aetiology and risk factors

Last edited 10/2020 and last reviewed 11/2020

Conduct disorder is caused by a combination of biological and environmental factors that differs among individuals - there is no identified singular causation of Conduct Disorder.

• authoritarian or high-discipline, low-affection parenting style and permissive parenting, which are low on discipline and low on child engagement, have been shown to be correlated with an increased risk of Conduct Disorder development (1,2)
• traumatic experiences and generational trauma are also commonly identified correlates in the development of Conduct Disorder
• associations with development of conduct disorders include large family size, lower social class, and residential care

Risk factors that increase the likelihood of conduct disorders include:

• Individual characteristics
  • male sex
    • boys are 2.5 times more likely than girls to develop conduct disorders.
  • lower than average intelligence (3)
  • co-occurring substance abuse and mental illness
  • brain injury, impaired frontal lobe, neurological abnormality
  • children with brain damage and epilepsy are more likely to develop conduct disorders that the general paediatric population
  • learning or reading difficulties, or difficulty learning socially acceptable behaviours.
  • coexisting conditions mental health problems
  • observed in 46% of boys and 36% of girls with a conduct disorder
  • coexistence with attention deficit hyperactivity disorder (ADHD) - observed in more than 40% of some groups of children and young people with conduct disorders
  • conduct disorder and delinquency may be present in association with ADHD and internalising disorders such as depression. These co-morbidities will negatively influence the clinical picture and prognosis (4)
    
    
• Risks within the family
  • having a parent or sibling with a conduct disorder
  • parenting style and attachment
  • parental mental illness
  • antisocial parents
  • harsh and erratic discipline
  • child abuse and neglect
  • poor parental supervision,
  • parental substance abuse
  • parental rejection of the child
  • parental disharmony
  • single parenthood and large family size
  • parents that abuse drugs and alcohol
  • frequent changes in caregivers, or experience of early institutional living.
  • family poverty - poverty is associated with an increased risk of conduct disorder and delinquency, probably because it exacerbates family dysfunction (4)
    
    
• Risks outside the family
  • being bullied.
  • not being accepted by peer groups, social rejection
  • exposure to gang activity
  • physical or sexual abuse
  • drug misuse
  • traumatic events

Reference:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
• Mueser, K. T., Crocker, A. G., Frisman, L. B., Drake, R. E., Covell, N. H., & Essock, S. M. (2006). Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders. Schizophrenia bulletin, 32(4), 626–636.
• NICE CKS. Conduct disorders in children and young people (Accessed 27/10/2020)
• Woolfenden S et al. Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10-17. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD003015. DOI: 10.1002/14651858.CD003015