Diagnosis: Conduct Disorder

Conduct disorder, a "disruptive behavior disorder," can seriously impair the way a child reacts to certain situations and people. We asked experts for advice on diagnosing and treating the disorder so kids can effectively improve their functioning in school and with peers.

Typical Diagnosis

Children diagnosed with conduct disorder, one of the “disruptive behavior disorders,” show a repetitive and persistent pattern of behavior in which they violate the rights of others and/or major age-appropriate societal norms. These children often engage in bullying, fighting, stealing, and aggressive or covert behaviors. “It goes beyond bullying at school,” says Melanie Fernandez, Ph.D., ABPP, director of the parent-child interaction therapy program at the Child Mind Institute in Manhattan.

To be diagnosed, a child must present three or more symptoms, like those listed above, in the last year, and one of those symptoms—often bullying, stealing, or talking without permission—must be present within the last six months.

Conduct disorder is more common among boys than girls. Studies indicate that 6 to 16 percent of boys suffer from the disorder while the rate among girls ranges from 2 to 9 percent.

The disorder’s onset can either occur early, before age 10, or in adolescence. While the cause is unknown, it seems to arise from a variety of factors. “We look at how conduct disorder aggregates in families and we see pretty significant sibling correlations [as well as] correlations between parents’ anti-social behavior and their kids’ conduct problems. So there’s definitely a big genetic piece,” Dr. Fernandez says. “But there are also environmental influences on the genetic predispositions. So things like the prenatal environment even, such as environmental toxins. Lead is a huge and preventable risk factor for disruptive behavior disorders. And there’s evidence that maternal smoking is a predictor of conduct disorder in boys.”

Oppositional defiant disorder, another disruptive behavior disorder characterized by persistent patterns of resistance to authority, defiance, non-compliance, and irritability, is often a precursor to conduct disorder. This doesn’t mean that all kids with ODD go on to develop conduct disorder, but it is a risk factor.

What It Means for Your Child

Kids with conduct disorder are at significantly greater risk of depression, substance-abuse disorders, incarceration, and suicide. “Some kids improve over time, but many kids get worse,” Dr. Fernandez says, explaining that the latter group can have lasting functional impairment in terms of their relationships with others, how they do in school, and ultimately in their jobs.