Conduct Disorder

Conduct disorder (CD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated” (American Psychiatric Association, 2000, p. 93). Patterns of behavior associated with CD fall into four main categories (American Psychiatric Association, 2000, p. 94):

• 1.
  “Aggressive conduct that causes or threatens physical harm to other people or animals”
• 2.
  “Nonaggressive conduct that causes property loss or damage”
• 3.
  “Deceitfulness or theft”
• 4.
  “Serious violations of rules”

Conduct disorder may have its onset in childhood or in adolescence; prevalence estimates of CD in the population of youth range from 1% to more than 10% (American Psychiatric Association, 2000).

Researchers have found that the causes of childhood-onset CD are multiple and interactive; biological risks (e.g, verbal IQ, executive cognitive functioning) interact with environmental risks (from family, peer, and school contexts) to increase children's chances of developing CD.

The social contexts of family, peers, and school interact with the child's biology over the course of a child's development. Certain children are apparently born with biological predispositions (e.g., neuropsychological deficits) that make them vulnerable to developing conduct problems. In the family context, maintaining a balance of warmth and control has long been considered a hallmark of effective parenting. Children who develop CD are more likely to experience parenting strategies that are harsh and ineffective (Patterson, 1982). Through these strategies, children learn to use coercive behavior (e.g., temper tantrums, whining) to get what they want. Parents, in turn, learn to escape the coercive behavior of their children by failing to discipline and monitor them (Patterson, 1982). Ironically, parents of children with conduct disorder may actually monitor their children less closely than do parents of children without CD to avoid highly aversive conflicts with them. As a result, a child is free to affiliate with deviant peers and fails to learn effective strategies for managing the adolescent world (Dodge & Pettit, 2003).

Peers can play a substantial role in the development and maintenance of CD. When children enter elementary school, they may continue on the trajectory of CD if their academic and social readiness skills fall short of their nonaggressive peers and they are ridiculed and rejected by them (Dodge & Pettit, 2003; Patterson & colleagues, 1992). The support of aggressive peers for the continuing development of CD cannot be overestimated; aggressive children affiliate together in school and support one another in bullying, fighting, and getting in trouble (Cairns & Cairns, 1994). From childhood through adolescence, youth with CD are likely to associate with one another and together participate in aggressive and delinquent activities (Cairns & Cairns, 1994; Moffitt, 1993; Patterson & colleagues, 1992).

The role of peers for youth with adolescent-onset conduct disorder is particularly critical. Moffitt (1993) has theorized that youth with childhood-onset CD provide the model for those for whom aggressive and antisocial acts begin during adolescence. Behaviors associated with CD take a different form during adolescence—they include covert activities such as lying, stealing, vandalism, and drug and alcohol use. Nearly all adolescents engage in some form of these activities (Moffitt, 1993), thus making it a challenge to distinguish youth with adolescent-onset CD from those for whom participation is experimental.

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