Editing Conduct disorder (section)

==Signs and symptoms==
One of the symptoms of conduct disorder is a lower level of fear. Research performed on the impact of toddlers exposed to fear and distress shows that negative emotionality (fear) predicts toddlers' empathy-related response to distress. The findings support that if a caregiver is able to respond to infant cues, the toddler has a better ability to respond to fear and distress. If a child does not learn how to handle fear or distress the child will be more likely to lash out at other children. If the caregiver is able to provide therapeutic intervention teaching children at risk better empathy skills, the child will have a lower incident level of conduct disorder.<ref>Spinrad, Tracy, and Cynthia Stifter. "Toddlers' Empathy-Related Responding to Distress: Predictions from Negative Emotionality and Maternal Behavior in Infancy." ''Infancy'' 10(2), 97-121, n.d. Web</ref>

The condition is also linked to a rise in violent and antisocial behaviour;<ref>{{Cite web|url=https://childmind.org/guide/guide-to-conduct-disorder/|title=Conduct Disorder Basics|website=Child Mind Institute|language=en|access-date=2019-06-21}}</ref> examples may range from pushing, hitting and biting when the child is young, progressing towards beating and inflicted cruelty as the child becomes older.<ref>{{Cite web|url=https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/behavioural-problems-and-conduct-disorder-for-parents-carers-and-anyone-who-works-with-young-people|title=Behavioural problems and conduct disorder: for parents and carers|website=RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS|language=en|access-date=2019-06-21}}</ref><ref>{{Cite journal|last1=MYERS|first1=WADE C.|last2=SCOTT|first2=KERRILYN|date=1998-05-01|title=Psychotic and Conduct Disorder Symptoms in Juvenile Murderers|journal=Homicide Studies|language=en|volume=2|issue=2|pages=160–175|doi=10.1177/1088767998002002004|s2cid=145559982|issn=1088-7679}}</ref> Additionally, self-harm has been observed in children with conduct disorder (CD).  A predisposition towards impulsivity and lowered [[emotional intelligence]] have been cited as contributing factors to this phenomenon.   However, in order to determine direct causal links further studies must be conducted.<ref>{{Cite journal |last1=Halicka-Masłowska |first1=Joanna |last2=Szewczuk-Bogusławska |first2=Monika |last3=Rymaszewska |first3=Joanna |last4=Adamska |first4=Agnieszka |last5=Misiak |first5=Błażej |date=2021 |title=From Emotional Intelligence to Self-Injuries: A Path Analysis in Adolescents With Conduct Disorder |journal=Frontiers in Psychiatry |volume=11 |page=556278 |doi=10.3389/fpsyt.2020.556278 |pmid=33488414 |pmc=7819897 |issn=1664-0640|doi-access=free }}</ref>

Conduct disorder can present with limited prosocial emotions, lack of remorse or guilt, lack of empathy, lack of concern for performance, and shallow or deficient affect. Symptoms vary by individual, but the four main groups of symptoms are described below.<ref name="NCBI">{{Cite web|last=Substance Abuse and Mental Health Services Administration (US)|date=2016-06-01|title=Table 17, DSM-IV to DSM-5 Conduct Disorder Comparison|url=https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t13/|access-date=2020-08-16|website=www.ncbi.nlm.nih.gov|language=en}}{{PD-notice}}</ref>

=== Aggression to people and animals ===
* Often bullies, threatens or intimidates others
* Often initiates physical fights
* Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
* Has been physically cruel to people
* Has been physically cruel to animals
* Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
* Feels no remorse or empathy towards the harm, fear, or pain they may have inflicted on others

=== Destruction of property ===
* Has deliberately engaged in fire setting with the intention of causing serious damage
* Has deliberately destroyed others' property (other than by fire setting)<ref name="NCBI"/>

=== Deceitfulness or theft ===
* Has broken into someone else's house, other building,  car, other vehicle, etc
* Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
* Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)<ref name="NCBI"/>

=== Serious violations of rules ===
* Often stays out at night despite parental prohibitions, beginning before age 13
* Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
* Is often truant from school, beginning before age 13<ref name="NCBI"/>
The lack of empathy these individuals have and the aggression that accompanies this carelessness for the consequences is dangerous, not only for the individual but for those around them.<ref>{{Cite web|title=Conduct Disorder: Definition, Symptoms, and Treatment Options|url=https://www.psycom.net/conduct-disorder/|access-date=2021-03-20|website=Psycom.net - Mental Health Treatment Resource Since 1996|language=en-US}}</ref>

