View source for Conduct disorder

{{short description|Developmental disorder}}
{{distinguish|Disorderly conduct}}
{{Lead too short|date=October 2020}}
{{Infobox medical condition
| name = Conduct disorder
| synonyms = Conduct-dissocial disorder<ref name="j379">{{cite web | title=ICD-11 for Mortality and Morbidity Statistics: 6C91 Conduct-dissocial disorder | website=[[World Health Organization]] | url=https://icd.who.int/browse/2024-01/mms/en#719572464 | access-date=2025-01-12}}</ref>
| image = Bullying_on_Instituto_Regional_Federico_Errázuriz_(IRFE)_in_March_5,_2007.jpg
| caption = [[Physical abuse]] and [[bullying]], such as this boy attacking another boy, is a characteristic of a child with an established conduct disorder.
| pronounce = 
| field = [[Psychiatry]], [[pediatrics]], [[clinical psychology]]
| symptoms = [[Malice (legal term)|Maliciousness]], [[bullying]], [[abuse]], [[crime]], [[Juvenile delinquent|delinquency]], [[truancy]], [[substance use disorder|substance abuse]], [[injury]], [[impulsivity]]
| complications = [[Sadomasochism]], [[self-injury]], [[crime]], [[substance use disorder|substance abuse]], [[imprisonment]], [[violence]], [[antisocial personality disorder]]
| onset = 
| duration = 
| types = 
| causes = 
| risks = [[Attention deficit hyperactivity disorder]], [[schizophrenia]], [[substance use disorder|substance abuse]], [[fetal alcohol syndrome]], child physical abuse, maternal [[Smoking and pregnancy|smoking during pregnancy]], [[domestic violence]], [[sexual bullying]], [[molestation]]
| diagnosis = Through a prolonged pattern of antisocial behaviour such as serious violation of laws, [[social norm]]s, and rules in people younger than the age of 18
| differential = 
| prevention = 
| treatment = 
| medication = 
| prognosis = 
| frequency = 
| deaths = 
}}
<!-- Definition and symptoms -->

'''Conduct disorder''' ('''CD''') is a [[mental disorder]] diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes [[theft]], [[lie]]s, [[physical violence]] that may lead to destruction, and reckless breaking of rules,<ref>{{cite web |url=https://www.lecturio.com/concepts/conduct-disorder/|title=Conduct disorder and Its Clinical Management|last= Barzman |first= D |publisher= DeckerMed Medicine |date=2017 |website= The Lecturio Medical Concept Library |access-date=June 24, 2021}}</ref> in which the basic rights of others or major [[age-appropriate]] norms are violated. These behaviors are often referred to as "[[Anti-social behaviour|antisocial behaviors]]",<ref name="Hinshaw">{{cite book|last1=Hinshaw|first1=S. P.|last2=Lee|first2=S. S.|date=2003|title=Conduct and oppositional defiant disorders: Child psychopathology|edition=E. J. Mash & R. A. Barkley|pages=144–198|location=New York|publisher=Guilford Press}}</ref> and is often seen as the precursor to [[antisocial personality disorder]]; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old.<ref>{{Cite book| author=American Psychiatric Association| date=2013| title=Diagnostic and Statistical Manual of Mental Disorders| edition=5th| publisher=American Psychiatric Publishing| location=Arlington, VA| pages=[https://archive.org/details/diagnosticstatis0005unse/page/659 659]| isbn=978-0-89042-555-8| url=https://archive.org/details/diagnosticstatis0005unse/page/659}}</ref>  Conduct disorder may result from parental rejection and neglect and in such cases can be treated with family therapy, as well as behavioral modifications and pharmacotherapy.<ref>{{cite journal |url=https://www.ncbi.nlm.nih.gov/books/NBK470238/|title= Conduct disorder |last1= Mohan |first1= L |last2= Yilanli  |first2= M |last3= Ray  |first3= S |publisher= StatPearls Publishing LLC |date= 2020 |website= National Center for Biotechnology Information, U.S. National Library of Medicine |pmid= 29261891 |access-date=June 24, 2021}}</ref> It may also be caused by environmental [[lead exposure]].<ref>Michael J. McFarland, Aaron Reuben, Matt Hauer. Contribution of Childhood Lead Exposure to Psychopathology in the U.S. Population over the Past 75 Years. Journal of Child Psychology and Psychiatry, 2024 DOI: 10.1111/jcpp.14072</ref> Conduct disorder is estimated to affect 51.1 million people globally {{As of|2013|lc=on|post=.}}<ref name="GBD2015">{{cite journal |last1=((Global Burden of Disease Study 2013 Collaborators)) |date=5 June 2015 |title=Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 301 Acute and Chronic Diseases and Injuries in 188 Countries, 1990-2013: a Systematic Analysis for the Global Burden of Disease Study 2013 |journal=Lancet |volume=386 |issue=9995 |pages=743–800 |doi=10.1016/S0140-6736(15)60692-4 |pmc=4561509 |pmid=26063472}}</ref> 
{{TOC limit|3}}

==Signs and symptoms==
One of the symptoms of conduct disorder is a lower level of fear. Research performed on the impact of toddlers exposed to fear and distress shows that negative emotionality (fear) predicts toddlers' empathy-related response to distress. The findings support that if a caregiver is able to respond to infant cues, the toddler has a better ability to respond to fear and distress. If a child does not learn how to handle fear or distress the child will be more likely to lash out at other children. If the caregiver is able to provide therapeutic intervention teaching children at risk better empathy skills, the child will have a lower incident level of conduct disorder.<ref>Spinrad, Tracy, and Cynthia Stifter. "Toddlers' Empathy-Related Responding to Distress: Predictions from Negative Emotionality and Maternal Behavior in Infancy." ''Infancy'' 10(2), 97-121, n.d. Web</ref>

The condition is also linked to a rise in violent and antisocial behaviour;<ref>{{Cite web|url=https://childmind.org/guide/guide-to-conduct-disorder/|title=Conduct Disorder Basics|website=Child Mind Institute|language=en|access-date=2019-06-21}}</ref> examples may range from pushing, hitting and biting when the child is young, progressing towards beating and inflicted cruelty as the child becomes older.<ref>{{Cite web|url=https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/behavioural-problems-and-conduct-disorder-for-parents-carers-and-anyone-who-works-with-young-people|title=Behavioural problems and conduct disorder: for parents and carers|website=RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS|language=en|access-date=2019-06-21}}</ref><ref>{{Cite journal|last1=MYERS|first1=WADE C.|last2=SCOTT|first2=KERRILYN|date=1998-05-01|title=Psychotic and Conduct Disorder Symptoms in Juvenile Murderers|journal=Homicide Studies|language=en|volume=2|issue=2|pages=160–175|doi=10.1177/1088767998002002004|s2cid=145559982|issn=1088-7679}}</ref> Additionally, self-harm has been observed in children with conduct disorder (CD).  A predisposition towards impulsivity and lowered [[emotional intelligence]] have been cited as contributing factors to this phenomenon.   However, in order to determine direct causal links further studies must be conducted.<ref>{{Cite journal |last1=Halicka-Masłowska |first1=Joanna |last2=Szewczuk-Bogusławska |first2=Monika |last3=Rymaszewska |first3=Joanna |last4=Adamska |first4=Agnieszka |last5=Misiak |first5=Błażej |date=2021 |title=From Emotional Intelligence to Self-Injuries: A Path Analysis in Adolescents With Conduct Disorder |journal=Frontiers in Psychiatry |volume=11 |article-number=556278 |doi=10.3389/fpsyt.2020.556278 |pmid=33488414 |pmc=7819897 |issn=1664-0640|doi-access=free }}</ref>

