Behavior or Conduct Problems in Children

Overview

Children sometimes argue, are aggressive, or act angry or defiant around adults and peers. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are sometimes called externalizing disorders. There are two types of disruptive behavior disorders: Oppositional Defiant Disorder, and Conduct Disorder.

Signs and symptoms

Oppositional Defiant Disorder

When children act out persistently causing serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. All children will test limits sometimes, and it is part of healthy development for children and does not necessarily mean that a child has ODD. Children with ODD show these behaviors more often than other children their age, and their behavior has a negative impact with their daily functioning or relationships with adults or peers.

Examples of ODD behaviors include:

• Often being angry or losing one's temper
• Often arguing with adults or refusing to comply with adults' rules or requests
• Often being resentful or spiteful
• Often deliberately annoying others or becoming annoyed with others
• Often blaming other people for one's own mistakes or misbehavior

Conduct disorder

Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers. Although it can be diagnosed earlier, CD commonly develops in adolescence and can persist into late adolescence. Some children with ODD develop CD.

Examples of CD behaviors include:

• Breaking serious rules, such as running away, staying out at night when told not to, or skipping school
• Aggression toward people and animals in a way that causes harm, such as bullying, fighting, or being cruel to animals
• Damaging other people's property on purpose or setting fires on purpose
• Stealing, lying, or breaking into houses or businesses

Managing symptoms: staying healthy

Good physical and mental health is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:

• Engaging in regular physical activity, including aerobic and vigorous exercise
• Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
• Getting the recommended amount of sleep each night based on age
• Strengthening relationships with family members, friends, and the community

Treatment for disruptive behavior disorders

Starting treatment early for ODD and CD is important. Treatment is most effective if it fits the needs of the specific child and family. The first step to treatment is to talk with a health care provider. A comprehensive evaluation by a mental health professional may be needed to get the right diagnosis.

Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. For younger children, the treatment with the strongest evidence is behavior therapy training for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child's behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.

Get help finding treatment

Pediatricians and other health care professionals who interact regularly with children can help support children's mental health and work with families to identify when specialist care is needed for diagnosis and treatment. To find a pediatrician near you, visit HealthyChildren.org, a service of the American Academy of Pediatrics (AAP) practice organization.

Families can also seek referrals for a mental health provider through multiple avenues, including the child's school, a primary care provider, or through health insurance. They can also ask for advice from trusted family or friends who may have some experience with providers in the local area.

If you need insurance coverage, learn more about enrolling in Medicaid, Children's Health Insurance Program (CHIP), or a Marketplace plan at HealthCare.gov. If your child does not qualify for insurance coverage, you can get low-cost health care at a nearby community health center.

Mental health specialists

Here are additional tools to find a healthcare provider familiar with treatment options:

• Psychologist Locator, a service of the American Psychological Association (APA) Practice Organization.
• Child and Adolescent Psychiatrist Finder, a research tool by the American Academy of Child and Adolescent Psychiatry (AACAP).
• Find a Cognitive Behavioral Therapist, a search tool by the Association for Behavioral and Cognitive Therapies.
• If you need help finding treatment facilities, visit FindTreatment.gov.

What CDC is doing

Prevention

It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they experience or witness violence or neglect or are exposed to criminal behavior. Also, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders, depression, or attention-deficit/hyperactivity disorder (ADHD).

Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

Resources

• Oppositional Defiant Disorder - American Academy of Child & Adolescent Psychiatry (AACAP) fact sheet
• Conduct Disorder – AACAP fact sheet
• Practice Parameters – AACAP healthcare provider guidelines for diagnosing and treating mental health conditions in children and adolescents
• CDC's Mental Health Homepage