Bad Boy. Bad Boy. Is It Conduct Disorder?

Defining the line between normal childhood behavior and more serious problems like conduct disorder (CD) is important.

Conduct disorder is linked to a significant risk for a lifelong problem with aggression. 

Identifying CD early in life provides the hope that early intervention might reduce the later consequences of the disorder.

The American Academy of Child and Adolescent Psychiatry has an excellent online resource center to understand conduct disorder. They note the condition is characterized by four key diagnostic features with onset in childhood:

• Aggression toward people and animals
• Destruction of property
• Frequent lying/theft
• Chronic violation of rules

A recent research study by Benjamin Lahey and Irwin Waldman analyzed the validity of conduct disorder in relationship to the other common childhood forms of psychopathology.

They note a key diagnostic challenge is to differentiate conduct disorder from a similar disorder known as oppositional defiant disorder or ODD. The main conclusions from their literature review included the following:

1. CD appears distinct from ODD in many ways
2. CD more strongly predicts adult antisocial behavior compared to ODD
3. It may be of value to identify the type of aggressive behavior in cases of CD: proactive vs reactive, physical vs non-physical aggression towards other
4. Age of onset of CD may be an important signal. Early age of onset appears to have a worse prognosis
5. CD in the context of a callous, unemotional, without regret may also be an important marker for severity
6. CD is a male predominant disorder and there may be important differences in the manifestation of the disorder between boys and girls
7. Factor analysis finds CD to cluster in a broad group of externalizing disorders that includes ODD, ADHD hyperactivity and impulsivity and inattention
8. This externalizing group of disorders appears distinct from a group of childhood internalizing disorders that includes social anxiety, obsessive compulsive disorder, separation anxiety and phobias including agoraphobia
9. Externalizing disorders appear to share some distinct genetic risk
10. Although genetic factors appear key in CD and other externalizing disorders, environmental factors may interact with genetic risk to effect outcome
11. Future research implications from this review include the methods needed for refining the CD phenotype, molecular genetic studies, nonshared environmental studies and studies of the neurobiology of CD and studies of gender difference
12. It is likely that CD will share "neurobiological mechanisms with other prevalent forms of psychopathology" although is is likely there are mechanisms that will be specific or unique to CD

This review is a good place to start in understanding the phenotype of CD and how it is understood from a current research prospective.

Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link in the citation below.

Image of toy dog is an original photo from the author's files.

Follow the author on Twitter @WRY999

Lahey BB, & Waldman ID (2012). Annual research review: phenotypic and causal structure of conduct disorder in the broader context of prevalent forms of psychopathology. Journal of child psychology and psychiatry, and allied disciplines, 53 (5), 536-57 PMID: 22211395