Paeds · mental-behavioural-and-psychosomatic
Conduct disorder and antisocial behaviour
Also known as Conduct disorder · Antisocial behaviour in children · Disruptive behaviour disorder · Aggressive behaviour in children · CD
Fellowship guide to conduct disorder and antisocial behaviour in children: the rights-violation definition, the Moffitt developmental taxonomy, the callous-unemotional specifier, the biopsychosocial coercion-loop model, and a NICE CG158 stepped-care ladder built on evidence-based parenting programmes (Incredible Years, Triple P, PCIT, MST) rather than medication, with ANZ/UK/US guideline differences.
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- A child whose aggression carries genuine risk to others or to themselves — weapon use, cruelty to people or animals, sexual aggression, or fire-setting — needs same-day safeguarding review, a multi-agency plan, and careful risk assessment before any routine management plan is agreed
- Callous-unemotional traits (no remorse, no empathy, shallow affect) alongside conduct problems mark a severe, persistent, treatment-resistant trajectory that needs specialist multimodal care, not a community parenting group alone
- Conduct problems that follow abuse, neglect, or family violence are as much a trauma/attachment and safeguarding problem as a behaviour problem — a behaviour plan that ignores the trauma and the home safety will fail and may endanger the child
- Rapid escalation, new risk-taking, hypervigilance, or affective instability after puberty raises bipolar disorder, substance use, or an emerging psychotic illness — do not assume every worsening adolescent is 'just conduct disorder'
- A very young child (under five) with severe aggression and no attachment security — look first at the caregiving environment, neurodevelopment, and safeguarding, not at a label of conduct disorder
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- General and Community Paediatrics
- Mental and behavioural health
- Behavioural and emotional problems in children
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Adolescent medicine and mental-health competencies
- Clinical Applications
- Long Cases
- Short Cases
- Communication stations
- Themes: Behavioural, emotional and mental health problems
- Mental health: assessment and management of common problems
- Child and adolescent mental health
- Behavioural paediatrics
- Communication scenarios
- History-taking and management planning
- General Pediatrics
- Developmental-Behavioral Pediatrics
- Pediatrics
- Behavioral and mental health
- Developmental and behavioural paediatrics
Overview & Definition
Picture the ten-year-old who has been suspended twice for fighting, whose teacher describes cruelty to younger children at lunchtime, and whose mother — exhausted and frightened — tells you he steals from her purse and will not come home until midnight. The defining feature is not that he is "naughty" or even that he is angry; it is that his behaviour crosses a line into violating the rights of others or breaking major social rules, and that it does so persistently and outside the developmental norm. [4]
Conduct disorder is a behavioural syndrome, not a single broken circuit, and it sits at the severe end of the disruptive-behaviour spectrum that runs from ordinary boundary-testing, through oppositional defiant disorder, to frank rights-violating conduct. What makes it a disorder is the triad of persistence (at least twelve months, with at least one symptom in the past six months), pervasiveness (more than one setting, or clearly impairing), and severity (the rights of others or major norms are actually violated, not merely bent). [4]
The reason the definition matters in clinic is that it tells you where to look next. A child whose behaviour fits conduct disorder needs an assessment of risk to self and others, a search for comorbidity (especially ADHD, which is the commonest travelling partner, and trauma), a developmental history that places the child on the Moffitt taxonomy, and a plan that almost always begins with the family rather than the child alone. [1] [4]
References12ShowHide
- [1]Moffitt TE Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychol Rev, 1993.PMID 8255953
- [2]Scott S, Knapp M, Henderson J, Maughan B Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ, 2001.PMID 11473907
- [3]Erskine HE, Ferrari AJ, Polanczyk GV, et al. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J Child Psychol Psychiatry, 2014.PMID 24447211
- [4]Burke JD, Loeber R, Birmaher B Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry, 2002.PMID 12410070
- [5]Furlong M, McGilloway S, Bywater T, et al. Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev, 2012.PMID 22336837
- [6]Eyberg SM, Nelson MM, Boggs SR Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. J Clin Child Adolesc Psychol, 2008.PMID 18444059
- [7]Sanders MR, Markie-Dadds C, Tully LA, Bor W The triple P-positive parenting program: a comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. J Consult Clin Psychol, 2000.PMID 10965638
- [8]Kim-Cohen J, Caspi A, Moffitt TE, et al. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry, 2003.PMID 12860775
- [9]Dretzke J, Davenport C, Frew E, et al. The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children. Health Technol Assess, 2005.PMID 16336845
- [10]Kazdin AE Treatments for aggressive and antisocial children. Child Adolesc Psychiatr Clin N Am, 2000.PMID 11005009
- [11]Goulter N, Hur YS, Jones DE, et al. Kindergarten conduct problems are associated with monetized outcomes in adolescence and adulthood. J Child Psychol Psychiatry, 2024.PMID 37257941
- [12]McCabe G, Godwin JW, Rothenberg WA, et al. Fast Track Intervention Effects and Mechanisms of Action Through Established Adulthood. Prev Sci, 2025.PMID 39392546