Behavioural Problems and Conduct Disorder

Behavioural problems - the signs

All children have moments when they do not behave properly. They can go through different phases as they develop and become more independent. Toddlers and adolescents can have their challenging moments and this might mean they push limits from time to time. With the help of parents, carers and teachers, most of them will learn to behave appropriately. Occasionally, a child will have a temper tantrum, or an outburst of aggressive or destructive behaviour, but this is often nothing to worry about.

Behavioural problems can happen in children of all ages. Some children have serious behavioural problems. The signs to look out for:

• If the child continues to behave badly for several months or longer, is repeatedly being disobedient, cheeky and aggressive.
• If the child's behaviour is out of the ordinary, and seriously breaks the rules accepted in their home and school; this is much more than ordinary childish mischief or adolescent rebelliousness.

What is conduct disorder?

Sometimes, a child's behaviour can affect their development and interfere with their ability to lead a normal life. When behaviour is this much of a problem, it is called a conduct disorder.

Younger children who behave disruptively and aggressively at home may be diagnosed as having ‘oppositional defiant disorder’.

What does having conduct disorder mean for a young person?

Children with a conduct disorder may get involved in more violent physical fights and may steal or lie, without any sign of remorse or guilt when they are found out. They refuse to follow rules and may start to break the law. They may start to stay out all night and play truant from school during the day.

Teenagers with conduct disorder may also take risks with their health and safety by taking illegal drugs or having unprotected sexual intercourse.

What effect can this have on others?

Conduct disorder can cause a lot of distress to children, families, schools and local communities. Children who behave like this will often find it hard to make friends and have difficulties understanding social situations.

Even though they might be quite bright, they will not do well at school and are often near the bottom of the class. On the inside, the young person may be feeling that they are worthless and that they just cannot do anything right. It is common for them to show anger and to blame others for their difficulties if they do not know how to change for the better.

What causes oppositional defiant disorder/conduct disorder?

There is no single cause of conduct disorder. We are beginning to understand that there are many different possible reasons which lead to conduct disorder. A child may be more likely to develop an oppositional defiant disorder/conduct disorder if they:

• Have certain genes leading to antisocial behaviour.
• Have difficulties learning good social and acceptable behaviours.
• Have a difficult temperament.
• Have learning or reading difficulties, making it hard for them to understand and take part in lessons; it is then easy for them to get bored, feel stupid and misbehave.
• Are depressed.
• Have been bullied or abused.
• Are ‘hyperactive’ - this causes difficulties with self-control, paying attention and following rules.
• Are involved with other difficult young people and drug misuse.

Other factors:

• Boys are more likely to have behavioural problems and conduct disorder than girls.
• Parenting factors, including discipline issues and family disorganisation - parents can sometimes make things worse by giving too little attention to good behaviour, always being too quick to criticise or by being too flexible about the rules and not supervising their children.

What are the longer-term effects of conduct disorder?

A young person showing signs of conduct disorder at an early age is more likely to be male, have attention deficit hyperactivity disorder (ADHD) and lower intelligence (general learning disability or specific difficulties in reading). The earlier the problems start, the higher the risk of the young person ending up being involved with violence and criminal acts. This may also be related to friendship groups, gangs and use of illegal substances.

What are the types of help out there?

Early diagnosis of conduct disorder and other related difficulties is important to give your child a better chance for improvement and hope for the future.

Depending on the severity of the problem, the treatment can be offered across different settings - for instance, at home or in educational and community settings. The help offered will depend on the child's development, age and circumstances.

Involving and supporting the family is very important. Focusing on strengths and identifying any specific problem areas for the young person, such as learning difficulties, can improve the outcomes for young people with conduct disorders.

Help for behavioural problems can involve supporting the young person to increase their positive social behaviours, and controlling their antisocial destructive behaviours.

Home-based help

It can be difficult for parents and carers when their child has oppositional defiant disorder or conduct problems. You may fear your own child, and feel embarrassed or even ashamed of your child's situation.

You may feel helpless and unsure how to manage it.

As a parent, it can be easy to ignore your child when they are being good and only pay attention to them when they are behaving badly. Over time, the child learns that they only get attention when they are breaking the rules. Most children, including teenagers, need a lot of attention from their parents and may be unsure how to get this. Perhaps surprisingly, they seem to prefer angry or critical attention to being ignored. It is easy to see how, over time, a vicious circle can be set up.

With children, it can help if discipline is fair and consistent and for parents/carers to agree on how to handle their child's behaviour and offer positive praise and love. This can be difficult to manage alone without the support of others, and many parents/carers require extra help.

Parenting groups can advise you on how to access the support you need, and share experiences with others who are facing similar problems with their own children. These groups can offer training in helping you encourage positive behaviour in your child.

School-based help

Many young people with behavioural problems struggle at school and this can be a source of distress.

School staff can help to focus on positive behaviours and reinforce work taking place at home and in the community.

Young people with behavioural problems often need help with social skills, and school may be able to offer this. Some children need individual classroom support and an assessment of learning difficulties. When the problems are severe, some children may have to be moved to special educational placements or schools where their behavioural problems can be managed.

Community-based help

If the behavioural problems are severe and persistent or a conduct disorder is suspected, ask your GP for advice.

Antisocial behaviours are commonly seen in specialist services. If specialist help is needed, the GP will make a referral to your local child and adolescent mental health service (CAMHS). This specialist team will work together with you, the school and other community groups to support you and your child.

Specialists can help to fully assess what is causing the problem and also to suggest practical ways of improving the difficult behaviour. They can also offer assessment and treatment of other conditions which can occur at the same time, such as depression, anxiety and hyperactivity.

The treatment may include social skills groups, behavioural therapy and talking therapy. These therapies can help the child to appropriately express themself in different situations, and manage their anger more effectively.

References and further reading

• Bailey S, Shooter M (eds) The Young Mind: An Essential Guide to Mental Health for Young Adults, Parents and Teachers. Royal College of Psychiatry Publications, 2009.
• Rutter M, Bishop D, Pine D, et al (eds) Rutter's Child and Adolescent Psychiatry (5th edn). Wiley-Blackwell, 2008.
• Scott S. An update on interventions for conduct disorder. Adv Psychiatr Treat 2008; 14: 61-70.
• Parent-Training/Education Programmes in the Management of Children with Conduct Disorders. NICE, 2006.
• Youth Justice Board

Content used with permission from the Royal College of Psychiatrists website: Behavioural problems and conduct disorder: information for parents, carers and anyone who works with young people (March 2012, due for review March 2014). Copyright for this leaflet is with the Royal College of Psychiatrists.