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'''For patient information click [[Conduct disorder (patient information)|here]]'''
'''For patient information click [[Conduct disorder (patient information)|here]]'''
__NOTOC__
__NOTOC__
{{SI}}
{{SI}}
{{CMG}}; {{AE}}: {{KS}}, {{HW}}, {{I.D.}}
{{CMG}}; {{AE}} {{KS}}, {{HW}}, {{I.D.}}


{{SK}} Conduct problems, disordered conduct, behavioral problems
{{SK}} Conduct problems, disordered conduct, behavioral problems


==Overview==
==Overview==
'''Conduct disorder''' is a psychiatric disorder characterized by a pattern of repetitive behavior wherein social norms or the rights of others are routinely violated. Possible symptoms include excessively aggressive behavior, bullying, physical aggression, cruel behavior toward people and animals, destructive behavior, lying, truancy, vandalism, and stealing.
'''Conduct disorder''' is a psychiatric disorder characterized by a pattern of repetitive behavior wherein social norms or the rights of others are routinely violated. Possible symptoms include excessively aggressive behavior, bullying, physical aggression, cruel behavior toward people and animals, destructive behavior, lying, truancy, vandalism, and stealing. After the age of 18, conduct disorder may develop into [[antisocial personality disorder]].
 
After the age of 18, conduct disorder may develop into [[antisocial personality disorder]].


== Historical Perspective ==
== Historical Perspective ==


*Three distinct periods in history have been defined for the causation of conduct disorders:<ref>{{cite web |url=https://www.duo.uio.no/handle/10852/30539 |title=The historical foundation of conduct disorders : historical context, theoretical explanations, and interventions |format= |work= |accessdate=}}</ref>
*In 1880, the origins of conduct disorder lie within the social and legal problem of delinquency.<ref>{{cite web |url=https://www.duo.uio.no/handle/10852/30539 |title=The historical foundation of conduct disorders : historical context, theoretical explanations, and interventions |format= |work= |accessdate=}}</ref>
**In 1880, the origins of conduct disorder lie within the social and legal problem of delinquency.
**From 1910 until 1968, there was increased research interest in conduct problems of children as researchers attempted to identify the causes of inappropriate behaviors.
**In 1968, a rapid accumulation in the knowledge around VI conduct disorders and an increasingly holistic perception of the cause and treatment of conduct disorders occurred.
 
*In 1904, Stanley Hall published the book, "Adolescence". This marked the beginning of the recognition of adolescence as a distinct developmental period.
*In 1904, Stanley Hall published the book, "Adolescence". This marked the beginning of the recognition of adolescence as a distinct developmental period.
*From 1910 until 1968, there was increased research interest in conduct problems of children as researchers attempted to identify the causes of inappropriate behaviors.
*In 1968, a rapid accumulation in the knowledge around VI conduct disorders and an increasingly holistic perception of the cause and treatment of conduct disorders occurred.
*At the end of the 19th century, therefore, the "norm" shifted from children working as young adults to focusing on becoming a young adult.
*At the end of the 19th century, therefore, the "norm" shifted from children working as young adults to focusing on becoming a young adult.
*In 1968, conduct disorders were established as a valid medical diagnosis.
*In 1968, conduct disorders were established as a valid medical diagnosis.
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*There are four categories that could present behavior similar to conduct disorder:<ref>American Psychiatric Association (2013). [[Diagnostic and Statistical Manual of Mental Disorders]] (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 469–470.</ref>
*There are four categories that could present behavior similar to conduct disorder:<ref>American Psychiatric Association (2013). [[Diagnostic and Statistical Manual of Mental Disorders]] (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 469–470.</ref>
**Aggression to people and animals.
**Aggression to people and animal
**Destruction of property.
**Destruction of property
**Deceitfulness or theft.
**Deceitfulness or theft
**Serious violation of rules.
**Serious violation of rules


