Conduct disorder, a “disruptive behavior disorder,” can seriously impair the way a child reacts to certain situations and people. We asked experts for advice on diagnosing and treating the disorder so kids can effectively improve their functioning in school and with peers.
Typical Diagnosis
Children diagnosed with conduct disorder, one of the “disruptive behavior disorders,” show a repetitive and persistent pattern of behavior in which they violate the rights of others and/or major age-appropriate societal norms. These children often engage in bullying, fighting, stealing, and aggressive or covert behaviors. “It goes beyond bullying at school,” says Melanie Fernandez, Ph.D., ABPP, director of the parent-child interaction therapy program at the Child Mind Institute in Manhattan.
To be diagnosed, a child must present three or more symptoms, like those listed above, in the last year, and one of those symptoms—often bullying, stealing, or talking without permission—must be present within the last six months.
Conduct disorder is more common among boys than girls. Studies indicate that 6 to 16 percent of boys suffer from the disorder while the rate among girls ranges from 2 to 9 percent.
The disorder’s onset can either occur early, before age 10, or in adolescence. While the cause is unknown, it seems to arise from a variety of factors. “We look at how conduct disorder aggregates in families and we see pretty significant sibling correlations [as well as] correlations between parents’ anti-social behavior and their kids’ conduct problems. So there’s definitely a big genetic piece,” Dr. Fernandez says. “But there are also environmental influences on the genetic predispositions. So things like the prenatal environment even, such as environmental toxins. Lead is a huge and preventable risk factor for disruptive behavior disorders. And there’s evidence that maternal smoking is a predictor of conduct disorder in boys.”
Oppositional defiant disorder, another disruptive behavior disorder characterized by persistent patterns of resistance to authority, defiance, non-compliance, and irritability, is often a precursor to conduct disorder. This doesn’t mean that all kids with ODD go on to develop conduct disorder, but it is a risk factor.
What It Means for Your Child
Kids with conduct disorder are at significantly greater risk of depression, substance-abuse disorders, incarceration, and suicide. “Some kids improve over time, but many kids get worse,” Dr. Fernandez says, explaining that the latter group can have lasting functional impairment in terms of their relationships with others, how they do in school, and ultimately in their jobs.
“I think people get very nervous when they hear ‘conduct disorder’ because they automatically assume that this is a child who is antisocial [or] a psychopath,” Dr. Fernandez says. “I think the label can often really affect kids in terms of what schools will take them, and in terms of how they interact with peers. It’s important to think about helping these families and not automatically assuming that these kids will turn out very negatively.”
What It Means for Your Family
Conduct disorder is characterized by covert or hidden behaviors, so it helps when parents are effective in monitoring these behaviors in their children.
Treatment is effective when family members go through the sessions with the diagnosed child, which teaches not only the child, but also the parent how to better interact in challenging situations they may face every day at home.
With intervention, there is evidence of improvements in the child’s functioning, but this largely depends on getting families into treatment.
Treatment
Conduct disorder is usually managed by behavioral therapy. “The good news is that if kids are identified [with conduct disorder] then they can be involved in treatments, and right now we have what are called ‘well established treatments’ for kids with conduct problems,” Dr. Fernandez says. These treatments generally involve working with parents on specific strategies to help reduce harsh parenting, which can exacerbate conduct problems. They also work to help parents increase monitoring of their child’s behavior.
Another treatment option is multi-systemic therapy, which works with families at all levels: the parents, kids in school, and in the school environment. Peer influences can exacerbate the problems in children with conduct disorder, Dr. Fernandez explains.
There’s evidence that kids who complete these treatments can have successful outcomes and effectively improve their functioning. As with most behavior disorders, the earlier treatment starts, the better the outlook.
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