===Developmental course===
Currently, two possible developmental courses are thought to lead to conduct disorder. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors. Specifically, children in this group have greater levels of [[ADHD]] symptoms, neuropsychological deficits, more academic problems, increased family dysfunction and higher likelihood of [[aggression]] and [[violence]].<ref name="Moff">{{cite journal | author = Moffitt T.E. | year = 1993 | title = Life-course persistent" and "adolescence-limited" antisocial behavior: A developmental taxonomy | journal = Psychological Review | volume = 100 | issue = 4| pages = 674–701 | doi = 10.1037/0033-295x.100.4.674 | pmid = 8255953 }}</ref>

There is debate among professionals regarding the validity and appropriateness of diagnosing young children with conduct disorder. The characteristics of the diagnosis are commonly seen in young children who are referred to mental health professionals.<ref>{{cite journal | author = Volkmar F | year = 2002 | title = Considering disruptive behaviors | journal = Am J Psychiatry | volume = 159 | issue = 3| pages = 349–350 | doi = 10.1176/appi.ajp.159.3.349 | pmid=11869994}}</ref> A premature diagnosis made in young children, and thus labeling and stigmatizing an individual, may be inappropriate. It is also argued that some children may not in fact have conduct disorder, but are engaging in developmentally appropriate disruptive behavior.

The second developmental course is known as the "adolescent-onset type" and occurs when conduct disorder symptoms are present after the age of 10 years. Individuals with adolescent-onset conduct disorder exhibit less impairment than those with the childhood-onset type and are not characterized by similar psychopathology.<ref>{{cite journal |author1=Moffitt T.E. |author2=Caspi A. | year = 2001 | title = Childhood predictors differentiate life-course life-course persistent and adolescence-limited antisocial pathways among males and females | doi = 10.1017/s0954579401002097 |pmid=11393651 | journal = Development and Psychopathology | volume = 13 | issue = 2| pages = 355–375 |s2cid=29182035 }}</ref> At times, these individuals will remit in their deviant patterns before adulthood. Research has shown that there is a greater number of children with adolescent-onset conduct disorder than those with childhood-onset, suggesting that adolescent-onset conduct disorder is an exaggeration of developmental behaviors that are typically seen in [[adolescence]], such as rebellion against authority figures and rejection of conventional values.<ref name="Moff" /> However, this argument is not established<ref>{{cite journal | author = Roisman G. I. | author2 = Monahan K. C. | author3 = Campbell S. B. | author4 = Steinberg L. | author5 = Cauffman E. | author6 = Early Child Care Research Network | year = 2010 | title = Is adolescence-onset antisocial behavior developmentally normative? | journal = Development and Psychopathology | volume = 22 | issue = 2| pages = 295–311 | doi=10.1017/s0954579410000076| pmid = 20423543 | s2cid = 18497078 }}</ref> and empirical research suggests that these subgroups are not as valid as once thought.<ref name="Hinshaw" />

In addition to these two courses that are recognized by the [[DSM-IV-TR]], there appears to be a relationship among [[oppositional defiant disorder]], conduct disorder, and antisocial personality disorder. Specifically, research has demonstrated continuity in the disorders such that conduct disorder is often diagnosed in children who have been previously diagnosed with oppositional defiant disorder, and most adults with antisocial personality disorder were previously diagnosed with conduct disorder. For example, some research has shown that 90% of children diagnosed with conduct disorder had a previous diagnosis of oppositional defiant disorder.<ref name="Loeber">{{cite journal |author1=Loeber R. |author2=Keenan K. |author3=Lahey B.B. |author4=Green S.M. |author5=Thomas C. | year = 1993 | title = Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder | journal = Journal of Abnormal Child Psychology | volume = 21 | issue = 4| pages = 377–410 | doi=10.1007/bf01261600 | pmid=8408986|s2cid=43444052 }}</ref> Moreover, both disorders share relevant risk factors and disruptive behaviors, suggesting that oppositional defiant disorder is a developmental precursor and milder variant of conduct disorder. However, this is not to say that this trajectory occurs in all individuals. In fact, only about 25% of children with oppositional defiant disorder will receive a later diagnosis of conduct disorder.<ref name="Loeber"/> Correspondingly, there is an established link between conduct disorder and the diagnosis of [[antisocial personality disorder]] as an adult. In fact, the current diagnostic criteria for antisocial personality disorder require a conduct disorder diagnosis before the age of 15.<ref name="APA" /> However, again, only 25–40% of youths with conduct disorder will develop an antisocial personality disorder.<ref name="OutcomeofCD">{{cite journal |author1=Zocccolillo M. |author2=Pickles A. |author3=Quinton D. |author4=Rutter M. | year = 1992 | title = The outcome of conduct disorder: Implications for defining adult personality disorder and conduct disorder | doi = 10.1017/s003329170003854x |pmid=1488492 | journal = Psychological Medicine | volume = 22 | issue = 4| pages = 971–986 |s2cid=25470721 }}</ref> Nonetheless, many of the individuals who do not meet full criteria for antisocial personality disorder still exhibit a pattern of social and personal impairments or antisocial behaviors.<ref>{{cite journal | author = Rutter M | year = 1989 | title = Pathways from childhood to adult life | journal = Journal of Child Psychology and Psychiatry | volume = 30 | issue = 1| pages = 25–51 | doi=10.1111/j.1469-7610.1989.tb00768.x| pmid = 2647779 }}</ref> These developmental trajectories suggest the existence of antisocial pathways in certain individuals,<ref name="Hinshaw" /> which have important implications for both research and treatment.

