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Synonyms and Keywords: Conduct problems, disordered conduct, behavioral problems
Conduct disorder is a psychiatric disorder characterized by a pattern of repetitive behavior wherein social norms or the rights of others are routinely violated. Possible symptoms include excessively aggressive behavior, bullying, physical aggression, cruel behavior toward people and animals, destructive behavior, lying, truancy, vandalism, and stealing. After the age of 18, conduct disorder may develop into antisocial personality disorder.
- In 1880, the origins of conduct disorder lie within the social and legal problem of delinquency.
- In 1904, Stanley Hall published the book, "Adolescence". This marked the beginning of the recognition of adolescence as a distinct developmental period.
- From 1910 until 1968, there was increased research interest in conduct problems of children as researchers attempted to identify the causes of inappropriate behaviors.
- In 1968, a rapid accumulation in the knowledge around VI conduct disorders and an increasingly holistic perception of the cause and treatment of conduct disorders occurred.
- At the end of the 19th century, therefore, the "norm" shifted from children working as young adults to focusing on becoming a young adult.
- In 1968, conduct disorders were established as a valid medical diagnosis.
- At the end of the 19th century and the start of the 20th century, Phrenology laid the foundation for biological determinism.
- Biological determinism is a large contributing factor to children who are delinquents and commit a crime.
- 'Uri Bronfenbrenner's Ecological Systems Theory' has largely contributed to the development and maintenance of conduct disorders.
- Developmental psychopathology has helped to integrate how biological, cognitive, and environmental factors have accumulated to increases the risk of a pathological outcome, such as conduct disorders.
- Conduct disorder is classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
- There are four categories that could present behavior similar to conduct disorder:
- Aggression to people and animal
- Destruction of property
- Deceitfulness or theft
- Serious violation of rules
- Early-onset (EO-CD) and adult-onset (AO-CD) conduct disorder are widely considered distinct diseases with divergent etiologies, though severe executive function is observed in both diseases.
- Patients with adult-onset conduct disorder (AO-CD) show increased cortical thinning in the paralimbic system, particularly in the precuneus/posterior cingulate cortex, as compared to healthy controls. This finding has not been reported in patients with early-onset conduct disorder (EO-CD).
- In children, the onset of conduct disorder (CD) seems to be associated with abnormalities in white matter pathways, particularly in the form of increased axial and radial diffusivity.
- This effect seems to be especially prominent in girls with CD.
Commonly Comorbid Conditions
- Substance abuse disorder
- Oppositional defiant disorder (ODD)
- Disruptive behavior disorders
Differentiating conduct disorder from other diseases
- Adjustment disorders
- Attention-deficit/hyperactivity disorder
- Bipolar disorder
- Depressive disorder
- Intermittent explosive disorder
- Oppositional defiant disorder
|Oppositional defiant disorder||
|Major depression and dysthymic disorder|
|Bipolar mood disorder||
|Intermittent explosive Disorder||
Epidemiology and Demographics
- The one year prevalence of conduct disorder is 2,000 to >10,000 per 100,000 people (2% to >10%) within the overall population.
- Worldwide, estimates of the prevalence of ODD and CD range from 3-5%. A recent meta-analysis estimated the combined prevalence of ODD/CD to be 6.1%.
- Among American children and adolescents aged 8 to 15 years, the prevalence of conduct disorder is approximately 2.1%.
- Children diagnosed with conduct disorder tend to be >10 years of age.
- In 2007, 4.6% of children between the ages of 3-17 years were diagnosed with conduct disorder.
- The lifetime prevalence of CD was 10.2% in an adult community sample, with men at 11.2% and women at 9.2%.
- Currently, there are no population- or national-level data on the prevalence trends of ODD or CD among caucasion U.S. children.
- The cause of conduct disorder is not fully understood. Family history plays a role that stems primarily from genetics, though common environmental circumstances also have an effect.
- While the male children of women who experience moderate or severe anxiety during the pre- and post-natal periods are more likely to experience conduct disorder than male children of women who do not, the same effect does not apply to female children.
- There exists evidence that a parenting style may have an outcome in CD:
- Excessive controlling parenting/behavior
- Substandard involvement with or supervision of children
- Tendency to avoid expressing one's emotions may facilitate the development of conduct disorder in children
- Risk factors for the development of conduct disorder include:
- Association with a delinquent peer group
- Biological parents with:
- Childhood access to violent video games
- Difficult under controlled infant temperament
- Early institutionalization
- Familial psychopathology
- Frequent changes of caregivers
- Harsh discipline
- Inconsistent child-rearing practices
- Lack of supervision
- Large family size
- Lower-than-average intelligence
- Neighborhood exposure to violence
- Parental criminality
- Parental neglect or rejection
- Physical or sexual abuse
- Social isolation
- Substance abuse
Natural History, Complications, and Prognosis
- Childhood conduct disorder is a known risk factor for the development of substance abuse disorder during a patient's youth.
