By Patrick J. McGrath, OC, PhD, FRSC
Question:
My son was diagnosed with early onset conduct disorder when he was 12. What factors lead to this condition?
Dr. Pat responds:
Children with conduct disorder often:
- steal
- run away from home
- deliberately hurt others
- are cruel to animals
- lie
- cheat
Biological factors such as fetal alcohol spectrum disorder and genetic factors may contribute to conduct disorder.
Environment is equally important as the other factors in conduct disorder. Some specific genes have been associated with conduct disorder in some studies but this has not often been confirmed in other studies. There is no good medical test to help diagnose conduct disorder.
Early onset conduct disorder may be more likely to have biological causes.
The interaction between genes and environment is important. A child with a strong genetic predisposition to conduct disorder may not show problems unless the environment is poor. Similarly, even a poor environment may not have a bad effect without the genetic predisposition.
Biological risk factors include:
- toxic exposures or injury before birth
- parental depression
- parental antisocial behaviours
- having attention-deficit/hyperactivity disorder
Environmental risk factors include:
- verbal abuse of child
- witnessing violence
- physical or sexual abuse
- harsh punishment
- antisocial environment
- school failure
The causes of conduct disorder are complex and poorly understood.
Psychopathy, or the lack of a conscience, is also poorly understood. Psychopathy may be associated with brain abnormalities in the limbic system (a part of the brain associated with emotions). Also, the balance between the systems controlling dopamine and serotonin may be upset. These findings are still very unclear and preliminary.
Children with conduct disorder are NOT doomed to continue to have these problems.
They are more likely to get better if:
- the child learns in school
- there are fewer family fights
- the parents keep track of what the child is doing
- the mother has good mental health
- the child is not shouted at a lot
- the child has friends who do not have conduct disorder
- parents use positive but firm discipline
About half of the children with conduct disorder get better over time. Even children with strong biological factors can be helped by a good environment.
Psychological treatments that help parents use positive discipline are helpful. Sometimes medical treatments are helpful in controlling symptoms.
Conduct disorder is a long-term problem. It places great stress on a family. It is hard on the child who has the problem. But it is not a hopeless problem. Many children with conduct disorder overcome their difficulties.
Don't give up. Your efforts will make a difference.
Thanks for consultation to Dr. Normand Carey, psychiatrist at IWK who specializes in child behaviour problems.
Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.
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Dr. Pat will respond to as many letters as possible with evidence-based answers. We hope that the column will be interesting and helpful for readers; however, Dr. Pat cannot provide health care through the column. Please contact a physician or other registered health care professional to provide health care guidance or advice.