===Associated conditions===
Children with conduct disorder have a high risk of developing other adjustment problems. Specifically, risk factors associated with conduct disorder and the effects of conduct disorder symptomatology on a child's psychosocial context have been linked to overlapping with other psychological disorders.<ref name="McMahon, R. J. 2005">{{cite journal |author1=McMahon R. J. |author2=Frick P. J. | year = 2005 | title = Evidenced-based assessment of conduct problems in children and adolescents | journal = Journal of Clinical Child and Adolescent Psychology | volume = 34 | issue = 3 | pages = 477–505 | doi=10.1207/s15374424jccp3403_6|pmid=16026215 |s2cid=39028273 }}</ref> In this way, there seems to be reciprocal effects of [[comorbidity]] with certain disorders, leading to increased overall risk for these youth.

====Attention Deficit Hyperactivity Disorder====
[[ADHD]] is the condition most commonly associated with conduct disorders, with approximately 25–30% of boys and 50–55% of girls with conduct disorder having a comorbid ADHD diagnosis.<ref name="Waschbusch">{{cite journal | author = Waschbusch D. A. | year = 2002 | title = A meta-analytic evaluation of comorbid hyperactive-impulsive-inattention problems and conduct problems | journal = Psychological Bulletin | volume = 128 | issue = 1| pages = 118–150 | doi=10.1037/0033-2909.128.1.118| pmid = 11843545 }}</ref> While it is unlikely that ADHD alone is a risk factor for developing conduct disorder, children who exhibit hyperactivity and impulsivity along with aggression is associated with the early onset of conduct problems.<ref name="Hinshaw" /> Moreover, children with comorbid conduct disorder and ADHD show more severe aggression.<ref name="Waschbusch" />

'''Oppositional Defiant Disorder''' 

[[Oppositional defiant disorder|ODD]] is a mental disorder characterized by angry, argumentative, and resentful behavior. ODD and CD both fall under the umbrella of Disruptive Behavior Disorders (DBD). The main difference is in severity. While ODD is based on verbal hostility, CD is more severe in that it includes aggression and violence towards other people and animals, theft, deceit, and breaking of rules. <ref>{{Cite journal |last1=Kerekes |first1=Nóra |last2=Lundström |first2=Sebastian |last3=Chang |first3=Zheng |last4=Tajnia |first4=Armin |last5=Jern |first5=Patrick |last6=Lichtenstein |first6=Paul |last7=Nilsson |first7=Thomas |last8=Anckarsäter |first8=Henrik |date=2014-04-22 |title=Oppositional defiant- and conduct disorder-like problems: neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study |journal=PeerJ |language=en |volume=2 |pages=e359 |doi=10.7717/peerj.359 |doi-access=free |issn=2167-8359 |pmc=4006222 |pmid=24795851}}</ref> ODD has also been found to be a precursor for CD. The chances of developing CD is four times higher in children who previously had ODD than in children who do not have a history of ODD. <ref>{{Cite journal |last1=Burke |first1=Jeffrey D. |last2=Loeber |first2=Rolf |last3=Birmaher |first3=Boris |date=2002-11-01 |title=Oppositional Defiant Disorder and Conduct Disorder: A Review of the Past 10 Years, Part II |url=https://linkinghub.elsevier.com/retrieve/pii/S089085670960633X |journal=Journal of the American Academy of Child & Adolescent Psychiatry |language=English |volume=41 |issue=11 |pages=1275–1293 |doi=10.1097/00004583-200211000-00009 |issn=0890-8567 |pmid=12410070}}</ref>

