Family history particularly characterizes individuals with the childhood-onset subtype of conduct disorder. Slower resting heart rate has been reliably noted in individuals with conduct disorder compared with those without the disorder, and this marker is not char- acteristic of any other mental disorder. Reduced autonomic fear conditioning, particularly low skin conductance, is also well documented. However, these psychophysiological find- ings are not diagnostic of the disorder. Structural and functional differences in brain areas associated with affect regulation and affect processing, particularly frontotemporal-limbic connections involving the brain’s ventral prefrontal cortex and amygdala, have been con- sistently noted in individuals with conduct disorder compared with those without the dis— order. However, neuroimaging findings are not diagnostic of the disorder.
Course modifiers. Persistence is more likely for individuals with behaviors that meet criteria for the childhood-onset subtype and qualify for the specifier ”with limited pro- social emotions”. The risk that conduct disorder will persist is also increased by co-occurring
ADHD and by substance abuse.
Conduct disorder diagnosis may at times be potentially misapplied to individuals in set- tings where patterns of disruptive behavior are viewed as near-normative (e.g., in very threatening, high-crime areas or war zones). Therefore, the context in which the undesir- able behaviors have occurred should be considered.
Males with a diagnosis of conduct disorder frequently exhibit fighting, stealing, vandalism, and school discipline problems. Females with a diagnosis of conduct disorder are more likely to exhibit lying, truancy, running away, substance use, and prostitution. Whereas males tend lationships of others), females tend to exhibit relatively more relational aggression.
Functional Consequences of Conduct Disorder
Conduct disorder behaviors may lead to school suspension or expulsion, problems in work adjustment, legal difficulties, sexually transmitted diseases, unplanned pregnancy, and physical injury from accidents or fights. These problems may preclude attendance in ordinary schools or living in a parental or foster home. Conduct disorder is often associ- ated with an early onset of sexual behavior, alcohol use, tobacco smoking, use of illegal substances, and reckless and risk-taking acts. Accident rates appear to be higher among in— dividuals with conduct disorder compared with those without the disorder. These func- tional consequences of conduct disorder may predict health difficulties when individuals reach midlife. It is not uncommon for individuals with conduct disorder to come into con- tact with the criminal justice system for engaging in illegal behavior. Conduct disorder is a common reason for treatment referral and is frequently diagnosed in mental health fa- cilities for children, especially in forensic practice. It is associated with impairment that is more severe and chronic than that experienced by other clinic-referred children.
Oppositional defiant disorder. Conduct disorder and oppositional defiant disorder are both related to symptoms that bring the individual in conﬂict with adults and other au- thority figures (e.g., parents, teachers, work supervisors). The behaviors of oppositional defiant disorderare typically of a less severe nature than those of individuals with conduct disorder and do not include aggression toward individuals or animals, destruction of property, or a pattern of theft or deceit. Furthermore, oppositional defiant disorder in- cludes problems of emotional dysregulation (i.e., angry and irritable mood) that are not in- cluded in the definition of conduct disorder. When criteria are met for both oppositional defiant disorder and conduct disorder, both diagnoses can be given.
Attention-deficit/hyperactivity disorder. Although children with ADHD often exhibit hyperactive and impulsive behavior that may be disruptive, this behavior does not by it— self violate societal norms or the rights of others and therefore does not usually meet cri- teria for conduct disorder. When criteria are met for both ADHD and conduct disorder, both diagnoses should be given.