Conduct Disorder - Kid Catch

Conduct disorder describes children and adolescents who violate the rights of others, commit illegal acts, and show a lack of empathy for others. The same behaviors earn individuals the diagnosis of antisocial personality disorder when they turn 18 years-old. Personality disorders are considered rather stable and permanent character traits. Makers of the diagnosis system have been reluctant to label children and teenagers with personality disorder diagnoses as an acknowledgement that youth are still developing. The conduct disorder diagnosis reflects that the symptoms are temporarily manifest in some youth. For example, children and teens who commit illegal behaviors may reflect youthful indiscretions that disappear as people mature; but empathy and remorse are either intact or developing.

Symptoms:

Bullies, threatens, intimidates
Initiates physical fights
Used a weapon that can cause serious harm
Physically cruel to people
Physically cruel to animals
Stolen while confronting
Forced someone into sexual activity
Deliberate fire setting
Destroys other’s property
Broken into a house, building, or car
Lies to obtain goods or avoid obligations (cons others)
Stolen non-trivial items without confronting
Stays out at night despite prohibitions, beginning before 13 years
Run away from home at least twice, or once without returning for lengthy period
Often truant, beginning before 13 years

Cases can be specified by age of onset:

Childhood-onset type, symptoms appeared prior to age 10 years. Tends to have worse prognosis.
Adolescent-onset type, no symptoms prior to age 10 years.

In the DSM-5 revision in 2013, a new specifier was added "with limited prosocial emotions" (thanks largely due to the years of excellent research by local researcher Paul Frick, PhD when he was at the University of New Orleans, and is now at LSU Baton Rouge). This corresponds to Frick's label of Callous and Unemotional, and indicates a worse prognosis in the opinions of many:

Lack of remorse or guilt
Callous – lack of empathy
Unconcerned about performance
Shallow or deficient affect

Screening:

The Swanson, Nolan, and Pelham scale (SNAP) contains 6 items (#41-46) to screen for conduct disorder. The scale can be downloaded on the Bipolar or ODD issues pages. Endorsement of any of these items ought to generate a referral for further assessment.

Treatment:

Short-term or single interventions are not typically effective for conduct disorder. Medications are best viewed as adjuncts for circumscribed comorbid problems. Conduct disorder that is mild, adolescent onset, and includes some degree of empathy is likely to show relatively more improvement.

Multiple services delivered in a continuum of care are the most promising approach, and even then the effects tend to be modest. Multisystemic Therapy (MST) is the most widely-recognized and studied intervention for chronic juvenile offenders. MST appears to have more effect on arrest rates, incarceration, and substance abuse rather than on underlying symptoms of psychopathology.

Local Experts

On the Find A Provider page of the Kid Catch Directory, you can use the Issues filter box to search for local experts on conduct disorder. Clicking on this filter selection will return results of clinicians who advertise themselves as working with this problem. Kid Catch cannot guarantee that clinicians who advertise themselves this way are truly expert.

-Updated 11/21/19