*Early-onset (EO-CD) and adult-onset (AO-CD) conduct disorder are widely considered distinct diseases with divergent [[etiologies]], though severe executive function is observed in both diseases.<ref name="pmid26820149">{{cite journal| author=Etchells PJ, Gage SH, Rutherford AD, Munafò MR| title=Prospective Investigation of Video Game Use in Children and Subsequent Conduct Disorder and Depression Using Data from the Avon Longitudinal Study of Parents and Children. | journal=PLoS One | year= 2016 | volume= 11 | issue= 1 | pages= e0147732 | pmid=26820149 | doi=10.1371/journal.pone.0147732 | pmc=4731569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26820149  }} </ref><ref name="pmid25835393">{{cite journal| author=Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB| title=Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. | journal=PLoS One | year= 2015 | volume= 10 | issue= 4 | pages= e0121627 | pmid=25835393 | doi=10.1371/journal.pone.0121627 | pmc=4383334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25835393  }} </ref>
*Early-onset (EO-CD) and adult-onset (AO-CD) conduct disorder are widely considered distinct diseases with divergent [[etiologies]], though severe executive function is observed in both diseases.<ref name="pmid26820149">{{cite journal| author=Etchells PJ, Gage SH, Rutherford AD, Munafò MR| title=Prospective Investigation of Video Game Use in Children and Subsequent Conduct Disorder and Depression Using Data from the Avon Longitudinal Study of Parents and Children. | journal=PLoS One | year= 2016 | volume= 11 | issue= 1 | pages= e0147732 | pmid=26820149 | doi=10.1371/journal.pone.0147732 | pmc=4731569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26820149  }} </ref><ref name="pmid25835393">{{cite journal| author=Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB| title=Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. | journal=PLoS One | year= 2015 | volume= 10 | issue= 4 | pages= e0121627 | pmid=25835393 | doi=10.1371/journal.pone.0121627 | pmc=4383334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25835393  }} </ref>
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==Pathophysiology==
==Pathophysiology==
*Patients with adult-onset conduct disorder (AO-CD) show increased cortical thinning in the paralimbic system, particularly in the precuneus/posterior cingulate cortex, as compared to healthy controls. This finding has not been reported in patients with early-onset conduct disorder (EO-CD).<ref name="pmid26189512">{{cite journal| author=Jiang Y, Guo X, Zhang J, Gao J, Wang X, Situ W et al.| title=Abnormalities of cortical structures in adolescent-onset conduct disorder. | journal=Psychol Med | year= 2015 | volume= 45 | issue= 16 | pages= 3467-79 | pmid=26189512 | doi=10.1017/S0033291715001361 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26189512  }} </ref>
*Patients with adult-onset conduct disorder (AO-CD) show increased cortical thinning in the paralimbic system, particularly in the precuneus/posterior [[cingulate cortex]], as compared to healthy controls. This finding has not been reported in patients with early-onset conduct disorder (EO-CD).<ref name="pmid26189512">{{cite journal| author=Jiang Y, Guo X, Zhang J, Gao J, Wang X, Situ W et al.| title=Abnormalities of cortical structures in adolescent-onset conduct disorder. | journal=Psychol Med | year= 2015 | volume= 45 | issue= 16 | pages= 3467-79 | pmid=26189512 | doi=10.1017/S0033291715001361 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26189512  }} </ref>
*In children, the onset of conduct disorder (CD) seems to be associated with abnormalities in [[white matter]] pathways, particularly in the form of increased axial and radial diffusivity.<ref name="pmid26195297">{{cite journal| author=Decety J, Yoder KJ, Lahey BB| title=Sex differences in abnormal white matter development associated with conduct disorder in children. | journal=Psychiatry Res | year= 2015 | volume= 233 | issue= 2 | pages= 269-77 | pmid=26195297 | doi=10.1016/j.pscychresns.2015.07.009 | pmc=4536170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26195297  }} </ref>
*In children, the onset of conduct disorder (CD) seems to be associated with abnormalities in [[white matter]] pathways, particularly in the form of increased axial and radial diffusivity.<ref name="pmid26195297">{{cite journal| author=Decety J, Yoder KJ, Lahey BB| title=Sex differences in abnormal white matter development associated with conduct disorder in children. | journal=Psychiatry Res | year= 2015 | volume= 233 | issue= 2 | pages= 269-77 | pmid=26195297 | doi=10.1016/j.pscychresns.2015.07.009 | pmc=4536170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26195297  }} </ref>
**This effect seems to be especially prominent in girls with CD.
**This effect seems to be especially prominent in girls with CD.


===Commonly Comorbid Conditions===
===Commonly Comorbid Conditions===
Conditions that are commonly comorbid with conduct disorder include:<ref name=”2”>National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml</ref><ref name="pmid26281760">{{cite journal| author=Grant JD, Lynskey MT, Madden PA, Nelson EC, Few LR, Bucholz KK et al.| title=The role of conduct disorder in the relationship between alcohol, nicotine and cannabis use disorders. | journal=Psychol Med | year= 2015 | volume= 45 | issue= 16 | pages= 3505-15 | pmid=26281760 | doi=10.1017/S0033291715001518 | pmc=4730914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26281760  }} </ref><ref name="pmid24931565">{{cite journal| author=Schepman K, Fombonne E, Collishaw S, Taylor E| title=Cognitive styles in depressed children with and without comorbid conduct disorder. | journal=J Adolesc | year= 2014 | volume= 37 | issue= 5 | pages= 622-31 | pmid=24931565 | doi=10.1016/j.adolescence.2014.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24931565  }} </ref>
Conditions that are commonly comorbid with conduct disorder include:<ref name="”2”">National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml</ref><ref name="pmid26281760">{{cite journal| author=Grant JD, Lynskey MT, Madden PA, Nelson EC, Few LR, Bucholz KK et al.| title=The role of conduct disorder in the relationship between alcohol, nicotine and cannabis use disorders. | journal=Psychol Med | year= 2015 | volume= 45 | issue= 16 | pages= 3505-15 | pmid=26281760 | doi=10.1017/S0033291715001518 | pmc=4730914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26281760  }} </ref><ref name="pmid24931565">{{cite journal| author=Schepman K, Fombonne E, Collishaw S, Taylor E| title=Cognitive styles in depressed children with and without comorbid conduct disorder. | journal=J Adolesc | year= 2014 | volume= 37 | issue= 5 | pages= 622-31 | pmid=24931565 | doi=10.1016/j.adolescence.2014.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24931565  }} </ref>
*[[ADHD]]
*[[ADHD]]
*[[Substance abuse|Substance abuse disorder]]
*[[Substance abuse|Substance abuse disorder]]
*[[Depression]]
*[[Depression]]
*[[Oppositional defiant disorder]] (ODD)
*[[Oppositional defiant disorder]] (ODD)
*Disruptive behavior disorders
*[[Disruptive behavior disorder]]s
 
