conduct disorders in childhood

Last edited 10/2020 and last reviewed 10/2020

Conduct disorders are associated with a wide range of clinical features and attempts have been made to sub-classify conduct disorders into different types eg unsocialised, socialised, and compulsive conduct disorders. Though attempts have been made to sub-classify conduct disorders this section of the system will refer only to the general term 'conduct disorders'.

• conduct disorders, and associated antisocial behaviour, are the most common mental and behavioural problems in children and young people
  • Office of National Statistics (ONS) surveys of 1999 and 2004 reported that their prevalence was 5% among children and young people aged between 5 and 16 years
  • conduct disorders nearly always have a significant impact on functioning and quality of life
  • 1999 ONS survey demonstrated that conduct disorders have a steep social class gradient, with a three- to fourfold increase in prevalence in social classes D and E compared with social class A
  • 2004 survey found that almost 40% of looked-after children, those who had been abused and those on child protection or safeguarding registers had a conduct disorder

Conduct disorders are characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations

• the World Health Organization's ICD-10 classification of mental and behavioural disorders divides conduct disorders into socialised conduct disorder, unsocialised conduct disorder, conduct disorders confined to the family context and oppositional defiant disorder
• the major distinction between oppositional defiant disorder and the other subtypes of conduct disorder is the extent and severity of the antisocial behaviour
• isolated antisocial or criminal acts are not sufficient to support a diagnosis of conduct disorder or oppositional defiant disorder
• oppositional defiant disorder is more common in children aged 10 years or younger; the other subtypes of conduct disorder are more common in those aged over 11 years or older

Prevalence of conduct disorders increases throughout childhood and they are more common in boys than girls

• for example, 7% of boys and 3% of girls aged 5 to 10 years have conduct disorders; in children aged 11 to 16 years the proportion rises to 8% of boys and 5% of girls

Conduct disorders commonly coexist with other mental health problems:

• 46% of boys and 36% of girls have at least 1 coexisting mental health problem
  • the coexistence of conduct disorders with attention deficit hyperactivity disorder (ADHD) is particularly prevalent and in some groups more than 40% of children and young people with a diagnosis of conduct disorder also have a diagnosis of ADHD
  • conduct disorders in childhood are also associated with a significantly increased rate of mental health problems in adult life, including antisocial personality disorder - up to 50% of children and young people with a conduct disorder go on to develop antisocial personality disorder
  • prevalence of conduct disorders in the UK varies across ethnic groups; for example, their prevalence is lower than average in children and young people of south Asian family origin and higher than average in children and young people of African-Caribbean family origin

Diagnosis of a conduct disorder is strongly associated with poor educational performance, social isolation and, in adolescence, substance misuse and increased contact with the criminal justice system

• association continues into adult life with poorer educational and occupational outcomes, involvement with the criminal justice system (as high as 50% in some groups) and a high level of mental health problems (at some point in their lives 90% of people with antisocial personality disorder will have another mental health problem).

Reference:

• (1) NICE (April 2017). Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management