Conduct Disorder
Prevalence
One-year population prevalence estimates range from 2% to more than 10%, with a median of 4%.
Prevalence rates rise from childhood to adolescence and are higher among male.
Risk Factors
Temperamental
Temperamental risk factors include a difficult undercontrolled infant temperament and lower-than-average intelligence, particularly with regard to verbal IQ.
Environmental
Family-level risk factors include parental rejection and neglect, inconsistent child-rearing practices, harsh discipline, physical or sexual abuse, lack of supervision, early institutional living, frequent changes of caregivers, large family size, parental criminality, and certain kinds of familial psychopathology (e.g., substance-related disorders).
Community-level risk factors include peer rejection, association with a delinquent peer group, and neighborhood exposure to violence. Both types of risk factors tend to be more common and severe among individuals with the childhood-onset subtype of conduct disorder.
Genetic and physiological
The risk is increased in children with a biological or adoptive parent or a sibling with conduct disorder.
The disorder also appears to be more common in children of biological parents with severe alcohol use disorder, depressive and bipolar disorders, ADHD or schizophrenia.
Family history particularly characterizes individuals with the childhood-onset subtype of conduct disorder.
Slower resting heart rate has been reliably noted in individuals with conduct disorder compared with those without the disorder, and this marker is not characteristic of any other mental disorder.
Reduced autonomic fear conditioning, particularly low skin conductance, is also well documented.
Structural and functional differences in brain areas associated with affect regulation and affect processing, particularly frontotemporal-limbic connections involving the brain's ventral prefrontal cortex and amygdala, have been consistently noted in individuals with conduct disorder compared with those without the disorder.
Symptoms
A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following criteria in the past 12 months from any category below:
Aggression to People and Animals
Often bullies, threatens, or intimidates others.
Often initiates physical fights.
Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
Has been physically cruel to people.
Has been physically cruel to animals.
Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
Has forced someone into sexual activity.
Destruction of Property
Has deliberately engaged in fire setting with the intention of causing serious damage.
Has deliberately destroyed others’ property (other than by fire setting).
Deceitful ness or Theft
Has broken into someone else’s house, building, or car.
Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery).
Serious Violations of Rules
Often stays out at night despite parental prohibitions, beginning before age 13 years.
Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
Is often truant from school, beginning before age 13 years.
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.