What is Conduct Disorder?

Conduct Disorder (CD) is a psychological condition. It typically begins in childhood or adolescence and is characterised by persistent patterns of disruptive, aggressive, and antisocial behaviour. These behaviours go beyond minor mischief or teenage rebellion. People with CD may disregard the rights of others, social norms, or rules.

For children and young people diagnosed with this disorder, the behaviour is often severe enough to cause significant problems at home, school, or in social settings. Behaviours associated with Conduct Disorder might include bullies others, being physically aggressive, stealing, lying, or damaging property.

CD is recognised as a mental health issue. It can sometimes lead to more serious conditions in adulthood, such as antisocial personality disorder (ASPD), if left untreated. Early diagnosis and treatment are crucial.

What are the Causes of Conduct Disorder?

There isn’t a single cause of Conduct Disorder. Instead, it stems from a combination of genetic, biological, and environmental factors. Some contributing causes include:

• Genetics: A family history of mental health disorders, such as depression or behaviour issues, can increase the likelihood of CD.
• Brain Development: Some children with CD have differences in brain areas linked to emotions and impulse control.
• Trauma or Abuse: Experiencing physical, emotional, or sexual abuse can lead to this condition.
• Parenting Style: Authoritarian or neglectful parenting can contribute to behavioural issues.
• Social Environment: Children raised in deprived or unsafe environments might be more vulnerable.
• Other Mental Health Disorders: Co-existing conditions, such as ADHD or anxiety, can increase the risk of developing CD.

Some children may only display behaviour problems in specific settings, such as at home, while others struggle across multiple environments. Understanding the root causes is an important step in deciding the right type of support and intervention.

Conduct Disorder Symptoms

The symptoms of Conduct Disorder generally fall into four main categories:

Aggression to People and Animals:

• Physical fights with others.
• Bullying, threatening, or intimidating others.
• Hurting animals deliberately (animal cruelty).
• Using weapons to cause harm.

Destruction of Property:

• Destroying items or property on purpose (arson is a common example).
• Vandalising property.

Deceitfulness or Theft:

• Breaking into buildings or homes.
• Lying for personal gain or to avoid punishment.
• Stealing objects, such as shoplifting.

Serious Violation of Rules:

• Running away from home without parental permission regularly.
• Skipping school (truancy).
• Breaking curfews or engaging in illegal activities.

The severity and frequency of these behaviours vary between individuals, but they must persist for at least six months to meet diagnostic criteria. Symptoms can cause long-term problems in relationships, education, or employment if not addressed.

Types of Conduct Disorders

Conduct Disorder can be divided into three subtypes based on when the symptoms begin:

1. Childhood-Onset Type: Symptoms appear before the age of 10. This type tends to involve more severe behaviour, and children are more likely to develop long-term problems.
2. Adolescent-Onset Type: Symptoms appear after the age of 10. Behavioural problems are usually less severe, and individuals are more likely to grow out of the condition.
3. Unspecified Onset Type: Symptoms are present, but it’s uncertain whether they began in childhood or adolescence.

CD is also classified based on severity:

• Mild: Fewer behaviour problems, like lying or truancy.
• Moderate: Includes more harm to others, such as vandalism or stealing.
• Severe: Highly aggressive behaviour, like fighting, bullying, or weapon use.

Conduct Disorder Treatment

Treatment for Conduct Disorder can vary depending on the individual’s needs. Early intervention tends to be the most effective approach. Some of the common methods of treatment include:

• Psychotherapy: Talking therapies such as Cognitive Behavioural Therapy (CBT) can help children or adolescents understand the consequences of their behaviour and learn better ways to manage emotions.
• Parent Training Programmes: Parents receive training to help them support their child effectively. These programmes focus on discipline techniques, positive reinforcement, and managing challenging situations.
• Social Skills Training: This method helps children build skills to interact appropriately with others. It focuses on empathy, sharing, and respect.
• Medication: While medication is not typically the primary treatment, it may be recommended in some situations. For example, medicines could help manage co-occurring issues like ADHD, anxiety, or depression.

Regardless of the method, a tailored and team-based approach is key. Families, schools, and healthcare professionals often work together.

Conduct Disorder in Adults

While CD is commonly diagnosed in children and adolescents, some adults may continue to display these patterns of behaviour. In adults, the disorder may present as a long-standing disregard for social norms or laws, similar to traits seen in antisocial personality disorder. These individuals might struggle with maintaining relationships, employment, or avoiding legal issues.

Adults with untreated CD often exhibit persistent aggression, hostility, manipulation, and violations of others’ rights. It’s worth noting that, in many cases, if Conduct Disorder is not managed during childhood or adolescence, it can develop into more severe behaviour.

Conduct Disorder and Children & Young People

The understanding and support for those with Conduct Disorder have improved in recent years. Services such as Child and Adolescent Mental Health Services (CAMHS) provide referrals, diagnoses, and interventions for children showing signs of the condition. There is growing awareness and recognition of how important it is to address CD early.

Organisations such as YoungMinds and the National Autistic Society offer resources for parents and carers to provide insight into managing behaviour and seeking help.

Conduct Disorder and the NHS

The NHS provides free support and information for individuals and families dealing with Conduct Disorder. Through the NHS, families can access:

• CAMHS: Specialist services for young people with mental health problems, which include Conduct Disorder.
• Therapy Programmes: Depending on the severity of the condition, the NHS may provide therapies like family therapy or individual counselling.
• Support Groups: The NHS can connect families with other carers to share experiences and tips.

Parents of children with Conduct Disorder can start by contacting their GP, who can refer them to CAMHS or behavioural specialists.

How to Discipline a Child with Conduct Disorder

Disciplining a child with Conduct Disorder requires a consistent, structured, and nurturing approach. Standard discipline techniques might not work, as children with CD often act without considering consequences. Here are some strategies:

• Set Clear Rules and Boundaries: Children need to understand what behaviours are acceptable. Be specific and fair.
• Be Consistent: All caregivers should enforce the same rules and consequences.
• Use Positive Reinforcement: Reward the child for good behaviour to encourage repetition of those actions.
• Provide Natural Consequences: Allow the child to see the outcomes of their behaviour, such as having to apologise or replace damaged items.
• Teach Problem-Solving: Help the child learn to resolve conflicts without aggression.
• Seek Professional Help: Engage with therapy or parenting programmes to better equip oneself with appropriate strategies.

Avoid using harsh punishment. This can escalate aggression or worsen their non-compliance.

Final Thoughts

Conduct Disorder is a complex condition that can have profound impacts on children, families, and communities. With the right diagnosis and a structured plan, many children can learn to develop healthier patterns of behaviour. If you suspect that a young person in your care may have Conduct Disorder, reaching out to professionals for guidance can make a marked difference.