Conduct disorder

The main features of conduct disorders are persistent antisocial behaviours such as fighting, bullying, severe temper tantrums, damaging property, starting fires, stealing, truancy, and persistent and defiant disobedience. The child’s age must be taken into account, and normal naughtiness should not be considered a sign of conduct disorder. A third of cases have specific reading disorder, and there is considerable overlap with hyperactivity disorder. Conduct disorders are common. Among adolescents about 8% of boys and 5% of girls have a conduct disorder. It is less common in younger children, particularly in girls.

There are two types of conduct disorder:

Socialised conduct disorder. These children are able to make friends who usually also behave in an antisocial way. The bad behaviour is therefore usually most evident away from home. Relationships with adults may be good, although there are often difficulties with authority figures.

Unsocialised conduct disorder. These children do not have friends, either because they have been rejected by their peers or because they deliberately choose to isolate themselves. The antisocial behaviour therefore occurs alone. Some degree of emotional disorder is often also present in these children.

The causes of conduct disorders are a complex interaction between the biological make-up of the child, family influences and environmental factors as summarised in Figure 1. The style of parenting is thought to be important. Conduct disorders are likely to develop if parents fail to give clear boundaries, monitor behaviour and administer ineffective or inconsistent discipline. Improving parenting skills is likely to improve behaviour even if other causative factors are present. Other treatment approaches include family therapy, behavioural therapy, remedial teaching and provision of alternative peer group activities. The outcome is better for the socialised group. Two-thirds of the unsocialised group will have persisting dissocial behaviour in adulthood.

Fig. 1 Aetiology of conduct disorder.

Emotional disorders

Emotional disorders of childhood are characterised by anxiety and depression. They are present in 2–3% of children and, unusually for childhood psychiatric disorders, are more common in girls. They generally have a good prognosis.