- Childhood conduct disorder may be a risk factor for the development of schizophrenia.
- Children who suffer from conduct disorder are more likely than their unaffected peers to become violent, an effect that may continue into adulthood.
DSM-V Diagnostic Criteria for Conduct Disorder
Destruction of Property
Deceitfulness or Theft
Serious Violations of Rules
Specify current severity:
History and Symptoms
Symptoms of conduct disorder include:
- Compromised executive function
- Violent behavior
- Disregard for the rights of others
- Cruelty toward people and animals
- A child with conduct disorder may display a pattern of disruptive and violent behavior and have problems following rules.
- No laboratory test has been found to help diagnose this disorder.
- No recent imaging findings are available for this disorder.
- Therapy is recommended mong all patients who develop conduct disorder.
- Three main therapies are used to treat conduct disorder:
- Some critics of psychiatry allege that individuals exhibiting symptoms of a "conduct disorder" (similar to oppositional defiant disorder) may be reacting to an abnormal circumstance.
- Patients may also be committing criminal and/or uncivil acts out of selfishness.
- Critics of the classification of this disorder also may state that the coming of age of an individual does not automatically signify a new disorder.
- It has also been noted that the criteria for diagnosis can often be subjective and that only exemplifying a few of the above behaviors may just indicate normal teenage rebellion.
- "The historical foundation of conduct disorders : historical context, theoretical explanations, and interventions".
- Blair RJ, Leibenluft E, Pine DS (2014). "Conduct disorder and callous-unemotional traits in youth". N Engl J Med. 371 (23): 2207–16. doi:10.1056/NEJMra1315612. PMID 25470696.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 469–470.
- Etchells PJ, Gage SH, Rutherford AD, Munafò MR (2016). "Prospective Investigation of Video Game Use in Children and Subsequent Conduct Disorder and Depression Using Data from the Avon Longitudinal Study of Parents and Children". PLoS One. 11 (1): e0147732. doi:10.1371/journal.pone.0147732. PMC 4731569. PMID 26820149.
- Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB (2015). "Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function". PLoS One. 10 (4): e0121627. doi:10.1371/journal.pone.0121627. PMC 4383334. PMID 25835393.
- Jiang Y, Guo X, Zhang J, Gao J, Wang X, Situ W; et al. (2015). "Abnormalities of cortical structures in adolescent-onset conduct disorder". Psychol Med. 45 (16): 3467–79. doi:10.1017/S0033291715001361. PMID 26189512.
- Decety J, Yoder KJ, Lahey BB (2015). "Sex differences in abnormal white matter development associated with conduct disorder in children". Psychiatry Res. 233 (2): 269–77. doi:10.1016/j.pscychresns.2015.07.009. PMC 4536170. PMID 26195297.
- National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml
- Grant JD, Lynskey MT, Madden PA, Nelson EC, Few LR, Bucholz KK; et al. (2015). "The role of conduct disorder in the relationship between alcohol, nicotine and cannabis use disorders". Psychol Med. 45 (16): 3505–15. doi:10.1017/S0033291715001518. PMC 4730914. PMID 26281760.
- Schepman K, Fombonne E, Collishaw S, Taylor E (2014). "Cognitive styles in depressed children with and without comorbid conduct disorder". J Adolesc. 37 (5): 622–31. doi:10.1016/j.adolescence.2014.04.004. PMID 24931565.
- Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- Glasheen C, Richardson GA, Kim KH, Larkby CA, Swartz HA, Day NL (2013). "Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring". Dev Psychopathol. 25 (4 Pt 1): 1045–63. doi:10.1017/S0954579413000369. PMC 4310683. PMID 24229548.
- Freeze MK, Burke A, Vorster AC (2014). "The role of parental style in the conduct disorders: a comparison between adolescent boys with and without conduct disorder". J Child Adolesc Ment Health. 26 (1): 63–73. doi:10.2989/17280583.2013.865627. PMID 25391571.
- Oakley C, Harris S, Fahy T, Murphy D, Picchioni M (2016). "Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia". Schizophr Res. 172 (1–3): 54–9. doi:10.1016/j.schres.2016.01.047. PMID 26879586.
- Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A; et al. (2014). "Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms". J Stud Alcohol Drugs. 75 (2): 279–89. PMC 3965682. PMID 24650822.
- Maniglio R (2014). "Prevalence of sexual abuse among children with conduct disorder: a systematic review". Clin Child Fam Psychol Rev. 17 (3): 268–82. doi:10.1007/s10567-013-0161-z. PMID 24306094.