Unraveling Conduct Disorders: Types, Causes, and What Happens Next

Conduct disorders (CD) are behavioral and emotional problems that typically begin in childhood or adolescence. They’re more than just “acting out”—these patterns of aggression, rule-breaking, and deceit are persistent and often severe. While all conduct disorders share certain disruptive behaviors, they can manifest in different ways depending on when they emerge and their underlying causes. Let’s explore the different types of conduct disorders, their causes, and how these behaviors evolve over time.

1. Childhood-Onset Conduct Disorder

Characteristics: Childhood-Onset Conduct Disorder starts before the age of 10 and is often the most severe form. Imagine a young tree starting to grow crooked—without early intervention, it will continue to twist and deform over time. Children with this disorder often exhibit aggression, bullying, and defiance, and their behaviors tend to escalate as they grow older.

Causal Factors:

• Genetic predisposition: A family history of mental health disorders such as Antisocial Personality Disorder (ASPD) increases the risk of CD (Frick et al., 2014).
• Environmental factors: Exposure to trauma, neglect, or harsh parenting is a key driver of childhood-onset CD (American Psychiatric Association, 2013).
• Neurological factors: Issues with impulse control and emotional regulation contribute to these early behaviors (Blair, 2013).

Onset and Progression: Symptoms usually begin between ages 5 and 10. Without treatment, this form of CD can progress into Antisocial Personality Disorder (ASPD) in adulthood.

2. Adolescent-Onset Conduct Disorder

Characteristics: Adolescent-Onset Conduct Disorder typically starts after age 10 and is less severe than the childhood-onset type. This form often involves less aggression and more rule-breaking behaviors like lying, truancy, and vandalism. Think of it as a plant that grows wild due to poor caretaking—it may eventually stabilize with better conditions.

Causal Factors:

• Peer pressure: Adolescents are often influenced by delinquent peers, which can exacerbate risk-taking behaviors.
• Family dynamics: Dysfunctional family relationships or lack of parental involvement can trigger adolescent-onset CD (Odgers et al., 2008).
• Environmental stressors: Academic struggles, family conflict, or financial hardship can push adolescents toward destructive behaviors.

Onset and Progression: Usually begins between ages 11 and 15. Many adolescents outgrow these behaviors by adulthood, though untreated cases may still lead to ASPD.

3. Callous-Unemotional Subtype

Characteristics: This subtype of conduct disorder is characterized by a lack of empathy, guilt, or remorse. Individuals with callous-unemotional (CU) traits are often cold and manipulative. These traits can be likened to a frozen river—there is no emotional warmth flowing beneath the surface. The presence of CU traits increases the likelihood of severe, long-lasting behavioral issues.

Causal Factors:

• Biological factors: Children with CU traits often show differences in brain regions related to empathy and emotion regulation (Frick & White, 2008).
• Early trauma: Severe early neglect or abuse can contribute to the development of these unemotional behaviors (Viding & McCrory, 2019).

Onset and Progression: CU traits can appear as early as age 5. These individuals are at a higher risk of developing chronic antisocial behavior that continues into adulthood, often leading to ASPD.

What Happens Next?

While many children and adolescents with conduct disorder may outgrow these behaviors with proper intervention, some do not. The progression of conduct disorder often depends on factors such as the age of onset, severity of the behavior, and co-occurring mental health conditions. Early intervention, including therapy and behavioral strategies, is essential to help individuals manage their behaviors and avoid long-term consequences like Antisocial Personality Disorder.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Blair, R. J. R. (2013). The neurobiology of psychopathic traits in youths. Nature Reviews Neuroscience, 14(11), 786-799.
• Frick, P. J., & White, S. F. (2008). Research review: The importance of callous‐unemotional traits for developmental models of aggressive and antisocial behavior. Journal of Child Psychology and Psychiatry, 49(4), 359-375.
• Frick, P. J., Ray, J. V., Thornton, L. C., & Kahn, R. E. (2014). Can callous‐unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? Psychological Bulletin, 140(1), 1.
• Odgers, C. L., Moffitt, T. E., Broadbent, J. M., Dickson, N., Hancox, R. J., Harrington, H., & Caspi, A. (2008). Female and male antisocial trajectories: From childhood origins to adult outcomes. Development and Psychopathology, 20(2), 673-716.
• Viding, E., & McCrory, E. J. (2019). Towards understanding atypical social affiliation in psychopathy. The Lancet Psychiatry, 6(5), 437-444.