Frequent acting out, cruelty to people or animals, defiance, and aggressive behavior are just some of the warning signs of conduct disorder in children and teens.  While some of these behaviors can be alarming to parents, they can also have serious consequences for you teen –  including getting suspended or expelled from school or landing in a juvenile detention facility.

Fortunately, proper treatment early on can have a very positive impact on teens with conduct disorder.  But first, you need to know what to look for and the steps to take to ensure your teen gets the help he or she needs.

This brief guide is designed to help you identify the signs and know what steps to take if you believe your teen has conduct disorder.

Adolescent conduct disorder – statistics and facts

• Conduct disorder is nearly twice as common in males than females – in the general population, an estimated 6 to 16% of boys have conduct disorder, while somewhere between 2% to 9% have it
• Conduct disorder is more likely to develop in youth who grow up in urban areas than rural areas
• An estimated 1% to 4% of youth between the ages of 9 and 17 are affected by conduct disorder
• In mental health settings, conduct disorder is one of the most common diagnosed psychiatric disorders among children and adolescents
• Conduct disorder starts in childhood or adolescence – “child-onset” develops before age 10 and has a worse prognosis than “adolescent-onset” conduct disorder
• Teens with adolescent-onset conduct disorder are less likely to be diagnosed with antisocial personality after age 18 than those with child-onset conduct disorder
• Treatment for conduct disorder is more likely to be effective if started early
• Disruptive behavior disorder is another name for conduct disorder

Co-occurring Disorders

Other mental health disorders that often exist before or co-occur with conduct disorder include:

• Attention-deficit hyperactivity disorder (ADHD)
• Posttraumatic stress disorder (PTSD)
• Oppositional defiant disorder (ODD)
• Depression
• Anxiety
• Substance use disorders

Risk factors for conduct disorder include:

• A history of abuse or neglect
• Any history of trauma
• Genetic predisposition
• Failure in school
• A traumatic brain injury

Looking for and Recognizing the Signs of Conduct Disorder

To get your child the help he or she needs as early as possible, which is crucial with conduct disorder, you need to know what to look for.  Signs and symptoms of conduct disorder include:

• Aggression towards people or animals
• Threatening harm towards others
• Frequently starting fights with others
• Cruelty towards animals
• Destruction of property, such as setting fires
• Frequently lying
• Stealing
• Frequent run-ins with the law
• Forcing someone into sexual behavior without the person’s consent
• Frequently violating the rights of others
• Often creating conflicts by escalating problems
• Lack of remorse for bad behavior or hurting others
• Difficulty feeling or showing empathy
• Breaking into people’s homes or cars
• Conning people
• Frequent attempts to intimidate others
• Bullying behavior
• Frequently breaking rules
• Getting in trouble at school on a regular basis
• Frequently missing school
• Running away from home
• Physical fights
• Seeing others has hostile or aggressive (even when they’re not)
• Trouble accurately interpreting social cues
• Frequent injuries from getting into fights or having accidents

Knowing the First Steps to Take

If your observations and instincts lead you to suspect your adolescent has conduct disorder, the first three steps to take towards handling the situation are to:

1 – Talk to your teen.  Sit down with your teen and express your concerns about the troubling behaviors you’ve noticed.  Chances are you’ve brought these up before, perhaps when you were frustrated or angry.  Let your child know that you want to help in any way you can and that you’re willing to listen.

Since defiance is typically a major aspect of conduct disorder, your teen may not be willing to open up to you.  Don’t pressure, but don’t allow yourself to be manipulated either.  You’ll need to consistently set firm boundaries and expectations without yelling, lecturing, or getting into a power struggle.

2 – Set up an appointment for an evaluation.  Your child’s pediatrician or your family doctor can be one place to start. It’s important to remember, however, that he or she isn’t a mental health professional with specialized training and experience in dealing with particularly challenging disorders like conduct disorder.  Your doctor can do a physical examination to determine if there’s an underlying medical cause or substance abuse problem that could be causing or playing a role in your child’s behavior.

With conduct disorder, it’s generally best to have your teen evaluated by a psychologist or psychiatrist, ideally one who specializes in working with children and adolescents.  Their background and experience enable these professionals to recognize and understand the more subtle aspects of conduct disorder and the treatment challenges associated with it.  Ask your family doctor for a referral or recommendation.

3 – Get your teen into treatment.  The third step to take is to get your child into treatment.  The primary form of treatment for conduct disorder in teens is therapy, although medication may be used to treat co-occurring issues.

Talk Therapy – Three of the most effective and common forms of talk therapy used in the treatment of conduct disorder include cognitive behavioral therapy (CBT), multisystemic therapy, behavior therapy, and family therapy.

• Cognitive behavioral therapy is a type of talk therapy that focuses on helping your teen identify and change negative thought patterns, self-talk, and beliefs by replacing them with healthy, more positive thoughts, self-talk, and beliefs
• Multisystemic therapy is an intensive therapy that involves both the family and the community. It helps juvenile offenders by addressing environmental factors (e.g. home life, teachers, friends, neighborhood) that may be having a negative impact on your teen
• Behavior therapy focuses primarily on changing unwanted behaviors using things like positive reinforcement
• Family therapy, particularly functional family therapy, focuses on identifying and changing unhealthy family dynamics that may be contributing to or worsening your teen’s conduct disorder. Functional family therapy is geared specifically for children and adolescents who frequently act out.  It focuses on reducing negativity in the home while increasing support and improving communication among family members.

