Conduct disorder (CD) is classified in the spectrum of disruptive behavior disorders which also includes the diagnosis of oppositional defiant disorder (ODD). Disruptive behavior disorders (DBD) are frequently comorbid with attention deficit hyperactivity disorder (ADHD). It is to be noted that ADHD was previously listed in the DBDs spectrum in DSM-IV-TR, but DSM V has moved the diagnosis of ADHD to Neurodevelopmental disorders. ODD can be seen as a precursor to CD. CD is characterized by a pattern of behaviors that demonstrates aggression and violation of rights of others and evolves over time. Conduct disorder is comorbid with many other psychiatric conditions including depression, ADHD, learning disorders and thus a thorough psychiatric evaluation is required to understand the psychopathology before initiating an appropriate treatment plan (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013; Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994).
The etiology of CD is complex and results from an interaction between multiple biological and psychosocial factors.
Parental and Family
It is important to note that occasional rebellious behavior and tendency to be disrespectful and disobedient towards authority figures can present commonly during childhood and adolescent periods. The signs and symptoms that lead to the diagnosis of CD demonstrate a pervasive and repetitive pattern of aggression towards people, animals, with the destruction of property and violation of rules. Conduct disorder is more common in boys than girls, and the ratio could range from 4:1 as much as 12:1. The lifetime prevalence rate in the general population could range from anywhere between 2% to 10% and is consistent among different race and ethnic groups. Children with conduct disorder are often categorized as antisocial personality different disorder in adult life. Early onset of conduct disorder in childhood years could lead to the worse prognosis of the condition. Multiple socio-economic factors contribute to higher incidence of CD in children and adolescents which includes substance abuse disorders and criminal problems in parents of these children.
Exhibits a pattern of behavior that violates the rights of others and disregards social norms
Dysfunction in following areas:
CD, Childhood-Onset Type
CD, Adolescent-Onset Type
CD, Unspecified-Onset Type
Basic laboratory investigation, including urine drug screen, is necessary to rule out any comorbid medical problems or substance abuse disorders. Multimodal treatments that target family and community resources have improved outcomes.
Evidence-based psychosocial treatments include:
Differential diagnoses include new onset of a mood disorder or psychotic disorder that precipitate excessive indulgence in negative behaviors and hostility toward others. CD should be excluded if the problems occur only during episodes of mood or psychotic disorder.
Furthermore, untreated depressive disorder or ADHD lead to substance abuse and can be the precursor to CD.
Prognosis is variable and depends on the presence of subtle psychiatric comorbidities and initiation of early interventions.
Low intelligence capacities and dysfunctional family environment with persistent criminality in parents predict a poor prognosis. Adequate treatment of ADHD, proper school placements with assistance for difficulties in learning, higher verbal intelligence, and positive parenting contribute to a better prognosis.
While the definitive diagnosis of a conduct disorder is made by a mental health expert, the follow up is usually done by the primary care provider and nurse practitioner. The management of these patients is difficult because of low compliance. A variety of treatments have been devised depending on the age of the patient and comorbidity but relapse rates are high. Pharmacological therapy is often used to manage mood and aggression but again these patients never remain compliant. Many get into trouble with the law and are then forced into treatments. (Level V)
|||Chung YE,Chen HC,Chou HL,Chen IM,Lee MS,Chuang LC,Liu YW,Lu ML,Chen CH,Wu CH,Huang MC,Liao SC,Ni YH,Lai MS,Shih WL,Kuo PH, Exploration of microbiota targets for major depressive disorder and mood related traits. Journal of psychiatric research. 2019 Jan 19; [PubMed PMID: 30685565]|
|||Bansal PS,Waschbusch DA,Haas SM,Babinski DE,King S,Andrade BF,Willoughby MT, Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits. Behavior therapy. 2019 Jan; [PubMed PMID: 30661550]|
|||Gatej AR,Lamers A,van Domburgh L,Crone M,Ogden T,Rijo D,Aronen E,Barroso R,Boomsma DI,Vermeiren R, Awareness and perceptions of clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: A qualitative survey with academic experts. European psychiatry : the journal of the Association of European Psychiatrists. 2019 Jan 15; [PubMed PMID: 30658274]|
|||Thomson KC,Richardson CG,Gadermann AM,Emerson SD,Shoveller J,Guhn M, Association of Childhood Social-Emotional Functioning Profiles at School Entry With Early-Onset Mental Health Conditions. JAMA network open. 2019 Jan 4; [PubMed PMID: 30646194]|
|||Miranda-Mendizabal A,Castellví P,Parés-Badell O,Alayo I,Almenara J,Alonso I,Blasco MJ,Cebrià A,Gabilondo A,Gili M,Lagares C,Piqueras JA,Rodríguez-Jiménez T,Rodríguez-Marín J,Roca M,Soto-Sanz V,Vilagut G,Alonso J, Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. International journal of public health. 2019 Jan 12; [PubMed PMID: 30635683]|
|||Weintraub MJ,Axelson DA,Kowatch RA,Schneck CD,Miklowitz DJ, Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder. Journal of affective disorders. 2018 Dec 25; [PubMed PMID: 30623821]|
|||McDowell YE,Vergés A,Sher KJ, Are Some AUD Criteria More (or Less) Externalizing than Others? Distinguishing Alcohol Use Symptomatology from General Externalizing Psychopathology. Alcoholism, clinical and experimental research. 2019 Jan 8; [PubMed PMID: 30620411]|
|||DeLisi M,Drury AJ,Elbert MJ, Do behavioral disorders render gang status spurious? New insights. International journal of law and psychiatry. 2019 Jan - Feb; [PubMed PMID: 30616846]|