==Causes==
*The cause of conduct disorder is not fully understood. [[Family history]] plays a role that stems primarily from [[genetics]], though common environmental circumstances also have an effect.<ref name="pmid26281760">{{cite journal| author=Grant JD, Lynskey MT, Madden PA, Nelson EC, Few LR, Bucholz KK et al.| title=The role of conduct disorder in the relationship between alcohol, nicotine and cannabis use disorders. | journal=Psychol Med | year= 2015 | volume= 45 | issue= 16 | pages= 3505-15 | pmid=26281760 | doi=10.1017/S0033291715001518 | pmc=4730914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26281760  }} </ref>
*While the male children of women who experience moderate or severe [[anxiety]] during the pre- and post-natal periods are more likely to experience conduct disorder than male children of women who do not, the same effect does not apply to female children.<ref name="pmid24229548">{{cite journal| author=Glasheen C, Richardson GA, Kim KH, Larkby CA, Swartz HA, Day NL| title=Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring. | journal=Dev Psychopathol | year= 2013 | volume= 25 | issue= 4 Pt 1 | pages= 1045-63 | pmid=24229548 | doi=10.1017/S0954579413000369 | pmc=4310683 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24229548  }} </ref>
*There exists evidence that a parenting style may have an outcome in CD:<ref name="pmid25391571">{{cite journal| author=Freeze MK, Burke A, Vorster AC| title=The role of parental style in the conduct disorders: a comparison between adolescent boys with and without conduct disorder. | journal=J Child Adolesc Ment Health | year= 2014 | volume= 26 | issue= 1 | pages= 63-73 | pmid=25391571 | doi=10.2989/17280583.2013.865627 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25391571  }} </ref>
**Excessive controlling parenting/behavior.
**Substandard involvement with or supervision of children
**Tendency to avoid expressing one's emotions may facilitate the development of conduct disorder in children.


==Differentiating conduct disorder from other diseases==
==Differentiating conduct disorder from other diseases==
Conduct disorder must be differentiated from diseases that share common symptoms, including:<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref><ref name=”2”>National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml</ref>
Conduct disorder must be differentiated from diseases that share common symptoms, including:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref><ref name="”2”">National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml</ref>
*[[Adjustment disorders]]
*[[Adjustment disorders]]
*[[Attention-deficit/hyperactivity disorder]]
*[[Attention-deficit/hyperactivity disorder]]
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*[[Intermittent explosive disorder]]
*[[Intermittent explosive disorder]]
*[[Oppositional defiant disorder]]
*[[Oppositional defiant disorder]]
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! style="background:#4479BA; color: #FFFFFF;" |Disease
! style="background:#4479BA; color: #FFFFFF;" |Distinguishing features
! style="background:#4479BA; color: #FFFFFF;" |Treatment
|-
| align="center" style="background:#DCDCDC;" |'''[[Conduct disorder]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Persistent pattern of violating others' rights
*Aggression and illegal acts
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Family therapy]]
*[[Behavior modification]]
*[[Pharmacotherapy]]
|-
| align="center" style="background:#DCDCDC;" |'''[[Oppositional defiant disorder]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Chronic argumentativeness
*Refusal to comply with adult requests
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Family therapy]]
*[[Behavior modification]]
|-
| align="center" style="background:#DCDCDC;" |'''[[ADHD]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hyperactivity]]
*Behavior disinhibition
*Inattention and distractibility
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Pharmacotherapy]] (stimulants)
*[[Behavior modification]]
|-
| align="center" style="background:#DCDCDC;" |'''[[Substance abuse]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Pattern of [[substance use]] associated with adverse social/personal consequences or physiologic tolerance or [[withdrawal]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Specialized multimodal treatment, including group, individual and [[family therapies]]
*Medical detoxification and inpatient treatment
|-
| align="center" style="background:#DCDCDC;" |'''[[Major depression]] and [[Dysthymia|dysthymic disorder]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Dysphoric]], irritable mood
*Sleep and appetite disturbance
*[[Anhedonia]]
*[[Suicidal ideation]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Pharmacotherapy]] (SSRIs)
*Individual and [[family therapy]]
|-
| align="center" style="background:#DCDCDC;" |'''[[Bipolar disorder|Bipolar mood disorder]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Depressive symptoms coexist or alternate with periods of excess energy and/or thought racing
*[[Mania]] or [[hypomania]] may include hallucinations, delusions
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Pharmacotherapy]] (lithium, selected anticonvulsants)
|-
| align="center" style="background:#DCDCDC;" |'''Intermittent explosive Disorder'''
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Sudden, unpredictable physically/verbally aggressive outbursts
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Pharmacotherapy]] (anticonvulsants, clonidine, lithium, SSRIs)
*[[Cognitive behavior therapy]]
|}


