Conduct disorders

Conduct Problems

Age-inappropriate behaviours that violate norms/others’ rights; difficulty regulating emotions/behaviour; wide range of antisocial actions.

Normal Rule-Breaking (Context)

50% of toddlers show lying/stealing/disobedience vs. ~10% of young adolescents; most decline with age.

Early Anger/Aggression Risk

High anger/aggression in infancy increases risk of ODD or CD.

Cost of Conduct Problems

Most costly childhood mental health issue; ~$70,000 per child over 7 years; lifetime cost $3.2–5.5 million.

Criminal Convictions Contribution

Youth with conduct problems responsible for ~53% of convictions; prevalence 2–10%.

Juvenile Delinquency

Legal term for minors violating laws; involves debate over age of criminal responsibility (typically 7–12).

Externalizing Behaviour Spectrum

Includes rule-breaking and aggressive behaviour; conduct problems fall along this continuum.

Rule-Breaking Behaviours

Running away, fire-setting, theft, truancy, substance use.

Aggressive Behaviours

Fighting, disobedience, threats, showing off.

Overt–Covert Dimension

Overt = visible aggression (fighting); Covert = hidden behaviours (lying, stealing).

Destructive–Nondestructive Dimension

Destructive = assault/property damage; Nondestructive = arguing, irritability.

Intermittent Explosive Disorder

Recurrent aggressive outbursts not proportional to triggers.

Pyromania

Recurrent deliberate fire-setting.

Kleptomania

Inability to resist stealing unneeded items.

Oppositional Defiant Disorder (ODD)

Pattern of angry/irritable mood, argumentative/defiant behaviour, and vindictiveness ≥6 months.

ODD Onset

Usually before age 8; <5 yrs = symptoms most days; 5+ yrs = at least weekly for 6 months.

ODD Prevalence

~12% (1–11%).

Vindictiveness (ODD)

Spiteful or vindictive behaviour ≥2 times in 6 months.

ODD Severity Levels

Mild = 1 setting; Moderate = 2+ settings; Severe = 3+ settings.

Conduct Disorder (CD)

Severe, repetitive violations of rights/social norms (aggression, theft, vandalism, rule violations).

CD Symptom Dimensions

(1) Aggression to people/animals (2) Property destruction (3) Deceit/theft (4) Rule violations.

Limited Prosocial Emotions Specifier

Lack of guilt/empathy, shallow affect, unconcerned about performance.

CD Severity Levels

Mild = minor harm; Moderate = between; Severe = many symptoms/major harm.

Childhood-Onset CD

Symptoms before age 10; more boys; more aggressive; higher ADHD/family dysfunction.

Adolescent-Onset CD

After age 10; equal gender ratio; less severe; fewer violent offences.

ODD → CD Progression

ODD appears 2–3 years before CD; but only ~50% of children with CD previously had ODD.

Antisocial Personality Disorder (APD)

Adult pattern of violating rights, deceitfulness, impulsivity, aggression, lack of remorse.

CD → APD Progression

~40% of children with CD develop APD.

Psychopathic Features

Callous, manipulative, remorseless interpersonal style.

Callous–Unemotional Traits (CU)

No guilt/empathy, shallow emotions, narcissism, impulsivity; stable across development.

IQ Deficits in Conduct Problems

Average ~8 points lower IQ; verbal IQ especially affected; linked to early verbal deficits.

Executive Function Deficits

Difficulty planning, inhibiting impulses; similar to ADHD but linked to motivation/incentives in CD.

School Problems

Underachievement, reading/language difficulties, truancy.

General Family Disturbances

Parental mental illness, antisocial history, instability, marital conflict, low resources.

Specific Parenting Problems

Harsh/inconsistent discipline, low supervision, low warmth, parental disagreement.

Peer Problems

Aggression toward peers, rejection, poor social skills, affiliation with antisocial peers.

Hostile Attribution Bias

Interpreting ambiguous cues as hostile; common in reactive aggression.

Health Risks

Injury, STDs, substance abuse, drug overdose, early mortality.

Comorbidity: ADHD

~50% of children with CD/ODD have ADHD.

Comorbidity: Depression/Anxiety

~50% have mood/anxiety problems; girls with CD especially prone.

Anxiety as Risk/Protection

Shy/fearful anxiety may protect; negative emotionality may increase risk.

ODD Prevalence vs CD

ODD more common in childhood; equal in adolescence.

CD Prevalence

~8% (9% male; 6% female).

