Disruptive Behavior Disorders

What are Conduct Problems in Childhood?

Conduct problems in childhood are patterns of intentional rule-breaking or law-breaking behavior. 

These patterns are clinically known as a Disruptive Behavior Disorder. Extreme behaviors or conduct problems are less likely to be diagnosed in childhood. Conduct disorders are more likely in adolescence. Noticing and treating problematic conduct early, though, can prevent later problems.

Symptoms of Conduct Problems in Children 

• Behaving in extreme ways that appear to be intentional: your child is starting fires or fights or causing pain to others intentionally
• Breaking the law: your child is behaving in a way that has become so concerning that if caught, law enforcement would be involved
• Trusting your child is hard: your child is making choices that put themselves and others in harm regularly 
• Ending up in the principal’s office: your child is disrupting the school environment and is continually in trouble 
• Stealing: your child is stealing from parents or other children 
• Starting fights with other children: your child is seeking revenge on other people 
• Immune to consequences: your child is not understanding cause and effect or is unwilling to take ownership for their mistakes

Nine Causes of Conduct Problems in Childhood 

1. Environmental factors: including parenting challenges, family discord, and school discipline issues

Most often, environmental factors are a huge contributor to conduct problems. Perhaps situations in your child’s life or environment have been really negative. Your child may experience a breakup with a friend group or be having difficulty in your neighborhood or community. Other adults in their lives, such as coaches or teachers, may be overly strict or harsh. Although your child is still ultimately responsible for their behavior, it is important to be aware of how their environment is contributing to their wellbeing and conduct.

Inconsistent discipline or a family history of trauma can lead a child to act out as a cry for help. A child who bullies or intimidates others may have been bullied or threatened in their own life. Sometimes social norms are not maintained by some of the role models in a child’s life, and it can be confusing for that child as they try to figure out right versus wrong. Even in the best circumstances with very loving parents, there may be personality mismatches in the family, or the parents may be having extreme difficulties making rules, setting limits, and establishing conduct expectations in the household.

In child development, children learn from behavior that others around them exhibit. Young children are sponges to the world around them; if maladaptive behaviors are modeled, they can certainly start acting in a similar fashion. 

Sometimes a child will have a history of behavior problems at school. They may get somewhat targeted or blackballed by school administrators, which can cause increased behavioral issues. In this situation, parents are wise to reach out frequently and be collaborative with the school administrators and other staff.

2. Impulse control issues: including a natural tendency to act without thinking and to get in trouble without evaluating the consequences

Another factor in conduct problems may be impulse control issues. Perhaps your child acts without thinking, is making poor decisions, and hurting others accidentally. Seeking help immediately is essential if your child is exhibiting any of these behaviors: bullying, hurting animals, intimidating, physical cruelty, or starting fires. Some other early signs of conduct issues include gravitating toward a trouble-making peer group, substance use, and a recent decline in academic performance.

Behavioral therapy and family therapy can effectively treat these challenges.

Seeking help is important even if you are noticing extreme behaviors in your child. Getting this help is important, whether or not your child shows remorse. Conduct problems can become very serious very quickly. Even in families where the parents are very engaged and children are receiving support, conduct problems can emerge. Parents are wise to consider more intensive treatment options, such as day treatment, partial hospitalization, and residential care.

3. Trauma: including developmental trauma, significant life events, and maladaptive family dynamics

Developmental trauma: New research abounds regarding something called ‘developmental trauma.’ Before discussing these concepts, it is important for parents to know this is not an attempt to blame you or anyone else for your child’s behaviors. Rather, knowing about developmental trauma can foster understanding, closeness, and connection in your family. The concept of developmental trauma as defined by Dr. Lawrence Heller, is that when a child’s needs go unmet by the environment, certain maladaptive patterns may emerge. The core needs identified are: connection, trust, autonomy, attunement, and love. Often, even in very loving families, these needs may go unmet by the environment. If the child perceives a lack of support and safety from the neighborhood, school, or community, these patterns may emerge.

