Behavioural problems and conduct disorder

All children have moments when they do not behave properly. They can go through different phases as they develop and become more independent. Toddlers and adolescents can have their challenging moments and this might mean they push limits from time to time. With the help of parents, carers and teachers, most of them will learn to behave appropriately.

Occasionally, a child will have a temper tantrum, or an outburst of aggressive or destructive behaviour, but this is often nothing to worry about.

Behavioural problems can happen in children of all ages. Some children have serious behavioural problems. The signs to look out for are:

• if the child continues to behave badly for several months or longer, is repeatedly being disobedient, cheeky and aggressive
• if their behaviour is out of the ordinary, and seriously breaks the rules accepted in their home and school. This is much more than ordinary childish mischief or adolescent rebelliousness.

This sort of behaviour can affect a child's development, and can interfere with their ability to lead a normal life. When behaviour is this much of a problem, it is called a ‘conduct disorder’.

In younger children where the disruptive and aggressive behaviours are happening within the home, they may be diagnosed as having ‘oppositional defiant disorder’.

What does having conduct disorder mean for a young person?

Children with a conduct disorder may get involved in more violent physical fights, and may steal or lie, without any sign of remorse or guilt when they are found out.

They refuse to follow rules and may start to break the law. They may start to stay out all night, and play truant from school during the day.

Teenagers with conduct disorder may also take risks with their health and safety by taking illegal drugs or having unprotected sexual intercourse.

What effect can this have on others?

Conduct disorder can cause a lot of distress to children, families, schools and local communities. Children who behave like this will often find it difficult to make friends and have difficulties understanding social situations.

Even though they might be quite bright, they will not do well at school and are often near the bottom of the class.

On the inside, the young person may be feeling that they are worthless and that they just cannot do anything right. It is common for them to show anger and blame others for their difficulties if they do not know how to change for the better.

There is no single cause of conduct disorder. We are beginning to understand that there are many different possible reasons which lead to conduct disorder. A child may be more likely to develop an oppositional defiant disorder/conduct disorder if they:

• have certain genes leading to antisocial behaviour – boys are also more likely to have these disorders than girls
• have difficulties learning good social and acceptable behaviours
• have a difficult temperament
• have learning or reading difficulties - making it difficult to understand and take part in lessons. It is then easy to get bored, feel stupid and misbehave
• are depressed
• have been bullied or abused
• are ‘hyperactive’ - this causes difficulties with self-control, paying attention and following rules
• parenting factors, including discipline issues and family disorganization - parents can sometimes make things worse by giving too little attention to good behaviour, always being too quick to criticise or by being too flexible about the rules and not supervising their children
• are involved with other difficult young people and drug abuse.

A young person showing signs of conduct disorder at an early age is more likely to be male, have ADHD and lower intelligence.

The earlier problems start, the higher the risk for the young person being involved with violence and criminal acts. This may also be related to friendship groups, gangs and use of illegal substances.

 

Early diagnosis of conduct disorder and other related difficulties is important to give your child a better chance for improvements and hope for the future.

Depending on the severity of the problem, the treatment can be offered across different settings, for instance at home or in educational and community settings.

The help offered will depend on the child’s development, age and circumstances.

Involving and supporting the family is very important. Focussing on strengths and identifying any specific problem areas for the young person, such as learning difficulties, can improve the outcomes for young people with conduct disorders.

Help for behavioural problems can involve supporting the young person to increase their positive social behaviours, and controlling their antisocial destructive behaviours. 

Home-based help

It can be difficult for parents and carers when their child has oppositional or has conduct problems. You may fear your own child, and feel embarrassed, or even ashamed of your child’s situation. You may feel helpless and unsure how to manage it.

As a parent, it can be easy to ignore your child when they are being good, and only pay attention to them when they are behaving badly. Over time, the child learns that they only get attention when they are breaking rules. Most children, including teenagers, need a lot of attention from their parents and may be unsure how to get this. Perhaps surprisingly, they seem to prefer angry or critical attention to being ignored. It's easy to see how, over time, a ‘vicious cycle’ can be set up.

With children, it can help if discipline is fair and consistent and for parents/carers to agree on how to handle their child’s behaviour and offer positive praise and love. Understandably, this can be difficult to manage alone without the support of others, and many parents/carers require extra help.

Parenting groups can help you to access the support you need and share experiences with others who are experiencing a similar situation with their own children. These groups can offer training in helping support you in encouraging positive behaviour in your child.

School-based help

Many young people with behavioural problems struggle at school and this can be a source of distress. School staff can help to focus on positive behaviours and reinforce work taking place at home and in the community.

Young people with behavioural problems often need help with social skills and school may be able to offer this. Some children need individual classroom support and an assessment of learning difficulties. When the problems are severe, some children may be placed in special educational placements or schools for their behavioural problems.

Community-based help

If the behavioural problems are severe and persistent or a conduct disorder is suspected, ask your GP for advice.

Antisocial behaviours are commonly seen in specialist services. If specialist help is needed, they will make a referral to your local child and adolescent mental health service (CAMHS). This specialist team will work together with you, school and other community groups to support you and your child.

Specialists can help to fully assess what is causing the problem and also to suggest practical ways of improving the difficult behaviour. They can also offer assessment and treatment of other conditions which can occur at the same time, such as depression, anxiety and hyperactivity.

The treatment may include social skills groups, behavioural therapy and talking therapy. These therapies can help the child to appropriately express themselves in different situations and manage their anger more effectively.

My mum said that I was getting “out of control” when I was 14 years old. I was getting suspended for fighting and bunking off school. Looking back I was not happy and finding school work hard.

I was having problems with some of the teachers at school. They said that I was causing trouble and I kept really losing my temper. I was feeling really frustrated with things and getting into fights with my dad who I don’t see that much.

It was much better spending time with my friends. I wasn’t going home when my mum wanted me there.

My mum and social worker told me to go and see someone for help. I went to see someone my local clinic who said that we all needed to have some family work especially to help us talk better, and get me back on track.

I also met with someone on my own at the clinic and we talked about my anger and how it was affecting everyone, and where it was coming from.

I started thinking about ways to cope with my feelings and frustration. I still have good and bad days but it was good to see someone who understands.

The Samaritans - Provide a 24-hour service offering confidential emotional support to anyone who is in crisis. Helpline 08457 909090 (UK), 1850 609090 (ROI); e-mail: jo@samaritans.org

The Youth Justice Board - Its website works to prevent offending and re-offending by children and young people under the age of eighteen.

National Institute for Health and Clinical Excellence: Parent-training/education programme in the management of conduct disorders (2006).

 

References

• The Young Mind: an essential guide to mental health for young adults, parents and teachers. Edited by Bailey, S. and Shooter, M. (2009)
• Rutter, M. & Taylor, E. (eds) (2008)'Rutter’s Child and Adolescent Psychiatry' (5th edn). London: Blackwell Publishing.
• Stephen Scott (2008): An update on interventions for conduct disorder Advances in Psychiatric Treatment, 14:61-70.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Delphine Coyle, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.