Conduct disorder can present with limited prosocial emotions, lack of remorse or guilt, lack of empathy, lack of concern for performance, and shallow or deficient affect. Symptoms vary by individual, but the four main groups of symptoms are described below.<ref name="NCBI">{{Cite web|last=Substance Abuse and Mental Health Services Administration (US)|date=2016-06-01|title=Table 17, DSM-IV to DSM-5 Conduct Disorder Comparison|url=https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t13/|access-date=2020-08-16|website=www.ncbi.nlm.nih.gov|language=en}}{{PD-notice}}</ref>

=== Aggression to people and animals ===
* Often bullies, threatens or intimidates others
* Often initiates physical fights
* Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
* Has been physically cruel to people
* Has been physically cruel to animals
* Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
* Feels no remorse or empathy towards the harm, fear, or pain they may have inflicted on others

=== Destruction of property ===
* Has deliberately engaged in fire setting with the intention of causing serious damage
* Has deliberately destroyed others' property (other than by fire setting)<ref name="NCBI"/>

=== Deceitfulness or theft ===
* Has broken into someone else's house, other building,  car, other vehicle, etc
* Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
* Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)<ref name="NCBI"/>

=== Serious violations of rules ===
* Often stays out at night despite parental prohibitions, beginning before age 13
* 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)
* Is often truant from school, beginning before age 13<ref name="NCBI"/>
The lack of empathy these individuals have and the aggression that accompanies this carelessness for the consequences is dangerous, not only for the individual but for those around them.<ref>{{Cite web|title=Conduct Disorder: Definition, Symptoms, and Treatment Options|url=https://www.psycom.net/conduct-disorder/|access-date=2021-03-20|website=Psycom.net - Mental Health Treatment Resource Since 1996|language=en-US}}</ref>

===Developmental course===
Currently, two possible developmental courses are thought to lead to conduct disorder. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors. Specifically, children in this group have greater levels of [[ADHD]] symptoms, neuropsychological deficits, more academic problems, increased family dysfunction and higher likelihood of [[aggression]] and [[violence]].<ref name="Moff">{{cite journal | author = Moffitt T.E. | year = 1993 | title = Life-course persistent" and "adolescence-limited" antisocial behavior: A developmental taxonomy | journal = Psychological Review | volume = 100 | issue = 4| pages = 674–701 | doi = 10.1037/0033-295x.100.4.674 | pmid = 8255953 }}</ref>

There is debate among professionals regarding the validity and appropriateness of diagnosing young children with conduct disorder. The characteristics of the diagnosis are commonly seen in young children who are referred to mental health professionals.<ref>{{cite journal | author = Volkmar F | year = 2002 | title = Considering disruptive behaviors | journal = Am J Psychiatry | volume = 159 | issue = 3| pages = 349–350 | doi = 10.1176/appi.ajp.159.3.349 | pmid=11869994}}</ref> A premature diagnosis made in young children, and thus labeling and stigmatizing an individual, may be inappropriate. It is also argued that some children may not in fact have conduct disorder, but are engaging in developmentally appropriate disruptive behavior.

The second developmental course is known as the "adolescent-onset type" and occurs when conduct disorder symptoms are present after the age of 10 years. Individuals with adolescent-onset conduct disorder exhibit less impairment than those with the childhood-onset type and are not characterized by similar psychopathology.<ref>{{cite journal |author1=Moffitt T.E. |author2=Caspi A. | year = 2001 | title = Childhood predictors differentiate life-course life-course persistent and adolescence-limited antisocial pathways among males and females | doi = 10.1017/s0954579401002097 |pmid=11393651 | journal = Development and Psychopathology | volume = 13 | issue = 2| pages = 355–375 |s2cid=29182035 }}</ref> At times, these individuals will remit in their deviant patterns before adulthood. Research has shown that there is a greater number of children with adolescent-onset conduct disorder than those with childhood-onset, suggesting that adolescent-onset conduct disorder is an exaggeration of developmental behaviors that are typically seen in [[adolescence]], such as rebellion against authority figures and rejection of conventional values.<ref name="Moff" /> However, this argument is not established<ref>{{cite journal | author = Roisman G. I. | author2 = Monahan K. C. | author3 = Campbell S. B. | author4 = Steinberg L. | author5 = Cauffman E. | author6 = Early Child Care Research Network | year = 2010 | title = Is adolescence-onset antisocial behavior developmentally normative? | journal = Development and Psychopathology | volume = 22 | issue = 2| pages = 295–311 | doi=10.1017/s0954579410000076| pmid = 20423543 | s2cid = 18497078 }}</ref> and empirical research suggests that these subgroups are not as valid as once thought.<ref name="Hinshaw" />

In addition to these two courses that are recognized by the [[DSM-IV-TR]], there appears to be a relationship among [[oppositional defiant disorder]], conduct disorder, and antisocial personality disorder. Specifically, research has demonstrated continuity in the disorders such that conduct disorder is often diagnosed in children who have been previously diagnosed with oppositional defiant disorder, and most adults with antisocial personality disorder were previously diagnosed with conduct disorder. For example, some research has shown that 90% of children diagnosed with conduct disorder had a previous diagnosis of oppositional defiant disorder.<ref name="Loeber">{{cite journal |author1=Loeber R. |author2=Keenan K. |author3=Lahey B.B. |author4=Green S.M. |author5=Thomas C. | year = 1993 | title = Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder | journal = Journal of Abnormal Child Psychology | volume = 21 | issue = 4| pages = 377–410 | doi=10.1007/bf01261600 | pmid=8408986|s2cid=43444052 }}</ref> Moreover, both disorders share relevant risk factors and disruptive behaviors, suggesting that oppositional defiant disorder is a developmental precursor and milder variant of conduct disorder. However, this is not to say that this trajectory occurs in all individuals. In fact, only about 25% of children with oppositional defiant disorder will receive a later diagnosis of conduct disorder.<ref name="Loeber"/> Correspondingly, there is an established link between conduct disorder and the diagnosis of [[antisocial personality disorder]] as an adult. In fact, the current diagnostic criteria for antisocial personality disorder require a conduct disorder diagnosis before the age of 15.<ref name="APA" /> However, again, only 25–40% of youths with conduct disorder will develop an antisocial personality disorder.<ref name="OutcomeofCD">{{cite journal |author1=Zocccolillo M. |author2=Pickles A. |author3=Quinton D. |author4=Rutter M. | year = 1992 | title = The outcome of conduct disorder: Implications for defining adult personality disorder and conduct disorder | doi = 10.1017/s003329170003854x |pmid=1488492 | journal = Psychological Medicine | volume = 22 | issue = 4| pages = 971–986 |s2cid=25470721 }}</ref> Nonetheless, many of the individuals who do not meet full criteria for antisocial personality disorder still exhibit a pattern of social and personal impairments or antisocial behaviors.<ref>{{cite journal | author = Rutter M | year = 1989 | title = Pathways from childhood to adult life | journal = Journal of Child Psychology and Psychiatry | volume = 30 | issue = 1| pages = 25–51 | doi=10.1111/j.1469-7610.1989.tb00768.x| pmid = 2647779 }}</ref> These developmental trajectories suggest the existence of antisocial pathways in certain individuals,<ref name="Hinshaw" /> which have important implications for both research and treatment.

