• What is Conduct Disorder?

    Conduct Disorder (CD), occurring in children and adolescents, is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. CD refers to a clinical category characterized by the co-occurrence of several anti-social and aggressive behaviors over a given period of time (6 month in ICD-10, 12 month in DSM-IV diagnostic criteria).

    CD is often preceded by Oppositional Defiant Disorder (ODD). Most children/adolescents with CD also have symptoms of ODD. Progression from CD to antisocial personality disorder is a chronic condition of adulthood characterized by extreme disregard for others. Societal norms follow a similar pattern: one third to a half of youngsters with CD will meet criteria of this personality disorder in adulthood. CD is a serious public health concern because of its high psychiatric morbidity and association with risk-taking behaviors, legal complication and overall impairment of adaptive functioning. CD is often preceded by Oppositional Defiant Disorder (ODD). Most children/adolescents with CD also have symptoms of ODD. Progression from CD to antisocial personality disorder is a chronic condition of adulthood characterized by extreme disregard for others. Societal norms follow a similar pattern: one third to a half of youngsters with CD will meet criteria of this personality disorder in adulthood. CD is a serious public health concern because of its high psychiatric morbidity and association with risk-taking behaviors, legal complication and overall impairment of adaptive functioning. CD is a serious public health concern because of its high psychiatric morbidity and association with risk-taking behaviors, legal complication and overall impairment of adaptive functioning.

  • Diagnosis

    Main clinical features of Conduct Disorder (CD) are:

    • aggression towards people and animals,
    • destruction of property,
    • deceitfulness or theft,
    • serious violations of rules.

    Clinical presentation is heterogeneous: some children and adolescents show a predominance of overt antisocial behavior, such as reactive aggression, theft with confrontation, use of weapons, etc., while some show more covert antisocial behaviors (truancy, lying, stealing without confrontation, etc.). Severity is variable as is social context, but to retain a clinical diagnosis of CD impairment in social, academic or occupational functioning has to be significant. Severity of CD as well as age of onset are variable. In mild severity CD, symptoms are just at the level needed to make a diagnosis (three anti-social behaviors in the previous 12 months or one in the previous 6 months) and social consequences are significant but impairment is limited. In severe CD, antisocial symptoms are numerous, and considerably harmful for the affected child or adolescent and for people of his/her social environment. When CD starts before the age of ten, it is called childhood-onset as opposed to adolescent-onset CD.

    A diagnosis of CD requires a careful developmental history and a thorough analysis of the temporal pattern of symptoms and environmental context. A significant proportion of children/adolescents with antisocial behaviors will not meet criteria for CD. Furthermore, mild and occasional conduct problems can be seen in normally developing children/adolescents and, in the general population, aggressive behavior tends to decrease across the first 10 years of life. Although CD heightens risk for delinquency, the first is a clinical category and the latter is a legal term referring to offenses against the law.

  • How frequent is conduct disorder?

    The prevalence of Conduct Disorder (CD) in the general population is estimated to amount to 1,5 - 3,4 % (Lahey et al., 1999 ; Verhulst et al., 1997). An increase in prevalence has been documented over the last years, but it remains unclear if this is related to improved recognition or to varying definitions of CD. The diagnosis of CD is more frequent in boys with ratios ranging from 10:1 to 2:1, but the “covert” symptoms in girls (compared with more overt aggressive behaviors in males with CD) have been incriminated in possible under-diagnosis in this population. Peak age at onset is late childhood.

  • What are the differences between occasional conduct problems and CD?

    Mild and occasional conduct problems can be seen in normally developing children/adolescents. In the general population, aggressive behavior tends to decrease across the first 10 years of life. In youngsters with Conduct Disorder (CD), aggressive behavior or other conduct problems are frequent, chronic and have negative consequences on their social, academic and family life. A significant proportion of children/adolescents with transient or moderate antisocial behaviors do not meet criteria for CD.

  • What are the differences between CD and delinquency?

    Although Conduct Disorder (CD) heightens the risk for delinquency, the first is a category of mental health problems and the latter is a legal term referring to offenses against the law. CD is a serious public health concern because it is often associated with other mental health problems (depression/suicidal acts, substance abuse/dependency) risk-taking behaviors, legal complications and family conflict.

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