Bullying, hurting animals, and lying for no reason are all signs of Conduct Disorder. In younger kids, Conduct Disorder starts with pushing, hitting, and biting. In older kids, conduct disorder can come with more extreme violent behavior and/or crimes like stealing, destroying things, and setting fires.

All kids act out sometimes, so Conduct Disorder is only diagnosed when this extreme behavior shows up over a long period and is not associated with the child’s environment.

What are the symptoms of Conduct Disorder?

Conduct Disorder is diagnosed in an individual when they show a persistent, repetitive pattern of behavior where age-appropriate social norms or rules or the basic rights of others are violated. These behaviors result in significant impairment in social, academic, or day-to-day functioning. Specific symptoms Conduct Disorder are as follows:

Core Symptoms

Aggression toward people or animals:

  • Often bullying, threatening or intimidating others
  • Often initiating physical fights
  • Having used a weapon that can cause serious harm to others
  • Being physically cruel to others
  • Being physically cruel to animals
  • Having stolen during a confrontation (e.g., mugging, robbery, extortion)
  • Having forced another into sexual activity

Destruction of property:

  • Deliberately engaging in fire setting with intention of causing damage
  • Destroying others’ property deliberately

Deceitfulness or theft:

  • Breaking into another's home or car
  • Often lying to obtain goods, favors, or to avoid obligations
  • Stealing items without confronting the victim (e.g., shoplifting, breaking-and-entering, forgery)

Serious violations of rules:

  • Often staying out at night despite parents’ requests and prohibitions, beginning before age 13 years
  • Has a history of running away from home at least twice, once without returning for a lengthy period of time
  • Often truant from school, beginning before age 13 years

How is Conduct Disorder Diagnosed?

Conduct disorder is different from just bad behavior or acting out, which most kids do at some point. Kids and teens must show symptoms of Conduct Disorder for several months at a time to be diagnosed. Before diagnosing someone with Conduct Disorder, a child-adolescent psychiatrist will also try to figure out if their extreme behavior could be a reaction to problems at home or elsewhere. To be diagnosed, the individual’s enjoyment of causing pain must seem to come from something inside them.

A child-adolescent psychiatrist will diagnose a child with Conduct Disorder after determining whether the symptoms they are experiencing meet the diagnostic criteria and that the symptoms are having a significant impact on day-to-day life. This may be accomplished through caregiver, teacher, and child interviews, as well as behavior and emotion rating form results to support the diagnosis.

Conduct Disorder Facts

Worldwide frequency of the condition

Worldwide estimates for Conduct Disorder vary greatly between 2% and 10%. For children and adolescents, the prevalence is about 2%. While there is no recent, specific epidemiological data for Greece, a recent review of European countries reported a 1.5% frequency of the disorder in children and adolescents.

Burden of the condition in Greece

Conduct-related disorders account for 5.8% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents. They are the 2nd most prominent mental health condition adding to the health burden of the Greek child and adolescent population.

Gender ratio

Gender comparative data for Conduct Disorder suggests that males are more likely to be diagnosed than females at a rate between 1.5:1 and 2:1.

Peak age of onset

There is no recent, specific epidemiological data for Conduct Disorder onset. However, adolescents who showed no symptoms prior to age 10, receiving an “adolescent-onset” diagnosis are more common than children receiving a “childhood-onset” diagnosis.

Proportion of the condition that emerges before age 18

Conduct Disorder is not diagnosed in adults. Therefore, the proportion that emerges before age 18 years is near 100%, meaning that near 100% of individuals with Conduct Disorder will have been diagnosed by the time they are 18 years old.

What are the associated factors for Conduct Disorder?

Several things put individuals at higher risk of developing Conduct Disorder:

  • Genetic and familial factors. Predisposition toward Conduct Disorder most likely results from a combination of multiple genes that interact in a complex way with multiple environmental factors. Having a first-degree relative, such as a parent or sibling, with Conduct Disorder places an individual at higher risk. Also, having a biological parent who abuses alcohol or has depression, ADHD, bipolar disorder, or schizophrenia.
  • Birth complications.
  • Temperament.
  • Emerging personality traits.
  • Environmental factors. Maternal stress, smoking, or alcohol/substance abuse. Harsh or inconsistent discipline, parent-child conflict, as well as community violence, low socioeconomic status, or poverty, may also contribute. Experiencing abuse or neglect, including malnutrition, being bullied, or having friends who encourage negative behavior.

What other disorders co-occur with Conduct Disorder?

ADHD and ODD are commonly comorbid with Conduct Disorder. Conduct Disorder may also co-occur with learning disabilities, anxiety disorders, depressive disorders, bipolar disorders, and/or substance abuse disorders.

How is Conduct Disorder treated?

Conduct Disorder is difficult to treat but treatment can work if the individual’s family, friends, and teachers get involved. Treatment works better if it starts when the individual is young.

In therapy for Conduct Disorder, the individual learns healthier ways to interact with others. At the same time, his or her family and support system learn ways to communicate with them. Children or teens with Conduct Disorder usually stay in psychotherapy or behavioral therapy for a long time.

In younger children, therapy for Conduct Disorder usually involves teaching parents how to encourage good behavior. In adolescents, therapy may also focus on the teen’s relationships with friends, other kids, and adults at school (i.e., teachers and principals).

There is no medication specifically for Conduct Disorder. But kids sometimes have other disorders as well, like depression or ADHD. Treating those other disorders with medication can help therapy for Conduct Disorder work better.

