Investigating And Understanding Conduct Disorders Within The DSM-5

Conduct disorder (CD) is a mental health condition that occurs in children and adolescents, often characterized by a pattern of disruptive or aggressive behavior. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), CD is divided into two main subtypes: childhood-onset and adolescent-onset.

Behavioral science research indicates the condition affects between 2% and 5% of children between the ages of 5 and 12 and between 5% and 9% of adolescents aged 13 to 18. Additional factors like ethnicity and socioeconomic status may also contribute to the prevalence of CD in specific populations.

When considering conduct disorder as a condition, it can be valuable to consider the underlying causes and risk factors. Clinical studies suggest that a child's genetics and environment are often linked to their susceptibility to developing CD. For example, family dynamics, parenting styles, peer relationships, school systems, and community resources may all contribute to this condition. 

The biology of the brain and its impact on conduct

In addition to environmental and social factors, research has suggested that specific neurological processes may also impact the development of conduct disorders.

The prefrontal cortex (PFC) is an area of the brain responsible for controlling emotions, decision-making, and impulse control. Abnormalities or disruptions in PFC functioning can lead to deficits in these areas, potentially causing difficulty in an individual's behavioral management skills. Cortical thickness and folding deficits have been observed in children with CD, suggesting that brain development is an integral factor in the manifestation of CDs. 

Recent research has also shed light on the impact of the amygdala on emotional responses. This small but essential area of the brain is responsible for processing emotions like fear and aggression, and it plays a crucial role in controlling emotional responses. Neuroimaging studies have found that decreased activation in the amygdala is associated with higher levels of aggression, impulsivity, and difficulties with emotional control.

Neurotransmitters are chemical messengers that facilitate communication within the brain. Neurotransmitters like dopamine, serotonin, and norepinephrine are all involved in controlling behavior and emotion. Research suggests that imbalances in these neurotransmitters may contribute to the development of conduct disorder, leading to poor impulse control, aggression, and mood dysregulation.

DSM-5 criteria for conduct disorder

Conduct disorder (CD) is a serious and complex mental illness that children and adolescents may face. This condition can affect a person's ability to follow social norms, rules, and regulations, leading to behavior that often violates other people's rights or disrupts the safety of those around them. The DSM-5 outlines the criteria for the diagnosis of conduct disorder as follows. 

Repetition and persistence 

Conduct disorder is defined as a repetitive and persistent pattern of behavior that violates the rights of others or significant societal norms, including aggression towards people or animals, destruction of property, and deceitfulness or theft. Moreover, the behavior must also cause significant impairment in the affected individual's social, academic, or occupational functioning.

Onset in childhood or adolescence 

The onset of symptoms of a conduct disorder happens in childhood or adolescence, with early behavioral problems involving lying or truancy often progressing to more serious offenses such as stealing, vandalism, and aggression.

Behavioral requirements 

To diagnose CD, the DSM-5 outlines several types of behavior that must be present, including the following: 

• Aggression towards people and animals: This criterion is met when an individual engages in behavior that threatens or causes physical harm to others, such as bullying, physical fights, and cruel acts toward animals.
• Destruction of property: This criterion is met when an individual deliberately destroys property that belongs to someone else, such as breaking windows, setting fires, or damaging vehicles.
• Deceitfulness or theft: This criterion is met when an individual engages in lying, cheating, or stealing items of nontrivial value, such as shoplifting, breaking into homes or cars, or stealing from others.
• Serious rule violations: This criterion is met when an individual repeatedly violates rules or laws, such as skipping school, running away from home, breaking curfew, or stealing. 

The DSM-5 criteria for CD provide a comprehensive overview of the behaviors that must be present for a diagnosis. However, note that the DSM-5 criteria may not be the only indicators of CD. A mental health professional can consider other factors, such as the individual's age and personal history, to make an accurate diagnosis. 

Childhood-onset type and adolescent-onset type conduct disorders: Key differences and treatment approaches

Childhood-onset type conduct disorder and adolescent-onset type conduct disorder are two subtypes of conduct disorder identified by the DSM-5, differentiated mainly by the age of onset of symptoms. However, there are a few differences between the two subtypes that families and caregivers should be aware of.

