Conduct Disorder in Teens

Conduct disorder in teens is a highly disruptive mental health condition that can significantly interfere with relationships, the school experience, and connection to community. Featuring a pattern of behaviors that involve aggression, bullying, rule violation, and destruction to property, conduct disorder presents serious challenges.

If your teen has been diagnosed with conduct disorder, he or she may or may not have shown signs of the disorder in earlier years. The majority of children, about 70%, who do display symptoms of conduct disorder will grow out of it by adolescence. The children that do not grow out of it and progress on to adolescence have a poorer prognosis than those with the adolescent-onset type.

Treatment for teens with conduct disorder will consist of various evidence-based therapies, family-based interventions, and parental training techniques. Although conduct disorder is difficult to treat, with this combination of interventions the mental health condition can be manageable.

What is Conduct Disorder?

Antisocial and conduct disorders are the most prevalent mental health disorders among young people. Conduct disorder affects 9.5% of the population, including 12% of males and 7.1% of females, according to an article published in Psychological Medicine. For parents of teenagers, it is hard to tell if their child is just going through a temporary rebellious period or if their teen has a serious mental health issue. There are certain signs of conduct disorder that can help distinguish it from typical teenage behavior. In fact, many of these behaviors are disturbing, and impact all aspects of life including school, social, family, and the community. Recognizing these signs and seeking treatment for the teen as early as possible will improve the long-term outcome. Signs of conduct disorder may include:

• Aggression directed toward people or animals
• Excessive agitation and irritability
• Destruction of property, setting fires
• Stealing
• Lying
• Threatening harm to others
• Lacks patience
• Cruelty toward animals
• Poor impulse control
• Lack of empathy, compassion, or remorse
• Bullying
• Truancy
• Acquiring sexually transmitted diseases due to risky sexual behaviors
• Running away from home
• Physical violence towards others
• Getting in fights, instigating the fights
• Breaking into to people’s cars or homes
• Conning people, deceitful behaviors
• Violating the rights of others
• Below average intelligence
• Problems discerning social cues, socially challenged
• Difficulty concentrating

Conduct disorder can co-occur with other mental health disorders, such as ADHD or mood disorders, as well as substance use disorder.

What Causes Conduct Disorder?

While it hasn’t yet been determined what causes conduct disorder, there are several factors that seem to play a role. These include:

• Brain differences. Brain scans reveal functional abnormalities in certain brain regions, such as the limbic system and prefrontal cortex in individuals with conduct disorder. There is also evidence of a neurochemical deficit, with low levels of serotonin and cortisol.
• Cognitive deficits. Having a low I.Q., impairment in executive functioning, or poor verbal skills.
• Environmental. Growing up in a home where there is a disregard for rules or where aggression is common may be a risk factor. Other environmental factors might include dysfunctional family life, lack of or inconsistent discipline, inadequate supervision, or harsh parenting or childhood abuse.
• Genetics. Having a close family member who also exhibits aggressive behavior, lack of remorse, deceitful behavior and other signs of conduct disorder increases the risk for developing it.
• Social factors. Social issues, such as living in poverty, family breakdown, and poor schools may contribute to conduct disorder.

Diagnosing conduct disorder begins with a physical examination to rule out any medical cause of the behaviors. Following this, an interview with the teen and the parents reveals the behavior patterns that align with a diagnosis of conduct disorder. These fall into categories, including aggression, destruction of property, deceitfulness, and serious violation of rules. The DSM-5 categorizes conduct disorder into two subsets, either child-onset or adolescent-onset types.

Signs of Conduct Order in Childhood

In some cases, parents may have recognized signs of the disorder when the teen was younger. Some children with oppositional defiance disorder (ODD) may later develop conduct disorder. Signs of ODD include angry outbursts, irritability, argumentativeness, defiance, and vindictiveness. This disorder may be a precursor to conduct disorder in the teen years.

Children’s conduct disorder symptoms tend to emerge in later childhood, such as between 8-10 years of age, although it might emerge as early as age five or six. When the disorder is present in childhood years it can impair the child’s ability to function. Excessive misbehavior, truancy, and frequent disciplinary action lead to a negative impact on the child’s education. In addition to the impact on schooling, conduct disorder in children can disrupt interpersonal relationships with peers and family members.

