Conduct disorder is characterized by repetitive violations of others' rights or societal rules. It is fairly common in childhood and adolescence, affecting approximately 9% of boys and 2% of girls. It is influenced by a variety of bio-psychosocial factors including parental psychopathology, chaotic home environments, socioeconomic deprivation, and possible neurological issues. Treatment is difficult and often requires a multimodal approach including psychotherapy, family therapy, medication, and residential placement.

2. DIAGNOSIS
The essential feature of conduct disorder is a
repetitive and persistent pattern of conduct in
which either the basic rights of others or major
age-appropriate societal norms or rules are
violated.
 The conduct is more serious than the ordinary
mischief and pranks of children and adolescents.


3. EPIDEMIOLOGY
Conduct disorder is fairly common during
childhood and adolescence. It is estimated that
approximately 9 percent of boys and 2 percent of
girls under the age of 18 years have the disorder.
 The disorder is more common among boys than
among girls and the ratio ranges from 4 to 1 to 12
to 1.
 Conduct disorder is more common in children of
parents with antisocial personality and alcohol
dependence than it is in the general population.
 The prevalence of conduct disorder and antisocial
behavior is significantly related to socioeconomic
factors.


4. ETIOLOGY
 No
single factor can account for
children’s antisocial behavior and
conduct disorder.
 Rather,
a variety of bio-psychosocial
factors contribute to their development.

5. PARENTAL FACTORS
It has long been recognized that some parental
attitudes and faulty child-rearing practices
influence the development of children’s
maladaptive behaviors.
 Chaotic home conditions are associated with
conduct disorder and delinquency. However,
broken homes per se are not causatively
significant it is the strife between the parents
that contributes to conduct disorder.
 Parental psychopathology, child abuse and
negligence often contribute to conduct disorder.


6.  Sociopathy,
alcoholism and substance
abuse in parents are associated with
conduct disorder in their children.
 Recent studies suggest that many parents
of conduct disorder children suffer from
serious psychopathology, including
psychoses.
 Psychodynamic hypotheses suggest that
children with conduct disorder
unconsciously act out their parents
antisocial wishes.

7. SOCIOCULTURAL FACTORS
 Current
theories
suggest
that
socioeconomically
deprived
children,
unable to achieve status and obtain
material goods through legitimate routes,
are forced to resort to socially
unacceptable means to reach those goals
and that such behavior is normal and
acceptable
under
circumstances
of
socioeconomic deprivation, as the children
are adhering to the values of their own
subculture.

8. PSYCHOLOGICAL FACTORS
Children brought up in chaotic, negligent
conditions generally become angry, disruptive,
demanding and unable to progressively develop
the tolerance for frustration necessary for mature
relationships.
 As their role models are poor and often
frequently changing, the basis for developing
both an ego-ideal and a conscience is lacking.
 The children are left with little motivation to
follow societal norms and are relatively
remorseless.


9. NEUROBIOLOGICAL FACTORS
 Neurobiological
factors in conduct
disorder have been little studied.
However, ADHD research yields
some important findings and conduct
disorder and ADHD often coexist.

10. OTHER FACTORS
ADHD, central nervous system (CNS)
dysfunction or damage and early extremes of
temperament can predispose a child to conduct
disorder.
 Propensity to violence correlates with CNS
dysfunction and signs of severe psychopathology,
such as paranoid tendencies.
 Longitudinal temperament studies suggest that
many behavioral deviations are initially a
straightforward response to a poor fit between,
on the one hand, a child’s temperament and
emotional needs and on the other hand, parental
attitudes and child-rearing practices.


12. CLINICAL FEATURES
 Children
with the solitary aggressive type of
conduct disorder commit solitary, rather than
group acts of aggression.
 The aggressive antisocial behavior may take
the form of bullying, physical aggression and
cruel behavior toward peers.
 The children may be hostile, verbally
abusive, impudent, defiant and negativistic
toward adults.
 Persistent lying, frequent truancy and
vandalism are common. In severe cases there
is often destructiveness, stealing and
physical violence.

13. TREATMENT



Multimodality treatment is often necessary and can
include individual psychotherapy, family therapy,
special schooling, Pharmacotherapy, homemaking
services and residential placement.
Treatment is difficult, given the child’s and the
family’s pathology. Both the child and the family can
undermine therapy and frequently the conductdisordered child proceeds to delinquency in
adolescence and to antisocial behavior in adulthood.
Medications are generally used in the conductdisordered child to quell aggressive, Assaultive
behavior. Once under control the child may be able to
learn more in school and may be more amenable to
psychotherapy.

15. CLINICAL FEATURES




The DSM-III-R criteria for the group type of conduct
disorder list the predominant feature as conduct
problems occurring mainly as a group activity in the
company of friends who have similar problems and to
whom the child is loyal.
Physical aggression may be included in this condition.
The group antisocial behavior invariably occurs
outside the home. It includes repeated truancy,
vandalism and serious physical aggression or assault
against others, such as mugging, gang fighting and
beating.
The important and constant dynamic features in this
condition are the significant influence of the peer
group on such youngsters’ behavior and their extreme
dependency needs to maintain membership in the
gang.

16. COURSE AND PROGNOSIS
Very few youngsters with the group type of
conduct disorder remain delinquent beyond
adolescence; they may even given it up during
adolescence.
 They may relinquish their delinquent behavior in
response to fortuitous positive happenings, such
as academic or athletic success, romantic
attachment and role modeling of an interested
adult.
 Other youngsters may be dissuaded from the
repetitive pattern through the unpleasantness of
arrest and appearance in juvenile court. Such
occurrences may also awaken the family to their
responsibilities toward the child.


17. TREATMENT
Traditional individual psychotherapy alone has
proved to be relatively ineffective, party because
of adolescent’s common resistance to this type of
therapy.
 Some delinquent youngsters respond better to
the accepting, permissive, and dynamically
oriented counseling approach.
 The relatively high success rate in treating
delinquent youngsters with the group oriented
approach is explained by the group conduct
disordered youngsters natural tendency to turn
to peers for advice and emotional support.


18. Occasionally, such youngsters need to be
separated from their previous peer group and to
be transplanted to an entirely new environment,
as in training schools, Outward Bound and
therapeutic camping programs.
 Therapeutic optimism is very much warranted in
this group of youngsters. Any approach that
alters the attitudes of the entire group or that
separates the youngsters from their delinquent
peer group and offers them contact with strong
adult leaders and less delinquent peer is likely to
improve the group’s antisocial or criminal
behavior.


20. 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 three (or more) of the following
criteria in the past 12 months, with at least
one criterion present in the past 6 months:

21. 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., abat, 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

22. 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)

23. 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)

24. 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 parental or parental surrogate
home (or once without returning for a lengthy
period)
(15) is often truant from school, beginning before
age 13 years

25. B. The disturbance in behavior causes
clinically significant impairment in social,
academic, or occupational functioning.
C. If the individual is age 18 years or older,
criteria are not met for Antisocial
Personality Disorder.