Conduct Disorder (CD) is a more severe type of behavioral disorder than Oppositional Defiant Disorder (ODD) and is more likely to develop in kids with ADHD. According to the publication of the American Psychiatric Association that provides current diagnostic criteria for all recognized psychiatric disorders, the essential feature of Conduct Disorder is "...a repetitive and persistent pattern of behavior in which the basic rights of others or age appropriate social norms or rules are violated." These behaviors fall into 4 main groupings:
- Serious violation of rules (e.g., truancy from school; running away from home; staying out at night prior to age 13)
- Non-aggressive conduct that causes property loss or damage (e.g., fire setting with intent to cause damage; deliberate destruction of property)
- Deceitfulness or theft (e.g., shoplifting; breaking into someone's house; frequent lying to obtain goods or avoid obligations)
- Aggressive behavior that causes or threatens to cause harm (e.g., initiating fights; cruelty to people or animals)
For the diagnosis of Conduct Disorder to be correctly assigned, at least 3 of the specific symptoms must have occurred during the prior 12 months, with at least one criterion present in the last 6 months. In addition, the disturbance in behavior must clearly result in clinically significantly impairment in the youngster or teenager's social, academic, or occupational functioning. These criteria are intended to assure that the diagnosis is not assigned for an isolated antisocial act, but is instead reserved for children/teens who show a pattern of antisocial behavior over a significant period of time.
In addition to these core diagnostic criteria, children/teens with Conduct Disorder often display a number of associated features as well:
- guilt and remorse over clear misdeeds are often absent, other than feeling badly about having been caught
- poor frustration tolerance and irritability are often present
- self-esteem is often poor even though an image of "toughness" is often presented
- they are prone to often misinterpret other's intentions towards them as being hostile which can lead them to overreact in a retaliatory, aggressive manner
- they often have little empathy or concern for the feelings and wishes of others
Conduct Disorder is often also associated with:
- dropping out of school
- early onset of sexual behavior
- excessive risk taking
- poor academic performance
- school suspension
- self-destructive behavior
- substance use and abuse
It is important to recognize that the symptoms of Conduct Disorder do not really share any overlap with diagnostic criteria for ADHD. These two disorders certainly share many of the "associated features," but the actually symptoms that are used to make the diagnosis for each condition are really quite distinct.
This is why if a youngster with ADHD is also displaying the types of behaviors that may warrant a Conduct Disorder diagnosis, it is important not to attribute the antisocial behavior to just another facet of the youngster's ADHD. The danger in doing this is that the youngster may not receive the necessary and appropriate treatment as a result.
Two different types of Conduct Disorder are currently recognized:
1. The Adolescent-Onset Type. This type is applicable to teens who currently meet the diagnosis for Conduct Disorder but who showed no symptoms of Conduct Disorder prior to age 10. People with adolescent-onset Conduct Disorder are less likely to display aggressive behavior and are more likely to have decent peer relationships. Of utmost importance is that adolescent-onset Conduct Disorder less likely to be associated with serious behavior problems that persist into adulthood.
2. The Childhood-Onset Type is defined by the onset of at least on symptom of Conduct Disorder prior to age 10. Thus, even though a youngster may not meet full diagnostic criteria before age 10, if these criteria are met when the youngster is 12, and at least one symptom was present (e.g. running away) before 10, the Childhood-Onset Type would apply. Almost all kids who meet criteria for childhood-onset Conduct Disorder would have previously been diagnosed with Oppositional Defiant Disorder.
Although Conduct Disorder may occur in kids as young as 5-6, its onset is usually in late childhood or early adolescence. The course of Conduct Disorder is variable: in a majority of people, the disorder remits by adulthood. Nonetheless, a substantial percentage continues to display sufficient antisocial behaviors into adulthood to warrant the diagnosis of antisocial personality disorder as young adults. This is most likely to be true as noted above, for people whose Conduct Disorder begins early in life and is marked by aggressive behavior.
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