Acting out is a normal part of emotional development in kids. But when does disruptive behavior become a greater cause for concern?
Children occasionally act out in disruptive ways as they learn to understand and control their emotions. But when disruptive behavior becomes repetitive or common for a child, it may be a symptom of a mental health condition.
For some children, consistent difficulty with following rules or adhering to socially acceptable behavior at home, school, or other social settings could be a sign of conduct disorder.
Conduct disorder is a manageable childhood mental health condition characterized by a series of emotional and behavioral problems. This condition affects
According to San Diego-based clinical psychologist Dr. Bruce L. Thiessen, the most common characteristics of conduct disorder are:
- aggressive and unruly behavior
- general disregard for others’ rights
- a tendency to recklessly violate boundaries
Children and teens living with conduct disorder are sometimes labeled as “bad” or “delinquent,” and their disruptive behavior may not be recognized as a symptom of a mental health condition.
Because acting out is such a common element of childhood development, isolated acts of aggression don’t necessarily indicate the presence of conduct disorder in every child.
For a conduct disorder diagnosis to be considered, behavioral symptoms must be severe enough that they raise concern among teachers, peers, and other adults.
Symptoms of conduct disorder are often persistent and follow a predictable, repetitive pattern. A child must display at least one symptom of conduct disorder in the last 6 months and at least three symptoms in the past year to be diagnosed.
According to the Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5), symptoms of conduct disorder include:
- Aggression towards people and animals. This may include initiating physical fights, bullying, wielding weapons, engaging in acts of physical cruelty, threatening and intimidating others, and engaging in acts of sexual aggression, including rape.
- Deception. This includes lying and deceiving, especially for personal gain or cheating.
- Theft. Another sign may be stealing. This may involve serious offenses like breaking into homes, mugging, or shoplifting.
- Rule-breaking. Skipping school and staying out late can be signs of conduct disorder, especially if the behavior starts before the age of 13.
- Destruction of property. Signs include vandalism and fire-setting.
Children and adolescents with conduct disorder may often misinterpret the actions of others as being hostile or aggressive and respond by escalating the situation.
In teenagers, conduct disorder might also be associated with more serious issues, including:
- adolescent substance use disorder
- risk-taking behavior
- academic performance problems
Symptoms can range from mild to severe, depending on the child. Conduct disorder may generally contribute to challenges for caregivers and might impact a child’s ability to function normally, day to day.
According to licensed counselor Dr. Nakpangi Thomas, behaviors associated with conduct disorder have the potential to cause “significant impairment” in many aspects of a child’s life, including:
- social life
- family relationships
Conduct disorder isn’t one overarching childhood mental health condition, but three separate disorders. Each disorder is categorized based on the age when symptoms first appear:
- Unspecified onset. It’s unclear at what age the disorder developed.
- Childhood onset. Symptoms of conduct disorder appeared before the age of 10.
- Adolescent onset. Signs of conduct disorder developed in the teenage years.
Children diagnosed with childhood onset conduct disorder may be more likely to show early signs of aggression. They may have persistent conduct disorder difficulties or develop another disorder.
The DSM-5 also distinguishes between conduct disorder with or without “limited prosocial emotions,” which is when children and adolescents with the condition appear:
The truth is, mental health researchers don’t know exactly why some children develop conduct disorder. However, according to Thiessen, experts and psychologists “generally agree that nature and nurture play a significant role” in its onset.
Some people might be genetically predisposed to conduct disorder, but environmental and neurological factors may also contribute to developing this condition.
Neurological and cognitive factors
Some experts believe certain neurological and cognitive factors may play a role in whether a person develops conduct disorder.
- emotional expression
Frontal lobe damage tends to interfere with a child’s ability to:
- plan ahead
- avoid harm
- learn from experiences
Other cognitive conditions may also be indicators of a
- low IQ
- poor verbal skills
- executive function impairment
Genetics and neurology may influence a person’s likelihood of developing conduct disorder, but environmental factors could also contribute to the development of this condition in children and adolescents.
Families come in many different shapes and sizes, and not every family structure is right for every child. According to
- living within a high-conflict or stressful family dynamic
- having a parent with narcissistic or antisocial personality traits
- having infrequent or inconsistent parental supervision
- having a parent with a substance use disorder
Other environmental factors could play a role in the onset of conduct disorder in children and adolescents, including:
- experiencing childhood abuse, including sexual abuse
- being bullied
- living in a neighborhood or area with high crime rates, especially violent offenses
- living in under-resourced communities
Conduct disorder sometimes co-occurs with other common childhood mental health disorders. Some research suggests children with certain temperaments or personalities could be more likely to develop these conditions in addition to conduct disorder:
- attention deficit hyperactivity disorder (ADHD)
- post-traumatic stress disorder (PTSD)
- anxiety disorders
- mood disorders
- learning disorders
Antisocial personality disorder and conduct disorder
Antisocial personality disorder is a mental health condition marked by impulsive behavior and reckless disregard for yourself and others. This condition can only be diagnosed in adults since cognitively developing children may outgrow some of the behaviors that may be considered symptoms of antisocial personality disorder.
However, because certain symptoms of antisocial personality disorder and conduct disorder seem to overlap, some experts believe there’s a link between the two conditions.
According to Thomas, conduct disorder may be considered a “precursor” to antisocial personality disorder for some children.
This means that children diagnosed with conduct disorder could be more likely to develop antisocial personality disorder later in life, especially if conduct disorder symptoms don’t subside by adulthood.
