How Are Conduct Disorders Diagnosed?

Conduct disorder, affecting children under the age of 18, involves difficulty with emotions and behaviors. A child with conduct disorder acts violently, does not understand or respect the physical boundaries of others, and violates social norms or behavioral expectations. Lying, stealing, difficulty in school, truancy, and violent attacks on people or animals are characteristic symptoms of CD. About 9 percent of boys, and 2-9 percent of girls, struggle with the disorder.

There are many potential contributors to conduct disorder, but this condition is often triggered by feelings of alienation from others. This can occur in an unstable or unsafe home environment, or at school when the child does not make friends. If left untreated, conduct disorder can turn into other disorders in adults, such as antisocial personality disorder. The condition also co-occurs with other health problems, such as mood disorders or substance abuse.

Diagnosing a Conduct Disorder

It is important to diagnose and treat conduct disorder as soon as it appears.

Step 1: Get help from a child psychologist.

When a parent, guardian, or school official notices that a child is unable to understand social norms or continuously acts inappropriately around others, they should consult with a child psychologist or other mental health professional who has experience diagnosing conduct disorder and working with children. The psychologist will observe the child’s behavior for a period of time. Symptoms of conduct disorder include:

  • Aggressiveness:intimidation of peers or adults, bullying, getting into physical fights, using weapons, forcing sexual acts on others, sexual assault, or violence toward animals or people
  • Destructive conduct: vandalism, arson, or destruction of property
  • Deceitfulness: lying, stealing, delinquency, violating curfew, or forgery
  • Violation of rules: truancy, running away from home, aggressive pranks, or sexual activity early in life

If at least three of these symptoms have appeared in the year leading up to observation, and one has occurred within the last six months, the psychologist has grounds to diagnose conduct disorder. The psychologist will also attempt to rule out other conditions, such as ADHD or bipolar disorder.

Step 2: Take specific tests for conduct disorder.

After observation, the psychologist will administer one or more scales to determine if the child has conduct disorder. Some of these include:

  • Youth Self-Report
  • Overt Aggression Scale
  • Behavioral Assessment System for Children
  • Child Behavior Checklist
  • Diagnostic Interview Schedule for Children

At least one, but often more than one, of these tests is used to evaluate the child’s experience and condition from their own perspective and that of the therapist. Although conduct disorder often occurs or causes other mental health issues, such as ADHD, anxiety disorder, post-traumatic stress disorder, substance abuse, and learning disorders, it should not be confused with these conditions.

A physical exam and blood tests can also rule out underlying medical conditions that may affect brain state and can appear as conduct disorder.

Step 3: Assess the cause of conduct disorder.

There are many different reasons a child develops conduct disorder. Here are a few causes:

  • Damage to the frontal lobe, through genetics, difficulties, or substance abuse during pregnancy or later physical harm
  • Inherited personality traits from close family members with similar conditions
  • Unsafe home environment (abuse, dysfunctional family, extreme poverty, or a parent with a substance abuse problem)
  • Other psychiatric disorders or family history of mental illness
  • Other traumatic events early in life

The cause of the conduct disorder is important to understand, so an appropriate treatment plan can be created.

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Step 4: Determine the severity of the condition.

Children with conduct disorder can develop symptoms in young childhood, prior to age 10, or in adolescence, after age 10. Conduct disorders can be mild, moderate, or severe, and a treatment plan will take the child’s age and severity of the diagnosis into account.

The primary mode of treatment for any conduct disorder is some level of counseling, both for the individual child and for the child’s family. Individual counseling helps the child understand boundaries and the rights of others, while family counseling helps parents and siblings understand the condition, set firm boundaries and punishments, and maintain stability in those rules.

Treatment of co-occurring mood disorders, substance abuse, ADHD, and other conditions will be handled separately, but it is important to get treatment for other conditions in concert with treatment for conduct disorder.

Moderate or severe conduct disorder will likely also involve mood-stabilizing medication, although the effectiveness of this approach is debated among child psychologists. Symptoms like mood swings and depression, however, can be treated with medication in some instances. Hospitalization may be required initially, or the child may be transferred to a school that specializes in treating and teaching children with conduct disorder.

Parents and children can also attend summer camps, wilderness programs, and other intensive therapy experiences that remove everyone from their home and school environments, and treat underlying relationship problems in a different setting.

Step 5: Continue treatment.

If diagnosed early enough, conduct disorder is a very treatable condition. Most children who get the help they need early overcome their behavioral problems. Although it is important not to jump to conclusions about a child’s behavior, getting help for symptoms as soon as possible can prevent the child from developing further serious complications in adulthood, including severe mood disorders and substance abuse and addiction problems.

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