
Conduct Disorder
September 30, 2021
Contents
- What are conduct disorders?
- Signs of CDs in children and young adults
- Causes of CDs in children and young adults
- Managing CDs
- What types of professionals are involved?
- The journey of managing CDs
- How to support someone with CDs?
- How can parents support their child with a CD?
- Useful resources
What is conduct disorder?
When a child has a conduct disorder (CD), it is different from when a child is occasionally naughty and has tantrums. Conduct disorder (CD) refers to a set of disruptive and dissocial behaviours within a child that are severe and persist over time. Conduct disorders are also referred to as disruptive behaviour or dissocial disorders.
They are common mental health disorders in children and young people separated into two main types: Conduct-dissocial disorder (CD) and Oppositional Defiant Disorder (ODD).
Conduct-dissocial Disorder (CD)
It refers to a repetitive pattern of behaviour, where the child or young person acts in an anti-social way by disobeying, causing harm or distress to themselves or others, and not acting normally according to their age.
Oppositional Defiant Disorder (ODD)
It involves less severe behaviours involving interpersonal conflict compared to CD, where there is a repetitive pattern of disobeying, arguing and opposing parents and people in authority.
Causes of conduct disorder
The cause of CDs is unknown but likely involves a combination of genetic and environmental factors. These are some factors that increase the risk of developing this disorder:
Individual characteristics
- It is more common in boys than in girls
- Co-existing problems with learning
- Co-existing mental health conditions
- Co-existing attention deficit hyperactivity disorder (ADHD)
Family influences
- Has a parent or sibling with a conduct disorder
- Physical or sexual abuse
- Rejection or harsh criticism from parents
- Exposed to conflict between parents
- Family poverty
Other risk factors
- Being bullied
- Physical or sexual abuse outside of family
- Involvement with other young people with behavioural problems
- Using recreational drugs
The symptoms of conduct disorders
ODD symptoms have to be persisting for at least six months and cause problems in the child’s everyday life. The symptoms can include:
- Having many temper tantrums
- Refusing to follow requests and arguing with adults
- Purposefully doing things to annoy others
- Easily annoyed
- Blaming others for things they do
- Easily losing temper
- Is often angry, spiteful or resentful
CD symptoms are more severe, persisting for at least a year. This can include the same symptoms of ODD and the following:
- Lying, stealing and breaking promises
- Starting fights with others
- Using weapons that cause serious harm (e.g. knife, razor, gun)
- Inflicting harm to people and animals (e.g. kicking, cutting, burning)
- Purposefully destroying property
- Running away from school or home
- Mugging, breaking into houses or cars
- Bullying, molesting, intimidating others
Noticing the signs of ODD or CD early on and accessing early treatment can help to reduce symptoms and stop the disorder from becoming worse as the child grows up.
Getting help for conduct disorder
Treatment will depend on the child’s age and the severity of the conduct disorder. When treating CDs, there are psychosocial types of therapy that are involved. This means that the therapy aims to focus on the child or young person and the influence of others around them. Therefore, as well as having child-focused programmes, their parent/guardian might also go through parent training and multimodal programmes. The main support offered is discussed below.
Parent/guardian training programmes
This programme helps parents/guardians to improve their parenting skills, usually offered when a child is three to eleven years old. Research shows that parenting programs can be effective in treating conduct disorders.
The theory it is based on is that parents hold the key to stopping behavioural problems from persisting. This is because parents are the ones responsible for setting boundaries, ensuring discipline and giving appropriate love and affection.
Other professionals aside from counsellors and psychotherapists can also deliver this programme. This can include social and community workers.
The parents/guardians will learn to adapt their parenting skills in a way that helps the child or young person to change their problematic behaviour. The child might be invited to some sessions together with their parents, where they will get to practice these new skills and get feedback from the professional.
Child-focused programmes
This is a specialised programme that helps children and young people to reduce their problem behaviours. This might also include CBT, which focuses on the link between thoughts, feelings and behaviours, which research shows can reduce CD symptoms.
