It is normal for all children to act out on occasion, particularly against parents and family members. However, if this behavior becomes repetitive or lasts for more than six months, parents, guardians or caregivers should consider getting professional help for their child.
Conduct disorder and oppositional defiant disorder are two different types of disruptive behavior disorders in children. Disruptive behavior disorders are characterized by children acting out against other children or adults through defiant and disrespectful behavior. Alternatively, a child may be disobedient when it comes to accepting typical societal structures and norms.
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) classifies both conduct disorder and oppositional defiant disorder as disruptive, impulse-control and conduct disorders. While there are many similarities between these two, there are also quite a few differences between these conditions.
Table of Contents
What Is Oppositional Defiant Disorder?
The DSM-5 classifies oppositional defiant disorder as a condition involving recognizable and negative behavioral patterns. The definition of oppositional defiant disorder includes an overall negative or agitated mood, a quarrelsome attitude or being vengeful for at least six months.
For a child to be diagnosed with an oppositional defiant disorder, they must exhibit at least four out of eight symptoms found in the diagnostic criteria of DSM-5. These symptoms must be present during interactions with others and do not include interactions with siblings.
Signs and Symptoms
Typically, the age of onset of oppositional defiant disorder begins before age eight and no later than age 12. While the exact causes of oppositional defiant disorder are unknown, several factors predispose a child to develop this disorder. Some of these factors include genetic predisposition, a lack of structure in the home and slight differences in the brain.
Signs and symptoms that a child has oppositional defiant disorder include:
- The child often loses their temper
- The child is easily agitated
- The child often expresses anger and resentment
- The child becomes argumentative to anyone with authority (e.g., adults, teachers, strangers)
- The child purposely disobeys established rules
- The child causes commotions or partakes in disruptive behavior
- The child lays blame on others
- The child exhibits spite or vengeance at least twice within a six-month period
To properly diagnose a child with an oppositional defiant disorder, a mental health professional defers to the DSM-5 and performs a full psychological evaluation, which assesses:
- The child’s mental, physical and emotional health
- How frequently the child exhibits negative behaviors
- How the child interacts with others
- The child’s mental health history
If a child exhibits four of the eight signs and symptoms from the DSM-5, there are several additional criteria they must meet to be diagnosed with this disorder. Criteria include:
- Children that are younger than five years old should exhibit signs and symptoms most days of the week for six months
- Children five years of age or older must exhibit symptoms at least once a week for six months
- The child’s behavior must have a negative impact on their own life or social interactions with family, friends, acquaintances, and teachers
- Negative behaviors would not meet criteria for other mental health conditions like bipolar disorder or substance use disorder
- Severity of oppositional defiant disorder ranges from mild to severe and should be assessed by a mental health professional
What Is Conduct Disorder?
A conduct disorder is defined as a continual pattern of aggression toward others as well as intentional rule-breaking behavior. Conduct disorder is also a childhood disorder, like oppositional defiant disorder. The DSM-5 characterizes a conduct disorder as a condition where a child intentionally violates rules and the rights of others.
Signs and Symptoms
The age of onset of a conduct disorder is around 11 years of age, but it can still develop in early adolescence. General conduct disorder symptoms involve aggressive displays toward other children, adults, and animals, destroying other people’s property, stealing and lying.
Some common conduct disorder signs and symptoms include:
- Expressing aggressive behaviors, including bullying or intimidation tactics
- Initiating fights
- Using a weapon to injure people or animals
- Past instances of physical cruelty to people and animals
- Directly stealing property from victims
- Forcing someone to perform an activity they are not comfortable with (e.g., sexual activity)
- Intentionally causing a fire or another major dilemma
- Finding multiple ways to destroy another’s property
- Breaking into another person’s private property
- Lying to get out of duties or obligations
- Staying out later than they are supposed to for their age
- Running away from home numerous times overnight
- Being absent from school without a reason
According to the DSM-5, there are several additional criteria for being diagnosed with a conduct disorder. A child or adolescent must meet at least three out of 15 criteria within a span of a year and have one of those criteria present in the past six months for an accurate diagnosis.
Additionally, a medical professional will try to determine the age of onset through a psychological evaluation.
The severity of a conduct disorder ranges from mild to severe. Someone close to the child (e.g., parent, guardian, friend or teacher) should take note of:
- The child’s emotions in the past few months
- Whether the child shows guilt for their bad behavior or actions
- Whether the child expresses empathy
- Whether the child is upset by their poor performance in school
- How sincere the child’s emotions are
Similarities in Disruptive Behavior Disorders
There are many similarities and differences between disruptive behavior disorders. How severe each disorder is will be unique to the child and their specific environment. Nevertheless, both predisposing factors and several signs and symptoms are similar between oppositional defiant disorder and conduct disorder. Some overlapping factors include:
- In both cases, children may be defiant and will not obey rules imposed by society or those closest to them
- Both conditions may co-occur with other mental health conditions like ADHD, mood disorders, anxiety or depression
- It is possible for children to have oppositional defiant disorder and conduct disorder, or for one to develop after the other
- Both conditions can be successfully treated by medical professionals
- Both conditions are likely caused by a mix of genetic, environmental and psychological factors
DBDs vs. ADHD
Attention-deficit hyperactivity disorder (ADHD) often co-occurs with disruptive behavior disorders and is another common childhood and adolescent mental health condition. Typically, ADHD involves impulsive behavior, an inability to pay attention for long periods, procrastinating, being hyper and having trouble starting and completing tasks.
It is estimated that between one-third to one-half of children diagnosed with ADHD also meet diagnostic criteria for an oppositional defiant disorder. Males are more likely to be diagnosed with ADHD and oppositional defiant disorder, as well as children that experience divorce or are raised in a low socioeconomic status family.