===Associated conditions===
Children with conduct disorder have a high risk of developing other adjustment problems. Specifically, risk factors associated with conduct disorder and the effects of conduct disorder symptomatology on a child's psychosocial context have been linked to overlapping with other psychological disorders.<ref name="McMahon, R. J. 2005">{{cite journal |author1=McMahon R. J. |author2=Frick P. J. | year = 2005 | title = Evidenced-based assessment of conduct problems in children and adolescents | journal = Journal of Clinical Child and Adolescent Psychology | volume = 34 | issue = 3 | pages = 477–505 | doi=10.1207/s15374424jccp3403_6|pmid=16026215 |s2cid=39028273 }}</ref> In this way, there seems to be reciprocal effects of [[comorbidity]] with certain disorders, leading to increased overall risk for these youth.

====Attention deficit hyperactivity disorder====
[[ADHD]] is the condition most commonly associated with conduct disorders, with approximately 25–30% of boys and 50–55% of girls with conduct disorder having a comorbid ADHD diagnosis.<ref name="Waschbusch">{{cite journal | author = Waschbusch D. A. | year = 2002 | title = A meta-analytic evaluation of comorbid hyperactive-impulsive-inattention problems and conduct problems | journal = Psychological Bulletin | volume = 128 | issue = 1| pages = 118–150 | doi=10.1037/0033-2909.128.1.118| pmid = 11843545 }}</ref> While it is unlikely that ADHD alone is a risk factor for developing conduct disorder, children who exhibit hyperactivity and impulsivity along with aggression is associated with the early onset of conduct problems.<ref name="Hinshaw" /> Moreover, children with comorbid conduct disorder and ADHD show more severe aggression.<ref name="Waschbusch" />

'''Oppositional defiant disorder'''

[[Oppositional defiant disorder|ODD]] is a mental disorder characterized by angry, argumentative, and resentful behavior. ODD and CD both fall under the umbrella of Disruptive Behavior Disorders (DBD). The main difference is in severity. While ODD is based on verbal hostility, CD is more severe in that it includes aggression and violence towards other people and animals, theft, deceit, and breaking of rules.<ref>{{Cite journal |last1=Kerekes |first1=Nóra |last2=Lundström |first2=Sebastian |last3=Chang |first3=Zheng |last4=Tajnia |first4=Armin |last5=Jern |first5=Patrick |last6=Lichtenstein |first6=Paul |last7=Nilsson |first7=Thomas |last8=Anckarsäter |first8=Henrik |date=2014-04-22 |title=Oppositional defiant- and conduct disorder-like problems: neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study |journal=PeerJ |language=en |volume=2 |article-number=e359 |doi=10.7717/peerj.359 |doi-access=free |issn=2167-8359 |pmc=4006222 |pmid=24795851}}</ref> ODD has also been found to be a precursor for CD. The chances of developing CD is four times higher in children who previously had ODD than in children who do not have a history of ODD.<ref>{{Cite journal |last1=Burke |first1=Jeffrey D. |last2=Loeber |first2=Rolf |last3=Birmaher |first3=Boris |date=2002-11-01 |title=Oppositional Defiant Disorder and Conduct Disorder: A Review of the Past 10 Years, Part II |url=https://linkinghub.elsevier.com/retrieve/pii/S089085670960633X |journal=Journal of the American Academy of Child & Adolescent Psychiatry |language=English |volume=41 |issue=11 |pages=1275–1293 |doi=10.1097/00004583-200211000-00009 |issn=0890-8567 |pmid=12410070|url-access=subscription }}</ref>

====Substance use disorders====
Conduct disorder is also highly associated with both substance use and abuse. Children with conduct disorder have an earlier onset of [[substance abuse|substance use]], as compared to their peers, and also tend to use multiple substances.<ref>{{cite journal |author1=Lynskey M. T. |author2=Fergusson D. M. | year = 1995 | title = Childhood conduct problems, attention deficit behaviors, and adolescent alcohol, tobacco, and illicit drug use | journal = Journal of Abnormal Child Psychology | volume = 23 | issue = 3| pages = 281–302 | doi=10.1007/bf01447558|pmid=7642838 |s2cid=40789985 }}</ref> Studies have shown that a diagnosis of conduct disorder during early adolescence (11–14 years old) was a significant predictor of substance abuse by the age of 18.<ref name="jamanetwork.com">{{Cite journal |last1=Elkins |first1=Irene J. |last2=McGue |first2=Matt |last3=Iacono |first3=William G. |date=2007-10-01 |title=Prospective Effects of Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Sex on Adolescent Substance Use and Abuse |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210070 |journal=Archives of General Psychiatry |volume=64 |issue=10 |pages=1145–1152 |doi=10.1001/archpsyc.64.10.1145 |pmid=17909126 |issn=0003-990X|url-access=subscription }}</ref> However, substance use disorders themselves can directly or indirectly cause conduct disorder-like traits in about half of adolescents who have a substance use disorder.<ref name="Brown-1996"/> As mentioned above, it seems that there is a transactional relationship between substance use and conduct problems, such that aggressive behaviors increase substance use, which leads to increased aggressive behavior.<ref>{{cite journal |author1=White H.R. |author2=Loeber R. |author3=Stouthamer-Loeber M. |author4=Farrington D.P. |s2cid=9357010 | year = 1999 | title = Developmental associations between substance use and violence | journal = Development and Psychopathology | volume = 11 | issue = 4| pages = 785–803 | doi=10.1017/s0954579499002321|pmid=10624726 }}</ref> Notably, while older studies may have failed to find a correlation between hyperactivity or impulsivity as a predictor of conduct disorder, more recent studies have found that even a single symptom of ADHD or conduct disorder is associated with increased risk of substance abuse.<ref name="jamanetwork.com"/>

Substance use in conduct disorder can lead to antisocial behavior in adulthood.<ref>{{cite journal|last1=Khalifa|first1=N|last2=Duggan|first2=C|last3=Howard|first3=R|last4=Lumsden|first4=J|title=The relationship between childhood conduct disorder and adult antisocial behavior is partially mediated by early-onset alcohol abuse.|journal=Personality Disorders|date=October 2012|volume=3|issue=4|pages=423–32|pmid=22888992|doi=10.1037/a0027017}}</ref>

====Schizophrenia====
Conduct disorder is a precursor to schizophrenia in a minority of cases,<ref>{{cite journal |last1=Schiffer |first1=Boris |last2=Leygraf |first2=Norbert |last3=Muller |first3=Bernhard |last4=Scherbaum |first4=Norbert |last5=Forsting |first5=Michael |last6=Wiltfang |first6=Jens |last7=Gizewski |first7=Elke |last8=Hodgins |first8=Sheilagh |title=Structural Brain Alterations Associated With Schizophrenia Preceded by Conduct Disorder: A Common and Distinct Subtype of Schizophrenia? |journal=Schizophrenia Bulletin |date=September 2012 |volume=39 |issue=5 |pages=1115–1128 |doi=10.1093/schbul/sbs115 |pmid=23015687 |pmc=3756783 |url=https://academic.oup.com/schizophreniabulletin/article/39/5/1115/1925725|doi-access=free }}</ref> with about 40% of men and 31% of women with schizophrenia meeting criteria for childhood conduct disorder.<ref>{{cite journal |last1=Dalteg |first1=Arne |last2=Zandelin |first2=Anders |last3=Tuninger |first3=Eva |last4=Levander |first4=Sten |title=Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood |journal=Nordic Journal of Psychiatry |date=2014 |volume=68 |issue=8 |pages=560–566 |doi=10.3109/08039488.2014.892151 |pmid=24620816 |s2cid=46031432 |url=https://www.tandfonline.com/doi/full/10.3109/08039488.2014.892151|url-access=subscription }}</ref>

