Conduct disorder and oppositional defiant disorder

Also known as: Conduct disorder; Oppositional Defiant disorder

A child may be diagnosed as having conduct disorder (CD) and oppositional defiant disorder (ODD) when they display long-lasting, aggressive and defiant behaviours that are extreme.

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What is conduct disorder and oppositional defiant disorder?

Tantrums and some oppositional behaviour can be part of normal development for most young children. They can be an expression of boundary testing when learning social rules.

But in roughly five per cent of children and young people, this negative behaviour is severe, persistent and enormously challenging. It may involve serious and repeated rule breaking and aggressive behaviour, which is often disturbing to others. It can strain family relationships and affect school progress.

Conduct disorder (CD) and oppositional defiant disorder (ODD) are the diagnostic terms for those types of long-lasting, aggressive and defiant behaviours that are extreme. These problems are the most frequently occurring mental health difficulty in young people. It is more common in boys and may start at a very young age. Some children grow out of them, but some do not.

Children who show such behaviours at a very early age (around two to three years) often have other problems such as a difficult temperament, hyperactivity and attention deficit hyperactivity disorder (ADHD), language disorders and some degree of learning disability. Older children may have depression and specific learning problems with reading. Sometimes these behaviours can result from chronic physical problems, anxiety, experience of traumatic events or autistic spectrum conditions (see entry Autism Spectrum conditions).

Some young people with difficult behaviour can become depressed and may be using alcohol and illicit substances in an attempt to cope. This strategy generally worsens the problems. Self-esteem is often low despite the superficial appearance of bravado. In some cases, children may relish the attention their negative behaviour can bring.

ODD is the term usually reserved for less severe, but equally persistent conduct problems in younger children. It describes behaviours such as aggression, defiance and disobedience rather than those that are severely antisocial or against the law. Children with ODD frequently defy adults, deliberately annoy people and seem angry and resentful. They may blame others for things that they themselves have done and will not take responsibility for their behaviour. They may be very provocative and rude, especially to those in authority.

How is conduct disorder and oppositional defiant disorder diagnosed?

The International Classification of Diseases, 10th revision (ICD-10) describes CD as including many of the following: severe fighting, aggressiveness, bullying, cruelty to animals or other people, theft, fire setting, severe destruction of property, persistent and severe lying, truancy from school, severe disobedience or extreme or very frequent tantrums. These behaviours must persist for six months or more for a diagnosis of CD.

How is conduct disorder and oppositional defiant disorder treated?

There are effective ways to treat CD and ODD in younger children (in particular in those aged 12 years and younger). These have been described in the NICE Guidelines (2003).

Group-based parent training/education programmes can be effective. These should be structured and comprise weekly sessions for eight to 12 weeks. These should focus on parents’ objectives, help build relationships, use role-play and be delivered by appropriately-trained facilitators. These can run alongside social skills programmes for children.

In contrast to parenting programmes for younger children, parenting programmes for antisocial behaviour in adolescence, on their own, have been less effective. Packages of help for the young person are usually necessary, involving individual, family and parenting interventions. The National Academy for Parenting Practitioners (NAPP), around since November 2007, trains and supports the practitioners that parents turn to for advice, training and information around parenting skills.

Parents and teachers can do a great deal to reduce negative and antisocial behaviour in children. It is important to play with children regularly in a warm, non-directive and interested way. Praise, verbal and through hugs and affectionate touches, is important to encourage positive behaviours. Instructions and commands given to children should be clear and specific. It is important to set limits and stick to these in a calm and predictable manner. These positive parenting strategies are helpful if used consistently from an early age and can help reduce antisocial behaviours in older children.

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Call our freephone helpline on 0808 808 3555 to get information, support and advice. We also offer emotional support for parents via our Listening Ear service.

We have a range of parent guides on aspects of caring for a disabled child in our resource library. You may also find our Early Years Support useful, which contains links to parent carer workshops and help for families going through the diagnosis process.

We’ve listed some support groups below and you can also meet other parents online in our closed Facebook group.

Information and support in the UK for conduct disorders and oppositional defiant disorder is provided by Young Minds (see entry Mental Health).

Credits

Medical text written June 2011 by Dr A Graham, Child and Adolescent Psychiatrist, Child and Family Consultation Centre, Richmond, London, UK.