Conduct Disorder

When a child or adolescent shows an ongoing pattern of behavior that violates the rights of others and breaks social rules, he or she may be said to have conduct disorder.

Joe's Story

Joe always seems to pick fights on the school bus. He intimidates and bullies others and has few friends. Serving detention does not seem to help Joe learn to behave. Last year, in fifth grade, he was always in trouble for writing graffiti on school property, and he was suspended once for throwing rocks at a school bus. Though he was never caught, Joe stole money from the teachers' lounge and from the backpack of the girl who sat in front of him in English class. This year, he frequently cuts school. When he does not attend school, he hangs out behind the local convenience store smoking cigarettes he sneaks from his father's car.

What Is Conduct Disorder?

While all children and adolescents misbehave on occasion, some seem to do so all the time. Conduct disorder refers to serious and frequent antisocial behavior ^* in young people. Conduct disorder describes behaviors such as aggression or cruelty toward people or animals, bullying, threatening, physical fights, using weapons to hurt others, destroying property, fire-setting, lying, stealing, running away, and school truancy ^* . Someone who is diagnosed with conduct disorder has demonstrated at least three or more of these serious behaviors over the past year.

Young people with conduct disorder may act alone or in groups. Many youth involved in gang violence or other criminal or delinquent ^* behaviors have conduct disorder. When caught violating rules of conduct, antisocial youth often deny their guilt and may shift blame onto others. They often lack remorse for the deeds they have done and lack feeling for people or animals they may have hurt.

For some, conduct disordered behavior begins early in childhood. The earlier and more frequently the antisocial behavior occurs, the more likely it is to develop into more serious problems during adolescence. Others may not develop antisocial behaviors until adolescence; though still serious, their behavioral problems are sometimes more temporary. Most young people who have conduct disorder do not go on to have serious problems in adulthood, although for some it will lead to a lifelong problem with antisocial behavior. In adults, a pattern of aggressive and antisocial behavior that disregards the rights of others may be diagnosed as antisocial personality disorder. All adults who have antisocial personality disorder have had symptoms of conduct disorder in their youth.

How Does Conduct Disorder Develop?

There are many different theories about what causes conduct disorder. There is no one single cause, and a number of factors seem to contribute to its development. Conduct disorder and related antisocial behaviors tend to run in families. This may be due in part to inherited genes that affect behavioral development, but there is strong evidence that antisocial behavior is learned and modeled in the family environment.

Genetics and behavior

Many researchers have tried to determine how genetics and biology contribute to conduct disorder. Some studies have found that youth with conduct disorder may crave more stimulation, have trouble with self-awareness and with making goals, and lack skills for forethought and planning. Other studies have found that youth with conduct disorder have problems with social learning, which includes the skills needed to learn social rules and to interact well with others. Young people with conduct disorder also have less empathy than do others their age. Empathy is a type of emotional feeling for others; it involves the ability to see another person's point of view and to understand how someone else might feel in a given situation.

Children who have deficiencies in empathy, social learning, planning, and self-awareness may have a harder time developing behavioral controls, good problem-solving skills, and respect for others. Because they have fewer skills to solve problems in socially acceptable ways, they may be more likely to develop conduct problems. However, to what extent these deficiencies are part of a person's genetic make-up, or are tendencies that are learned by example and behavior in the family, remains unclear.

Learned behavior

There is convincing evidence that aggression, the main ingredient of conduct disorder, is a learned behavior. People who observe others behaving in aggressive ways (and this includes watching aggression and violence on television, movies, and video games) are more likely to demonstrate the aggressive behaviors they have witnessed. Children who witness aggressive behaviors at home, such as physical fighting, pushing, and shoving, are at increased risk for developing conduct disorder. Children with conduct disorder often live in families in which there is a high level of conflict that takes physical form.

Certain parenting practices increase the risk that a child will develop conduct disorder. For example, parents who fail to provide enough supervision, consistent rules for behavior, and discipline contribute to conduct disorder. Parents who use overly harsh or abusive discipline also contribute to the development of conduct disorder.

Peers can also influence a child's behavior. Many young people with conduct disorder are rejected by their peers, which may make their conduct problems worse. Social rejection may also cause them to associate with other children with conduct problems; children and adolescents who have aggressive or delinquent peers are more likely to have conduct disorder.

How Is Conduct Disorder Treated?

Individual or group treatment for young people with conduct disorder often involves helping them to learn social skills they may be lacking, especially empathy and problem-solving skills. Good behaviors are rewarded and antisocial behaviors are punished. Parent training is an important ingredient in many treatment programs. It helps parents replace harsh and coercive parenting behaviors with consistent rules, appropriate consequences, and positive attention to children's good behaviors. Studies have demonstrated that these treatment methods can be effective in reducing antisocial behavior in youth with conduct disorder. Treatment works best when it begins soon after the child or adolescent has started to show antisocial behaviors and is more effective when the family also participates. Medication may also be used in some cases.