Conduct disorder

Abstract

Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene–environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic–pituitary–adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.

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Fig. 1: Environmental and dispositional risk factors for CD.
Fig. 2: Genetic influences on CD.
Fig. 3: Brain regions which are under-responsive or less active in CD.
Fig. 4: Structural brain abnormalities in CD.
Fig. 5: Management of CD without comorbid disorders in different developmental periods.
Fig. 6: Management of CD in those with comorbid disorders.
Fig. 7: Quality of life and CD.

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Acknowledgements

G.F., S.D.B. and C.M.F. were supported by the European Commission’s FP7 scheme under grant agreement no. 602047 (FemNAT-CD). W.E.C. was supported by R01HD093651 and R01MH117559 from the National Institutes of Health. C.L.O. is a Fellow of the Canadian Institute of Advanced Research. B.F. receives support from a personal grant from the Netherlands Organization for Scientific Research (NWO; Vici grant 016-130-669), from a grant for the Dutch National Science Agenda for the NWA NeurolabNL project (grant 400 17 602), from the European Commission’s FP7 under grant agreement no. 602805 (Aggressotype), and from the European Commission’s Horizon 2020 Program (H2020/2014–2020) under grant agreement no. 728018 (Eat2beNICE).

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Introduction (G.F.); Epidemiology (W.E.C.); Mechanisms/pathophysiology (G.F., B.F. and S.A.D.B.); Diagnosis, screening and prevention (D.J.H. and P.J.F.); Management (D.J.H. and C.M.F.); Quality of life (W.E.C., C.L.O. and G.F.); Outlook (G.F. and S.A.D.B.); overview of the Primer (G.F.)

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Correspondence to Graeme Fairchild.

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Competing interests

C.F. has served as a consultant on autism spectrum disorders for Desitin and Roche. She receives royalties for books on autism spectrum disorders, attention-deficit/hyperactivity disorder and depression. B.F. has received educational speaking fees from Medice. All other authors declare no competing interests.

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Fairchild, G., Hawes, D.J., Frick, P.J. et al. Conduct disorder. Nat Rev Dis Primers 5, 43 (2019). https://doi.org/10.1038/s41572-019-0095-y

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