduct disorder often affects the entire family, so involving them in treatment can be essential. Family therapy can improve communication, solve family problems, and help establish a more effective parenting style.
Parent management training: This form of therapy teaches parents how to better understand and manage their child's behavior. It includes strategies for managing symptoms and preventing relapses.
Group therapy: Particularly for adolescents, group therapy can provide a peer network for learning prosocial behaviors and reinforcing new skills.

Medication

There is no specific medication to treat conduct disorder and psychosocial interventions remain the first line of treatment. Still, various medications can be used to manage co-occurring conditions or specific troubling symptoms, including but not limited to the following:

Stimulant medications, like methylphenidate and amphetamine, can be effective for children with comorbid ADHD.
Antidepressants or mood stabilizers may help children manage symptoms if they have a co-occurring mood disorder such as signs of depression.
Atypical antipsychotics may be used in severe cases or when other treatment methods fail. They can help manage aggression but have significant side effects and must be used cautiously.

Consult a medical doctor before starting, changing, or stopping one of your child’s medications.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other treatment options

Other interventions may be helpful, depending on the specific circumstances of the child or adolescent. School-based programs can support academic difficulties and include behavior management strategies.

Residential treatment programs may benefit adolescents with severe symptoms who have not responded to other forms of treatment. These programs provide structured and therapeutic environments for children to live and receive treatment.

Self-care

Self-care strategies can also contribute to managing conduct disorder symptoms, including:

Regular physical activity can help children manage symptoms by reducing tension and promoting improved mood.
A balanced diet and sufficient sleep can also improve overall mental health.
Mindfulness and relaxation techniques can assist in anger management and impulse control.

The effectiveness of treatment can vary significantly from person to person. While conduct disorder can be a challenging condition to manage, with consistent treatment and support, individuals with conduct disorder can learn to manage their symptoms and lead productive lives.

Resources

Therapy can be a critical component of treatment for conduct disorder. Online platforms like BetterHelp for adults and TeenCounseling for teens aged 13 to 19 can make it easier to find quality mental healthcare. With an online platform, you can connect with licensed therapists specializing in treating conduct disorder and related conditions and receive support via phone, video, or live chat sessions.

Additional resources include the following:

American Academy of Child & Adolescent Psychiatry (AACAP): AACAP provides resources for families of children with mental health conditions, including conduct disorder.
Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA offers a variety of resources, including a treatment services locator and a helpline for individuals and families facing mental health or substance use disorders.
National Institute of Mental Health (NIMH): The NIMH provides comprehensive information on various mental health disorders, including conduct disorders.

Reach out to healthcare professionals for an accurate diagnosis and treatment options if you or a loved one is experiencing symptoms of conduct disorder. These resources may provide guidance and support as you navigate the challenges of this condition.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

For those with thoughts of suicide, contact the 988 Suicide & Crisis Lifeline at 988. Please see our Get Help Now page for more resources.

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Research

Emerging research on conduct disorder continually improves our understanding of its causes and treatment options. One area of interest involves the role of the brain's anatomy and function in developing this condition.
A study highlighted in the National Center for Biotechnology Information's report found differences in the amygdala and prefrontal cortex, brain areas related to emotion processing and decision-making, of individuals with conduct disorder. This study suggests that biological factors may be more significant than previously believed.

Regarding treatments, research is expanding beyond traditional methods to consider comprehensive and integrative approaches. According to Mental Health America's report, prevention and early intervention strategies that focus on improving family and school environments show promise in reducing antisocial behavior in children and adolescents (conduct disorder can be a precursor to antisocial traits and tendencies or antisocial personality disorder).

These strategies include family-based interventions, parenting programs, school-based programs, and community-wide interventions. These results underscore the importance of a holistic approach when treating conduct disorder, addressing the individual and their environment. Advancements in these research areas can be promising for looking at better diagnostic tools and more effective treatments for conduct disorder in the future.

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