This article is reprinted from the website of the National Mental Health Services Knowledge Exchange Network (KEN) from the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services.

Conduct Disorder in Children and Adolescents

This is one of a series of fact sheets on the mental, emotional, and behavior disorders that can appear in childhood or adolescence. The Center for Mental Health Services extends appreciation to the National Institute of Mental Health for contributing to the preparation of this fact sheet. Any questions or comments about its contents may be directed to the CMHS National Mental Health Services Knowledge Exchange Network (KEN)-see contact information below.

What Is Conduct Disorder?

Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely if the behavior continues for a period of 6 months or longer. Because of the impact conduct disorder has on the child and his or her family, neighbors, and adjustment at school, conduct disorder is known as a "disruptive behavior disorder."

Another disruptive disorder, called oppositional defiant disorder, often occurs before conduct disorder and may be an early sign of conduct disorder. Oppositional defiant disorder is diagnosed when a child's behavior is hostile and defiant for 6 months or longer. Oppositional defiant disorder can start in the preschool years, whereas conduct disorder generally appears when children are somewhat older. Oppositional defiant disorder is not diagnosed if conduct disorder is present.

What Are the Signs of Conduct Disorder?

• Some symptoms of conduct disorder include:
• aggressive behavior that harms or threatens to harm other people or animals;
• destructive behavior that damages or destroys property;
• lying or theft;
• and skipping school or other serious violations of rules.

Children with oppositional defiant disorder or conduct disorder may have other problems as well, including:

• hyperactivity;
• anxiety;
• depression;
• academic difficulties; and
• problems with peer relationships.

How Common is Conduct Disorder?

As many as 1 in 10 children and adolescents may have conduct disorder (*2). Most children and adolescents with conduct disorder do not have lifelong patterns of conduct problems and antisocial behavior.

Who Is at Risk?

Years of research show that the most troubling cases of conduct disorder begin in early childhood, often by the preschool years. In fact, some infants who are especially "fussy" are at risk for developing conduct disorder. Other factors that may make a child more likely to develop conduct disorder include:

• inconsistent rules and harsh discipline;
• lack of enough supervision or guidance;
• frequent change in caregivers;
• poverty;
• neglect or abuse; and
• a delinquent peer group.

What Help Is Available for Families?

Conduct disorder is one of the most difficult behavior disorders of childhood and adolescence to treat successfully. However, young people with conduct disorder often benefit from a range of services, which might include:

• parent training on how to handle their child's or adolescent's behavior;
• family therapy;
• training in problem-solving skills for children or adolescents; and
• community-based services that focus on the young person within the context of family and community influences.

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a "system of care." A system of care is designed to improve the child's ability to function in all areas of life-at home, at school, and in the community. For a fact sheet on systems of care, call 1.800.789.2647.

What Can Parents Do?

Antisocial behavior in children and adolescents is very hard to change after it has become ingrained. Therefore, the earlier the problem is identified and treated, the better. Some recent studies have focused on promising ways to prevent conduct disorder among children and adolescents who are at risk for developing the disorder. Most children or adolescents with conduct disorder are probably reacting to events and situations in their lives. More research is needed to determine if biology is a factor in conduct disorder. Parents should:

• Pay careful attention when a child or adolescent shows signs of oppositional defiant disorder or conduct disorder and try to understand the reasons behind it. Then parents can try to improve the situation or their own reactions.
• Talk with a mental health or social service professional, such as a teacher, counselor, psychiatrist, or psychologist specializing in childhood and adolescent disorders (if parents cannot reduce their child's or adolescent's antisocial behavior on their own).
• Get accurate information from libraries, hotlines, or other sources.
• Talk to other families in their community.
• Find family network organizations.

It is important for people who are not satisfied with the mental health care they are receiving to discuss their concerns with the provider, to ask for information, and/or to seek help from other sources.

*1 Prevalence of serious emotional disturbance in children and adolescents. Mental Health, United States, 1996. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996.

*2 This estimate provides only a rough gauge of the prevalence rates (number of existing cases in a defined time period) for this disorder. The National Institute of Mental Health is currently engaged in a nationwide study to determine with greater accuracy the prevalence of mental disorders among children and adolescents. This information is needed to increase understanding of mental health problems and to improve the treatments and services that help young people who are affected by these conditions.

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