==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Prevalence===
===Prevalence===
*The one year prevalence of conduct disorder is 2,000 to >10,000 per 100,000 people (2% to >10%) within the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*The one year prevalence of conduct disorder is 2,000 to >10,000 per 100,000 people (2% to >10%) within the overall population.<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Worldwide, estimates of the prevalence of [[ODD]] and CD range from 3-5%. A recent meta-analysis estimated the combined prevalence of ODD/CD to be 6.1%.
*Worldwide, estimates of the prevalence of ODD and CD range from 3-5%. A recent meta-analysis estimated the combined prevalence of ODD/CD to be 6.1%.
===Age===
===Age===
*Among American children and adolescents aged 8 to 15 years, the prevalence of conduct disorder is approximately 2.1%.<ref name=”2”>National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml</ref>
*Among American children and adolescents aged 8 to 15 years, the prevalence of conduct disorder is approximately 2.1%.<ref name="”2”">National Institute of Mental Health. 2009. “National Survey Tracks Rates of Common Mental Disorders Among American Youth.” https://www.nimh.nih.gov/news/science-news/2009/national-survey-tracks-rates-of-common-mental-disorders-among-american-youth.shtml</ref>
*Children diagnosed with conduct disorder tend to be >10 years of age.
*Children diagnosed with conduct disorder tend to be >10 years of age.
*In 2007, 4.6% of children between the ages of 3-17 years were diagnosed with conduct disorder.
*In 2007, 4.6% of children between the ages of 3-17 years were diagnosed with conduct disorder.
===Gender===
===Gender===
*The lifetime prevalence of CD was 10.2% in an adult community sample, with men at 11.2% and women at 9.2%
*The lifetime prevalence of CD was 10.2% in an adult community sample, with men at 11.2% and women at 9.2%.
===Race===
===Race===
*Currently, there are no population- or national-level data on the prevalence trends of [[ODD]] or CD among caucasion U.S. children.
*Currently, there are no population- or national-level data on the prevalence trends of [[ODD]] or CD among caucasion U.S. children.