Remember: normal parents from normal families may find that developmental trauma has occurred in their child. The child simply has the sense that, for any of a million reasons, their needs have gone unmet. To adapt to the perceived threat, the child will adopt one of these ‘adaptive survival styles’:

• Connection survival style: a child with this style will have the sense that even existing is too threatening and will attempt to appear invisible
• Autonomy survival style: a child with this style experiences difficulty with making choices, saying no, and setting limits. They avoid making decisions and instead feel resentment and a sense of revenge for having to comply with the choices of others
• Attunement survival style: a child with this style feels that others have not been attuned to their needs and accepting of who they are as people. As a result, they do not express their own needs and instead focus their energy on attuning to the needs of others
• Trust survival style: a child with this style believes that the only person they can trust is themselves. They think that they need to take charge and be in control to be safe. They may bulldoze over others to reach their goals. They tend to be high achievers and their sense of identity is closely tied to their attainment of accolades and accomplishments
• Love survival style: a child with this style believes that the way to get love is to perform. They will experience a sense of dread that they will be abandoned and worthless if they do not perform well. They have a hard time with closeness and intimacy in their relationships

Parenting through these adaptive survival styles: as hard as this sounds, parents can do a lot to help their children through these maladaptive patterns. The first step is identifying what pattern exists for your child. If you would like to learn more about this, download our app where Dr. Willard walks through the survival styles in detail and what to do about each one. 

The next important step is working on your communication with your child. The most common problem that allows these patterns to run amok is when communication breaks down between the parents and child. You want to send the message that all topics are allowed for discussion. You want your child to know that they will not be harshly criticized or abandoned for saying what they think and feel. Instead, you want to impart that you love your child for who they are. You want the child to know that although heartbreak does happen to us all, they are not alone, and you will always be there to support them through the inevitable trials of life.

Big T Trauma: As opposed to developmental traumas, which are the result of heartbreak over time, big T traumas tend to be related to a major life event. These traumatic events may be a car accident, abuse, witnessing gun violence, war, floods, tsunamis, and the like.  Adverse Childhood Experiences like these can have a significant impact on a child’s mental health, regardless of how nurturing the family life may be. In this case, your child will need therapy from a therapist trained in treating trauma in childhood.

Abuse: Consider whether abuse has occurred. Be sure you consider the consistency of relationships within your child’s life. Deep emotional trauma or childhood abuse may be the cause when a child displays extreme behavior. Caregivers and clinicians should be careful not to miss physical, sexual, or emotional abuse cues.

Look for bruising, odd extreme behavior, frequent toileting accidents, or a drawing or play that has a very violent or sexualized quality. Sudden and drastic changes in behavior such as: hiding under furniture and refusing to come out, smearing feces, eating non-food items, spinning wildly, or rapidly switching from very friendly to hostile in a short period of time are red flags for trauma or abuse.

If you notice any of these concerns, seeking support from a mental health professional is very important. Keep in mind that any poor conduct can be related to these traumatic experiences. Often, getting the right support for your child’s mental health can improve their behaviors significantly.

4. Attachment: including difficulty connecting with caregivers or creating strong bonds with others

Attachment problems often lead to poor behaviors. Psychologists use the term ‘disorganized attachment’ to refer to a relationship with caregivers that is not secure, resulting in behavior that can be erratic or extreme. Generally, although not always, there was a period where the child was separated from caregivers. 

These issues may come up in extreme situations where the parent was killed or incarcerated. It could also be something less severe like the child or parent being hospitalized for long periods of time, went through a bout of depression or has an addiction problem. If the child feels that it is not safe to rely on caregivers, these attachment issues will often emerge.

The primary consideration for attachment problems is whether the child is consistently trusting. 

Secure attachment to a caregiver translates into trust in other relationships. 

Kids who are close to their moms and dads generally have close friends too. Children who are not securely attached can be extremely distant and disconnected or very inconsistent with their trust. These children may have been victims of abuse or suffered a long separation from their parents. 

Children who have been abandoned or have simply never connected with any parent or adult will likely have significant attachment problems. This issue is similar to the trauma profile discussed above and requires mental health treatment support.

5. Behavior: including making poor behavioral choices in order to get a desired item or self-serving outcome

Significant behavior problems are also essential to assess here. In the absence of emotional symptoms, misbehavior that only serves to gain a reward or consequence could be Oppositional Defiant Disorder (ODD) or Conduct Disorder. The difference is that these disorders are defined as intentional without obvious emotional roots. More often, children’s behavior has an underlying emotional cause. However, the term ‘conduct’ refers mostly to behaviors that are intentional and not motivated by emotional upset. 

Disruptive behavior disorders in children tend to cause problems at school and at home and tend to have an intentional element. Some children learn that they can break the rules and norms to get what they want. Sometimes these disorders co-occur with ADHD because impulse control plays a significant role in these children’s choices. 