Where to find more information

If you need more information on these behaviors and reasons for concerns, you can also go to "Rule breaking behavior and aggression" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2021, September 7). Quick guide to Conduct Disorder. https://childmind.org/guide/quick-guide-to-conduct-disorder/
  • Miller, G. (2021, October 5). What Is Conduct Disorder? https://childmind.org/article/what-is-conduct-disorder/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6C91 Conduct-Dissocial Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f719572464

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Konrad, K., Kohls, G., Baumann, S., Bernhard, A., Martinelli, A., Ackermann, K., Smaragdi, A., Gonzalez‐Madruga, K., Wells, A., Rogers, J. C., Pauli, R., Clanton, R., Baker, R., Kersten, L., Prätzlich, M., Oldenhof, H., Jansen, L., Kleeven, A., Bigorra, A., … Freitag, C. M. (2022). Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. Journal of Child Psychology and Psychiatry, 63(2), 218–228. https://doi.org/10.1111/jcpp.13428
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Kerekes, N., Lundström, S., Chang, Z., Tajnia, A., Jern, P., Lichtenstein, P., Nilsson, T., & Anckarsäter, H. (2014). Oppositional defiant- and conduct disorder-like problems: Neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study. PeerJ, 2, e359. https://doi.org/10.7717/peerj.359
  • Mohammadi, M.-R., Salmanian, M., & Keshavarzi, Z. (2021). The Global Prevalence of Conduct Disorder: A Systematic Review and Meta-Analysis. Iranian Journal of Psychiatry. https://doi.org/10.18502/ijps.v16i2.5822
  • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. https://doi.org/10.1111/jcpp.12381
  • Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02131-2
  • Wu, J., Chen, L., Li, X., Yue, S., Huang, X., Liu, J., Hou, X., & Lai, T. (2022). Trends in the prevalence of conduct disorder from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. Psychiatry Research, 317, 114907. https://doi.org/10.1016/j.psychres.2022.114907

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Azeredo, A., Moreira, D., & Barbosa, F. (2018). ADHD, CD, and ODD: Systematic review of genetic and environmental risk factors. Research in Developmental Disabilities, 82, 10–19. https://doi.org/10.1016/j.ridd.2017.12.010
  • Karwatowska, L., Russell, S., Solmi, F., De Stavola, B. L., Jaffee, S., Pingault, J.-B., & Viding, E. (2020). Risk factors for disruptive behaviours: Protocol for a systematic review and meta-analysis of quasi-experimental evidence. BMJ Open, 10(9), e038258. https://doi.org/10.1136/bmjopen-2020-038258
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Maniglio, R. (2015). Significance, Nature, and Direction of the Association Between Child Sexual Abuse and Conduct Disorder: A Systematic Review. Trauma, Violence, & Abuse, 16(3), 241–257. https://doi.org/10.1177/1524838014526068
  • Maniglio, R. (2014). Prevalence of Sexual Abuse Among Children with Conduct Disorder: A Systematic Review. Clinical Child and Family Psychology Review, 17(3), 268–282. https://doi.org/10.1007/s10567-013-0161-z
  • Yockey, R. A., King, K. A., & Vidourek, R. A. (2021). Family factors and parental correlates to adolescent conduct disorder. Journal of Family Studies, 27(3), 356–365. https://doi.org/10.1080/13229400.2019.1604402

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Bevilacqua, L., Hale, D., Barker, E. D., & Viner, R. (2018). Conduct problems trajectories and psychosocial outcomes: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 27(10), 1239–1260. https://doi.org/10.1007/s00787-017-1053-4
  • Zavaglia, E., & Bergeron, L. (2017). Systematic review of comorbidity between DSM disorders and depression according to age and sex in youth. Canadian Psychology / Psychologie Canadienne, 58(2), 124–139. https://doi.org/10.1037/cap0000085

Interventions

  • Bakker, M. J., Greven, C. U., Buitelaar, J. K., & Glennon, J. C. (2017). Practitioner Review: Psychological treatments for children and adolescents with conduct disorder problems - a systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 58(1), 4–18. https://doi.org/10.1111/jcpp.12590
  • Battagliese, G., Caccetta, M., Luppino, O. I., Baglioni, C., Cardi, V., Mancini, F., & Buonanno, C. (2015). Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness. Behaviour Research and Therapy, 75, 60–71. https://doi.org/10.1016/j.brat.2015.10.008
  • Boldrini, T., Ghiandoni, V., Mancinelli, E., Salcuni, S., & Solmi, M. (2023). Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 62(2), 169–189. https://doi.org/10.1016/j.jaac.2022.05.002
  • Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., Odgers, C. L., Franke, B., Freitag, C. M., & De Brito, S. A. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 43. https://doi.org/10.1038/s41572-019-0095-y
  • Karukivi, J., Herrala, O., Säteri, E., Tornivuori, A., Salanterä, S., Aromaa, M., Kronström, K., & Karukivi, M. (2021). The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12–18—A Systematic Review. Frontiers in Psychiatry, 12, 779933. https://doi.org/10.3389/fpsyt.2021.779933
  • Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A systematic review and meta-analysis. Part 1: Psychostimulants, alpha-2 agonists, and atomoxetine. The Canadian Journal of Psychiatry, 60(2), 42–51. https://doi.org/10.1177/070674371506000202
  • Riise, E. N., Wergeland, G. J. H., Njardvik, U., & Öst, L.-G. (2021). Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clinical Psychology Review, 83, 101954. https://doi.org/10.1016/j.cpr.2020.101954

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