The diagnosis of conduct disorder refers to a set of ongoing behavioral and emotional problems displayed by a child or adolescent who typically demonstrates little or no concern for the rights or needs of others. The behavior is clearly outside of what is considered normal or acceptable and is consistently troubling to others. What is most troubling is that many of these teenagers show little remorse, guilt or understanding of the damage and pain caused by their behavior. It is among the most frequently diagnosed childhood disorders in outpatient and inpatient mental health facilities. It occurs in one to four percent of nine to seventeen year olds and is far more common in boys. However, adolescent girls are increasingly being diagnosed with the disorder.
The earlier a child displays extremely disturbed behavior, the worse the prognosis. The teen with a conduct disorder has moved from being disobedient and disrespectful (behaviors characteristic of oppositional defiant disorder) to violating the rights of others with aggression and illegal activity. The behaviors are repetitive and persistent and occur in multiple settings.
Symptoms of conduct disorder are divided into four major categories:
- Aggression to people and animals and is characterized by such behaviors as bullying, threatening, intimidating, fighting, cruelty to people and animals, use of a weapon and theft while confronting a victim,
- Destruction of property characterized by fire setting or deliberately destroying others’ property
- Deceitfulness and theft
- Serious violation of rules such as running away or truancy before the age of thirteen and breaking curfew.
The diagnosis of conduct disorder implies a multitude of potential criminal behaviors as well as numerous possible biological, psychiatric and social problems. Behaviors associated with conduct disorder can indicate very different underlying problems. There is often a mixture of biological and genetic vulnerabilities combined with significant environmental and individual characteristics. Neurobiological problems can include such things as motor delays, memory problems, language difficulties and other assorted learning disabilities. These deficits, especially if unrecognized, can contribute to problems with judgment, difficulty modulating and expressing feelings, increased anger and frustration, low self esteem and a sense of alienation.
Physical, sexual and emotional abuse can also be contributing factors to the development of conduct disorder. Maternal rejection, early separation from parents without an adequate caregiver, and early institutionalization are all risk factors. Antisocial behaviors abound in poor inner city areas with high rates of family instability, social disorganization, infant mortality and morbidity and severe mental illness. Conduct disorder is often associated with attention-deficit hyperactivity disorder (ADHD), depression, bipolar disorder, anxiety, post-traumatic stress disorder (PTSD), and substance abuse. Suicidal behavior and self-mutilating behavior are not uncommon with teenagers who have conduct disorder.
Because youngsters with conduct disorders have a myriad of biological, psychological and social vulnerabilities, a combination of treatment methods targeting each area is most effective. Early recognition of youngsters at risk for conduct disorder and early intervention is most beneficial. A youngster with severe and chronic behavior problems will need a comprehensive evaluation which includes individual interviews with the child and his family, a detailed medical history, family profile and psychological testing. A psychoeducational evaluation may uncover intellectual and learning problems that could contribute to academic and behavioral problems that in turn put the adolescent at risk for truancy and disruptive behaviors.
A variety of treatment methods are available. Psychotherpies include parent management training, individual therapy, family therapy and social skills training. Through such programs, a youngster can learn to identify problems, recognize causes, appreciate consequences, learn to verbalize feelings, and consider alternative ways of handling difficult situations.
School based treatment programs, including residential therapy programs, can be helpful in trying to help a teen achieve academic success and improve their self-esteem.
While not all youngsters with conduct disorder symptoms go on to become antisocial or criminal adults, ongoing adequate medical, emotional, educational and social supports are required for many years if teenagers with severely disturbed behavior are to go on to live meaningful lives and to become productive members of society.