Relational aggression: In some cases, these behavior patterns include ‘relational aggression’ where the child is consistently unkind to caregivers or others. The child may go to extreme lengths to avoid consequences. There may be ‘gas lighting’ or ‘scapegoating’ or ‘emotional hostage taking’ where the child projects or blames the parent for their decisions in an attempt to get the parent to feel guilty and give them what they want. If your child is displaying one of these patterns, it will be important to learn how to protect yourself, while still ensuring safety for your child. Your ability to establish boundaries is paramount to your own mental health. To learn more about boundaries see this video series: Boundaries in Childhood. 

Severe behavior problems will likely require intervention from a clinical professional, such as an Applied Behavior Analyst (ABA) combined with parent training. Parents really need support to manage these kinds of challenges.

6. Substance use: including the use of mood-altering drugs and alcohol

If your child is displaying concerning behaviors, it will be an important step to evaluate if substance use is a concern. Unfortunately, many substances are readily available to teenagers that will have a dramatic impact on their behavior. For example, THC, the main ingredient in marijuana, has many detrimental effects, including delusions, paranoia, irritability, and learning problems. 

This issue is even more concerning with the popularity of dabs, which are highly concentrated form of THC. Pay attention to your child’s behavior, especially if there are recent changes. If your child isn’t eating well, sleeping well, or participating in healthy activities, substance use may be in play. Resources are available in this Addiction in Teen article.

7. Mood: including an organic chemical-based tendency to have rapid shifts in emotions and mood swings

If emotional symptoms exist, like depressed mood, sleep difficulty, or lack of pleasure in life, determine whether depression or bipolar type symptoms might be present in addition to or separate from trauma and attachment mentioned above. 

Bipolar disorder includes a level of impulsivity that could make it appear as though your child does not care about rules or consequences. When a child acts impulsively, they may not be able to take the time to consider consequences.

8. ADHD: including poor planning, judgment, and attention

Attention deficit hyperactivity disorder (ADHD) shares a fairly common association with conduct disorders.The strongest association occurs because impulsive children tend to make poor behavior choices. In the right environment, these behaviors can be corrected, and children can learn more adaptive ways of coping. 

The other reason why kids with ADHD may have behavior challenges is because they have extreme problems paying attention. Ongoing attention challenges can lead to irritability, a sense of being unsettled, and a feeling of being uncomfortable in your own skin. However, all behavior is environmentally reinforced. A child with ADHD can, with the right support, demonstrate appropriate behavior and a happy life.

9. Autism: including deficits in executive functioning, perspective-taking, and understanding cause and effect

It is possible but unlikely that your child may have some symptoms of autism. For example, some children who seem callous or abusive to others are simply not taking another person’s perspective.

A child with autism may expect too much of a baby sibling or be rough with your pet while only trying to play. 

What to Do About Conduct Problems in Childhood 

Top 10 strategies for a child with conduct problems

1. Pick one or two behaviors you would like to change: with your child, pick the most important behavior you would like to change. For example, if your child is hitting, sit down with your child, and explain calmly that you would like your child to express their emotions in a way outside of hitting. Read a book together about emotional regulation. Give your child skills, so they have other ways to express what they need without hitting. 
2. Reward these behaviors: with your child, notice good behavior and provide a reward that is meaningful. When you are used to your child engaging in negative behaviors, it can be challenging to point out the positive. Take time to notice what is going well. It is best if your child does not lose points this will backfire for you if they engage in negative behavior they don’t earn points at that moment. 
3. Always have a positive time: with your child, engage in a positive conversation and quality time with your child regardless of their behavior.  Positive time looks like playing a game and being present with your child, listening while showing and demonstrating positive emotions within yourself towards your child. You would do this every day despite misbehavior.
4.  Do not provide attention for bad behavior: with your child, be careful not to reward behaviors like hitting and destroying things. If your child is destroying important items to you, then you need to move objects you do not want to be broken to a safe place or outside your home, do so when your child isn’t watching. When you provide negative attention to negative behavior, it reinforces the behavior.
5. Find time for closeness: with your child, take time for cozy snuggles and togetherness. Having a cup of hot cocoa and watching a favorite show, going for a walk, taking a drive to see the fall leaves, or enjoying a quiet dinner of your child’s favorite food can be provided at low cost. These positive experiences can be provided without being contingent on good behavior.
6. Have boundaries: with your child, it is extremely important to have clear boundaries. This is easy to say and hard to do. To learn more, see this video series: Use Clear Boundaries.
7. Focus on safety first: with your child, safety is always #1. To keep your child safe and others, remove items that could harm anyone and stay close by to reinforce calming behavior. Make sure you keep sharp knives or anything else dangerous under lock and key.
8. Model a calm demeanor: display deep breathing, sitting calmly (versus standing in a defensive posture), and looking out the window can help your child regain composure. Stay quiet, do not raise your voice or become elevated.
9. Seek out support for yourself: With your child, you may find that you are continually frustrated and upset. It may be helpful to see a therapist yourself. If you find staying calm with your child challenging, seek support to help you learn tools for calming down. All of our emotions are OKAY; it is just how we respond. How you react to a child with conduct problems is essential. As adults, we sometimes need to learn tools to stay calm and centered. In doing so, you can avoid getting upset and further escalating the situation. 
10. Seek professional help: If your child is behaving in extreme ways seeking professional help should be at the top of your list. Reach out to a psychologist, family therapist, or social worker who has expertise in parent training and a behavioral therapist who can help with consistency and structure. Always call 911 or visit the emergency room if you think someone (your child or someone else) is in danger.

