ICD-116C91	CONDUCT-DISSOCIAL DISORDER Conduct-dissocial disorder
ICD-10F91	Conduct disorders
DSM-5-TRF91.1	Conduct Disorder, Childhood-Onset Type

1. Definition and nosology

Conduct Disorder (ICD-11: 6C91 Conduct-Dissocial Disorder; DSM-5-TR: F91.1 Conduct Disorder) — a persistent and repetitive pattern of violating the rights of others or age-appropriate social norms. Typically begins in childhood/adolescence; may transition to ASPD in adulthood.

2. History

• DSM-III (1980) — Official diagnosis.
• DSM-5 (2013) — “limited prosocial emotions” specifier (childhood marker of psychopathic traits).
• NICE CG158 (2017) — child and adolescent antisocial behavior.

3. Epidemiology

• Prevalence: 12-month prevalence 2–10%, median 4%; higher in boys than in girls (DSM-5-TR).
• Sex: 3 times higher in males.
• Onset — childhood (before age 10, poor prognosis) or adolescence (age 10+, good prognosis).
• Comorbidity: ADHD 50%, ODD, MDD, anxiety, substance use, learning disorders.

4. Aetiology and pathogenesis

• Heritability 40–60%.
• Neurobiological — amygdala, prefrontal dysregulation, low sympathetic arousal.
• Environment — childhood trauma, harsh parenting, family dysfunction, peers.
• Prenatal — tobacco, alcohol.

5. Clinical features

DSM-5-TR 15 symptoms in 4 categories (≥ 3 symptoms in 12 months)

• Aggression — towards people/animals: threat, assault, use of weapons, physical violence, sexual violence.
• Object injury: Intentional arson, damage of other objects.
• Deception/theft: Breaking and entering, lying, theft.
• Serious rule violation: Arriving late, running away from home, truancy.

“Limited prosocial emotions” qualifier (psychopathic traits)

• Lack of empathy or remorse;
• Lack of concern about performance;
• Callous lack of emotion;
• Shallow affect.

6. Diagnosis

6.1 Unified diagnostic criteria

DSM-5-TR criteria (≥ 3 symptoms from 15 in 12 months; at least 1 symptom in the last 6 months). Severity: mild, moderate, severe.

Onset: childhood type (≥1 symptom by age 10), adolescent type.

6.2 Source-specific clarifications

• DSM-5-TR — ‘limited prosocial emotions’ qualifier.
• ICD-11 — ‘Conduct-Dissocial Disorder’; according to child, adolescent, adult patterns.
• NICE CG158 — diagnosis and intervention in children and adolescents.

6.3 Diagnostic algorithm

1. Clinical interview + parent, teacher.
2. Structured interview (K-SADS).
3. CBCL (Child Behavior Checklist), TRF (Teacher Report Form).
4. The Inventory of Callous-Unemotional Traits — for psychopathic traits.
5. Comorbidity (ADHD, MDD, substance, learning).

6.4 Differential diagnosis

7. Examination and assessment

• CBCL, TRF, ICU.
• Comorbidity screening.
• Intellectual and academic assessment.

8. Treatment

8.1 General Principles (NICE CG158 · AACAP)

1. Parent training programs first-line — for ages 3–11:
   • Incredible Years (Webster-Stratton);
   • PCIT (Parent-Child Interaction Therapy);
   • Triple P.
2. For adolescents:
   • MST — Multisystemic Therapy (Henggeler S.W.) — encompassing family, peer, school, community;
   • FFT — Functional Family Therapy;
   • MTFC — Multidimensional Treatment Foster Care.
3. Comorbid ADHD — stimulant (also reduces aggression).
4. Antipsychotic (risperidone) — off-label in severe aggression, with caution; no FDA approval (specific for childhood aggression).
5. “Scared Straight” and similar programs are contraindicated — Cochrane (Petrosino A. 2013) — these programs increase antisocial behaviour.
6. Boot camp type “tough love” programs — no evidence, harmful.

8.2 Source-specific clarifications

• NICE CG158 (2017).
• AACAP Practice Parameter (Steiner H. 2007).
• Cochrane (Petrosino 2013) — Scared Straight is counterproductive.

Treatment methods

1. “Incredible Years” program - Webster-Stratton — group program for parents of children aged 3–8 years; 14–22 sessions.
2. Parent-Child Interaction Therapy (PCIT) — 4–7 years; CDI + PDI.
3. Multisystemic Therapy (MST) — Home-based multisystem intervention for adolescents; evidence base strong for severe behavioral disturbances.
4. Functional Family Therapy (FFT) — Family-based, 8-30 sessions.
5. Multidimensional Treatment Foster Care (MTFC) — Structured fostering program; for severe case.

9. Prognosis

• With childhood-type and psychopathic traits — risk of ASPD in adulthood ~40–50%.
• Adolescent-type good prognosis.
• Early parent training and multisystem intervention significantly improve outcomes.

10. Myths and misconceptions

Myth 1: “Harsh punishment/discipline is the most effective intervention”

Evidence: Harsh punishment strengthens antisocial behavior; positive parenting training is evidenced.

Myth 2: “‘Scared Straight’ programs ‘correct’ youth”

Evidence: Petrosino A. Cochrane 2013 — Scared Straight increases antisocial behaviour (OR 1.68; 95% CI 1.20–2.36); contraindicated; sometimes presented as “effective” in media, but meta-analysis negative.

Myth 3: “Conduct disorder inevitably turns into ASPD”

Evidence: Approximately 50% of cases with adolescent-onset type remit; childhood-onset type and psychopathic traits indicate a poor prognosis.

Myth 4: “Stimulants increase aggression”

Evidence: In comorbid ADHD, stimulants REDUCE aggression; use with monitoring of behaviour and adverse effects.

Myth 5: “Boot camp or military environment cures severe CD”

Evidence: No evidence; some studies show counter-effect efficacy.

Myth 6: “Antipsychotic standard first-line”

Evidence: parent training and psychosocial approaches first-line; risperidone off-label in severe refractory cases.

11. Sources

1. WHO. ICD-11. 6C91 Conduct-dissocial disorder. 2024.
2. APA. DSM-5-TR. 2022.
3. NICE CG158. Antisocial behaviour and conduct disorders in children and young people: recognition and management. 2017.
4. Steiner H., Remsing L. AACAP Practice Parameter for the Assessment and Treatment of Conduct Disorder. J Am Acad Child Adolesc Psychiatry 2007;46(1):126–141.
5. Petrosino A. et al. “Scared Straight” and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database Syst Rev 2013;(4):CD002796.
6. Henggeler S.W. Multisystemic Therapy. Guilford Press; 1998.
7. Sanders M.R. Development, evaluation, and multinational dissemination of the Triple P-Positive Parenting Program. Annu Rev Clin Psychol 2012;8:345–379.