Does your child act out in ways that are disruptive at home and school? Maybe they sometimes become aggressive or violent with others? Perhaps they frequently break rules or even violate the law? It may be that your child or teen has conduct disorder. This is a mental health condition that requires psychological treatment to eliminate the symptoms and improve functioning:
Conduct disorder may be diagnosed in children and teenagers (similar symptoms in adults may qualify for a different diagnosis). The primary problem in conduct disorder is a persistent pattern of behavior that goes against age-appropriate societal norms.
Conduct disorder typically occurs in childhood or adolescence. It is more likely to occur in males. Studies indicate the prevalence rates are between 6% and 16% for boys, compared to 2% to 9% for girls.
Conduct disorder, like most other conditions, is typically due to many different factors that interact together. A history of harsh parenting, inconsistent parenting, or abuse could all be factors. Other factors may include genetics, brain abnormalities, and other difficult life circumstances.
Children and teens who have conduct disorder will repeatedly demonstrate behaviors that violate rules/guidelines set by parents/teachers, age-related expectations, societal laws, and even the rights of others. These behaviors will typically be observable at various settings, including home and school.
The most common behaviors and characteristics of conduct disorder are inappropriate behaviors that the violate rules and guidelines (for example, consistently staying out after curfew, cheating on a test). Children and teens with this condition may also act in ways that are not appropriate to their age (for example, smoking and drinking). These children and adolescents may break laws and societal norms (for example, stealing and lying). They may also violate the rights of others through actions such as physical aggression.
If you see concerning behaviors in your child or teen, then you will want to seek help for them. When visiting a mental health provider, they will conduct a psychological assessment to clarify the child/teen’s behaviors and symptoms. This will ultimately allow the professional to make a diagnosis.
The psychological assessment will usually involve asking the child or teen questions about their behavior, thoughts, and emotions. The mental health provider will also gather information from adults who interact with the child/teen (parents, teachers, other guardians or caregivers). There may also be formal psychological assessment measures to complete, such as self-report measures.
This information will be used to make a diagnosis. To formally assign a diagnosis, mental health professionals must also use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents these criteria to define conduct disorder:
If a child or teen meets the criteria, then the diagnosis of conduct disorder may be assigned. Someone over the age of 18 may instead be considered for a diagnosis of antisocial personality disorder. Mental health professionals can also indicate whether the child or teen has a specific type of conduct disorder. If the symptoms started in childhood versus adolescence, the child or teen will be assigned childhood-onset type or adolescent-onset type. Additionally, the intensity of the symptoms can be further described by indicating whether they are mild, moderate, or severe.
When making any diagnosis, a mental health professional must also rule out other similar conditions:
A person with intermittent explosive disorder will have frequent aggressive and angry outbursts towards objects, animals, or people. These outbursts are typically disproportionate to the events going on at that time. Such outbursts will cause problems for the person at work and at home. Although those with conduct disorder may show some similar symptoms, they also show many other inappropriate behaviors and those behaviors tend to be relatively less impulsive.
Symptoms of oppositional defiant disorder (ODD) include angry/irritable mood, argumentative behavior towards caregivers, and vindictiveness. Essentially, the child will act in ways that are oppositional and defiant. These behaviors will be disruptive at home and school, and in other social activities. Teens and children with conduct disorder will engage in many other inappropriate behaviors, including actions that are rule-breaking and illegal.
Antisocial personality disorder has symptoms of rules violations. However, antisocial personality disorder is also marked by a disregard for the rights of others. Furthermore, individuals with antisocial personality disorder tend to lack empathy for other people and remorse for their behavior. The symptoms of antisocial personality disorder often start in childhood and may be diagnosed as conduct disorder. When symptoms persist, the diagnosis may be changed.
Conduct disorder is placed within the Disruptive, Impulse-Control and Conduct Disorders category of the DSM-5. Other disorders in this category may appear similar to conduct disorder. Aside from oppositional defiant disorder and intermittent explosive disorder, this category also includes kleptomania and pyromania. Kleptomania refers to repeatedly stealing objects, while pyromania refers to repeatedly setting fires. Conduct disorder is different from each of these because, although it can include those behaviors, it also requires many other symptoms.
