Psych · Child and adolescent psychiatry — disruptive behaviour
Conduct and oppositional defiant disorders
Also known as Oppositional defiant disorder · ODD · Conduct disorder · CD · Disruptive behaviour disorders · Disruptive behavior disorders · Antisocial behaviour in youth · Callous-unemotional traits · Limited prosocial emotions
Exam-exhaustive fellowship reference on oppositional defiant disorder and conduct disorder — DSM-5-TR and ICD-11 criteria, Moffitt trajectories, ADHD and ASPD interfaces, multi-informant assessment, parent management training, multisystemic therapy concepts, and the limited evidence-based role of medication for severe aggression. FRANZCP-primary, globally tagged.
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Red flags
- Imminent risk of serious violence to others, sexual harm, or fire-setting — immediate safety plan, multiagency response, and local emergency pathways
- Child protection concerns (abuse, neglect, exploitation, weapons access) — mandatory reporting duties are jurisdiction-specific; document and act
- Severe aggression with untreated ADHD or psychosis — do not attribute everything to 'bad behaviour'; reassess comorbidity before escalating antipsychotics
- Metabolic deterioration or hyperprolactinaemia on risperidone — monitor weight, glucose/lipids, prolactin symptoms; review indication and duration
- Rapid escalation of substance use with conduct symptoms — integrate SUD care; peer and justice risks rise together
- Suicidal ideation or self-harm co-occurring with irritability/depression — full risk assessment; Stringaris irritable dimension predicts mood outcomes
Meet the patient
A 14-year-old boy is back in your clinic after his third school exclusion. He has broken a classmate's nose, set fire to a wheelie bin, and stays out overnight despite every prohibition. His mother, exhausted and harsh, shrugs: "he has been like this since he was six."[1][6]
The registrar reaches for a risperidone chart. The examiner's question is sharper: "Which pathway is he on, and what would actually change it?" Moffitt gave you the vocabulary to answer that — and most of the treatment lives in the family and the school, not the prescription pad.[1][7]
References24ShowHide
- [1]Moffitt TE Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy Psychol Rev, 1993.PMID 8255953
- [2]Nock MK, Kazdin AE, Hiripi E, Kessler RC Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication J Child Psychol Psychiatry, 2007.PMID 17593151
- [3]Canino G, Polanczyk G, Bauermeister JJ, Rohde LA, et al. Does the prevalence of CD and ODD vary across cultures? Soc Psychiatry Psychiatr Epidemiol, 2010.PMID 20532864
- [4]Steiner H, Remsing L; Work Group on Quality Issues Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder J Am Acad Child Adolesc Psychiatry, 2007.PMID 17195736
- [5]Steiner H Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. American Academy of Child and Adolescent Psychiatry J Am Acad Child Adolesc Psychiatry, 1997.PMID 9334568
- [6]Loeber R, Burke JD, Lahey BB, et al. Oppositional defiant and conduct disorder: a review of the past 10 years, part I J Am Acad Child Adolesc Psychiatry, 2000.PMID 11128323
- [7]Scott S, Spender Q, Doolan M, et al. Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice BMJ, 2001.PMID 11473908
- [8]Beauchaine TP, Webster-Stratton C, Reid MJ Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis J Consult Clin Psychol, 2005.PMID 15982136
- [9]Henggeler SW, Schaeffer CM Multisystemic Therapy: Clinical Overview, Outcomes, and Implementation Research Fam Process, 2016.PMID 27370172
- [10]Henggeler SW Efficacy studies to large-scale transport: the development and validation of multisystemic therapy programs Annu Rev Clin Psychol, 2011.PMID 21443449
- [11]Frick PJ, White SF Research review: the importance of callous-unemotional traits for developmental models of aggressive and antisocial behavior J Child Psychol Psychiatry, 2008.PMID 18221345
- [12]Pardini D, Frick PJ Multiple developmental pathways to conduct disorder: current conceptualizations and clinical implications J Can Acad Child Adolesc Psychiatry, 2013.PMID 23390429
- [13]Stringaris A, Goodman R Three dimensions of oppositionality in youth J Child Psychol Psychiatry, 2009.PMID 19166573
- [14]Stringaris A, Goodman R Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions J Am Acad Child Adolesc Psychiatry, 2009.PMID 19318881
- [15]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
- [16]Leibenluft E Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths Am J Psychiatry, 2011.PMID 21123313
- [17]Gorman DA, Gardner DM, Murphy AL, et al. Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder Can J Psychiatry, 2015.PMID 25886657
- [18]Snyder R, Turgay A, Aman M, et al. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs J Am Acad Child Adolesc Psychiatry, 2002.PMID 12218423
- [19]Barterian JA, Arnold LE, Brown NV, et al. Clinical Implications From the Treatment of Severe Childhood Aggression (TOSCA) Study: A Re-Analysis and Integration of Findings J Am Acad Child Adolesc Psychiatry, 2017.PMID 29173736
- [20]Blair RJ The neurobiology of psychopathic traits in youths Nat Rev Neurosci, 2013.PMID 24105343
- [21]Robins LN Deviant children grown up Eur Child Adolesc Psychiatry, 1996.PMID 9010663
- [22]Dishion T, Forgatch M, Chamberlain P, et al. The Oregon Model of Behavior Family Therapy: From Intervention Design to Promoting Large-Scale System Change Behav Ther, 2016.PMID 27993335
- [23]Copeland WE, Shanahan L, Costello EJ, Angold A Childhood and adolescent psychiatric disorders as predictors of young adult disorders Arch Gen Psychiatry, 2009.PMID 19581568
- [24]Bachmann CJ, Scholle O, Bliddal M, et al. Recognition and management of children and adolescents with conduct disorder: a real-world data study from four western countries Child Adolesc Psychiatry Ment Health, 2024.PMID 38281951