GPAtlas🧭 When to suspect
A conduct disorder is a repetitive and persistent pattern of antisocial, aggressive or defiant behaviour that significantly violates age-appropriate social expectations – well beyond the ordinary defiance, impulsivity and mischief seen in any child. The behaviour falls into four broad domains: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules (truancy, running away). Crucially, isolated antisocial or criminal acts are not sufficient for the diagnosis – ICD-10 requires the pattern to have been present for at least 6 months.
This matters because conduct disorders are the single most common reason children are referred to CAMHS, affecting around 5% of UK children aged 5–16, and they carry a long shadow: up to half go on to develop antisocial personality disorder in adulthood, alongside poorer educational, occupational and health outcomes. Early recognition and support genuinely change the trajectory.
The GP's role is rarely to make the formal diagnosis – that follows a comprehensive specialist assessment – but to recognise the pattern, screen for the very common treatable comorbidities (above all ADHD), think safeguarding, initiate evidence-based parenting support, and refer appropriately. Two anchors are worth holding onto: comorbidity is the rule, and the behaviour may be a signal of something wrong in the child's world – abuse, neglect or trauma – never simply “a bad child”.
| Oppositional defiant disorder (ODD) | Conduct disorder |
|---|---|
|
• More common in children aged 10 years or younger – often the earlier, milder end of the spectrum. |
• More common in those aged over 11 years – the more severe end, with greater risk of harm and offending. |
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• Persistent angry/irritable mood, argumentative and defiant behaviour and vindictiveness, typically directed at authority figures. |
• Repetitive violation of the basic rights of others and major societal norms – aggression, destruction, deceit/theft and serious rule-breaking. |
|
• Defiance, temper outbursts, refusing rules, deliberately annoying others and blaming others for one's own behaviour. |
• ODD may precede or evolve into a conduct disorder; the key distinction is the extent and severity of the antisocial behaviour. |
Source: NICE CG158
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