==Risk Factors==
==Risk Factors==
*Risk factors for the development of conduct disorder include:<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref><ref name="pmid26879586">{{cite journal| author=Oakley C, Harris S, Fahy T, Murphy D, Picchioni M| title=Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia. | journal=Schizophr Res | year= 2016 | volume= 172 | issue= 1-3 | pages= 54-9 | pmid=26879586 | doi=10.1016/j.schres.2016.01.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26879586  }} </ref><ref name="pmid26820149">{{cite journal| author=Etchells PJ, Gage SH, Rutherford AD, Munafò MR| title=Prospective Investigation of Video Game Use in Children and Subsequent Conduct Disorder and Depression Using Data from the Avon Longitudinal Study of Parents and Children. | journal=PLoS One | year= 2016 | volume= 11 | issue= 1 | pages= e0147732 | pmid=26820149 | doi=10.1371/journal.pone.0147732 | pmc=4731569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26820149  }} </ref><ref name="pmid24650822">{{cite journal| author=Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A et al.| title=Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms. | journal=J Stud Alcohol Drugs | year= 2014 | volume= 75 | issue= 2 | pages= 279-89 | pmid=24650822 | doi= | pmc=3965682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650822  }} </ref><ref name="pmid24229548">{{cite journal| author=Glasheen C, Richardson GA, Kim KH, Larkby CA, Swartz HA, Day NL| title=Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring. | journal=Dev Psychopathol | year= 2013 | volume= 25 | issue= 4 Pt 1 | pages= 1045-63 | pmid=24229548 | doi=10.1017/S0954579413000369 | pmc=4310683 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24229548  }}</ref>
*The cause of conduct disorder is not fully understood. [[Family history]] plays a role that stems primarily from [[genetics]], though common environmental circumstances also have an effect.<ref name="pmid26281760">{{cite journal| author=Grant JD, Lynskey MT, Madden PA, Nelson EC, Few LR, Bucholz KK et al.| title=The role of conduct disorder in the relationship between alcohol, nicotine and cannabis use disorders. | journal=Psychol Med | year= 2015 | volume= 45 | issue= 16 | pages= 3505-15 | pmid=26281760 | doi=10.1017/S0033291715001518 | pmc=4730914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26281760  }} </ref>
***Association with a delinquent peer group
*While the male children of women who experience moderate or severe [[anxiety]] during the pre- and post-natal periods are more likely to experience conduct disorder than male children of women who do not, the same effect does not apply to female children.<ref name="pmid24229548">{{cite journal| author=Glasheen C, Richardson GA, Kim KH, Larkby CA, Swartz HA, Day NL| title=Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring. | journal=Dev Psychopathol | year= 2013 | volume= 25 | issue= 4 Pt 1 | pages= 1045-63 | pmid=24229548 | doi=10.1017/S0954579413000369 | pmc=4310683 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24229548  }} </ref>
***Biological parents with:
*There exists evidence that a parenting style may have an outcome in CD:<ref name="pmid25391571">{{cite journal| author=Freeze MK, Burke A, Vorster AC| title=The role of parental style in the conduct disorders: a comparison between adolescent boys with and without conduct disorder. | journal=J Child Adolesc Ment Health | year= 2014 | volume= 26 | issue= 1 | pages= 63-73 | pmid=25391571 | doi=10.2989/17280583.2013.865627 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25391571  }} </ref>
***Severe alcohol use disorder ([[alcholism]])
**Excessive controlling parenting/behavior
***[[Depressive]] and [[bipolar|bipolar disorders]]
**Substandard involvement with or supervision of children
***[[Schizophrenia]]  
**Tendency to avoid expressing one's emotions may facilitate the development of conduct disorder in children
***[[ADHD]]  
*Risk factors for the development of conduct disorder include:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref><ref name="pmid26879586">{{cite journal| author=Oakley C, Harris S, Fahy T, Murphy D, Picchioni M| title=Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia. | journal=Schizophr Res | year= 2016 | volume= 172 | issue= 1-3 | pages= 54-9 | pmid=26879586 | doi=10.1016/j.schres.2016.01.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26879586  }} </ref><ref name="pmid26820149">{{cite journal| author=Etchells PJ, Gage SH, Rutherford AD, Munafò MR| title=Prospective Investigation of Video Game Use in Children and Subsequent Conduct Disorder and Depression Using Data from the Avon Longitudinal Study of Parents and Children. | journal=PLoS One | year= 2016 | volume= 11 | issue= 1 | pages= e0147732 | pmid=26820149 | doi=10.1371/journal.pone.0147732 | pmc=4731569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26820149  }} </ref><ref name="pmid24650822">{{cite journal| author=Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A et al.| title=Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms. | journal=J Stud Alcohol Drugs | year= 2014 | volume= 75 | issue= 2 | pages= 279-89 | pmid=24650822 | doi= | pmc=3965682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650822  }} </ref><ref name="pmid24229548">{{cite journal| author=Glasheen C, Richardson GA, Kim KH, Larkby CA, Swartz HA, Day NL| title=Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring. | journal=Dev Psychopathol | year= 2013 | volume= 25 | issue= 4 Pt 1 | pages= 1045-63 | pmid=24229548 | doi=10.1017/S0954579413000369 | pmc=4310683 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24229548  }}</ref>
***[[Anxiety disorder]]
 
***Conduct disorder
** Association with a delinquent peer group  
**Childhood access to violent video games
 
**Difficult under controlled infant temperament  
** Biological parents with:  
**Early institutionalization
*** Severe alcohol use disorder ([[alcholism]])  
**Familial [[psychopathology]]
*** [[Depressive]] and [[bipolar|bipolar disorders]]  
**Frequent changes of caregivers
*** [[Schizophrenia]]
**Harsh discipline
*** [[ADHD]]
**Inconsistent child-rearing practices
*** [[Anxiety Disorder|Anxiety disorder]]  
**Lack of supervision
*** Conduct disorder  
**Large family size
** Childhood access to violent video games  
**Lower-than-average intelligence
** Difficult under controlled infant temperament  
**Neighborhood exposure to violence
** Early institutionalization  
**Parental criminality
** Familial [[psychopathology]]  
**Parental neglect or rejection
** Frequent changes of caregivers  
**Physical or sexual abuse
** Harsh discipline
***The prevalence of a history of sexual abuse as a child is estimated to be 27% in individuals who suffer from conduct disorder.<ref name="pmid24306094">{{cite journal| author=Maniglio R| title=Prevalence of sexual abuse among children with conduct disorder: a systematic review. | journal=Clin Child Fam Psychol Rev | year= 2014 | volume= 17 | issue= 3 | pages= 268-82 | pmid=24306094 | doi=10.1007/s10567-013-0161-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24306094  }} </ref>
** Inconsistent child-rearing practices  
***Childhood abuse is more common among individuals with early-onset conduct disorder as compared to those with adult-onset conduct disorder.<ref name="pmid25835393">{{cite journal| author=Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB| title=Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. | journal=PLoS One | year= 2015 | volume= 10 | issue= 4 | pages= e0121627 | pmid=25835393 | doi=10.1371/journal.pone.0121627 | pmc=4383334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25835393  }} </ref>
** Lack of supervision  
**[[Social isolation]]
** Large family size  
**[[Substance abuse]]
** Lower-than-average intelligence  
** Neighborhood exposure to violence  
** Parental criminality  
** Parental neglect or rejection  
** Physical or sexual abuse
*** The prevalence of a history of sexual abuse as a child is estimated to be 27% in individuals who suffer from conduct disorder.<ref name="pmid24306094">{{cite journal| author=Maniglio R| title=Prevalence of sexual abuse among children with conduct disorder: a systematic review. | journal=Clin Child Fam Psychol Rev | year= 2014 | volume= 17 | issue= 3 | pages= 268-82 | pmid=24306094 | doi=10.1007/s10567-013-0161-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24306094  }} </ref>
*** Childhood abuse is more common among individuals with early-onset conduct disorder as compared to those with adult-onset conduct disorder.<ref name="pmid25835393">{{cite journal| author=Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB| title=Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. | journal=PLoS One | year= 2015 | volume= 10 | issue= 4 | pages= e0121627 | pmid=25835393 | doi=10.1371/journal.pone.0121627 | pmc=4383334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25835393  }} </ref>
* [[Social isolation]]
* [[Substance abuse]]


