Understanding and Dealing with Conduct and Oppositional Disorders

By: Michael G. Conner, Psy.D

Revised: May 21, 2014

Conduct and oppositional disorders represent a broad range of behaviors in pre-adolescent (3-12 years old) and adolescent children (13-18 years old). The behaviors which distinguish this disorder range from relatively minor behaviors such as yelling, whining, and temper tantrums to aggression, physical destructiveness and stealing. Conduct and oppositional disorders are considered behavioral disorders. These disorders do not occur in isolation but reflect a pattern or class of behaviors.

Conduct and Oppositional Disorders are the most frequently occurring behavioral disorder in the general population. It also represents the greatest percentage of referrals for treatment of children. Conduct disorders occur at a rate of approximately 3 to 10 children out of 100. Boys are 3 to 4 times more likely to have this disorder that girls. Children with severe conduct disorders are likely to exhibit similar patterns of behavior later in life. As adults, they have a greater risk to show more serious psychological/psychiatric impairments.

Most of the research regarding Conduct and Oppositional Disorders emphasizes the role of family patterns of interactions and the manner in which the family socializes a child. Biological, genetic and medical factors appear to be related to the occurrence of this disorder with some children. Neurological abnormalities and/or a history of head trauma have also been associated with extremely aggressive forms of conduct disordered behavior (but not less severe forms). The development and maintenance of these disorders are strongly influenced when both biological and environmental factors are present.

Environmental factors which influence the development of conduct disorders include family systems, educational systems and the impact of friends and peer relationships. Repeated noncompliance with appropriate parental expectations is a key factor in the development of these disorders (i.e. excessive disobedience of adults). Conflict and distress between parents, parents and the child, as well as conflict between the family system and others have been shown to lead to acting out and conduct disordered behaviors. Parents of aggressive children tend to be excessively commanding and coercive. Parents of children who steal tend to be more distant and less involved with their children. Discipline in the families of these children is often excessive, lacking, inconsistent or inappropriate. Mothers are often rejecting and fathers tend to be excessive or inconsistent in discipline practices. There is clear evidence that these families do not adequately monitor the child’s behaviors. Substance abuse strongly influences the occurrence of Conduct and Oppositional Disordered behavior. In addition, substance abuse often follows as a result of the progression of these disorders.

Conduct Disordered behaviors can be elicited and reinforced a number of ways. The most common are:

  • Negative reinforcement. Coercive, aggressive or conduct disordered behavior on the part of a child results in the removal of an aversive event (e.g. discipline) being applied to the child or another family member.
  • Modeling. When a parent or significant other engages in aggressive, coercive other conduct disordered behavior, the child initiates this behavior on the basis of his or her observations.

Using the Diagnostic and Statistical Manual of Mental Disorders (4th ed. rev.) there are 2 general diagnostic categories.

  • Conduct Disorder. A persistent pattern in which the basic rights of others and important social norms and rules are violated.
  • Oppositional Disorder. A pattern of negativistic, hostile and defiant behavior without the more serious violations of the basic rights of others that are seen in conduct disorders.

Behaviors Associated With Conduct Disorders

  • Stealing without confronting a victim
  • Running away from home
  • Lying
  • Setting fires
  • Truancy from school
  • Breaking into someone's house, building or car
  • Deliberate destruction of another's property
  • Physical cruelty to animals
  • Forcing someone into sexual activity
  • Use of a weapon
  • Initiating physical fights
  • Stealing when confronting a victim
  • Physical cruelty to people

Behaviors Associated With Oppositional Disorders

  • Loses temper
  • Argues with adults
  • Actively defies of refuses the requests of adults
  • Deliberately does things to annoy people
  • Blames others for his or her own mistakes
  • Touchy or easily annoyed by others
  • Angry or resentful
  • Spiteful or vindictive
  • Swears

Steps You Can Take

A large number of treatment strategies have been developed to deal with conduct disorders. For the most part, interventions designed for preadolescent children emphasize a family based approach in which additional interventions are considered supplemental.

  • Parent Training.  Is based on a determination or assumption that a parenting skill deficit is responsible for developing and maintaining conduct disordered behavior. Therapists usually employ a variety of techniques including didactic instruction, modeling, behavioral rehearsal, shaping (selective use of reinforcement), and homework exercises to instruct the parent(s).
  • Community Based Residential Programs.  Involves children and sometimes parents in a home or residential treatment setting. Some program utilize facilitators who assume a role of "teaching parents". Treatment may emphasize a multilevel point system, self-government procedures (daily family conferences, peer management) social skills training, academic tutoring, and home based reinforcement procedures for monitoring school behavior.
  • School Based Interventions.  Emphasize classroom contingency management behaviors. These approaches are difficult to implement for some children since Public Law 94-142 specifically excludes children who are socially maladjusted but not emotionally disturbed.
  • Interpersonal and Skills Training.  Provides children with individual experience and social skills that may be lacking which lead to conflict. Trains children how to initiate conversations, respond to others, refuse requests, and make requests of others.
  • Medication.  Medications are rarely used in the treatment of conduct disorders since these disorders are behavioral in nature. Medication is often used in the treatment of psychological and psychiatric disorders which may occur simultaneously (e.g. depression, anxiety).

The chance of a successful outcome is best when early interventions are made and when children are young.  Family based approaches are more effective than individual approaches which focus on the child while excluding the parents and family. Parent training and behavioral interventions are crucial when working with younger preadolescent children. As children reach adolescence, the use of peer group as well as an individual focus can be effective. Family based interventions which emphasize parent training are often more difficult with older children since the problems may have been going on for some time, and children are often beginning to individuate and separate from the family.  Wilderness based interventions are often the effective when all other approaches have failed and there is a high or extremely high risk that the problem behavior will continue or escalate.  

Copyright 1998 to 2008, Michael G. Conner