650 CHAPTER 14
- Moderate. The individual has a number of conduct problems, and their effect on
other people is between mild and severe (for example, vandalism or stealing objects
that were left unattended). - Severe. The individual has many conduct problems, or the conduct problems
create considerable harm to others (for example, forced sex, using a weapon, or
stealing while confronting a victim).
People with conduct disorder are also likely to use—and abuse—substances at
an earlier age than are people without this disorder. Similarly, they are more likely to
have problems in school (such as suspension or expulsion), legal problems, unplanned
pregnancies and sexually transmitted diseases, and physical injuries that result from
fi ghts. Because of their behavioral problems, children with conduct disorder may
live in foster homes or attend special schools. They may also have poor academic
achievement and score lower than normal on verbal intelligence tests. Problems with
relationships, fi nancial woes, and psychological disorders may persist into adulthood
(Colman et al., 2009).
When clinicians assess whether conduct disorder might be an appropriate di-
agnosis for an individual, they will of course talk with the person; however, the
nature of conduct disorder is such that a child may not provide complete informa-
tion about his or her behavior. Thus, clinicians try to obtain additional information
from other sources, usually school offi cials or parents, although even these people
may not know the full extent of a child’s conduct problems. Usually, the behaviors
that characterize conduct disorder are not limited to one setting but occur in a vari-
ety of settings: in school, at home, in the neighborhood. This was true for Brad, as
described in Case 14.5.CASE 14.5 • FROM THE OUTSIDE: Conduct Disorder
Brad was [a teenager and] small for his age but big on fi ghting. For him, this had gone beyond
schoolyard bullying. He had four assault charges during the previous six months, including
threatening rape and beating up a much younger boy who was mentally challenged. The fam-
ily was being asked to leave their apartment complex because of Brad’s aggressive behavior
and several stealing incidents. Other offi cial arrests included burglaries and trespassing.
Brad had participated in a number of outpatient services, including anger management
classes in which he had done well, but obviously he was not applying what he had learned to
everyday life. He was referred to the [a treatment] program by the juvenile court judge.
Prior to placement, Brad had lived with his mother and older brother. Their family life had
been characterized by many disruptions, including contact with several abusive father fi g-
ures and frequent moves. Mrs. B had epilepsy that was not controlled with medication. She
experienced several seizures per week. Brad’s older brother also had a record with the juve-
nile authorities, but his offenses were confi ned to property crimes and the use of alcohol. He
had graduated from an inpatient substance abuse program. Brad and his brother had a his-
tory of physical fi ghting. Prior to the boys’ births, Mrs. B had had two children removed from
her custody by state protective services. Mrs. B was very protective of Brad. She felt that the
police and schools had it “in for him” and regularly defended him as having been provoked or
blamed falsely. Although she was devastated at having Brad removed from her home, Mrs. B
reported that she could no longer deal with Brad’s aggression.
(Chamberlain, 1996, pp. 485–486)In addition to specifying the intensity of the symptoms, DSM-IV-TR also uses
the timing of onset to defi ne two types of conduct disorder, each of which typically
has a different course and prognosis:- adolescent-onset type, in which no symptoms were present before age 10; and
- childhood-onset type, which is more severe and in which the fi rst symptoms ap-
peared when the child was younger than 10 years old.
Let’s examine these two types of the disorder in more detail.