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
*Childhood conduct disorder is a known risk factor for the development of substance abuse disorder during a patient's youth.<ref name="pmid24650822">{{cite journal| author=Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A et al.| title=Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms. | journal=J Stud Alcohol Drugs | year= 2014 | volume= 75 | issue= 2 | pages= 279-89 | pmid=24650822 | doi= | pmc=3965682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650822  }} </ref>
*Childhood conduct disorder is a known risk factor for the development of [[substance abuse]] disorder during a patient's youth.<ref name="pmid24650822">{{cite journal| author=Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A et al.| title=Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms. | journal=J Stud Alcohol Drugs | year= 2014 | volume= 75 | issue= 2 | pages= 279-89 | pmid=24650822 | doi= | pmc=3965682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650822  }} </ref>
**[[Substance abuse]] may also intensify the symptoms of conduct disorder and negatively impact a patient's [[prognosis]].<ref name="pmid24650822">{{cite journal| author=Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A et al.| title=Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms. | journal=J Stud Alcohol Drugs | year= 2014 | volume= 75 | issue= 2 | pages= 279-89 | pmid=24650822 | doi= | pmc=3965682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650822  }} </ref>
**[[Substance abuse]] may also intensify the symptoms of conduct disorder and negatively impact a patient's [[prognosis]].<ref name="pmid24650822">{{cite journal| author=Wymbs BT, McCarty CA, Mason WA, King KM, Baer JS, Vander Stoep A et al.| title=Early adolescent substance use as a risk factor for developing conduct disorder and depression symptoms. | journal=J Stud Alcohol Drugs | year= 2014 | volume= 75 | issue= 2 | pages= 279-89 | pmid=24650822 | doi= | pmc=3965682 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24650822  }} </ref>
*Childhood conduct disorder may be a risk factor for the development of [[schizophrenia]].<ref name="pmid26879586">{{cite journal| author=Oakley C, Harris S, Fahy T, Murphy D, Picchioni M| title=Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia. | journal=Schizophr Res | year= 2016 | volume= 172 | issue= 1-3 | pages= 54-9 | pmid=26879586 | doi=10.1016/j.schres.2016.01.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26879586  }} </ref>
*Childhood conduct disorder may be a risk factor for the development of [[schizophrenia]].<ref name="pmid26879586">{{cite journal| author=Oakley C, Harris S, Fahy T, Murphy D, Picchioni M| title=Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia. | journal=Schizophr Res | year= 2016 | volume= 172 | issue= 1-3 | pages= 54-9 | pmid=26879586 | doi=10.1016/j.schres.2016.01.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26879586  }} </ref>
Line 126: Line 186:
===Diagnostic Criteria===
===Diagnostic Criteria===


====DSM-V Diagnostic Criteria for Conduct Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>====
====DSM-V Diagnostic Criteria for Conduct Disorder<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>====
{{cquote|
{{cquote|


Line 188: Line 248:
}}
}}


===Symptoms===
===History and Symptoms===
Symptoms of conduct disorder include:<ref name="pmid25835393">{{cite journal| author=Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB| title=Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. | journal=PLoS One | year= 2015 | volume= 10 | issue= 4 | pages= e0121627 | pmid=25835393 | doi=10.1371/journal.pone.0121627 | pmc=4383334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25835393  }} </ref>
Symptoms of conduct disorder include:<ref name="pmid25835393">{{cite journal| author=Johnson VA, Kemp AH, Heard R, Lennings CJ, Hickie IB| title=Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. | journal=PLoS One | year= 2015 | volume= 10 | issue= 4 | pages= e0121627 | pmid=25835393 | doi=10.1371/journal.pone.0121627 | pmc=4383334 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25835393  }} </ref>
*Compromised executive function
*Compromised executive function
Line 203: Line 263:


