Conduct disorder is known as a series of emotional and behavioral problems that usually occur in children and adolescents.
This disorder is characterized by displaying a pattern of disruptive and violent behavior and having trouble following rules. Although it is not uncommon for children or adolescents to behave in this way, it can be a case of conduct disorder when these problems have a long duration, and affect the daily life of both oneself and those around them.
Causes of conduct disorder
The exact cause(s) of conduct disorder is not known, however, experts believe that a combination of factors play a role:
- Environmental factorsThese include dysfunctional family life, a family history of substance abuse, child abuse, traumatic experiences, inconsistent, harsh, or ineffective parental discipline, and parental rejection or neglect.
- biological factors: as defects or lesions in certain areas of the brain, for example, those involved in the regulation of behavior, impulse control and emotions.
- Genetic factors: Such as close family members with mental illnesses, including mood disorders, anxiety disorders, substance use disorders, and personality disorders.
- Psychological factors: such as deficits in cognitive processing or problems with moral conscience, for example, lack of guilt and remorse.
- Social factors: such as low socioeconomic status or not being accepted by peers.
What are the symptoms of conduct disorder
Symptoms of conduct disorder can be divided into four general categories:
- Physical aggression: includes behaviors that threaten or cause physical harm, such as fighting, intimidation, cruelty to others or animals, or use of weapons, among others.
- violate the rights of others: Includes the intentional destruction of property, such as fire or vandalism, among others.
- lie or manipulation: includes repeatedly lying or manipulating the environment.
- criminal behavior: Includes shoplifting, breaking into homes or cars to steal, or skipping school, among others.
In addition, it is common for many children or adolescents with conduct disorder to be constantly irritable, have low self-esteem, abuse alcohol and drugs, and feel little or no guilt or remorse for hurting others.
How conduct disorder is diagnosed
To diagnose a conduct disorder, a child psychiatrist, psychologist, or other mental health professional will take a detailed history of the child’s behavior, as well as any relevant biological, psychological, social, and cultural factors.
They will also review historical data, such as school records, child welfare/court records, or past treatment, and conduct interviews with the child’s environment.
There is no physical exam or laboratory tests (for example, neuroimaging studies, or blood tests) that determine a conduct disorder, although these tests are often used because they are useful to know if there is another condition that may be responsible for the symptoms.
What treatments are there for conduct disorder?
Treatment for conduct disorder will depend on many factors, including the child’s age, severity of symptoms, and ability to tolerate or participate in therapies (people with conduct disorder tend to be uncooperative with others ).
Generally, a combination of the following options is chosen:
- Psychotherapy: The goal of this practice is to help the child learn to express and control anger in more appropriate ways. There are many options, for example, cognitive behavioral therapy seeks to improve problem-solving skills, anger management, moral reasoning skills and impulse control. Another option is family therapy, which serves to improve interactions and communication between family members.
- Medicines: There is no formally approved medication to treat conduct disorder, however, certain medications may be used to treat some of the distressing symptoms, such as impulsiveness, aggression, or dysregulated mood.
Although conduct disorder is difficult to treat, experts say it is manageable, and successful treatment largely depends on early intervention. It is not possible to prevent this condition, but recognizing and acting on symptoms when they appear is key.
It is also important to provide an environment at home that is pleasant, in which there is a constant balance between love and discipline.
If conduct disorder is not treated there is an increased risk of:
- Substance abuse.
- Develop comorbidities.
- Injure oneself.
- Suffer from sexually transmitted infections.
- Have legal problems.
- Having school problems, such as failing or dropping out.
- Develop other mental problems during adulthood, such as antisocial, personality, mood, or anxiety disorders.
Cases of conduct disorder
It is difficult to know the number of cases of conduct disorder in the world. This is largely due to the difficulty or impossibility of obtaining a correct diagnosis in many regions, as well as the different methodologies or criteria used to identify this problem.
The percentages tend to vary, while in Spain it is estimated that it affects between 3 and 7% of school-age children, in the US this figure is between 2 and 16%, and in Mexico it rises to 20%.
It is also recorded to be more common in boys than girls, and occurs more often in late childhood or early adolescence.
Sources consulted: American Psychiatric Association, US National Library of Medicine, Centers for Disease Control and Prevention (CDC), Mayo Clinic, World Health Organization (WHO), Pan American Health Organization (PAHO).