Conduct disorder most often emerges during childhood or adolescence. To be diagnosed with the disorder, the onset of symptoms is assessed. Such symptoms during adulthood may be given a different diagnostic label. Treatment options between children and adolescents also vary.
Consider this conduct disorder example to see if it reminds you of your child or teen:
12-year-old Jake has been acting out at home and at school. He frequently bullies his younger siblings and his classmates. Sometimes, he picks fights with them. He easily gets physically aggressive, even hitting or kicking people he is upset with. Sometimes, he will break other people’s belongings if he is angry at that person. His parents frequently find homework sheets in Jake’s backpack, after he has lied and said that he had no homework. He is failing his classes. Recently, they also found items that they knew did not belong to Jake. They can only assume that he stole them from other students. Jake’s parents decide they must seek help after he ran away for two days and returned home with no explanation for his whereabouts.
Children and teens will not usually seek out help themselves for their behaviors. Typically, they will not see their behaviors as particularly problematic. Instead, it is often parents, teachers, and other adults who interact with the child, that observe poor behavior and recommend help or seek it out for the child.
Many children and teens exhibit conduct disorder because of emotional or psychological problems. Instead of directing those problems inward (as might be seen in anxiety or depression), they direct them outward through inappropriate, acting out behaviors. Certain life circumstances can make this a more likely outcome for children. Additionally, even during or after treatment, a child/teen may relapse into these behavioral problems if they again face difficult circumstances, such as poor parenting and experiences of abuse or trauma.
A child or teen that exhibits these behaviors does need professional help from a mental health provider. Specifically, they will need a therapist who specializes in working with children and adolescents. Often, the family will also benefit from attending joint family therapy sessions. Therapy will address the child/teen’s behaviors and the emotions that may be causing the inappropriate actions. There will also be some work on behavior modification, to teach the child more appropriate behaviors.
Medications are not usually used to treat conduct disorder. They may be used to treat other conditions that a child might also have simultaneously. Such conditions might include attention-deficit/hyperactivity disorder, depression, and anxiety.
Conduct disorder is not typically treated just at home. Instead, professional help is needed for the child/teen and the family unit. The parents/family may be advised on new ways to interact with the child or teen to improve their behavior and maintain appropriate behaviors.
As noted, a child or teen living with conduct disorder may not personally feel very upset by it. They may see a consequence in their relationships and academic performance, but even then, they may not be particularly concerned. Those who live with and interact with the child or teen may need to learn new ways to approach caregiving. It can also be helpful for parents and caregivers to learn their own self-care techniques to manage the stress of managing the child.
Mental health providers and medical providers consider conduct disorder a diagnosable mental health condition. If your child has this condition and receives a formal diagnosis, it is likely that your health insurance will cover any necessary counseling or therapy. You can call your insurance company to ask about it. Your provider’s office may also be able to assist with that.
With the right resources, it can be easy to find the right mental health provider for your child and family. You might first ask your child’s pediatrician or their school who they would recommend. You can also search online for therapists in your area, using the name of your city/state. You can research the providers online and read reviews to ensure your prospective therapist is the right fit.
When seeking out a mental health provider for conduct disorder, you will first want to make sure that they are trained and licensed in their respective field. You will also want to find a provider who is specially trained to work with children and adolescents. It is even better if they specifically have experience working with conduct disorder and behavior modification.
When meeting with a potential therapist, you should ask about their training and experiences working with conduct disorder. You may also want to ask about their approach to therapy and how they will interact with not only your child, but with yourself and other members of your family. Finally, it can be helpful to ask how your child’s progress will be measured.
There are resources online regarding conduct disorder that may be helpful for parents/caregivers:
If you have questions about your child’s behaviors and want support in determining what you should do, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline.
Although the symptoms of conduct disorder can be frustrating to deal with, it is helpful to know that it is a diagnosable condition. Knowing that it is real and that other families struggle with the same situation can help you feel less alone. Seeking resources and treatment can also help your child and family.
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