== Cause ==
While the cause of conduct disorder is complicated by an intricate interplay of biological and environmental factors, identifying underlying mechanisms is crucial for obtaining accurate assessment and implementing effective treatment.<ref>Murrihy, R., Kidman, A., & Ollendick, T (2010). ''Clinical Handbook of Assessing and Treating Conduct Problems in Youth''. Springer: New York.</ref> These mechanisms serve as the fundamental building blocks on which evidence-based treatments are developed. Despite the complexities, several domains have been implicated in the development of conduct disorder including cognitive variables, neurological factors, intraindividual factors, familial and peer influences, and wider contextual factors.<ref name="Hinshaw" /> These factors may also vary based on the age of onset, with different variables related to early (e.g., neurodevelopmental basis) and adolescent (e.g., social/peer relationships) onset.<ref name="Passa">{{cite journal |author1=Passamonti L. |author2=Fairchild G. |author3=Goodyer I. |author4=Hurford G. |author5=Hagan C. |author6=Rowe J. |author7=Calder A. | year = 2010 | title = Neural abnormalities in early-onset and adolescence-onset conduct disorder | journal = Archives of General Psychiatry | volume = 67 | issue = 7| pages = 729–738 | doi=10.1001/archgenpsychiatry.2010.75 | pmid=20603454 | pmc=4471104}}</ref>

===Risks===
The development of conduct disorder is not immutable or predetermined. A number of interactive risk and protective factors exist that can influence and change outcomes, and in most cases conduct disorder develops due to an interaction and gradual accumulation of risk factors.<ref name="Murray">{{cite journal |author1=Murray J. |author2=Farrington D. P. | year = 2010 | title = Risk factors for conduct disorder and delinquency: Key findings from longitudinal studies | journal = The Canadian Journal of Psychiatry | volume = 55 | issue = 10| pages = 633–642 |doi=10.1177/070674371005501003 |pmid=20964942 |s2cid=21796448 | doi-access =  }}</ref> In addition to the risk factors identified under cause, several other variables place youth at increased risk for developing the disorder, including child physical abuse,<ref name="Murray" /> in-utero alcohol exposure, and maternal [[Smoking and pregnancy|smoking during pregnancy]].<ref>{{cite journal |author1=Larkby C. A. |author2=Goldschmidt L. |author3=Hanusa B. H. |author4=Day N. L. | year = 2011 | title = Prenatal alcohol exposure is associated with conduct disorder in adolescence: Findings from a birth cohort | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 50 | issue = 3| pages = 262–271 | doi=10.1016/j.jaac.2010.12.004|pmid=21334566 |pmc=3042714 }}</ref> Protective factors have also been identified, and most notably include high [[IQ]], being female, positive social orientations, good coping skills, and supportive family and community relationships.<ref>{{cite journal | author = Bassarath L | year = 2001 | title = Conduct disorder: A biopsychosocial review | journal = The Canadian Journal of Psychiatry | volume = 46 | issue = 7| pages = 609–616 | doi = 10.1177/070674370104600704 | pmid = 11582821 | doi-access =  }}</ref>

However, a correlation between a particular risk factor and a later developmental outcome (such as conduct disorder) cannot be taken as definitive evidence for a causal link. Co-variation between two variables can arise, for instance, if they represent age-specific expressions of similar underlying genetic factors.<ref>{{cite journal | author = Rutter M. | author2 = Moffi T. | author3 = Caspi A. | year = 2006 | title = Gene–environment interplay and psychopathology: Multiple varieties but real effects | journal = Journal of Child Psychology and Psychiatry | volume = 47 | issue = 3–4| pages = 226–261 | doi=10.1111/j.1469-7610.2005.01557.x| pmid = 16492258 }}</ref> There have been studies that found that, although smoking during pregnancy does contribute to increased levels of antisocial behaviour, in mother-fetus pairs that were not genetically related (by virtue of in-vitro fertilisation), no link between smoking during pregnancy and later conduct problems was found. Thus, the distinction between causality and correlation is an important consideration.<ref>{{cite journal |last1= Rice |first1= F. |last2= Harold | first2= T.G. | last3= Boivin | first3= J.  | last4=Hay |first4= D.F. |last5= van den Bree |first5= M |last6= Thapar |first6= A. |date= February 17, 2009 |title= Disentangling prenatal and inherited influences in humans with an experimental design
|journal= Proceedings of the National Academy of Sciences of the United States of America |volume= 106 |issue= 7 |pages= 2464–7 |doi= 10.1073/pnas.0808798106 | pmid = 19188591 |pmc= 2634805 |bibcode= 2009PNAS..106.2464R |doi-access= free }}</ref>

===Learning disabilities===
While language impairments are most common,<ref name="McMahon, R. J. 2005"/> approximately 20–25% of youth with conduct disorder have some type of [[learning disability]].<ref>{{cite journal |author1=Frick P. J. |author2=Kamphaus R. W. |author3=Lahey B. B. |author4=Christ M. A. |author5=Hart E. L. |author6=Tannenbaum T. E. | year = 1991 | title = the vast majority of these have ADHD. Academic underachievement and the disruptive behavior disorders | journal = Journal of Consulting and Clinical Psychology | volume = 59 | issue = 2| pages = 289–294 | doi=10.1037/0022-006x.59.2.289|pmid=2030190 }}</ref> Although the relationship between the disorders is complex, it seems as if learning disabilities result from a combination of ADHD, a history of academic difficulty and failure, and long-standing [[socialization]] difficulties with family and peers.<ref>{{cite journal |author=Hinshaw |first=S.P. |year=1992 |title=Externalizing behavior problems and academic underachievement in childhood adolescence: Causal relationships and underlying mechanisms |journal=Psychological Bulletin |volume=111 |issue=1 |pages=127–155 |doi=10.1037/0033-2909.111.1.127 |pmid=1539086}}</ref> However, [[Confounding|confounding variables]], such as language deficits, [[Socioeconomic status|SES]] disadvantage, or [[Development of the nervous system|neurodevelopmental]] delay also need to be considered in this relationship, as they could help explain some of the association between conduct disorder and learning problems.<ref name="Hinshaw" />

===Cognitive factors===
In terms of cognitive function, intelligence and cognitive deficits are common amongst youths with conduct disorder, particularly those with early-onset and have intelligence quotients (IQ) one standard deviation below the mean<ref>Lynham, D. & Henry, B. (2001). The role of neuropsychological deficits in conduct disorders. In J. Hill & B. Maughan (Eds.), ''Conduct disorders in childhood and adolescence'' (pp.235-263). New York: Cambridge University Press.</ref> and severe deficits in verbal reasoning and [[Executive functions|executive function]].<ref>Moffitt, T. & Lynam, D. (1994). The neuropsychology of conduct disorder and delinquency: Implications for understanding antisocial behavior. In D.C. Fowles, P. Sutker, & S.H. Goodman (Eds.), ''Progress in experimental personality and psychopathology research'' (pp. 233-262). New York: Springer.</ref> Executive function difficulties may manifest in terms of one's ability to shift between tasks, plan as well as organize, and also inhibit a prepotent response. These findings hold true even after taking into account other variables such as socioeconomic status (SES), and education. However, IQ and executive function deficits are only one piece of the puzzle, and the magnitude of their influence is increased during transactional processes with environmental factors.<ref>{{cite journal |author1=Pennington B. |author2=Benneto L. | year = 1993 | title = Main effects or transactions in the neuropsychology of conduct disorder? Commentary on "The neuropsychology of conduct disorder | journal = Development and Psychopathology | volume = 5 | issue = 1–2| pages = 153–164 | doi=10.1017/s0954579400004314|s2cid=145599127 }}</ref>

