Conduct Disorder

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KEY POINTS

• Children with conduct disorder may lie, steal, set fires, run away from home, be cruel to animals and people, and defy authority.
• Treatment may include therapy, medicines, and parent counseling on how to set limits with their child and be consistent and realistic when disciplining. Some children with this disorder need to spend time in special schools and residential facilities.

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What is conduct disorder?

Children with conduct disorder repeatedly break the rules of home, school, and community. They ignore the personal and property rights of others. They may lie, steal, set fires, run away from home, be cruel to animals and people, and defy authority. A child with this disorder behaves this way for at least a year or longer.

What is the cause?

The cause of conduct disorder is unknown. It seems to occur more in some families. Many times, environment is a factor. A child may imitate physical or verbal abuse seen within the family. Watching violent TV shows and movies or being exposed to violence may teach children that violence is okay.

Factors that may increase the risk of developing this disorder include:

• Brain injury or physical differences in the brain
• Poor parenting, such as using harsh discipline, not setting consistent rules or limits for children, or not supervising children
• Parents who abuse drugs or alcohol, commit crimes, or are violent
• Neglect, abuse, or poverty
• Hanging out with friends who misbehave

What are the symptoms?

Symptoms may include:

• Aggression to people and animals. Children may bully, threaten, or intimidate others. They may start fights or be physically cruel to animals or people. This may include violence or unwanted sexual activity.
• Destruction of property. Children may deliberately destroy other's property or set fires.
• Deceitfulness or theft. Children often lie. They may break into people’s homes or cars, steal money from others, or steal from stores or other people.
• Break rules. Children may stay out late without parent’s permission, run away from home, and skip school.

Children with conduct disorder often have other problems as well. These may include:

• Hyperactivity
• Depression
• Anxiety
• Learning disabilities
• Substance abuse
• Problems making friends and getting along with others because a child with conduct disorder doesn’t care how other people feel

How is it diagnosed?

The healthcare provider will do a physical exam and ask about the child's symptoms and behavior. Medical tests and a psychological evaluation may be done. Diagnosis of conduct disorder is made only after other conditions are ruled out.

How is it treated?

It is usually best to use several different approaches to treat conduct disorder.

• Behavioral therapy can help a child learn to control his anger and develop new coping skills.
• Parenting skill training can help you learn how to manage your child’s behaviors. You can learn ways to set firm limits, solve conflicts calmly, and be consistent with rules and consequences. It helps to praise your child when he behaves well. You can also look at ways to help such as making sure there is no violence in the home, including no violent TV shows, movies, or video games.
• Group therapy can help teach social skills, such as controlling anger. It may help teach your child how to cooperate with others.
• Home based family therapy is often very helpful. Family therapy treats all members of the family rather than working with just the child. It helps the whole family to make changes.
• Medicines may be prescribed if the child is depressed, hyperactive, anxious, or violent.
• Some children with this disorder need to spend time in special schools and residential facilities.

About half of the children with this disorder "grow out of it" by adulthood. The others often have problems as adults. These problems may include criminal behavior, aggression, and trouble holding a job.

How can I help my child?

The following suggestions may help you to help your child.

• Set firm limits. Make it clear to your child that being mean is not OK. Give clear, consistent messages such as “we don’t hit people.” Always supervise your child when he is playing with other children so that you can quickly step in if needed. Never allow aggressive behavior, even in play. If your child is not able to calm down, remove him from the situation. Do not yell, roughhouse with, or spank an aggressive child. To do so will encourage aggressive behavior.
• Be a good role model. Always show self-control. You can’t teach your child self-control when he sees you lose your temper, threaten, or hit people. It helps if you do not use physical punishment, such as spanking. Spanking may be very confusing to an aggressive child if you have just told him not to hit people. Make sure that everyone who cares for your child agrees to use the same type of discipline.
• Keep your child away from violence. The less violence your child sees, the less likely he is to be aggressive with others. Keep your child away from people who act aggressively. Make sure there is no violence in the home and that your child is not a victim of abuse. Do not let your child watch violent TV shows or movies or play violent games. Check the age rating for any game that your child plays, including games that are played on friends devices.

You may be at a loss as to what to do. Contact a mental health professional who has experience with conduct disorder. Learn as much as you can. It is very important to be involved with your child in the treatment. Parents or other caregivers still remain the strongest influence on the child.