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
 
*Therapy is recommended mong all patients who develop conduct disorder.
===Surgery===
*Three main [[therapies]] are used to treat conduct disorder:<ref>'''3'''</ref>
Surgery is not indicated for the management of conduct disorder.
**[[Family therapy]]
 
**[[Behavior modification]]
===Prevention===
**[[Pharmacotherapy]]


==Criticism==
==Criticism==

Latest revision as of 20:48, 9 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2], Haleigh Williams, B.S., Irfan Dotani

Synonyms and keywords: Conduct problems, disordered conduct, behavioral problems

Overview

Conduct disorder is a psychiatric disorder characterized by a pattern of repetitive behavior wherein social norms or the rights of others are routinely violated. Possible symptoms include excessively aggressive behavior, bullying, physical aggression, cruel behavior toward people and animals, destructive behavior, lying, truancy, vandalism, and stealing. After the age of 18, conduct disorder may develop into antisocial personality disorder.

Historical Perspective

  • In 1880, the origins of conduct disorder lie within the social and legal problem of delinquency.[1]
  • In 1904, Stanley Hall published the book, "Adolescence". This marked the beginning of the recognition of adolescence as a distinct developmental period.
  • From 1910 until 1968, there was increased research interest in conduct problems of children as researchers attempted to identify the causes of inappropriate behaviors.
  • In 1968, a rapid accumulation in the knowledge around VI conduct disorders and an increasingly holistic perception of the cause and treatment of conduct disorders occurred.
  • At the end of the 19th century, therefore, the "norm" shifted from children working as young adults to focusing on becoming a young adult.
  • In 1968, conduct disorders were established as a valid medical diagnosis.
  • At the end of the 19th century and the start of the 20th century, Phrenology laid the foundation for biological determinism.
  • Biological determinism is a large contributing factor to children who are delinquents and commit a crime.
  • 'Uri Bronfenbrenner's Ecological Systems Theory' has largely contributed to the development and maintenance of conduct disorders.
  • Developmental psychopathology has helped to integrate how biological, cognitive, and environmental factors have accumulated to increases the risk of a pathological outcome, such as conduct disorders.[2]

Classification

  • There are four categories that could present behavior similar to conduct disorder:[3]
    • Aggression to people and animal
    • Destruction of property
    • Deceitfulness or theft
    • Serious violation of rules
  • Early-onset (EO-CD) and adult-onset (AO-CD) conduct disorder are widely considered distinct diseases with divergent etiologies, though severe executive function is observed in both diseases.[4][5]
    • Children with EO-CD are more likely to experience psychosis and to commit acts of violence.[5]

Pathophysiology

  • Patients with adult-onset conduct disorder (AO-CD) show increased cortical thinning in the paralimbic system, particularly in the precuneus/posterior cingulate cortex, as compared to healthy controls. This finding has not been reported in patients with early-onset conduct disorder (EO-CD).[6]
  • In children, the onset of conduct disorder (CD) seems to be associated with abnormalities in white matter pathways, particularly in the form of increased axial and radial diffusivity.[7]
    • This effect seems to be especially prominent in girls with CD.

Commonly Comorbid Conditions

Conditions that are commonly comorbid with conduct disorder include:[8][9][10]

Differentiating conduct disorder from other diseases

Conduct disorder must be differentiated from diseases that share common symptoms, including:[11][8]

Disease Distinguishing features Treatment
Conduct disorder
  • Persistent pattern of violating others' rights
  • Aggression and illegal acts
Oppositional defiant disorder
  • Chronic argumentativeness
  • Refusal to comply with adult requests
ADHD
  • Hyperactivity
  • Behavior disinhibition
  • Inattention and distractibility
Substance abuse
  • Pattern of substance use associated with adverse social/personal consequences or physiologic tolerance or withdrawal
  • Specialized multimodal treatment, including group, individual and family therapies
  • Medical detoxification and inpatient treatment
Major depression and dysthymic disorder
Bipolar mood disorder
  • Depressive symptoms coexist or alternate with periods of excess energy and/or thought racing
  • Mania or hypomania may include hallucinations, delusions
Intermittent explosive Disorder
  • Sudden, unpredictable physically/verbally aggressive outbursts

Epidemiology and Demographics

Prevalence

  • The one year prevalence of conduct disorder is 2,000 to >10,000 per 100,000 people (2% to >10%) within the overall population.[11]
  • Worldwide, estimates of the prevalence of ODD and CD range from 3-5%. A recent meta-analysis estimated the combined prevalence of ODD/CD to be 6.1%.

Age

  • Among American children and adolescents aged 8 to 15 years, the prevalence of conduct disorder is approximately 2.1%.[8]
  • Children diagnosed with conduct disorder tend to be >10 years of age.
  • In 2007, 4.6% of children between the ages of 3-17 years were diagnosed with conduct disorder.

Gender

  • The lifetime prevalence of CD was 10.2% in an adult community sample, with men at 11.2% and women at 9.2%.

Race

  • Currently, there are no population- or national-level data on the prevalence trends of ODD or CD among caucasion U.S. children.