When to Seek Help

If you are concerned about any of these behaviors, it is best to seek help immediately from a professional who has experience treating children with conduct problems. 

If your child is in school, it is generally a good idea to let the school counselor or psychologist know if your child has an incident of this nature. Collaboration with school professionals, clinical therapists, and parents can be the key to facilitating positive behavior in your child.

If you are worried about serious safety concerns, call 911 or visit the nearest emergency room.

Further Resources on Conduct Problems in Childhood 

• Psychotherapist or play therapist: to treat emotional symptoms, teach adaptive coping techniques, and practice social skills
• ABA therapist: to treat behavior, analyze the function of poor behavior, create appropriate systems for reinforcement of positive behavior, and to develop a home behavior management system. Also, to provide extensive parent training support.
• Psychologist or neuropsychologist: to conduct a full assessment to look at symptoms in mental health and behavioral contexts
• Psychiatrist: to prescribe and manage psychotropic medication for depression or bipolar, impulsivity, or aggressive behaviors

Similar Conditions to Conduct Problems in Childhood

• Social skills problems: conduct problems can be related to difficulty with social perspective-taking, understanding what reactions are appropriate in a situation, and reading other people’s reactions
• Emotional problems: conduct problems such as the tendency to be irritable and explosive can be related to underlying feelings of sadness and depression
• Suicidal ideation: conduct problems can be related to dangerous behavior and suicidal thoughts. Take your child’s statements seriously and seek help immediately if they talk about death or suicide. If you have immediate risk, think your child has a plan, or have worries about safety, call 911 or visit the nearest emergency room. You or your child may also call the National Suicide Prevention Lifeline Phone Number at 1-800-273-8255.
• Self-esteem: conduct problems sometimes occur due to a child’s low self-esteem. Academic, social, and relational failures can lead to a sense of hopelessness, and a child may ‘act out’ as a result.
• Attachment: conduct problems can be related to a lack of trust and connection to caregivers. Attachment problems are likely if the child has been abandoned by a parent or has simply never connected to an adult.
• Aggression: conduct problems sometimes occur when children with pent-up anger or low self-esteem get into physical fights. In extreme circumstances, they may also have anti-social behavior, which involves intent to harm others without empathy or remorse

Book Resources on Conduct Problems in Children

Barkley, Russell A. (2013). Taking charge of ADHD, 3rd edition: The complete, authoritative guide for parents. 

Cooper-Kahn, Joyce & Dietzel, Laurie (2008). Late, lost and unprepared: A parent’s guide to helping children with executive functioning. 

Greene, Ross W. (2001). The explosive child: A new approach for understanding and parenting easily frustrated, chronically inflexible children. 

Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

Papolos, Demitri & Papolos, Janice (2002). The Bipolar Child: The definitive and reassuring guide to childhood’s most understood disorder.

Siegel, Dan (2013): Brainstorm: The Power and Purpose of the Teenage Brain.

Winfrey, Oprah & Perry, Bruce (2021). What Happened to You?: Conversations on Trauma, Resilience, and Healing 

Books for kids

Esham, Barbara (2015). Mrs. Gorski, I think I have the wiggle fidgets. (New edition) (Adventures of everyday geniuses.) 

Smith, Bryan & Griffen, Lisa M. (2016). What were you thinking? Learning to control your impulses (Executive function).