Conduct disorders

CONDUCT DISORDER WHO-EM/MNH/217/E What is conduct disorder? Conduct disorder is a common mental and behavioural problem which occurs among 4–10% of children and young people, especially in boys. Younger children who display disruptive and aggressive behaviour within the home may be diagnosed as having “oppositional defiant disorder”. Any child may sometimes have temper tantrums, display aggressive or destructive behaviour, or not respect rules at home or at school. If this type of behaviour is not unusually frequent or severe then it is just ordinary childish mischief or adolescent rebelliousness, and does not qualify as conduct disorder. Common signs and symptoms of conduct disorder Conduct disorder is characterized by repeated and persistent patterns of antisocial, aggressive or defiant behaviour at home and school and with peers – much worse behaviour than would normally be expected in a child of that age. Prominent examples of such behaviour include excessive levels of fighting or bullying, cruelty to animals or other people, setting things on fire, severe destruction of property, stealing, repeated lying and running away from school or home. What causes conduct disorder? There is no single cause of conduct disorder. Genetics and environmental factors can both be involved. A child may be more likely to develop an oppositional defiant disorder or conduct disorder if they: • have one or more individual factors including a difficult temperament, poor social and emotional skills, low achievement at school, other mental health problems (like being hyperactive), or difficulties learning good, acceptable social behavior; • have parents who give too little attention to good behaviour and are too quick to criticize, or who physically punish or neglect the child; or, conversely, parents who are too flexible about rules, children being involved with other difficult young people or drug abuse; • have parents with mental health problems such as depression or substance abuse; or • live in poverty. When to seek help Conduct disorder can cause a lot of distress to children, their families, schools and local communities, leading to serious, even life-long, consequences such as: • interfering with a child’s development and ability to lead a normal life; • legal problems and being arrested; • serious injury to the child or others; • dropping out of school; • increased risk of depression; • increased risk of having alcohol or drug use problems and criminal behaviour. If you are concerned that your child has a serious behaviour problem causing difficulty for the child or the family, or you think you are unable to manage their behaviour, contact your doctor or pediatrician. They can introduce you to a psychologist or psychiatrist who has experience of dealing with these issues. Treating conduct disorder Early intervention is important to: • reduce suffering and disability • prevent serious consequences such as the child harming themselves or others • improve educational and health outcomes • improve the child’s relationship with their family, teachers and peers. Treatment mainly includes: • programmes to help parents improve their parenting skills and learn how to positively shape good behaviour and discourage unacceptable behaviour in their child without being harsh or violent towards them • behaviour therapies for affected children to help them understand and practice socially acceptable behaviour and respect other people’s feelings • treating other problems that may be making the situation worse such as attention deficit hyperactivity disorder (ADHD), depression or learning disabilities. (For more information about these other disorders, see WHO’s factsheets about them in this series. You can download them from the link given at the end of this leaflet.) Usually medicines have no or little role in treating conduct disorder. In some cases they are used to control extreme anger or improve sleep. How can you help your child if they have conduct disorder? Parents usually find it difficult to deal with conduct disorder in their child. They may feel ashamed and embarrassed and try to hide the situation. It is crucial to understand that punishment cannot control your child’s disruptive behaviour and may even make it worse. In addition to following treatment plans, there are steps you can take to help your child and the whole family to reduce the tension in your house: • Try to understand conduct disorder. It is not a situation that your child can simply resolve through willpower. • It is important to express your love, and to praise positive and cooperative behaviour. Constantly focusing on and criticizing unacceptable behaviour will escalate the situation. • Set firm boundaries, communicate them clearly to your child, be consistent and fair in enforcing them, but be careful not to get into a power struggle with your child. • Create a low-stress, safe and structured environment in your home to help your child keep control of their emotions and behaviour. • Be patient and do not take your child’s negative behaviour personally. • Stay calm. Do not show excessive anger or emotion about negative behavior. Respond in a firm and reasonable manner. • Take part actively in treatment appointments and plans. • Talk with school authorities about your child’s treatment plan and share it with them. • Take part in support groups. Share your experiences with other parents in a similar situation and hear their stories. This will help you feel that you are not alone and learn other ways of coping with the situation. How can teachers help a child with conduct disorder? Teachers need to know the signs and symptoms of conduct disorder to be able to recognize the condition. As a teacher, you can consider these questions: • Does your student have severe temper tantrums? • Do they repeatedly show strong opposition to reasonable requests? • Do they often behave in a provocative or manipulative way? • Do they often bully or fight other children? • Do they show cruelty to other people and/ or animals? • Do they destroy or damage property in the school or classroom? If you answer yes to some questions, and the child’s behaviour has been disruptive in the classroom, you need to share your concern with the child’s parents and encourage them to seek help. Many children with conduct disorder struggle at school because of their condition, and they may also have other diseases such as learning disabilities that make the situation even harder for them. As a teacher, there are things you can do to help a child with conduct disorder: • Try to understand the student’s problem. Do not take their behaviour personally – you are not the reason for it. • Always remember that rewards are much more effective than sanctions. Stay positive and encourage and reward flexible and cooperative behavior. Identify and enhance the child’s social skills. Reward effort as much as achievement. • Set specific, consistent and realistic classroom rules and display a daily schedule. Explain the rules and schedule clearly to the child and enforce them consistently. Use visual approaches to explain the rules if the child has learning disabilities. • Help the child to build relationships with other students. Allow them to help other students in their strength areas. • If an incident happens, stay calm, do not raise your voice, be neutral, focus on the behaviour not on the child, explain the consequence that you already agreed upon and keep the child accountable. This is one of a series of factsheets produced by the World Health Organization (WHO) to give the general public more information about mental disorders and how they can be treated. You can download all the factsheets free of charge from the WHO website at: www.emro.who.int/mnh. © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).