Conduct Disorder (CD) is a serious behavioral disorder of childhood and adolescence characterized by a repetitive and persistent pattern of behavior that violates the basic rights of others or major age-appropriate societal norms. Unlike oppositional defiant disorder, which involves argumentativeness and defiance, conduct disorder includes aggression toward people or animals, destruction of property, deceit or theft, and serious violations of rules. CD is a developmental precursor of adult antisocial personality disorder in roughly 40% of cases.
Key Facts
- Prevalence: 2–10% of children and adolescents
- Male-to-female ratio: roughly 4:1 in childhood-onset
- Two subtypes: childhood-onset (before age 10) and adolescent-onset
- Childhood-onset has worse prognosis
- Multisystemic Therapy (MST) and Functional Family Therapy strongest evidence
- Early intervention substantially improves outcomes
DSM-5 Diagnostic Criteria
Conduct Disorder (312.8x / F91.x) requires three or more of the following 15 criteria in the past 12 months, with at least one in the past 6 months:
Aggression to People and Animals
- Often bullies, threatens, or intimidates
- Often initiates physical fights
- Has used a weapon that can cause serious physical harm
- Has been physically cruel to people
- Has been physically cruel to animals
- Has stolen while confronting a victim
- Has forced someone into sexual activity
Destruction of Property
- Has deliberately engaged in fire setting with intent to cause serious damage
- Has deliberately destroyed others' property
Deceitfulness or Theft
- Has broken into someone's house, building, or car
- Often lies to obtain goods or favors or avoid obligations ("cons")
- Has stolen items of nontrivial value without confronting victim (e.g., shoplifting)
Serious Violations of Rules
- Often stays out at night despite parental prohibitions, beginning before age 13
- Has run away from home overnight at least twice
- Often truant from school, beginning before age 13
Plus: clinically significant impairment, not meeting criteria for antisocial personality disorder if 18 or older.
Childhood-Onset vs. Adolescent-Onset
Childhood-Onset (≥1 criterion before age 10)
- Predominantly male
- More aggression, less peer-driven behavior
- Worse prognosis
- Higher likelihood of progression to ASPD
- Often comorbid with ADHD
Adolescent-Onset (no criteria before age 10)
- More balanced gender ratio
- More peer-influenced antisocial behavior
- Better prognosis
- Many remit in adulthood
Callous-Unemotional Traits
- DSM-5 specifier "with limited prosocial emotions"
- Lack of remorse or guilt
- Lack of empathy
- Lack of concern about performance
- Shallow or deficient affect
- Identifies a more severe subgroup with stronger genetic loading and worse prognosis
- Predicts adult psychopathy
Causes
- Genetic loading (~50% heritability)
- Reduced amygdala reactivity to others' distress (especially in CU subtype)
- Childhood maltreatment, neglect, harsh parenting
- Family violence and parental antisocial behavior
- Poverty and community violence
- Deviant peer affiliation in adolescence
- Comorbid ADHD increases risk
- Prenatal smoking and birth complications
Treatment
Multisystemic Therapy (MST)
- Intensive, home- and community-based intervention
- Targets multiple systems: family, peers, school, community
- Strong evidence for serious adolescent antisocial behavior
- Reduces re-arrest, out-of-home placement, substance use
Functional Family Therapy (FFT)
- Short-term, family-based
- Targets family dynamics maintaining behavior
- Strong evidence base
Parent Management Training
- For younger children with conduct problems
- The Incredible Years, PCIT, Triple P
Cognitive-Behavioral Approaches
- Anger management
- Problem-solving skills training
- Moral reasoning programs
Treat Comorbidities
- ADHD treatment substantially reduces conduct problems
- Address depression, anxiety, substance use, learning issues
Medication
- No medication treats CD itself
- Stimulants for comorbid ADHD
- Atypical antipsychotics for severe aggression (use cautiously)
Avoid
- "Scared straight" programs and boot camps — evidence shows they can worsen outcomes
- Group treatments that congregate antisocial youth — risk of "deviancy training"
Conclusion
Conduct disorder is among the most consequential childhood mental health conditions, with implications spanning families, schools, and the justice system. It is also more treatable than commonly believed, particularly when intervention happens early and addresses the multiple systems shaping the child's behavior. Multisystemic Therapy and Functional Family Therapy have transformed outcomes for many youth who would otherwise have followed a trajectory toward adult antisocial personality disorder. Early identification and evidence-based intervention are the most consequential decisions families and systems can make.