The idea behind this is that children and young people with CDs think about anger and violence in a different way. For example, a young person might think that hitting is enjoyable. So, if they change the way they think about this, they will stop the behaviour.
The professional will help the child to come up with new ways of problem-solving without the need for anger or violence. They will learn how to cope with negative emotions, manage their anger and be more attentive to the consequences of their actions.
Medication
Medication is not usually prescribed for CDs alone. It may be prescribed if your child also has symptoms of other conditions, such as ADHD, and helps to manage the other conditions making it easier to treat CDs.
Multimodal programmes
This is another effective and intensive form of treatment for children and young people with CDs, where all of the above programmes are given with the additional involvement of the school, the community and the criminal justice system. This might be organised by a professional, such as a case manager/social worker.
The idea behind a multimodal programme is to manage the child or young person’s behaviour in different settings, to increase the chances that they will recover from the CDs.
The professional will make sure that the child or young person is getting therapy and that their parents, teachers, members of the community and the criminal justice system are also helping to support the child.
What types of professionals are involved?
Different professionals might be involved throughout the treatment process for CDs. These include counsellors, psychotherapists doctors/psychiatrists and social/community workers. The main difference between them is the training that each of these professionals has received.
In the UK, there is not much of a distinction made between counsellor and psychotherapist. However, there are some slight differences between these two professional terms. These are outlined below.
Counsellors
Counselling is focused on helping people with what they need right now. Compared to psychotherapists, counsellors tend to have had shorter training and they help people deal with their issues on a more short-term basis. There may be school-based counsellors available that children and young people can approach at their school if they feel they need support with their difficulties. Here at Mindsum, we have counsellors who are available to provide support.
Psychotherapists
Psychotherapy training tends to be longer, they can give counselling but their approach to talk therapy is more in-depth exploring the history and causes of certain behaviours and emotional issues. The psychotherapist will then treat the CDs in this specialised way. Here at Mindsum, we also have psychotherapists who are available to provide support.
It doesn’t mean that one professional is better than the other and all go through intensive training before they begin to practice. Also, many counsellors seek additional training throughout their careers.
Some doctors and psychiatrists can be involved in the treatment of CDs.
Cognitive Behavioural Therapists
These are therapists who have been trained in Cognitive Behavioural Therapy using this model to form an idea of a patient’s mental health difficulties and to treat them. When working with CDs the therapists would have been trained in how to help the child/young person manage their symptoms to improve wellbeing.
Doctors
These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help the child or young person, especially if other conditions make the conduct disorder more complicated to treat.
Psychiatrist
These are professionals who are likewise trained in medicine. However, they also specialise in the field of psychiatry so can provide consultation and medication for a wide range of mental disorders including anxiety, depression, and schizophrenia.
Social/community workers
Workers trained in working with vulnerable individuals and the community might also be involved with the child or young person and might help to provide parent training or multimodal programmes. They can make regular visits to the family home and provide or make arrangements for support. They may also work with law enforcement and other sectors to ensure that the child is safe.
The journey of recovery from conduct disorder
The journey of recovery from CDs can look different for each child or young person depending on the child’s age and severity of behavioural problems. An example journey through a child-focused programme is discussed below.
Assessment
This is an important phase, where the therapist will get a feel of what is going on with the child or young person. The therapist will ask some questions, which will help to identify important background information and to know what type of treatment will be most helpful.
Therapy sessions
These sessions will be regular with an important aspect of the session being the relationship that the therapist will build with the child or young person, the therapeutic relationship. This will create a safe space that will encourage them to talk and be open with the therapist. Sessions might include different activities such as role-playing, games, rehearsal and feedback depending on the intervention chosen.
Progress and setbacks
When having treatment for CDs, there will be progress and setbacks. Problem behaviours can take a long time to change, so it is unrealistic to expect the child or young person to improve quickly or without any setbacks. It is important to not get discouraged when setbacks happen. They are an opportunity for the child or young person, parents and the therapist to think about new ways to progress and overcome challenges.
