Conduct Disorder

Conduct disorder (CD) refers to a broad spectrum of potentially enduring behaviors that violate social norms. The behaviors and symptoms of CD vary, with diagnostic criteria clustered into one of four FIGURE 1 broad categories: (a) aggressive behavior; (b) nonaggressive misbehavior; (c) deceitfulness or theft; and (d) a serious infraction of established rules.

Aggressive conduct is that which threatens or causes physical harm to people or animals and typically involves acts such as initiating fights, bullying, intimidating, overt aggression, and physical cruelty. Nonaggressive conduct is characterized by vandalism or intentional destruction of property. Common manifestations of deceitfulness include stealing, persistent lying, and fraudulent behavior. Lastly, rule violation entails deeds that defy or circumvent social convention. The severity of observed behaviors is rated as mild, moderate, or severe, depending upon the number and seriousness of acts committed and the extent to which others are harmed.

Reported rates of the disorder have increased over several decades, with 6 to 16 percent of males and 2 to 9 percent of females under the age of 18 fulfilling diagnostic criteria (American Psychiatric Association 1994). These results are generally consistent across cultures. Epidemiological data indicate that the prevalence rates for CD are generally greater for males than females. However, some researchers are concerned that the current diagnostic protocol overemphasizes behaviors that are more typical of male than female problem behavior.

To receive a diagnosis of CD, three or more behaviors in any of the four categories must occur within the last twelve months, with at least one of these behaviors persisting during the previous six months. Noncompliance with adults (parents, teachers, or both) typically marks the beginning of a behavior pattern that often culminates in the youth engaging in acts consistent with CD. In general, the early onset of problem behavior in multiple settings and variability of observed problem behavior are associated with more serious psychosocial disruption, escalation to more serious problem behaviors in adolescence (Loeber and Dishion 1983), and ultimately, continuity of adjustment problems into adulthood (e.g., antisocial personality disorder, chronic offending, substance use, marital problems, employment difficulties).

Children and adolescents diagnosed with CD also tend to suffer from elevated rates of hyperactivity and emotional difficulties. Many individuals with behavior problems experience clinical levels of attention deficit hyperactivity disorder (ADHD), depression, and anxiety. Research suggests that youth with both ADHD and CD experience high levels of peer rejection, academic problems, psychosocial hardship, conflict with parents, and parental psychopathology (see Angold and Costello 2001, for a review). The prognosis for persons with both ADHD and behavioral maladjustment also tends to be worse than for those with either diagnosis alone. Combined with depression, CD is generally a marker for more severe psychosocial disruption and heightens the risk for suicide and other adjustment problems in young adulthood. Children with CD often do not simply outgrow their problem behavior (Robins 1966).