Childhood-onset type 

Children with childhood-onset type conduct disorder often exhibit more severe and persistent conduct challenges. These symptoms may manifest before age ten and are associated with a higher risk of developing long-lasting conduct problems, anti-social behavior, and criminality in adulthood. While the prognosis for individuals with childhood-onset type conduct disorder may be challenging to cope with, early intervention may help reduce the risk of long-term adverse outcomes.

Associated comorbidities can also differ between the two subtypes. Children with childhood-onset may be more likely to have comorbid ADHD, oppositional defiant disorder, and learning disorders. Adolescents with adolescent-onset may have more significant difficulties with substance use, anxiety, and depression.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Adolescent-onset type 

Adolescents with adolescent-onset conduct disorder may engage in rule-breaking, deceitfulness, and aggression. Still, the symptoms may not be as intense or frequent as those with the childhood-onset type. These symptoms often first appear during adolescence after age ten but before 18. While this subtype can cause significant distress and impairment, the long-term prognosis might be more favorable than the childhood-onset type. Individuals with adolescent-onset type might notice a reduction in symptoms as they mature and enter adulthood.

Risk factors for both subtypes include genetic factors, environmental factors like exposure to violence or abuse, and neurobiological factors. However, peer influences and social stressors during adolescence may play a more significant role in the onset of symptoms for adolescent-onset type conduct disorder.

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat. 

If you're a teen or child experiencing or witnessing abuse of any kind from a family member or caregiver, reach out to the Child Help Hotline at 1-800-422-4453 or use the online chat feature.

Shared traits 

Both subtypes of CD may benefit from timely intervention and support, with treatment approaches tailored to the individual's specific needs and developmental stage. Puberty and adolescence can exacerbate specific symptoms, and a comprehensive treatment plan can be designed to address any co-occurring mental health conditions.

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Navigating conduct disorders in youth as a caregiver

Parents and caregivers may play an essential role in identifying and managing CD. Early interventions often yield the most favorable outcomes, so it can be helpful to be aware of any signs or symptoms that may suggest a conduct disorder is present.

Behavioral management techniques, such as consistent consequences and reinforcing desired behaviors, may reduce disruptive or destructive behaviors. Additionally, parenting skills training can teach parents and caregivers effective strategies for coping with these challenges. 

Schools and educators may also have a pivotal role in addressing conduct disorders in youth. At-risk students can be identified early so that appropriate interventions and support can be implemented. Schools can collaborate with mental health professionals to provide comprehensive treatment for students living with CD. Treatment can include social skills training, cognitive behavioral therapy, family therapy, and other evidence-based practices.

If your child exhibits symptoms of a conduct disorder, consider seeking support. A mental health professional can assess an individual's needs, develop an effective treatment plan, and provide guidance and resources to help navigate this complex disorder. The convenience of online therapy may also benefit youth who feel overwhelmed or intimidated by traditional in-person visits.

A 2021 study by Clinical Child and Family Psychology Review revealed that cognitive-behavioral therapy (CBT) might be effective in helping children and adolescents cope with the symptoms of a conduct disorder. CBT can help children and adolescents manage their anger and solve social problems by increasing emotion regulation, cognitive restructuring, and problem-solving. 

Treating conduct disorder in youth can take time, but the earlier it is identified and addressed, the sooner your child may receive support. With compassionate professional guidance, children and adolescents living with CD can learn to make healthier decisions that could benefit them long term. 

Counseling options for parents and caregivers 

Conduct disorders can have a significant impact on youth and their families. While certain biological and environmental factors can increase a person's risk, early intervention, parental guidance, and evidence-based therapy may help children and adolescents with the skills they need to manage their behaviors. 

Parents and caregivers may also benefit from therapy to discuss the impacts of their child's mental health. If you're living with stress or another mental health challenge due to home life, consider contacting an online therapist through a platform like BetterHelp. With online therapy, you can reach a professional from home at a time that fits your schedule. In addition, you can choose between phone, video, or live chat sessions depending on your needs each session. Online platforms like TeenCounseling are also available for teens aged 13 to 19. 

Studies have found that internet-based therapy can be as effective as face-to-face treatment in supporting families and caregivers living with prolonged and intense stress due to a family member's severe mental health condition. You're not alone if you're experiencing these symptoms, and a counselor can help you develop a plan to support yourself and your children healthily.