Ending therapy
The therapist will prepare the child, young person and parents for the end of therapy which occurs mainly in the final few sessions. This is an important phase because the child or young person needs to become confident in managing their behaviour without relying too much on the professional. It allows the child or young person will leave therapy with skills that they can use without the help of the therapist.
Follow up
There might be an agreement with the therapist to have a follow-up meeting. This is to check how the child or young person is coping. If they are doing well, there will be no need for more support. However, if they continue to show problem behaviours or any other issues, this will be an opportunity to consider extra support going forward.
How can I support someone with a conduct disorder?
It can be challenging when you have a loved one who has been diagnosed with a conduct disorder. It is a disorder that affects not only the child but also others in their life. Fortunately, there are some things that you can do to help.
Understand conduct disorders
It is a good idea to read as much information about CDs as you can. Understanding this disorder and what it means can help you to recognise the ways that your loved one is affected and the ways that you can help.
Help them to find the right support
If the challenging behaviours begin to get out of control, you should get professional support. You can contact the following services:
- The GP
- Mental health services
- School special education needs coordinator (SENCO)
- Parent/carer training for children with behavioural problems
Be positive and have hope
Continuous misbehaviour is not easy for any parent or carer to cope with. But it is important to stay positive and continue to believe that the behaviour can stop if you follow the advice from professionals and stay consistent.
Give attention to good behaviours
It can be easy to pay a lot of attention to the negative behaviours. Try to shift your attention to the positive behaviours, no matter how small and give praises. This is important because often the child misbehaves as a way of getting attention, therefore, it will show how positive behaviours are a better way of getting this desired outcome.
Be clear and consistent about rules and boundaries
Explain and show that there are consequences for their behaviour highlighting the boundaries between acceptable and unacceptable behaviours. For example, it is okay to feel frustrated, but it is never okay to hit your sibling and you will have a time-out. This can be facilitated by some of the interventions highlighted above such as the parent training.
It is crucial for all parents/carers to follow these same rules and boundaries. This will help the child to understand that the boundaries stay the same no matter who they are with.
Highlight their strengths
It is good to remind your child about the things they are good at. It can be easy to focus on all the ways that they misbehave but can cause the child to act up even more.
Point out their strengths, this will help them to build their self-esteem and will encourage them to do more positive behaviours.
Physical Activity
Doing physical activities such as exercise can be beneficial for children and adolescents with CDs. It allows them to release excessive energy, healthily focusing their attention and energy. You could invite them out for any type of exercise that will get them moving e.g. a walk or a jog.
These activities will also help to release ‘feel good’ chemicals in the brain, which can fight off other problems such as depression or anxiety.
Look after yourself too
It is extremely important for you to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too. To do this you might:
- Get other family members also involved in supporting your loved one
- Schedule some time off for yourself
- See a professional that can support your mental health
How can parents support their child with a conduct disorder?
When your child is anxious the best way to support them is to talk to them about their anxiety or worries to help them recognise signs of anxiety and encourage them to ask for help when they need it.
Some ways to support your child are:
- Try and improve the family home environment as conflict and arguments can make symptoms worse.
- Encourage a healthy diet and exercise
- Try to support them in implementing the techniques they have learnt in therapy. Reflecting on how those techniques have gone is a great way to maintain progress.
- Provide distractions – go out with them for a walk or play games with them
- Practice relaxation techniques with them e.g. yoga, meditation, breathing etc.
If after a while you see no improvement in your child's CD and it begins to have an effect on school, family and friendships it is best to seek professional help or visit the GP.
Useful resources
Mindsum AI Bot
You can have a chat with our AI bot to get free support 24/7. The bot can also offer a range of resources, such as videos, podcasts and articles.
Royal College of Psychiatrists
You can get more information about conduct disorders as there is a good collection of material.
Young Mind’s
There are useful resources on anger and coping with childhood aggression available on the Young Mind's website.
Nip in the Bud
On the website, you will find general information about CDs.
MIND
You will find information about helping someone with anger problems.
The British Association for the Counselling Professions (BACP)
You will find documents on different aspects of therapy.
Conduct Disorder Support
An online community dedicated to providing support and resources for parents.