Conduct Disorder (CD) refers to the diagnostic category that applies to children and adolescents who display a pervasive and persistent pattern of problem behaviour characterised by aggression, deceitfulness, serious violations of age-appropriate social norms and basic rights of others.
It is included in DSM-IV-TR (American Psychiatric Association, 2000) among Disruptive Behaviour Disorders, together with Oppositional Defiant Disorder (ODD) and Attention Deficit/Hyperactivity Disorder (ADHD). These disorders, especially ODD and CD, encompass consistent patterns of behaviours which break the rules and consistently compromise the life of people around the affected individual. Although in general it is common for children and adolescents to have problem behaviour at some time during their development, such behaviours are diagnosed as CD when they are long-lasting and violate the rights of others, going against accepted norms of behaviour and disrupting the child’s everyday life.
The pattern of antisocial and aggressive behaviours typical of CD may become prominent in childhood and persists through adolescence into adulthood as Antisocial Personality Disorder (ASPD). Evidence from longitudinal studies has been consistent with the view that antisocial behaviour in childhood might persist over time. It has been widely pointed out that it is rare to find an antisocial adult who did not exhibit conduct problems as a child (Robins, 1966, 1978), and approximately half of children and adolescents with CD develops ASPD in adulthood, highlighting the potential lifelong course of conduct problems (Loeber, 1982; Steiner, 1997).
To date, conduct problems are considered as one of the most prevalent problem behaviour in young people. A survey conducted on clinical population in the UK found that, among all young people who seek treatment at Child and Adolescent Mental Health Services, between 40% and 60% had some form of disruptive, antisocial or aggressive behaviour (Audit Commission, 1999).
With regards to gender differences, the majority of research on CD suggests that a significantly greater number of males, rather than females, is affected, with some reports demonstrating a threefold to fourfold difference in prevalence (Lahey et al., 1999). This difference, however, might be somewhat biased by the diagnostic criteria which focus on more overt behaviours, such as aggression and fighting, that are more likely to be exhibited by males. On the contrary, females with CD usually show covert behaviours, such as stealing.
CD is itself a complex disorder, which is further complicated by the fact that young people with behaviour disorders have often other conditions (Maughan et al, 2004). Children and adolescents with CD usually perform worse than peers at school and often do not complete schooling (Robins, 1991). They are characterised by continuous aggressive tendencies and seem to lack the social skills to interact with peers (e.g., they do not pay attention to social cues, often misinterpret other children’ behaviour as hostile and lack the ability to solve difficult social and relational issues). In conflict situations, these children tend to display intense anger and to have aggressive actions rather than verbally mediated responses. In these situations, they almost always blame peers and seldom take responsibility for their own actions. Additionally, sometimes children and adolescents with CD also present co-occurring disorders. CD is thought to be particularly related to ODD, which symptoms are sometimes followed by CD symptoms, and thus a large portion of young people with CD may simultaneously qualify for ODD (Faraone et al., 1991). Reversely, early-onset CD has been seen as a risk factor for ODD, and co-occurring ODD in young people with CD often results in more severe aggression and persistent or worsening conduct problems over time (Lahey et al., 2002). In addition to ODD, CD often co-occurs with ADHD, learning disabilities, substance use and abuse, depression (Rey, 1994; Searight et al., 2001; Greene et al., 2002).
In conclusion, CD is a severe developmental condition, generally exhibited by children but also persistent into adulthood. There is an extreme need of research aiming to identify factors that might prevent the onset of this disorder and the persistence of antisocial behaviour. A better awareness of its severity is also extremely important, in order to provide rigorous screening and assessment of conduct problems since the early childhood.
By Giorgia Michelini
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn. Text Revision ed.). Washington, DC, USA: American.
Audit Commission (1999). Children in Mind. London: Audit Commission Publications.
Faraone, S. V., Biederman, J., Keenan, K., & Tsuang, M. T. (1991). Separation of DSM-III attention deficit disorder and conduct disorder: Evidence from a family-genetic study of american child psychiatric patients. Psychological Medicine, 21(1), 109-121.
Greene, R. W., Biederman, J., Zerwas, S., Monuteaux, M. C., Goring, J. C., & Faraone, S. V. (2002). Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. The American Journal of Psychiatry, 159(7), 1214-1224.
Lahey, B. B., Loeber, R., Burke, J., Rathouz, P. J., & McBurnett, K. (2002). Waxing and waning in concert: Dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 7 years among clinic-referred boys. Journal of Abnormal Psychology, 111(4), 556-567.
Lahey, B. B., Waldman, I. D., & McBurnett, K. (1999). Annotation: The development of antisocial behavior: An integrative causal model. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 40(5), 669-682.
Loeber, R. (1982). The stability of antisocial and delinquent child behavior: A review. Child Development, 53(6), 1431-1446.
Maughan, B., Rowe, R., Messer, J., Goodman, R., & Meltzer, H. (2004). Conduct disorder and oppositional defiant disorder in a national sample: Developmental epidemiology. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 45(3), 609-621.
Rey, J. M. (1994). Comorbidity between disruptive disorders and depression in referred adolescents. The Australian and New Zealand Journal of Psychiatry, 28(1), 106-113.
Robins, L. N. (1966). Deviant Children Grown-Up: A Sociological and Psychiatric Study of Sociopathic Personalities. MD: Williams and Wilkins.
Robins, L. N. (1978). Sturdy childhood predictors of adult antisocial behaviour: Replications from longitudinal studies. Psychological Medicine, 8(4), 611-622.
Robins, L. N. (1991). Conduct disorder. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 32(1), 193-212.
Searight, H. R., Rottnek, F., & Abby, S. L. (2001). Conduct disorder: Diagnosis and treatment in primary care. American Family Physician, 63(8), 1579-1588.
Steiner, H. (1997). Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36(10 Suppl), 122S-39S.