Medication – Medication isn’t usually used to treat conduct disorder itself.  However, it may be prescribed to help alleviate symptoms of any co-occurring disorders, such as ADHD, anxiety, or depression.  Caution should always be used when it comes to medication for adolescents, as their young brains are still developing.  However, if your child’s symptoms are moderate to severe, the benefits usually outweigh the risks in most cases.

Appropriate treatment options for your child will be recommended once he or she has been evaluated.

Supporting and Encouraging Your Teen

It can be particularly difficult knowing how to support and encourage a teen with conduct disorder, especially when he or she is being defiant or hostile.  Following are some helpful tips:

• Educate yourself about conduct disorder so you’ll have a better understanding of what your teen is experiencing and why he or she engages in certain types of negative behavior
• Talk to your child’s therapist or psychiatrist regarding the best way to respond to aggressive, destructive, defiant, or cruel behaviors
• Set firm boundaries and rules in the home, but avoid getting into power-struggles with your teen
• Make yourself available (and willing) to listen and let your teen know you’re there for him or her
• Be fair, reasonable, and consistent with the rules you set and the ways in which you enforce them
• Communicate rules and consequences clearly
• Be patient, understanding that it will take time for your teen to break old patterns of behavior and develop a more positive attitude
• Don’t take your teen’s negative behavior personally
• Encourage your teen to use the skills he or she is learning in therapy at home
• Understand that conduct disorder isn’t something your teen can simply overcome with sheer willpower, nor is it merely a phase of adolescence
• Actively participate in your teen’s treatment and consult with his or her treatment provider regarding concerns and questions
• Strive to create and maintain a low-stress, safe, and structured home environment to help support your teen’s treatment and overall emotional health
• Respond to unwanted behaviors in a firm, consistent manner without drama or anger
• Strive to remain calm even if you’re scared or worried
• Be genuinely supportive in both your words and actions
• Frequently check-in with your child to see how he or she is doing, whether treatment is helping, and to see if there is anything you can do that would be helpful

What to Do When Things Escalate

One of the greatest challenges of parenting children and adolescents with conduct disorder is that they can be highly impulsive and unpredictable.  As a result, things can quickly escalate and lead to a crisis.  If your child is threatening to harm or actively harming you or anyone – other family members, family pets or other animals, classmates, etc. – then everyone’s safety is your highest priority.  Turning a blind eye or assuming things will calm down on their own can lead to disastrous outcomes.

If things do escalate don’t delay in reaching out for help.

• Contact your child’s provider asap

Or, if it’s after hours:

• Enlist the help of a close family member or friend to assist you
• Take your child to the nearest hospital emergency room (if you can do so safely)
• Call 911

When Individual Therapy isn’t Enough

Sometimes individual therapy simply isn’t enough to adequately treat and manage your teen’s conduct disorder.  If your teen is:

• Threatening to, actively planning to, or currently harming someone else
• Threatening or actively planning suicide
• Making suicide gestures or attempts
• Unable to function appropriately at home, school, or other settings

then it’s time to consider a more intensive level of treatment.  This may involve:

• Intensive outpatient treatment (IOP) / Psychiatric day treatment
• Residential treatment
• Dual diagnosis treatment
• Inpatient psychiatric treatment

Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how often (e.g. twice a week, 5 days a week) your child is required to go.  These programs are the next step up from regular outpatient treatment (i.e. an hour of therapy once or twice a week).

Residential treatment involves having your child stay at a non-hospital treatment facility that specializes in treating adolescents with mental health disorders.  Residential treatment typically lasts between 30 to 180 days, depending on the disorder and its severity.  If substance abuse is also a problem, look for a residential treatment center that offers dual diagnosis treatment.

Dual diagnosis treatment is recommended for adolescents who have both conduct disorder and a substance use disorder.  This type of treatment often occurs in a residential treatment setting or as part of an intensive outpatient treatment program.

Inpatient psychiatric treatment is the highest and most intensive level of treatment for adolescents who are an imminent danger to themselves or others.  It requires admitting your teen to an adolescent psychiatric hospital unit where medical staff will monitor him or her 24/7. This level of treatment may last for several days.

Each of these intensive levels of treatment typically provides daily therapy in various forms, such as individual and / or group therapy, as well as other types of therapies such as music therapy or art therapy.   Frequent or daily visits with a staff psychiatrist may also occur, especially if your teen is being treated with medication.  

Taking Care of Yourself

Dealing with a teen who has conduct disorder can elicit an array of negative emotions.  These may include feelings of hopelessness, helplessness, anger, frustration, and despair.  You may also struggle with a sense of failure as a parent; blaming yourself for your child’s behavior and wondering where you went wrong.  However, beating yourself up won’t help you and it certainly won’t benefit your teen.

Considering the emotional toll of conduct disorder, it’s essential that you make a daily, conscientious effort to take good care of yourself.  Proper self-care will help prevent those negative emotions from overwhelming and defeating you, and will help bolster your emotional well-being.

Some things you can do to take care of yourself include:

• Surrounding yourself with supportive individuals. This may include a therapist, a pastor or other members of your church, local or online support groups, family members, and close friends.  The more supported your feel, the easier it will be to support and encourage your teen.
• Get plenty of sleep and eat a healthy diet
• Make time for yourself
• Learn healthy ways to manage your stress

Conduct disorder is challenging, but having a healthy, supportive parent is one of the greatest gifts you can give your teen.