====Substance use disorders====
Conduct disorder is also highly associated with both substance use and abuse. Children with conduct disorder have an earlier onset of [[substance abuse|substance use]], as compared to their peers, and also tend to use multiple substances.<ref>{{cite journal |author1=Lynskey M. T. |author2=Fergusson D. M. | year = 1995 | title = Childhood conduct problems, attention deficit behaviors, and adolescent alcohol, tobacco, and illicit drug use | journal = Journal of Abnormal Child Psychology | volume = 23 | issue = 3| pages = 281–302 | doi=10.1007/bf01447558|pmid=7642838 |s2cid=40789985 }}</ref> Studies have shown that a diagnosis of conduct disorder during early adolescence (11-14 years old) was a significant predictor of substance abuse by the age of 18.<ref>{{Cite journal |last1=Elkins |first1=Irene J. |last2=McGue |first2=Matt |last3=Iacono |first3=William G. |date=2007-10-01 |title=Prospective Effects of Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Sex on Adolescent Substance Use and Abuse |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210070 |journal=Archives of General Psychiatry |volume=64 |issue=10 |pages=1145–1152 |doi=10.1001/archpsyc.64.10.1145 |pmid=17909126 |issn=0003-990X}}</ref> However, substance use disorders themselves can directly or indirectly cause conduct disorder-like traits in about half of adolescents who have a substance use disorder.<ref name="Brown-1996"/> As mentioned above, it seems that there is a transactional relationship between substance use and conduct problems, such that aggressive behaviors increase substance use, which leads to increased aggressive behavior.<ref>{{cite journal |author1=White H.R. |author2=Loeber R. |author3=Stouthamer-Loeber M. |author4=Farrington D.P. |s2cid=9357010 | year = 1999 | title = Developmental associations between substance use and violence | journal = Development and Psychopathology | volume = 11 | issue = 4| pages = 785–803 | doi=10.1017/s0954579499002321|pmid=10624726 }}</ref> Notably, while older studies may have failed to find a correlation between hyperactivity or impulsivity as a predictor of conduct disorder, more recent studies have found that even a single symptom of ADHD or conduct disorder is associated with increased risk of substance abuse.<ref>{{Cite journal |last1=Elkins |first1=Irene J. |last2=McGue |first2=Matt |last3=Iacono |first3=William G. |date=2007-10-01 |title=Prospective Effects of Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Sex on Adolescent Substance Use and Abuse |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210070 |journal=Archives of General Psychiatry |volume=64 |issue=10 |pages=1145–1152 |doi=10.1001/archpsyc.64.10.1145 |pmid=17909126 |issn=0003-990X}}</ref>

Substance use in conduct disorder can lead to antisocial behavior in adulthood.<ref>{{cite journal|last1=Khalifa|first1=N|last2=Duggan|first2=C|last3=Howard|first3=R|last4=Lumsden|first4=J|title=The relationship between childhood conduct disorder and adult antisocial behavior is partially mediated by early-onset alcohol abuse.|journal=Personality Disorders|date=October 2012|volume=3|issue=4|pages=423–32|pmid=22888992|doi=10.1037/a0027017}}</ref>

====Schizophrenia====
Conduct disorder is a precursor to schizophrenia in a minority of cases,<ref>{{cite journal |last1=Schiffer |first1=Boris |last2=Leygraf |first2=Norbert |last3=Muller |first3=Bernhard |last4=Scherbaum |first4=Norbert |last5=Forsting |first5=Michael |last6=Wiltfang |first6=Jens |last7=Gizewski |first7=Elke |last8=Hodgins |first8=Sheilagh |title=Structural Brain Alterations Associated With Schizophrenia Preceded by Conduct Disorder: A Common and Distinct Subtype of Schizophrenia? |journal=Schizophrenia Bulletin |date=September 2012 |volume=39 |issue=5 |pages=1115–1128 |doi=10.1093/schbul/sbs115 |pmid=23015687 |pmc=3756783 |url=https://academic.oup.com/schizophreniabulletin/article/39/5/1115/1925725|doi-access=free }}</ref> with about 40% of men and 31% of women with schizophrenia meeting criteria for childhood conduct disorder.<ref>{{cite journal |last1=Dalteg |first1=Arne |last2=Zandelin |first2=Anders |last3=Tuninger |first3=Eva |last4=Levander |first4=Sten |title=Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood |journal=Nordic Journal of Psychiatry |date=2014 |volume=68 |issue=8 |pages=560–566 |doi=10.3109/08039488.2014.892151 |pmid=24620816 |s2cid=46031432 |url=https://www.tandfonline.com/doi/full/10.3109/08039488.2014.892151}}</ref>