For many children and adolescents with unmanaged conduct disorder, disruptive behavior may negatively impact school and home life.
It can be common for children with conduct disorder to struggle academically and experience frequent disciplinary action at school, including suspension. Children who are regularly disciplined may develop self-esteem and confidence issues, and they could be at a greater risk for skipping school or dropping out.
Struggling to develop or maintain friendships and relationships — even with family members — may be more common in children with this condition.
According to Thiessen, children with untreated conduct disorder may be more likely to feel lonely or isolated due to strained social relationships. Children living with this condition might “deprive themselves of intimacy,” explains Thiessen, “by repeatedly offending and continuously alienating peers.”
Some studies suggest teens with conduct disorder may be more likely to engage in risky or illegal behaviors, such as violent actions and alcohol or substance use.
Sexual risk-taking may also be more common in adolescents with this condition, including having multiple partners and being less likely to use protection, which could lead to an increased risk of developing a sexually transmitted infection (STI).
Acting out at school or at home can be a normal part of growing up and developing. But for children with conduct disorder, disciplinary action may become frequent and disruptive to academic performance and everyday functioning.
Continuously disruptive or disrespectful behavior associated with symptoms of this condition can pose challenges to parents, teachers, and other caregivers in setting limits and establishing effective consequences.
According to Thiessen, setting clear rules and expectations can be beneficial in managing conduct disorder. Effective boundaries for children with conduct disorder should be:
- clearly communicated by the adults in charge
- reinforced by reasonable consequences
However, a positive relationship with your child is essential to creating rules and boundaries that stick, Thiessen says. “Without a relationship, rules are likely to fail,” he explains.
“A child or teen must know, without a doubt, that they are unconditionally accepted by their parents, even though certain behaviors they display may not be deemed acceptable and may result in discipline.”
No matter how unruly or disrespectful a child’s behavior, physical aggression or corporeal punishment is never an appropriate response to children and teens with conduct disorder, explains Thiessen. “Violence begets more violence.”
Conduct disorder may pose challenges for children and parents, but it’s possible to manage. Many children and adolescents with this condition live balanced lives once an effective treatment plan is in place.
Conduct disorder can sometimes be difficult to treat, but the earlier this condition is addressed, the more successful treatment may be. Treatment may be more effective if the child’s family, friends, and teachers are involved.
Treatment options for conduct disorder can range from therapy and behavior management to parent education and prescribed medications, depending on the child’s age and severity of symptoms.
People with conduct disorders may benefit from more than one coping method in their individual treatment plan.
Parents and caregivers often have to work with their child’s pediatrician and therapist to find what works for them. You may need to try multiple strategies before finding the best plan for your child and family.
It often takes time for children to establish new attitudes and behavior patterns, so it’s beneficial to be patient with your child as well as the process of finding the best treatment.
Treatment for conduct disorder is ineffective if abuse is present at home. If childhood abuse is occurring, it’s likely best for the child to be placed in another living situation where they will receive care and support alongside treatment.
Therapy is often the first method of treatment parents and caregivers go to when a child has been diagnosed with conduct disorder.
Several therapy modalities may be successful for treating children with conduct disorder:
- Individual talk therapy. This is solo therapy for a child or adolescent.
- Family therapy. This type of therapy involves the child’s parents and immediate family.
- Peer or group therapy. This type of therapy involves the child’s friends or classmates.
Parent training in behavior management strategies can be helpful in teaching parents and caregivers effective methods of managing conduct disorder behaviors, especially for young children.
This method may boost the parent-child relationship and can be beneficial for managing severe conduct disorder symptoms that might be aggressive or violent at times.
Medications may sometimes be prescribed for severe conduct disorder, though less frequently. In rare cases when medication is prescribed for this condition, it is usually for treating aggression.
Methylphenidate, a stimulant primarily used for ADHD, may sometimes be prescribed for severe conduct disorder.
Risperidone, an antipsychotic commonly prescribed for schizophrenia and bipolar disorder, is also prescribed for aggression in rare cases of conduct disorder.
However, neither of these medications seemed particularly effective for conduct disorder overall in clinical studies.
A conduct disorder diagnosis can be challenging for both children and parents. Disruptive behaviors associated with this condition can cause difficulties with frequent discipline at home and school and may carry stigma contributing to self-esteem issues.
If your child has conduct disorder, you’re not alone. Managing even severe symptoms of this condition is possible, and many children and families live well-balanced lives once an effective treatment plan is established.
Early intervention may be the key to successfully decreasing symptoms of conduct disorder. You may need to work with your child’s pediatrician or therapist to find the best treatment plan.
You may also need to try several strategies to find what works best for your child. Often, more than one method is used in individual treatment plans over time.
Treatment options for conduct disorder depend on the child’s age and severity of symptoms and might include:
- Therapy. Individual talk therapy, family therapy, and group therapy are often the first step seeking treatment.
- Parent education in behavior management. This teaches parents methods for managing behavior while supporting the child-parent relationship.
- Medication. Certain stimulants or antipsychotics might be prescribed for aggression in very rare cases of severe conduct disorder.
These tools may be useful for finding a mental healthcare provider with experience in conduct disorder:
- The American Psychological Association’s Psychologist Locator
- The Association for Behavioral and Cognitive Therapies Find a Therapist Tool
- The American Academy of Child and Adolescent Psychiatry’s Psychiatrist Finder
For more information on seeking support for conduct disorder, visit