===Brain differences===
Beyond difficulties in executive function, neurological research on youth with conduct disorder also demonstrate differences in brain anatomy and function that reflect the behaviors and mental anomalies associated in conduct disorder. Compared to normal controls, youths with early and adolescent onset of conduct disorder displayed reduced responses in brain regions associated with social behavior (i.e., [[amygdala]], [[ventromedial prefrontal cortex]], [[Insular cortex|insula]], and [[orbitofrontal cortex]]).<ref name="Passa" /> In addition, youths with conduct disorder also demonstrated less responsiveness in the orbitofrontal regions of the brain during a stimulus-reinforcement and reward task.<ref>{{cite journal |author1=Finger E. |author2=Marsh A. |author3=Blair K. |author4=Reid M. |author5=Sims C. |author6=Ng P. |author7=Pine D. |author8=Blair R. | year = 2011 | title = Disrupted reinforcement signaling in the orbitofrontal cortex and caudate in youths with conduct disorder or oppositional defiant disorder and a high level of psychopathic traits | journal = American Journal of Psychiatry | volume = 168 | issue = 2| pages = 152–162 | doi=10.1176/appi.ajp.2010.10010129|pmid=21078707 |pmc=3908480 }}</ref> This provides a neural explanation for why youths with conduct disorder may be more likely to repeat poor decision making patterns. Lastly, youths with conduct disorder display a reduction in grey matter volume in the amygdala, which may account for the fear conditioning deficits.<ref>{{cite journal | author = Raine A | year = 2011 | title = An amygdale structural abnormality common to two subtypes of conduct disorder: A neurodevelopmental conundrum | doi = 10.1176/appi.ajp.2011.11030416 | pmid = 21642478 | journal = American Journal of Psychiatry | volume = 168 | issue = 6| pages = 569–571 }}</ref> This reduction has been linked to difficulty processing social emotional stimuli, regardless of the age of onset.<ref>{{cite journal |author1=Fairchild G. |author2=Passamonti L. |author3=Hurford G. |author4=von dem Hagan C. |author5=Hagen E. |author6=van Goozen S. |author7=Goodyer I. |author8=Calder A. | year = 2011 | title = Brain structure abnormalities in early-onset and adolscent-onset conduct disorder | journal =   American Journal of Psychiatry| volume = 168 | issue = 6| pages = 624–633 | doi=10.1176/appi.ajp.2010.10081184|pmid=21454920 }}</ref> Aside from the differences in neuroanatomy and activation patterns between youth with conduct disorder and controls, neurochemical profiles also vary between groups.<ref name="Capp">{{Cite journal | last1 = Cappadocia | first1 = MC. | last2 = Desrocher | first2 = M. | last3 = Pepler | first3 = D. | last4 = Schroeder | first4 = JH. | title = Contextualizing the neurobiology of conduct disorder in an emotion dysregulation framework. | journal = Clin Psychol Rev | volume = 29 | issue = 6 | pages = 506–18 v|date=Aug 2009 | doi = 10.1016/j.cpr.2009.06.001 | pmid = 19573964 }}</ref> Individuals with conduct disorder are characterized as having reduced serotonin and cortisol levels (e.g., reduced hypothalamic-pituitary-adrenal (HPA) axis), as well as reduced autonomic nervous system (ANS) functioning. These reductions are associated with the inability to regulate mood and impulsive behaviors, weakened signals of anxiety and fear, and decreased self-esteem.<ref name="Capp" /> Taken together, these findings may account for some of the variance in the psychological and behavioral patterns of youth with conduct disorder.

===Intra-individual factors===
Aside from findings related to neurological and neurochemical profiles of youth with conduct disorder, intraindividual factors such as genetics may also be relevant. Having a sibling or parent with conduct disorder increases the likelihood of having the disorder, with a heritability rate of .53.<ref>{{cite journal |author1=Gelhorn H. L. |author2=Stallings M. C. |author3=Young S. E. |author4=Corley R. P. |author5=Rhee S. H. |author6=Hewitt J. K. | year = 2005 | title = Genetic and environmental influences on conduct disorder: Symptom, domain, and full-scale analyses | journal = Journal of Child Psychology and Psychiatry | volume = 46 | issue = 6| pages = 580–591 | doi=10.1111/j.1469-7610.2004.00373.x|pmid=15877764 }}</ref> There also tends to be a stronger genetic link for individuals with childhood-onset compared to adolescent onset.<ref>{{cite journal |author1=Burt S. |author2=Truger R. |author3=McGue M. |author4=Iacono W. | year = 2001 | title = Sources of covariation among attention deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder: The importance of shared environment | journal = Journal of Abnormal Psychology | volume = 110 | issue = 4| pages = 516–525 | doi=10.1037/0021-843x.110.4.516|pmid=11727941 }}</ref> In addition, youth with conduct disorder also exhibit polymorphism in the monoamine oxidase A gene,<ref>{{cite journal |author1=Foley D. L. |author2=Eaves L. J. |author3=Wormley B. |author4=Silberg J. L. |author5=Maes H. H. |author6=Kuhn J. |author7=Riley B. | year = 2004 | title = Childhood adversity, monoamine oxidase A genotype, and risk for conduct disorder | journal = Archives of General Psychiatry | volume = 61 | issue = 7| pages = 738–744 | doi=10.1001/archpsyc.61.7.738|pmid=15237086 |doi-access= }}</ref> low resting heart rates,<ref>{{cite journal |author1=Baker L. A. |author2=Tuvblad C. |author3=Reynolds C. |author4=Zheng M. |author5=Lozano D. I. |author6=Raine A. | year = 2009 | title = Resting heart rate and the development of antisocial behaviour from age 9 to 14: genetic and environmental influences | journal = Development and Psychopathology | volume = 21 | issue = 3| pages = 939–960 | doi=10.1017/s0954579409000509|pmid=19583891 |pmc=2756992 }}</ref> and increased testosterone.<ref>Coie, J. & Dodge, K. (1998). Aggression and antisocial behavior. In W. Damon (Series Ed.) & N. Eisenberg (Vol. Ed.), ''Handbook of child psychology: Vol.2. Social, emotional, and personality development'' (5th ed., pp.779-862). New York: Wiley.</ref>

===Family and peer influences===
Elements of the family and social environment may also play a role in the development and maintenance of conduct disorder. For instance, antisocial behavior suggestive of conduct disorder is associated with single parent status, parental divorce, large family size, and the young age of mothers.<ref name="Hinshaw" /> However, these factors are difficult to tease apart from other demographic variables that are known to be linked with conduct disorder, including poverty and low [[socioeconomic status]]. Family functioning and parent–child interactions also play a substantial role in childhood aggression and conduct disorder, with low levels of parental involvement, inadequate supervision, and unpredictable discipline practices reinforcing youth's defiant behaviors. Moreover, maternal depression has a significant impact on conduct disordered children and can lead to negative reciprocal feedback between the mother and conduct disordered child.<ref>{{Cite journal |last=Gardner |first=Frances E. M. |date=1992 |title=Parent—Child Interaction and Conduct Disorder |journal=Educational Psychology Review |volume=4 |issue=2 |pages=135–163 |doi=10.1007/BF01322342 |jstor=23359338 |issn=1040-726X}}</ref> Peer influences have also been related to the development of antisocial behavior in youth, particularly peer rejection in childhood and association with deviant peers.<ref name="Hinshaw" /> Peer rejection is not only a marker of a number of [[externalizing disorders]], but also a contributing factor for the continuity of the disorders over time. Hinshaw and Lee (2003)<ref name="Hinshaw" /> also explain that association with deviant peers has been thought to influence the development of conduct disorder in two ways: 1) a "selection" process whereby youth with aggressive characteristics choose deviant friends, and 2) a "facilitation" process whereby deviant peer networks bolster patterns of antisocial behavior. In a separate study by Bonin and colleagues, parenting programs were shown to positively affect child behavior and reduce costs to the public sector.<ref>{{cite journal |vauthors=Bonin EM, Stevens M, Beecham J, Byford S, Parsonage M | year = 2011 | title = Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study | journal = BMC Public Health | volume = 11 | page = 803 | doi=10.1186/1471-2458-11-803 | pmid=21999434 | pmc=3209459 | doi-access = free }}</ref>