Additionally, ADHD and conduct disorder also frequently co-occur. It is estimated that 25% of children and 45% of adolescents who are diagnosed with ADHD will have conduct disorder. Similar to oppositional defiant disorder, males are more likely to be diagnosed with both ADHD and conduct disorder and their risk for developing a co-occurring conduct disorder increases with age over their female counterparts.
Key Differences: The Role of Control
What are the main differences between oppositional defiant disorder and conduct disorder? It may be argued that both disruptive behavior disorders involve problems with impulse control, albeit in different ways.
The behavior of a child that is diagnosed with oppositional defiant disorder suggests that they hate being controlled by society or their loved ones. This reason is also the case for a child diagnosed with conduct disorder. However, a child with conduct disorder, in response to hating the feeling of being controlled, will usually try to control others, either consciously or subconsciously.
With antisocial personality disorder, children may go on to develop a co-occurring conduct disorder. Adolescents with antisocial personality disorder engage in many of the same behaviors that children with conduct disorders do. For instance, they may:
- Have difficulties maintaining friendships
- Have abusive relationships with parents and siblings
- Quickly become isolated from their peers
In both cases, children or adolescents with an antisocial personality disorder or a conduct disorder do not want to be controlled, yet want to control others simultaneously.
Treatment for Disruptive Behavior Disorders
What are the treatment options for disruptive behavior disorders? There are many effective treatments for either oppositional defiant disorder or conduct disorder. Typically, oppositional defiant disorder treatment includes:
- Parent training, which establishes consistency
- Parent-child interaction therapy
- Family therapy
- Individual therapy
- Problem-solving training
- Improving social skills
Conduct disorder treatment involves similar forms of therapy as oppositional defiant disorder. In addition to the treatments for oppositional defiant disorder, a child or adolescent with conduct disorder may need other treatments, including:
- Behavioral therapy
- Special education (if learning disabilities are present)
- Educational programs at home and at school
- Multisystemic therapy (treatment at home)
- Medication (if other mental health conditions are present, like depression)
Tips for Parents
Many resources exist for parents of children who have disruptive behavior disorders. Oppositional defiant disorder strategies for parents include:
- Always emphasizing and reinforcing positive behaviors
- Practicing relaxation and breathing techniques when conflicts arise
- Providing a structured home life
- Reinforcing rules with consistency
- Realizing that not every problem is worth a fight
Parenting a child with a conduct disorder can be extremely challenging and can impact the whole family dynamic. Conduct disorder resources for parents include:
- Developing a stable and helpful support system
- Having a partner who establishes consistency and enforces rules
- Finding healthy ways to manage stress
- Finding other parents who also have children with this disorder
Important Takeaways: Oppositional Defiant Disorder vs. Conduct Disorder
There are several important facts to remember about oppositional defiant disorder versus conduct disorder:
- Oppositional defiant disorder and conduct disorder are related but separate childhood conditions
- Children and adolescents may develop both of these behavior disorders or may develop one after the other
- Often, children struggle with oppositional defiant disorder or conduct disorder and a co-occurring condition like ADHD
- Both oppositional defiant disorder and conduct disorder have roots in control issues
- Oppositional defiant disorder involves problems with being controlled
- Conduct disorder involves problems with being controlled and the need to exert control over others
If you or a loved one struggle with a drug or alcohol addiction and a co-occurring mental health condition, The Recovery Village can help. Contact a representative today to discuss available treatment options for these co-occurring conditions.
American Academy of Child and Adolescent Psychiatry. “Conduct Disorder.” June 2018. Accessed June 14, 2019. The Centers for Disease Control and Prevention. “Behavior or Conduct Problems in Children.” March 12, 2019. Accessed June 13, 2019. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). “Disruptive Behavior Disorders.” (n.d.) Accessed June 14, 2019. National Academies Press. “7 Clinical Characteristics of Oppositional Defiant Disorder and Conduct Disorder.” NCBI Bookshelf, October 28, 2015. Accessed June 13, 2019. Silberg, Judy, Moore, Ashley and Rutter, Michael. “Age of onset and the subclassification of conduct/dissocial disorder.” J Child Psychol Psychiatry, July 2015. Accessed June 13, 2019. Substance Abuse and Mental Health Services Administration. “Table 17: DSM-IV to DSM-5 Conduct Disorder Comparison.” June 2016. Accessed June 13, 2019. Substance Abuse and Mental Health Services Administration. “Table 18: DSM-IV to DSM-5 Oppositional Defiant Disorder Comparison.” June 2016. Accessed June 13, 2019.
American Academy of Child and Adolescent Psychiatry. “Conduct Disorder.” June 2018. Accessed June 14, 2019.
The Centers for Disease Control and Prevention. “Behavior or Conduct Problems in Children.” March 12, 2019. Accessed June 13, 2019.
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). “Disruptive Behavior Disorders.” (n.d.) Accessed June 14, 2019.
National Academies Press. “7 Clinical Characteristics of Oppositional Defiant Disorder and Conduct Disorder.” NCBI Bookshelf, October 28, 2015. Accessed June 13, 2019.
Silberg, Judy, Moore, Ashley and Rutter, Michael. “Age of onset and the subclassification of conduct/dissocial disorder.” J Child Psychol Psychiatry, July 2015. Accessed June 13, 2019.
Substance Abuse and Mental Health Services Administration. “Table 17: DSM-IV to DSM-5 Conduct Disorder Comparison.” June 2016. Accessed June 13, 2019.
Substance Abuse and Mental Health Services Administration. “Table 18: DSM-IV to DSM-5 Oppositional Defiant Disorder Comparison.” June 2016. Accessed June 13, 2019.