Conduct disorder in Children


Conduct disorder (CD) is a repetitive and persistent psychiatric disorder that usually emerges in childhood or adolescence and is characterized by violating basic rights of others, severe antisocial such as destruction of property, stealing and aggressive behaviour such as initiating physical fights, threatening, animal cruelty. It is comorbid with attention-deficit/hyperactivity disorder (ADHD) and depression.

Children with CD are more likely to be remain isolated socially, difficulty in interacting and integrating with other children and increased involvement in criminal acts and substance misuse.

Low levels of 5-Hydroxy Indole acetic acid in Cerebrospinal Fluid, high testosterone levels, low levels of plasma dopamine beta-hydroxylas and heritability are the biological factors for increased antisocial and aggressive behaviour.

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Family risk factors include harsh parenting, poor infant nutrition, inconsistent discipline, low income groups, physical abuse, and family history of crime. Neurological risk factors include developmental delays, neuropsychological insults in childhood, brain injury, seizures and resting frontal brain electrical activity. Social risk factors include lack of positive feedback from teacher and exposure to gang violence in the community.

Diagnosis of CD in children is conducted by evaluating the behaviour patterns correlated with age. High degree of aggression, often lying, damage to property, frequent running away from home and school truancy are some of behavioural patterns to be evaluated. Complete psychiatric assessment, academic assessment and family dynamics of the child needs to be evaluated.

As there are many risk factors are involved, multi-modal treatment is most effective in addressing CD. The multi-modal treatment involves a family based approach addressing the negative situations ongoing in the family and in the neighborhood. Treatment starts with psycho educating the child and his/her parents and caretakers on the issue of CD and its complications in the long run.

Non-pharmacological treatment includes evidence-based psychosocial treatments such as parent management training where the parents or caretakers are educated about parenting and taking special care of the child by taking some measures such as not fighting in front of the child, using proper language, providing sufficient nutrition to the child, not venting anger on the child. Anger management training involves parent and physician contribution where the child should be taken out to peaceful areas, playing with colorful play items, counting numbers to vent out anger. Community-based treatment involves teaching the child on living socially with other children, pets and people. Individual psychotherapy is unique to each patient and the treatment varies depending on the medical and psychological history of the patient. The multisystem therapy targets positive family dynamics.

Pharmacological treatment is prescribed when CD exists with comorbidities such as aggression, depression, ADHD, bipolar disorder, seizers and any other neurodevelopmental disorders. Interventional therapy is suggested for children with psychiatric comorbidities such as ADHD, stimulant and non-stimulants are prescribed. Antidepressants are prescribed for treating depression. Mood stabilizers such as antiepileptic drugs and antipsychotic drugs are prescribed for reducing aggression and bipolar disorder. 


Thank& Regards

Lucy Morgan

Editorial assistant

Journal of Child Psychology