Risk Factors

  • The cause of conduct disorder is not fully understood. Family history plays a role that stems primarily from genetics, though common environmental circumstances also have an effect.[9]
  • While the male children of women who experience moderate or severe anxiety during the pre- and post-natal periods are more likely to experience conduct disorder than male children of women who do not, the same effect does not apply to female children.[12]
  • There exists evidence that a parenting style may have an outcome in CD:[13]
    • Excessive controlling parenting/behavior
    • Substandard involvement with or supervision of children
    • Tendency to avoid expressing one's emotions may facilitate the development of conduct disorder in children
  • Risk factors for the development of conduct disorder include:[11][14][4][15][12]
    • Association with a delinquent peer group
    • Biological parents with:
    • Childhood access to violent video games
    • Difficult under controlled infant temperament
    • Early institutionalization
    • Familial psychopathology
    • Frequent changes of caregivers
    • Harsh discipline
    • Inconsistent child-rearing practices
    • Lack of supervision
    • Large family size
    • Lower-than-average intelligence
    • Neighborhood exposure to violence
    • Parental criminality
    • Parental neglect or rejection
    • Physical or sexual abuse
      • The prevalence of a history of sexual abuse as a child is estimated to be 27% in individuals who suffer from conduct disorder.[16]
      • Childhood abuse is more common among individuals with early-onset conduct disorder as compared to those with adult-onset conduct disorder.[5]
  • Social isolation
  • Substance abuse

Natural History, Complications, and Prognosis

  • Childhood conduct disorder is a known risk factor for the development of substance abuse disorder during a patient's youth.[15]
  • Childhood conduct disorder may be a risk factor for the development of schizophrenia.[14]
  • Children who suffer from conduct disorder are more likely than their unaffected peers to become violent, an effect that may continue into adulthood.[14]

Diagnosis

Diagnostic Criteria

DSM-V Diagnostic Criteria for Conduct Disorder[11]

  • A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
    • Aggression to people and animals.
  • 1. Often bullies, threatens, or intimidates others.
  • 2. Often initiates physical fights.
  • 3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
  • 4. Has been physically cruel to people.
  • 5. Has been physically cruel to animals.
  • 6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
  • 7. Has forced someone into sexual activity.

Destruction of Property

  • 8. Has deliberately engaged in fire setting with the intention of causing serious damage.
  • 9. Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

  • 10. Has broken into someone else’s house, building, or car.
  • 11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
  • 12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

Serious Violations of Rules

  • 13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
  • 14. Has run away from home overnight at least twice while living in the parental or parental surrogate's home, or once without returning for a lengthy period.
  • 15. Is often truant from school, beginning before age 13 years.

AND

  • B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

AND


Specify whether:

  • Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder prior to age 10 years.
  • Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to age 10 years.
  • Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

Specify if:

  • With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, co-workers, extended family members, peers).
  • Lack of remorse or guilt: Does not feel bad or guilty when he or she does something wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules.
  • Callous—lack of empathy: Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on himself or herself, rather than their effects on others, even when they result in substantial harm to others.
  • Unconcerned about performance: Does not show concern about poor/problematic performance at school, at work, or in other important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance.
  • Shallow or deficient affect:Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off" quickly) or when emotional expressions are used for gain (e.g., emotions displayed to manipulate or intimidate others).

Specify current severity:

  • Mild: Few if any conduct problems in excess of those required to make the diagnosis are present, and conduct problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule-breaking).
  • Moderate: The number of conduct problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism).
  • Severe: Many conduct problems in excess of those required to make the diagnosis are present, or conduct problems cause considerable harm to others(e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

History and Symptoms

Symptoms of conduct disorder include:[5]

  • Compromised executive function
  • Violent behavior
  • Disregard for the rights of others
  • Cruelty toward people and animals

Psychiatric Examination

  • A child with conduct disorder may display a pattern of disruptive and violent behavior and have problems following rules.

Laboratory Findings

  • No laboratory test has been found to help diagnose this disorder.

Imaging Findings

  • No recent imaging findings are available for this disorder.

Treatment

Medical Therapy

Criticism

  • Some critics of psychiatry allege that individuals exhibiting symptoms of a "conduct disorder" (similar to oppositional defiant disorder) may be reacting to an abnormal circumstance.
  • Patients may also be committing criminal and/or uncivil acts out of selfishness.
  • Critics of the classification of this disorder also may state that the coming of age of an individual does not automatically signify a new disorder.
  • It has also been noted that the criteria for diagnosis can often be subjective and that only exemplifying a few of the above behaviors may just indicate normal teenage rebellion.

See also

References

  1. "The historical foundation of conduct disorders : historical context, theoretical explanations, and interventions".
  2. Blair RJ, Leibenluft E, Pine DS (2014). "Conduct disorder and callous-unemotional traits in youth". N Engl J Med. 371 (23): 2207–16. doi:10.1056/NEJMra1315612. PMID 25470696.
  3. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 469–470.
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