===Wider contextual factors===
In addition to the individual and social factors associated with conduct disorder, research has highlighted the importance of environment and context in youth with antisocial behavior.<ref name="Hinshaw" /> However, it is important to note that these are not static factors, but rather transactional in nature (e.g., individuals are influenced by and also influence their environment). For instance, neighborhood safety and exposure to violence have been studied in conjunction with conduct disorder, but it is not simply the case that youth with aggressive tendencies reside in violent neighborhoods. Transactional models propose that youth may resort to violence more often as a result of exposure to community violence, but their predisposition towards violence also contributes to neighborhood climate.

==Diagnosis==
Conduct disorder is classified in the fourth edition of ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM).<ref name ="APA">American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC: Author.</ref> It is diagnosed based on a prolonged pattern of antisocial behaviour such as serious violation of laws and [[social norm]]s and rules in people younger than the age of 18. Similar criteria are used in those over the age of 18 for the diagnosis of [[antisocial personality disorder]].<ref name="pmid20964942">{{cite journal  |author=Murray J |author2=Farrington DP |date=Oct 2010 |title=Risk factors for conduct disorder and delinquency: key findings from longitudinal studies. |journal=Can J Psychiatry |volume=55 |issue=10 |pages=633–42 |pmid=20964942 |doi=10.1177/070674371005501003 |s2cid=21796448 |doi-access= }}</ref> No proposed revisions for the main criteria of conduct disorder exist in the ''[[DSM-5]]''; there is a recommendation by the work group to add an additional specifier for [[callous and unemotional traits]].<ref>{{cite web |publisher=American Psychiatric Association |year=2010 |title= DSM 5 Development: Conduct Disorder |url= http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=370Baker}}</ref> According to DSM-5 criteria for conduct disorder, there are four categories that could be present in the child's behavior: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules.<ref>{{Cite book | last=American Psychiatric Association | year=2013 | title=Diagnostic and Statistical Manual of Mental Disorders | edition=Fifth | publisher=American Psychiatric Publishing | location=Arlington, VA | pages=[https://archive.org/details/diagnosticstatis0005unse/page/469 469–470] | isbn=978-0-89042-555-8 | url=https://archive.org/details/diagnosticstatis0005unse/page/469 }}</ref>

Almost all adolescents who have a substance use disorder have conduct disorder-like traits, but after successful treatment of the substance use disorder, about half of these adolescents no longer display conduct disorder-like symptoms. Therefore, it is important to exclude a substance-induced cause and instead address the substance use disorder prior to making a psychiatric diagnosis of conduct disorder.<ref name="Brown-1996">{{Cite journal | last1 = Brown | first1 = SA. | last2 = Gleghorn | first2 = A. | last3 = Schuckit | first3 = MA. | last4 = Myers | first4 = MG. | last5 = Mott | first5 = MA. | title = Conduct disorder among adolescent alcohol and drug abusers. | journal = J Stud Alcohol | volume = 57 | issue = 3 | pages = 314–24 |date=May 1996 | doi =  10.15288/jsa.1996.57.314| pmid = 8709590 }}</ref>

==Treatment==
{{Expand section|date=July 2020}}

First-line treatment is psychotherapy based on [[behavior modification]] and problem-solving skills. This treatment seeks to integrate individual, school, and family settings. Parent-management training can also be helpful. No medications have been FDA approved for conduct disorder, but the [[atypical antipsychotic]] [[risperidone]] has the most evidence to support its use for aggression in children who have not responded to behavioral and psychosocial interventions. [[Selective serotonin reuptake inhibitor]]s (SSRIs) are also sometimes used to treat irritability in these patients.{{Medical citation needed|date=June 2025}}

A 2025 systematic review found that psychosocial interventions, particularly those involving both parent and child (multicomponent) or parent-only approaches, were more effective than standard care or no intervention in reducing disruptive behaviors among children with conduct problems. In cases where behavioral therapy was insufficient, stimulant medications or risperidone showed modest benefits; however, medication use was associated with an increased risk of adverse events.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/disruptive-behavior/research |title=Psychosocial and Pharmacologic Interventions for Disruptive Behavior in Children and Adolescents: A Systematic Review |last=Selph |first=Shelley S. |last2=Skelly |first2=Andrea C. |last3=Dana |first3=Tracy |last4=Brodt |first4=Erika |last5=Atchison |first5=Chandler |last6=Riopelle |first6=Dakota |last7=Stabler-Morris |first7=Shay |last8=Schmidt |first8=Linda |last9=Ahmed |first9=Azrah |date=2025-04-10 |publisher=Agency for Healthcare Research and Quality |doi=10.23970/ahrqepcsrdisruptive|url-access=subscription }}</ref>

==Prognosis==
About 25–40% of youths diagnosed with conduct disorder qualify for a diagnosis of [[antisocial personality disorder]] when they reach adulthood. For those that do not develop ASPD, most still exhibit social dysfunction in adult life.<ref name="OutcomeofCD"/>

==Epidemiology==
Conduct disorder is estimated to affect 51.1 million people globally as of 2013.<ref name=GBD2015/> The percentage of children affected by conduct disorder is estimated to range from 1–10%.<ref name="Hinshaw" /> However, among incarcerated youth or youth in juvenile detention facilities, rates of conduct disorder are between 23% and 87%.<ref>U.S. Department of Justice. (2006).  Psychiatric disorders of youth in detention (NCJ 210331)Washington, DC: U.S. Government Printing Office.</ref>

===Sex differences===
The majority of research on conduct disorder suggests that there are a significantly greater number of males than females with the diagnosis, with some reports demonstrating a threefold to fourfold difference in prevalence.<ref>Lahey, B. B., Miller, T. L., Gordon, R. A., & Riley, A. W. (1999). Developmental epidemiology of disruptive behavior disorders. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive disorders (pp. 23-48). New York: Kluwer Academic/Plenum Publishers.</ref> However, this difference may be somewhat biased by the diagnostic criteria which focus on more overt behaviors, such as aggression and fighting, which are more often exhibited by males. Females are more likely to be characterized by covert behaviors, such as stealing or running away. Moreover, conduct disorder in females is linked to several negative outcomes, such as antisocial personality disorder and early pregnancy,<ref>{{cite journal |author1=Loeber R. |author2=Burke J.D. |author3=Lahey B.B. |author4=Winters A. |author5=Zera M. |s2cid=33898115 | year = 2000 | title = Oppositional defiant and conduct disorder: a review of the past 10 years, part I. | journal = Journal of the American Academy of Child & Adolescent Psychiatry| volume = 39 | issue = 12| pages = 1468–1484 | doi=10.1097/00004583-200012000-00007|pmid=11128323 }}</ref> suggesting that sex differences in disruptive behaviors need to be more fully understood.

