Child and adolescent conduct disorder

An 11-year-old boy has been stealing from his parents, fighting with his brothers, and threatening schoolmates to extract pocket change. He wanders the streets alone, breaks windows in cars, and sets fires. He has been caught shoplifting several times. When brought to account, he denies everything and blames others. He has run away from home twice and has begun to smoke cigarettes. Despite normal intelligence, he is far behind in school. He disrupts classes and is often truant. Teachers are losing patience and the school authorities are threatening to expel him.

Children like this one — the vast majority of them boys — usually also suffer from attention deficit hyperactivity disorder (hyperactivity, distractibility, impulsiveness) and oppositional defiant disorder (a tendency to be touchy, resentful, spiteful, argumentative, and defiant of adult authority). And besides these "externalizing" problems, they have a high rate of serious depression and anxiety. As they move into adolescence and young adulthood, they risk graduating to gang membership, drug dealing, robbery, and rape. They are a serious problem for themselves, their families, and society, and there is no easy explanation or solution.

Conduct disorder: The diagnosis

A persistent and repetitive pattern, beginning at an early age, of impulsive, aggressive, and deceitful behavior that involves violating basic social rules and the rights of others. It may include any of the following:

  1. Assaults and other aggressive behavior that causes or threatens physical harm.

  2. Behavior that causes property loss or damage, such as burglary, vandalism, and malicious mischief.

  3. Deceitfulness or theft.

  4. Serious rule violations such as truancy, staying out late at night, and using drugs and alcohol.

Adapted from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision, 2000.

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