Children with conduct disorder symptoms may engage in fights at school, running away from home, are easily frustrated, harming small animals, or stealing and other deceitful behaviors. When these behaviors persist for more than 12 months it is likely not just a phase, but could be indicative of conduct disorder. Childhood onset conduct disorder has a worse prognosis, as it is usually more rooted in genetic temperament or personality traits. These individuals tend to have more serious, deviant behaviors when they reach the teenage years if the disorder has not resolved prior to adolescence.

About Adolescent-Onset Conduct Disorder

A teen that had no signs of conduct disorder prior to age ten is considered to have adolescent-onset type conduct disorder. As the teen continues to display noncompliant attitudes about following school and societal rules, his or her peer group and school staff will eventually reject the youth. Parents may become so frustrated with continuous interactions with school administrators over the misconduct that they eventually give up and no longer monitor their teen’s activities.

Teens with conduct disorder are at a higher risk for dropping out of school, substance use disorder, and legal problems. Teens may gravitate toward other kids who have similarly failed academically or even join a gang. This only leads to continued run-ins with the law and possibly incarcerations. Other negative outcomes include self-harming behaviors and suicide. The sooner a teen is evaluated and becomes engaged in therapy, the better the outcome.

Treatment Interventions for Conduct Disorder

The clinical guidance of a psychotherapist is key to coordinating all aspects of conduct disorder treatment and ongoing therapy is instrumental in making positive strides in managing it. Treatment focuses on teaching impulse control, anger management, conflict resolution, and other copy techniques. Therapies may include the following:

• Cognitive behavioral therapy. CBT helps teens with conduct disorder examine dysfunctional thought/behavior patterns and guides them towards developing better coping skills, such as impulse control and improved moral reasoning skills.
• Multisystemic therapy. MST is a family and community-based intervention method for teens with conduct disorder. It addresses all systems that impact the teens who struggle with antisocial behaviors, such as in their natural environments.
• Family-based interventions. Family-focused group sessions help siblings and other family members learn methods to improve the family dynamic and communication skills.
• Parent management training. Parents are coached on behavior management strategies, as well as ways to increase safety in the home.

There is no medication for treating teens with conduct disorder. However, if the teen has co-occurring ADHD such medications as Adderall or Ritalin may be beneficial. Nearly 20% of children with conduct disorder have co-occurring ADHD.

Can Conduct Disorder Develop into Adult Mental Health Disorders?

Teens who exhibit conduct disorder symptoms should be evaluated and treated for the disorder as early as possible. Unaddressed conduct disorder has the potential to develop into more serious adult mental health disorders. Mental health disorders that a teen with conduct disorder might be at risk for include:

• Antisocial personality disorder. The earliest a diagnosis of antisocial personality disorder can be made is age 18. The disorder closely aligns with the traits of conduct disorder, such as impulsivity, a disregard for right and wrong, a lack of empathy or remorse, and ongoing legal problems.
• Anxiety disorder. Some teens with conduct disorder may develop an anxiety disorder in adulthood, in particular, social phobia and post-traumatic stress disorder. Anxiety disorders feature irrational feelings of fear, dread, and worry, irritability, fear of situations where they might be judged, avoidant behaviors.
• Substance use disorder. Co-occurring substance use disorders are highly prevalent in adults once diagnosed with conduct disorder in childhood or adolescence. Developing a substance use disorder may be an outcome of self-medicating the negative consequences of the disorder, or of falling into the wrong crowd.

Residential Treatment for Teen Conduct Disorder

Adolescents with symptoms of conduct disorder will initially receive mental health interventions through private practice outpatient care. For many teens struggling with conduct disorder, these outpatient services are adequate to manage the disorder. However, some teens may not be responsive to this level of treatment care and would benefit from a more intensive, focused approach. A residential mental health program for teens provides stepped up care for teens with unmanageable conduct disorder. Engaging in teen residential treatment allows the teen to participate in a variety of multisystemic interventions while residing at the center for a specified period of time.

BNI Treatment Centers is a Los Angeles-Based Residential Program for Teens

BNI Treatment Centers has designed an effective multisystemic treatment program for teens with conduct disorder. At BNI Treatment the program is tailored to address the features of conduct disorder, applying a diverse menu of treatment elements. Teens learn how to behave with more compassion and empathy, while also learning how to manage impulsive behaviors within their environmental systems. Family therapy and experiential activities are also components of conduct disorder treatment. For more information, please contact BNI Treatment today at (888) 522-1504.