Females are more responsive to peer pressure<ref>{{cite journal | author = Keenan Kate | author2 = Loeber Rolf | author3 = Green Stephanie | s2cid = 38741328 | year = 1999 | title = Conduct Disorder in Girls: A Review of the Literature | journal = Clinical Child and Family Psychology Review | volume = 2 | issue = 1 | pages = 3–19 | doi = 10.1023/A:1021811307364 | pmid = 11324095 }}</ref> including feelings of guilt<ref>{{cite journal | author = Stanger Nicholas | author2 = Kavussanu Maria | author3 = Ring Christopher | year = 2012 | title = Put Yourself in Their Boots: Effects of Empathy on Emotion and Aggression | journal = Journal of Sport & Exercise Psychology | volume = 34 | issue = 2| pages = 208–22 | doi=10.1123/jsep.34.2.208| pmid = 22605362 }}</ref> than males.

===Racial differences===
Research on racial or cultural differences on the prevalence or presentation of conduct disorder is limited. However, according to studies on American youth, it appears that black youths are more often diagnosed with conduct disorder,<ref>{{cite journal |author1=DelBello M. P. |author2=Lopez-Larson M. P. |author3=Soutullo C. A. |author4=Strakowski S. M. | year = 2001 | title = Effects of race on psychiatric diagnosis of hospitalized adolescents: A retrospective chart review | journal = Journal of Child and Adolescent Psychopharmacology | volume = 11 | issue = 1| pages = 95–103 | doi=10.1089/104454601750143528|pmid=11322750 }}</ref> while Asian youths are about one-third as likely<ref>{{cite journal |author1=Sakai J. T. |author2=Risk N. K. |author3=Tanaka C. A. |author4=Price R. K. | year = 2007 | title = Conduct disorder among Asians and Native Hawaiian/Pacific Islanders in the USA | url = https://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=4893&context=open_access_pubs| journal = Psychological Medicine | volume = 37 | issue = 7| pages = 1013–1025 | doi = 10.1017/s0033291707001316|pmid=17803831 |s2cid=16234399 | url-access = subscription }}</ref> to be diagnosed with conduct disorder when compared to white youths. It has been widely theorized for decades that this disparity is due to unconscious bias in those who give the diagnosis, although an alternative explanation is the culture and values of the communities the individuals arise from.<ref>{{cite journal |url=https://files.eric.ed.gov/fulltext/EJ901591.pdf|title=Conduct Disorders in African American Adolescent Males: The Perceptions That Lead to Overdiagnosis and Placement in Special Programs|last=Clark|first=Eddie|date=Fall 2007|via=files.eric.ed.gov|publisher=[[Troy University at Montgomery]] |journal=The Alabama Counseling Association Journal |volume=33 |number=2 |access-date=28 September 2020}}</ref>

== Anthropological approach to conduct disorder ==

=== Societal approach ===
Early societal perspectives on conduct disorder emerged in the mid-20th century, when researchers began linking disruptive behaviours to socioeconomic disadvantage, family instability, and community disorganisation.<ref name="doi.org">Shaw, D. S., & Shelleby, E. C. (2014). Early-starting conduct problems: Intersection of conduct disorder and poverty. ''Annual Review of Clinical Psychology, 10'', 503–528. https://doi.org/10.1146/annurev-clinpsy-032813-153650</ref> This shifted understanding away from solely individual pathology toward broader structural and environmental explanations.

A societal approach to conduct disorder (CD) emphasises the role of broader social systems, such as families, schools, neighbourhoods, and communities, in both the development and prevention of antisocial behaviours. Sociocultural contexts including poverty, social inequality, unstable neighbourhoods, and school environments rich in peer aggression are recognised as key risk factors for CD.<ref name="doi.org"/> In response, interventions have evolved from purely clinical models to systemic, community-integrated strategies. Programs like FAST Track, which combine family-based training, school curricula, mentoring, and home visits, have demonstrated effectiveness in reducing conduct problems and supporting social competence across multiple domains.<ref>Conduct Problems Prevention Research Group. (2019). Impact of early intervention on psychopathology, crime, and well-being at age 25. ''American Journal of Psychiatry, 176''(2), 129–137. https://doi.org/10.1176/appi.ajp.2018.17091025</ref><ref>Conduct Problems Prevention Research Group. (2011). The effects of a multiyear universal social–emotional learning program: The role of student and school characteristics. ''Journal of Consulting and Clinical Psychology, 79''(2), 218–228. https://doi.org/10.1037/a0022897</ref> Similarly, multi-systemic therapy (MST) targets the youth's interconnected systems, including individual, familial, peer, school, and neighbourhood factors, to promote behavioural change through intensive, personalised support.<ref>Henggeler, S. W., & Sheidow, A. J. (2012). Empirically supported family-based treatments for conduct disorder and delinquency in adolescents. ''Journal of Marital and Family Therapy, 38''(1), 30–58. https://doi.org/10.1111/j.1752-0606.2011.00244.x</ref><ref>Schaeffer, C. M., & Borduin, C. M. (2005). Long-term follow-up to a randomised clinical trial of multi-systemic therapy with serious and violent juvenile offenders. ''Journal of Consulting and Clinical Psychology, 73''(3), 445–453. https://doi.org/10.1037/0022-006X.73.3.445</ref> This societal approach underscores that addressing CD effectively requires coordinated, multi-sectoral efforts that acknowledge and transform the social environments influencing youth behaviour.

=== Mis/Pre diagnosing children with conduct disorders in a biomedical and biosocial sense ===
Mis-diagnoses and pre-diagnoses can occur due to the poor modelling surrounding Conduct Disorders. As noted by Frick, typical diagnoses, which rely heavily on 'patterns of covariation', can result in stigmatisation within Western societies.<ref>P.J. Frick, 'Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behaviour disorders', Clinical Psychology Review, vol 96 (2022), 2&6, https://doi.org/10.1016/j.cpr.2022.102188.</ref> An example of an unreliable model for which someone may be diagnosed with Conduct Disorder, such as psychopathy, is antisocial behaviour. Frick claims this is not universally agreed upon as necessary for individuals with psychopathy to portray.<ref>P.J. Frick, 'Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behaviour disorders', Clinical Psychology Review, vol 96 (2022), 6, https://doi.org/10.1016/j.cpr.2022.102188.</ref>

In attempts to make the diagnostic criteria more accurate and less harmful post-diagnosis, the DSM and ICD-11 added further symptoms that children and adults must meet to be diagnosed with Conduct Disorder, such as Oppositional Defiant Disorder.<ref>P.J. Frick, 'Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behaviour disorders', Clinical Psychology Review, vol 96 (2022), 2, https://doi.org/10.1016/j.cpr.2022.102188.</ref>

Addressing the potential stigma that can occur to children once diagnosed with conduct disorders may be aided by diagnostic speech, referring to "callous-unemotional behaviours" instead of "callous-unemotional traits". Following this, the DSM refers to the 'specifier for Conduct Disorder' as "with Limited Prosocial Emotions", allowing for a more accurate label of a typical trait.<ref>P.J. Frick, 'Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behaviour disorders', Clinical Psychology Review, vol 96 (2022), 7, https://doi.org/10.1016/j.cpr.2022.102188.</ref>

Emmott and Gibbon follow this means of improvement by again highlighting the impact of the diagnostic language, causing children generally to be viewed as developing positively or negatively, depending on whether they are becoming 'more advanced' or falling behind, respectively.<ref>E.H. Emmott & S. Gibbon,'Understanding Child Development: A Biosocial Anthropological Approach to Early Life', in Pentecost, Michelle and Keaney, Jaya Moll, Tessa and Penkler, Michael, ed., The Handbook of DOHaD and Society: Past, Present, and Future Directions of Biosocial Collaboration (Cambridge, UK: Cambridge University Press, 2024) 233.</ref> Phelps and McClintocks biosocial approach gives understanding to traits found in children or adolescents, such as antisocial behaviour, which may be impacted by 'genetic transmission', or modelled 'deviant behaviour' by parental figures.<ref>L. Phelps & K. McClintock, 'Papa and Peers: A Biosocial Approach to Conduct Disorder', Journal of Psychopathology and Behavioural Assessment, 16/1 (1994), 56, https://doi.org/10.1007/BF02229065.</ref>

Combining these biomedical and biosocial approaches allows professionals to gain a greater understanding into the harms of diagnosing children with Conduct Disorders, and gives a foundation on how to further improve the diagnostic system.

