Conduct disorder (CD) is a disruptive disorder that entails a high amount of problematic behaviors and antisocial activities. Children and adolescents with the condition show aggression toward others and willfully destroy property, steal, or lie.
Estimated prevalence in the United States:
- Highest in adolescent age group
- Boys > girls
40% of children diagnosed with CD will develop antisocial personality disorder in adulthood.
- No definitive theory owing to multiple risk factors and comorbidities
- Risk factors:
- Uncontrolled infant temperament
- Lower-than-average intelligence, especially verbal IQ
- Parental neglect
- Physical/sexual abuse
- Parental criminality
- Rejection by peers
- Exposure to violence and/or substance misuse
- Genetic and physiologic: higher risk in children with a biologic parent/sibling with other psychiatric comorbidities
Clinical Presentation and Diagnosis
DSM-5 diagnostic criteria
- A chronic pattern of maladaptive behavior in age-appropriate societal norms or infringing on the rights of others
- Several subsets, depending on the age at onset
|Aggression to people and animals|
|Destruction of property|
|Deceitfulness or theft|
|Serious violation of rules|
- The behavior causes clinically significant impairment in social, academic, or occupational functioning.
- If persistent after age 18, CD is reclassified as antisocial personality disorder.
- The diagnostic evaluation should include collateral information from family and other caregivers as well as academic reports, if available.
- Basic laboratory work, such as urine drug screening, can be valuable to rule out substance use disorders or other comorbid medical disorders.
- Family therapy: increase communication skills, improve family interactions
- Behavioral therapy: anger management, improve social skills
- Pharmacotherapy: directed at specific symptoms
|Target symptoms||Pharmacologic options|
|Aggression, explosiveness||Mood stabilizers (e.g., lithium)|
|Impulsivity, hyperactivity, inattention|
- Childhood-onset CD: higher risk of developing adult antisocial disorder and substance use disorders
- Adolescent-onset CD: better prognosis, may respond better to interventions
- Oppositional defiant disorder (ODD): pediatric psychiatric disorder featuring a continuous pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness directed at adults or other authority figures. Symptoms must be present for ≥ 6 months. ODD patients do not show aggressive or violent behavior, and they do not impinge on other people’s rights as do those with CD.
- ADHD: neurodevelopmental disorder characterized by a pattern of inattention and/or hyperactivity/impulsivity that occurs in ≥ 2 different settings for > 6 months. Onset is usually before age 12 years. ADHD is a common comorbidity of CD; however, the hyperactivity and impulsive behavior of ADHD generally do not violate societal norms or the rights of others.
- Disruptive mood dysregulation disorder (DMDD): childhood mental disorder that involves chronic negative mood, irritability, and severe recurrent temperamental outbursts. Although the emotional outbursts are disproportionate to the developmental/maturity stage of the child, these episodes are not severe enough to be classified as CD, nor do they affect others’ rights as in CD.
- Intermittent explosive disorder: recurrent, severe, angry outbursts with normal mood between outbursts. Symptoms persist for > 3 months. Onset can be in late childhood or adolescence, but intermittent explosive disorder is usually diagnosed in young men (> age 18). Angry outbursts are not as severe or violent/damaging to others as behaviors seen in CD. These outbursts are also accompanied by regret, which is not commonly seen in CD.
|Characteristics||Oppositional defiant disorder (ODD)||Disruptive mood dysregulation disorder (DMDD)||Conduct disorder (CD)|
|Onset||Preschool age||Ages 6–10|
|Mood||Angry/irritable||Angry/irritable||No mood component|
|Impairment in interpersonal relationships||Exhibits continued and frequent argumentative/defiant behaviors inconsistent with developmental level||Exhibits outbursts of emotion inconsistent with developmental level|
|Psychological features||Extreme and disproportionately angry response to stimulus||Lack of empathy, remorse, guilt|
|Exclusion diagnosis||Not diagnosed if patient meets criteria for DMDD||May co-occur with ADHD, CD, depressive disorders, and substance use disorders|
- Mohan L, Yilanli M, Ray S. (2020). Conduct disorder. In: StatPearls Retrieved June 7, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK470238/
- Sadock BJ, Sadock VA, Ruiz P. (2014). Child psychiatry. Chapter 31 of Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th ed. Philadelphia: Lippincott Williams and Wilkins, pp. 1247–1253..
- Barzman, D. (2017). Conduct disorder and Its Clinical Management. DeckerMed Medicine.