Gender Ratios

Conduct problems 2–4× higher in boys; severe antisocial behaviour approx. 10:1; transient antisocial ≈2:1.

Relational Aggression

More common in girls; gossip, exclusion, verbal insults.

Difficult Temperament

Early irritability/impulsivity predicts later conduct problems.

Diversification of Antisocial Acts

Children add new problem behaviours over time rather than replacing old ones.

Life-Course Persistent Path (LCP)

Early aggression persists into adulthood; high family risk; ~50% of early-onset cases follow this path.

Adolescent-Limited Path (AL)

Antisocial behaviour starts in puberty and ends in early adulthood; linked to peer influence.

Snares

Long-term consequences (e.g., school dropout) that trap AL youth into continuing antisocial behaviour.

Adult Outcomes: Persistence

Active offending drops 50% in early 20s; ~85% desist by late 20s.

LCP Adult Outcomes

Chronic criminality, psychiatric issues, poor relationships, poor parenting.

Genetic Influences

Heritability ~50%+; stronger in LCP and CU traits.

MAOA Gene Interaction

Low-activity MAOA + childhood maltreatment → higher antisocial behaviour.

DRD2 Gene Interaction

DRD2 risk + low parental support → increased delinquency.

Epigenetics and Conduct Problems

Prenatal stress, poor care, toxins modify gene expression increasing risk.

Prenatal/Birth Risks

Low birth weight, malnutrition, lead exposure, maternal substance use.

Smoking in Pregnancy

Association with conduct problems due to genetic factors rather than smoking itself.

BAS/BIS Theory

Overactive BAS and underactive BIS → impulsive, reward-driven antisocial behaviour.

Low Fear Conditioning

Low fear at age 3 predicts adult criminality 20 years later.

Low Heart Rate / Low Arousal

Linked to fearlessness and poor punishment learning.

Amygdala and Prefrontal Differences

Reduced activation → poor empathy/emotion processing.

DMN Connectivity Issues

Reduced connectivity → impaired self-reflection, moral reasoning.

Social–Cognitive Deficits

Poor perspective-taking, hostile intent bias, emotion recognition problems.

Social Information Processing Model

Aggressive children misread cues, generate fewer prosocial solutions.

Harsh/Inconsistent Parenting

Major risk factor; teaches aggression through negative reinforcement.

Coercion Theory

Children escalate misbehaviour to escape demands; parents reinforce by giving in.

CU Traits and Parenting

Ineffective parenting predicts conduct problems mainly in low-CU children.

Attachment Problems

Insecure/disorganized attachment → weak internalization of moral values; higher antisocial risk.

Family Instability/Stress

Divorce, poverty, conflict, moves increase conduct problem risk.

Parental Criminality

Parents with APD/substance abuse strongly predict child conduct problems.

Neighborhood Risk Factors

Poverty, crime, instability; antisocial norms; social disorganization.

School Quality Effects

Weak academic structure increases risk; strong structure protects.

Violent Media Research

Small link to minor aggression only; no link to serious violence.

Cultural Differences

Aggression varies by cultural values (warrior vs. cooperative norms).

SES and Conduct Problems

Socioeconomic disadvantage explains most group differences in antisocial behaviour.

Acculturation Effects

Higher conduct problems in U.S.-born vs. immigrant Mexican American youth.

Effective Treatment Principles

Multisystemic, early, family-centered; incarceration/boot camps are ineffective.

Parent Management Training (PMT)

Teaches monitoring, consistent consequences, positive reinforcement; most effective <12 yrs.

Problem-Solving Skills Training (PSST)

CBT to correct cognitive distortions; teaches emotional regulation and alternative responses.

Multisystemic Therapy (MST)

Intensive home/community intervention targeting family, peers, school; long-term reductions in crime.

Parent–Child Interaction Therapy (PCIT)

For preschoolers; improves attachment and behaviour via coached interactions.

Aggression Replacement Training (ART)

Social skills + anger control + moral reasoning; 10-week structured program.

SNAP Program

CBT-based; teaches children to stop, think, plan before acting; parent and child components.

Preventive Interventions

Most effective in ages 2–10; reduce long-term justice/mental-health costs.

Violent Behaviour Warning Signs

Tantrums, threats, weapon interest, substance abuse, serious rule violations.

Key Takeaway

Conduct problems emerge from interacting genetic, neurological, cognitive, family, peer, school, and cultural factors; early, multi-level intervention is essential.