=== Delinquency ===
Prior to conduct disorder as a diagnosis under the DSM, similar behaviour exhibited in children was often referred under the term '''[[Juvenile delinquency|delinquency.]]'''

Delinquency was ascribed to behaviour - often by children or adolescence deemed illegal/not acceptable and marked as a societal burden.<ref>{{Cite journal |last=French |first=Laurence |date=1977-01-01 |title=A Cultural Perspective Toward Juvenile Delinquency |journal=International Journal of Comparative and Applied Criminal Justice |volume=1 |issue=1-2 |pages=111–121 |doi=10.1080/01924036.1977.9688636 |issn=0192-4036}}</ref> Delinquency, however, despite its use as a prescriber of behaviour, is associated by factors of influence which increase the likelihood of exhibiting or acting it out.

Whether directly drawn from developmental such as child abuse or trauma, poor parental supervision, erratic or neglectful emotional contact, low-socio economic backgrounds; to further environmental factors such as high crime neighbourhoods, antisocial peer groups or lack of effective role models.<ref>{{Cite journal |last=Murray |first=Joseph |last2=Farrington |first2=David P |date=October 2010 |title=Risk Factors for Conduct Disorder and Delinquency: Key Findings from Longitudinal Studies |url=https://journals.sagepub.com/doi/10.1177/070674371005501003 |journal=The Canadian Journal of Psychiatry |language=en |volume=55 |issue=10 |pages=633–642 |doi=10.1177/070674371005501003 |issn=0706-7437|url-access=subscription }}</ref>

It is important to note that the causes and effects of antisocial behaviours, can be considerably different depending on age (e.g a preschooler versus a teenager), and function differently between genders.<ref>{{Cite journal |last=Hoge |first=Robert D. |date=February 2005 |title=Book Review: Causes of Conduct Disorder and Juvenile Delinquency |url=https://journals.sagepub.com/doi/10.1177/0093854804270616 |journal=Criminal Justice and Behavior |language=en |volume=32 |issue=1 |pages=117–119 |doi=10.1177/0093854804270616 |issn=0093-8548|url-access=subscription }}</ref>

The relationship between the individual, society and the cultural realm they inhabit have all shown to play a role in ascribing a person and/or their behaviour as delinquency.

Many such behaviours intersect with the criminal justice system, and despite being broadly deemed antisocial, not all exhibited behaviour in children and adolescence meet the diagnostic criteria for conduct disorder. More specifically, in assessment for conduct disorder, as for many personality disorders in adults, the focus of approach is not merely on the actions of a person but unemotional traits such as lack of empathy, extreme aggression, and lack of remorse.<ref>{{Citation |last=Kimonis |first=Eva R. |title=Disruptive and Conduct Disorders, Delinquency |date=2019-01-07 |work=The Oxford Handbook of Clinical Child and Adolescent Psychology |page=0 |editor-last=Ollendick |editor-first=Thomas H. |publisher=Oxford University Press |doi=10.1093/oxfordhb/9780190634841.013.27 |isbn=978-0-19-063484-1 |last2=Fleming |first2=Georgette E. |editor2-last=White |editor2-first=Susan W. |editor3-last=White |editor3-first=Bradley A.}}</ref>

==References==
=== Citations ===
{{Reflist}}

===Bibliography===
* Bernstein, N. (2000). ''Treating the unmanageable adolescent: A guide to oppositional defiant and conduct disorder''. New York: Jason Aronson, Inc.
* {{cite journal |author1=Decety J. |author2=Moriguchi Y. | year = 2007 | title = The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions | journal = BioPsychoSocial Medicine | volume = 1 | pages = 22–65 | doi=10.1186/1751-0759-1-22|pmid=18021398 | pmc = 2206036 |doi-access=free }}
* Eddy, J. (2006). ''Conduct disorders: The latest assessment and treatment strategies'' (4th Edition). Kansas City, MO: Compact Clinicals.
* {{cite journal |author1=Eyberg S. M. |author2=Nelson M. M. |author3=Boggs S. R. | year = 2008 | title = Evidence-based psychosocial treatments for child and adolescent with disruptive behavior | journal = Journal of Clinical Child & Adolescent Psychology | volume = 37 | issue = 1| pages = 215–237 | doi=10.1080/15374410701820117 | pmid=18444059|citeseerx=10.1.1.595.3142 |s2cid=53345 }}
* Hughes, T. (2010). ''Identifying, Assessing, and Treating Conduct Disorder at School'' (Development and Psychopathology at School). New York: Springer.
* Lahey, B.B., Moffitt, T.E.,& Caspi, A. (eds.). ''Causes of conduct disorder and juvenile delinquency''. New York: Guilford Press.
* Matthys, W. (2010). ''Oppositional defiant disorder and conduct disorder in children''. Malden, MA: Wiley-Blackwell.
* McIntosh, K., & Livingston, P. (2008). ''Youth with conduct disorder: In trouble with the world''. New York: Mason Crest Publishers.
* {{cite journal | author = Raine A | s2cid = 11608050 | year = 2002 | title = Biosocial Studies of Antisocial and Violent Behavior in Children and Adults: A Review | doi = 10.1023/A:1015754122318 | pmid = 12108763 | journal = Journal of Abnormal Child Psychology | volume = 30 | issue = 4| pages = 311–326 }}
* {{cite journal |author1=Van Goozen, S. H. M. |author2=Fairchild, G. | year = 2008 | title = How can the study of biological processes help design new interventions for children with severe antisocial behavior? | url = http://orca.cf.ac.uk/5654/1/Van%20Goozen%202008.pdf| journal = Development and Psychopathology | volume = 20 | issue = 3| pages = 941–973 | doi=10.1017/s095457940800045x|pmid=18606039 |s2cid=12035572 }}

== External links ==
* [https://web.archive.org/web/20110303093600/http://www.abct.org/SCCAP/?m=sPublic&fa=pub_Conduct#ConductTable Conduct Disorder Symptoms and Treatment] Society of Clinical Child and Adolescent Psychology
* [http://news.bbc.co.uk/2/hi/health/7714072.stm Bullying tendency wired in brain] from the BBC News.
* [https://www.nsf.gov/news/news_summ.jsp?cntn_id=112582&org=NSF&from=news Bullies may enjoy seeing others in pain] National Science Foundation
* [https://www.aafp.org/pubs/afp/issues/2001/0415/p1579.html Diagnosing Conduct Disorder in Primary Care]
{{Medical resources
| ICD11 = {{ICD11|6C91}}
| ICD10 = {{ICD10|F|91||f|90}} 
| ICD9 = {{ICD9|312}} 
| MeshID = D019955
| MedlinePlus = 000919
}}

{{Emotional and behavioral disorders}}
{{Psychopathy}}

[[Category:Mental disorders diagnosed in childhood]]
[[Category:Disruptive behaviour or dissocial disorders]]