Supporting children and young people with conduct disorder and ODD

What is Conduct Disorder or ODD?

Conduct disorder (CD) is a behavioural disorder characterised by hostile, and sometimes physically violent behaviour towards other people. Children and young people with conduct disorder (CD) often repeatedly break social rules and behave in a way that upsets other people. Oppositional defiant disorder (ODD) is similar but milder and is usually seen in younger children.

Younger children with conduct disorder or ODD might often disobey adults’ instructions, have angry outbursts or break things. For older children this could also include lying, stealing, bullying and repeatedly breaking rules. Teenagers might skip school, run away from home, misuse alcohol or drugs, or show antisocial behaviour (e.g. vandalism or assault).

Signs that a child or young person may be affected by Conduct Disorder

Although it is normal for children and young people to act out at times, a persistent pattern of callous, violent behaviour may indicate an underlying conduct disorder. There are some signs and symptoms to look out for, and if these behaviours persist for more than a few months, it is recommended to talk to your GP about a possible conduct disorder diagnosis.

One of the main characteristics of conduct disorder is a complete, and often callous, disregard for the feelings or rights of other people. It may seem that children and young people especially enjoy causing harm to others, and that lying and aggressive behaviours are gratifying to them.

In younger children, it may be more difficult to distinguish conduct disorder from more typical ‘acting out’ behaviours. However, these behaviours will be more coercive than typically expected, with instances of children stealing items for no apparent reason and with no apparent worth, lying simply for the sake of lying, and relentless bullying.

In older children, the behaviours associated with conduct disorder may be more apparent and include frequent fighting, cheating, lying, and trespassing. Young people with conduct disorder may also be involved in vandalism, emotionally or physically abusive behaviours towards others, such as forcing sex or having a potentially deadly weapon with them.

Although there is no single cause for Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD), a child or young person may be more likely to develop these if they are depressed, have been bullied or abused, are around other young people with behavioural problems or drug use, or in the presence of extreme family disorganisation. It is, therefore, important to take note of any severe behavioural changes in your child and seek help as soon as possible.

Symptoms can be divided into four main groups: aggression, destruction, deceit and violation of rules. If your child feels extreme depression or fear, feels out of control, cannot eat or sleep for 3 or more days in a row and shows behaviour that is worrying to friends or other family members, it may be time to seek professional help.

Common issues parents and carers may have to contend with

The earlier Conduct Disorder or ODD symptoms arise, the higher the risk for future violent and criminal activities. Parents, carers and families may have to contend with severe emotional abuse from a child or young person, difficulty in getting a diagnosis and suitable treatment, issues with the law and police, and violent outbursts.

The majority of children and young people with conduct disorder will have another diagnosis, with ADHD, depressive disorder or substance misuse being the most common. Young people are, therefore, more at-risk regarding problems with health and safety, such as engaging in unprotected sexual intercourse or experimenting with illegal drugs. They may be frequently involved in violent physical fights, refuse to follow rules and may also steal and lie about events. As the child gets older, they may start to skip school, stay out all night or even break the law. They may not show any remorse when caught doing any of these activities, and it may be very challenging to contend with this behaviour.

As conduct disorder may be challenging to overcome, parents and carers may be faced with feelings of helplessness and fear. It is important to have a network of people to support a child or young person with ODD or CD, including teachers and peers. Parents and carers may have to contend with difficulties at school or college, with fights between peers and with adherence to treatment, and may sometimes feel overwhelmed and helpless.

How to support a child or young person with Conduct Disorder

Early, consistent treatment for Conduct Disorder is very important, and there are a few options available to families: Cognitive Behavioural Therapy (CBT), Family Therapy and Group Therapy. It may be very challenging to support a young person during the initial stages of treatment as they may be resistant and uncooperative at first. It is very important to remain patient and committed to helping the young person get the help they need.

Treatment usually includes both individual and family therapy, where the primary goal is to improve the young person’s interactions with others. Treatment may include learning strategies to de-escalate conflicts and can also lead to a reduced risk of antisocial behaviours developing.

What to say to schools and colleges

Support from schools and colleges is an integral part of treatment for children and young people with Conduct Disorder. A team of school counsellors, school psychologists, social workers and administrators may be involved in managing your child’s diagnosis. In some cases, children and young people with Conduct Disorder may qualify for an individualised Education Healthcare Plan, which can support them with their academic and social needs at school.

Within the classroom, teachers and school staff can support a child or young person by minimising distractions and seating the child close to a good role model. Providing structure and routine during schoolwork and breaks may also be helpful. Work on identifying any triggers in your child’s behaviour, but do not provide any opportunities for arguments or confrontation. It is important for staff to be positive and to reward a child or young person’s efforts as achievements in the classroom.

What to say to siblings

It is normal for siblings to get into fights and have conflict at times. However, it is important for siblings to understand the diagnosis of Conduct Disorder, and to know what may trigger extreme behaviour in their brother/sister.

Siblings of people with Conduct Disorder are at-risk of verbal, emotional and physical abuse. It is therefore important that they know to remain calm and to try to avoid any power struggles and for parents and carers not to normalise abusive behaviour which can impact on the wellbeing of their other children.

Siblings can play an important role in managing conduct disorder in the home environment, and therefore their participation in family therapy may be particularly helpful.

What to say to extended family

Having a good support system is important in the treatment of Conduct Disorder. Therefore, extended family members should be aware of what Conduct Disorder is and what the strategies are to help manage the behaviour. It is also important that extended family members plan visits in advance, so that the child or young person with Conduct Disorder is prepared for this visit and it does not disrupt their schedule.

Most importantly, family members should remain calm when interacting with a child or young person who has Conduct Disorder, and to avoid confrontations wherever possible.

Additional support for parents and carers

• Royal College of Psychiatrists website

• YoungMinds: resources on managing anger and aggression

• See also Alcohol and substance misuse