Conduct Disorder

Conduct Disorder - Rebel Yell Defined

• Conduct Disorder (CD): A disruptive behavior disorder in children/adolescents.
• Key: Persistent behavior violating others' rights or major societal norms/rules.
• Manifests as:
  • Aggression (people/animals)
  • Property destruction
  • Deceitfulness/theft
  • Serious rule violations
• ⭐ > Core feature: A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Conduct Disorder - Rulebook Rundown

• DSM-5 Criteria: ≥3 of 15 criteria in past 12 months; ≥1 in past 6 months.
  • Categories (📌 TRAP):
    • Deceitfulness or theft
    • Serious violations of rules
    • Aggression to people/animals
    • Destruction of property
• Subtypes (Onset):
  • Childhood-onset: At least one symptom before age 10.
  • Adolescent-onset: No symptoms before age 10.
  • Unspecified onset.
• Specifier: With limited prosocial emotions (e.g., lack of remorse/guilt, callous-lack of empathy).

⭐ DSM-5 requires at least 3 of 15 criteria in the past 12 months, with at least one criterion present in the past 6 months.

Conduct Disorder - Why So Wild?

Multifactorial etiology:

• Biological Factors:
  • Genetic predispositions
  • Neurobiological: Frontal lobe dysfunction, altered serotonin/cortisol levels
  • Difficult temperament
• Psychosocial Risk Factors:
  • Parenting: Harsh, inconsistent, neglect, abuse
  • Family: Parental criminality, substance abuse
  • Peers: Rejection, deviant group affiliation
  • Environment: Low SES, neighborhood violence

⭐ Childhood-onset type (symptoms before age 10) is associated with a worse prognosis and higher risk of developing Antisocial Personality Disorder in adulthood.

Conduct Disorder - Who Else Is Who?

• Common Comorbidities:
  • ADHD (very high), ODD, specific learning disorders
  • Anxiety disorders, depressive disorders, substance use disorders
• Differential Diagnosis:
  • ODD: Less severe, no aggression, destruction, theft/deceit.
  • ADHD: Distinguish impulsivity from deliberate rule-breaking.
  • Mood Disorders: Irritability vs. pervasive aggression.
  • Intermittent Explosive Disorder, Adjustment Disorder.

⭐ Oppositional Defiant Disorder (ODD) often precedes childhood-onset Conduct Disorder; however, many children with ODD do not subsequently develop CD.

Conduct Disorder - Calming the Chaos

Multimodal treatment is key.

• Psychosocial Interventions:
  • Parent Management Training (PMT)
  • Cognitive Behavioral Therapy (CBT): Problem-Solving Skills Training (PSST), anger management.
• Family Therapy:
  • Functional Family Therapy (FFT)
  • Multisystemic Therapy (MST) for severe/complex cases.
• Pharmacotherapy: (Not first-line for core CD symptoms)
  • For comorbidities: Stimulants (ADHD), SSRIs (depression/anxiety).
  • Severe aggression: Low-dose atypical antipsychotics (e.g., risperidone), short-term.
• Prognosis: Variable.
  • Poorer outcomes: Childhood-onset, limited prosocial emotions, comorbid ADHD.
  • Risks: Antisocial Personality Disorder, substance abuse, criminal behavior in adulthood.

⭐ Parent Management Training (PMT) and Multisystemic Therapy (MST) are evidence-based psychosocial interventions with strong support for treating Conduct Disorder.

High‑Yield Points - ⚡ Biggest Takeaways

• Persistent behavior violating rights of others or major societal norms.
• Four key categories: aggression, property destruction, deceitfulness/theft, serious rule violations.
• Onset: childhood-onset (<10 years, poorer prognosis) or adolescent-onset (≥10 years).
• Specify if with Limited Prosocial Emotions (e.g., lack of remorse, callous).
• Strong precursor to Antisocial Personality Disorder (ASPD) in adulthood.
• Management focuses on psychosocial therapies (PMT, MST); medications for comorbidities.
• Differentiated from ODD by severity, aggression, and law-breaking acts.