What is Conduct Disorder?
Remember that kid at school who constantly seemed to be causing some sort of mayhem. Maybe he would bully other kids, maybe he would destroy school property or perhaps he would even break into people’s homes. All of these behaviours are potential indicators of someone who has conduct disorder. So what is conduct disorder?
Conduct disorder is a serious behavioural and emotional disorder that can be present in children and teenagers up to the age of 18. Young people with conduct disorder will often display patterns of disruptive and violent behaviour and may have difficulties following rules or complying with authority figures. Many young people with conduct disorder will go on to develop antisocial personality disorder (APD); in fact many of these symptoms tend to overlap with the primary difference being that APD is diagnosed after the age of 18.
They may also find themselves involved with police, attending court of even in the juvenile justice system as a result of committing crime. This is a pattern that can often extend into adulthood, understandably causing significant issues for the person themselves, their loved ones and the community.The DSM-5 outlines a number of behaviours that are often indicative of conduct disorder including:
Aggression to People and Animals
Often bullies, threatens, or intimidates others
Often initiates physical fights
Has used a weapon that can cause serious physical harm to others
Has been physically cruel to people
Has been physically cruel to animals
Has stolen while confronting a victim
Has forced someone into sexual activity
Destruction of Property
Has deliberately engaged in fire setting with the intention of causing serious damage
Has deliberately destroyed others’ property (other than by fire setting).
Deceitfulness or Theft
Has broken into someone else’s house, building or car
Often lies to obtain goods or favours or to avoid obligation
Has stolen items of nontrivial value without confronting a victim
Serious Violations of Rules
Often stays out at night despite parental prohibitions, beginning before age 13 years.
Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period
Is often truant from school, beginning before age 13 years
What are the causes of conduct disorder?
Genetic
In one study, children whose mothers were felons and who were later adopted were compared to adopted children of ‘normal’ mothers. It was found that adopted children of felons had significantly higher rates of arrest, conviction and APD than did adopted offspring’s of normal mothers, suggesting some sort of genetic influence. However, it is also worth noting that these children also spent more time in interim orphanages, suggesting a gene-environment interaction. Other studies have found that if a child’s biological parents had a history of APD and their adoptive families exposed them to chronic stress, they were at greater risk for conduct problems further reinforcing the notion of a gene-environment interaction.
Arousal theories
The under arousal hypothesis suggests that these children have abnormally low levels of cortical arousal compared to a healthy population. This may provide an explanation for many of these risk taking behaviours as behaviours such as lying or stealing may provide the same level of arousal that others get from seeing a close friend for lunch. The fearlessness hypothesis suggests that this population may have a higher threshold for experiencing fear and therefore, events that most people find frightening would appear to have little effect on them. It has been therefore suggested that young people with conduct disorder experience less fear and anxiety than others and may potentially experience more positive feelings and motivation to achieve the rewards associated with their risk taking behaviours.
Psychological and Social
One study had a group of people engage in a card playing task on a computer. It was fixed at first to provide rewards 90% of the time and losses 10% of the time however eventually the reward became 0%. Despite feedback that the rewards would no longer be available, the people displaying antisocial tendencies continued to play and lose while those without these tendencies stopped playing. This suggests that these people are often not easily deterred once they have their sights set on a reward, despite signs that this is no longer attainable.
It has been suggested that this may be a pattern that could have begun early on in life, particularly in situations by which a child and parent would continue to argue until the parent finally gave in. The child in this instance learned to continue fighting for what they desired, even if what they wanted was dysfunctional and went against authority, laws or social norms. Recently trauma has also been proposed as a potential pre-determinant of conduct disorder. In this way, many of the symptoms of conduct disorder including lack of empathy, impulsivity and anger may be viewed as a defence mechanism to ward away feelings of sadness, shame or inadequacy.
What are the treatment options?
A problem with treating this group is that often they do not recognise that they need any sort of treatment or support. The majority of treatment options for children with conduct disorder, and that which has been found to be highly effective is primarily around parenting training. This involves a process whereby parents are taught to recognise problem behaviours early and learn how to use praise and privileges to reduce these behaviours and encourage prosocial behaviours instead. Better yet, prevention strategies are even more effective if these behaviours are recognised early enough. These often take place in the form of school and preschool programs whereby the focus is on behavioural supports for good behaviour and skills training to improve social competence.
Conduct disorder is a serious mental health issue that can lead to significant issues in the lives of the person themselves, their friends and family and the community as a whole. Society tends to look down upon this group of people due to the damage that they can often cause, however conduct disorder is often highly misunderstood and there are usually much deeper issues going on for these young people.
Without a greater understanding of conduct disorder, young people may feel alienated and misunderstood further perpetuating this cycle of participating in risk taking behaviours. We still have a long way to go in our understanding and treatment of young people with conduct disorder but a greater awareness and understanding of what it looks like, its causes and available treatment options is a great first step.