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Childhood ADHD vs. Conduct Disorder

Medically Reviewed by Dan Brennan, MD on May 24, 2022

Kids often squirm, fidget, talk too much, or don’t want to take turns. It’s not unusual for any kid to have trouble paying attention sometimes. But for almost 10% of kids with ADHD (attention deficit hyperactivity disorder), these types of symptoms don’t get better with time in the way you’d expect. While kids with ADHD might be disruptive, they aren’t typically aggressive. When kids show a pattern of more aggressive, violent, or antisocial behaviors, such as skipping school, stealing, or harming others, it could be conduct disorder. About 3% of kids have conduct disorder.

Along with oppositional defiant disorder (ODD), ADHD and conduct disorder are among the most common disruptive behavior disorders in kids and teens. Together they affect up to 15% of all kids of school age. While ADHD and conduct disorder look very different, it’s possible and not uncommon for kids to have ADHD and conduct disorder. Kids with ADHD are more likely than other kids to have conduct disorder.

Symptoms of ADHD vs. Conduct Disorder

Kids with ADHD show an ongoing pattern of inattention, hyperactivity-impulsivity, or both.

Common symptoms of inattention in kids with ADHD include:

  • Failing to pay attention to details or making careless mistakes
  • Having trouble paying attention during tasks or play
  • Not listening when spoken to
  • Not following instructions
  • Not finishing tasks
  • Trouble staying organized
  • Avoiding tasks that require attention or mental effort
  • Losing items that are needed to do required tasks
  • Being easily distracted or forgetting things

Common symptoms of hyperactivity and impulsivity in kids with ADHD include:

  • Fidgeting, tapping, or squirming a lot
  • Getting up and moving around when they are supposed to sit still
  • Running around or climbing in places or at times when they shouldn't
  • Having trouble doing quiet activities
  • Being always “on the go”
  • Talking too much, blurting out answers, or interrupting
  • Not waiting their turn

Kids with conduct disorder may also have signs of ADHD and trouble with attention or hyperactivity-impulsivity. But kids with conduct disorder act as though they like hurting people and doing things that they really shouldn’t do. They may be “mean,” violent, or break things on purpose.

The criteria for conduct disorder include:

  • Bullying, threatening, or intimidating other people
  • Starting physical fights a lot
  • Using weapons, bats, or other items that can hurt people
  • Being physically cruel to other people or animals
  • Stealing directly from people
  • Forcing another person to have sex against their will

In addition to threatening or hurting other people or animals, kids with conduct disorder may:

  • Start fires that cause damage on purpose
  • Destroy other people’s things
  • Break into houses, cars, or buildings
  • Lie to get what they want
  • Shoplift or steal
  • Stay out all night before age 13
  • Run away from home more than once
  • Skip school from a young age

Diagnosing ADHD vs. Conduct Disorder

If you’re worried your child might have ADHD or conduct disorder or both, talk to your doctor or a mental health professional. Your regular doctor may be able to offer some initial help. They can also refer you for counseling or other more intensive therapy, as needed. 

For a diagnosis of ADHD, kids under 16 must show six or more symptoms of inattention or hyperactivity and impulsivity. Their symptoms must persist for at least 6 months in ways that are disruptive and inappropriate for their age. Once kids turn 17, ADHD can be diagnosed with 5 or more symptoms. But for it to be ADHD, kids must have had symptoms before they turn 12, even if they weren’t diagnosed.

For a doctor to diagnose ADHD, symptoms also have to come up in more than one place, such as at school and at home. They also have to get in the way of their ability to function at school or with friends and family. The symptoms also shouldn’t be explained by some other disorder. Sometimes this is tricky because kids with ADHD often do have other mental health disorders.

For a doctor to diagnose conduct disorder, kids must show a consistent pattern of hurtful or damaging behavior toward people, animals, or property that go against rules or social norms. Kids with conduct disorder should meet at least three of the criteria in the last year and at least one in the last 6 months.

 Since it’s fairly common for kids with ADHD to have conduct disorder or ODD, your doctor might want to consider whether a child may have symptoms of more than one condition. If you have concerns about hostile or aggressive behavior in addition to trouble paying attention or hyperactivity, be sure to ask your doctor about this possibility.

Treatment of ADHD vs. Conduct Disorder

ADHD symptoms can get better with treatment, although it usually doesn’t go away. For kids with ADHD under 6, your doctor might recommend you get training on how to manage your child’s behavior first before trying medicine. Kids age 6 and up are more likely to get medicine and therapy together. Stimulants are the most common medicine for ADHD. Your child may also benefit from extra support at school.

Conduct disorder isn’t easy to treat. Therapy might help your child learn how to interact with others in less hurtful ways. You and others in your child’s life also can learn new ways to interact with your child. Kids with conduct disorder often need long-term therapy and there’s no medicine to treat it. But if your child with conduct disorder also has ADHD, depression, or another mental health condition, treating the other conditions might help.

Understanding Risks for ADHD vs. Conduct Disorder

It’s not clear why any kid gets ADHD or conduct disorder. Kids with a family history or certain exposure might have more risk for ADHD.  Conduct disorder happens more in kids with another disorder or a parent or sibling with conduct disorder. It’s also more likely in kids who’ve been neglected or abused.

Sometimes ADHD progresses into conduct disorder. Because the two conditions sometimes happen together, it can be hard to separate the two in some cases. It’s possible that they can have some of the same underlying causes. But most kids with ADHD don’t end up with conduct disorder.

If you are worried that your child has signs of ADHD, conduct disorder, or any other mental health or behavioral disorder, it’s a good idea to get help early. Teens with ADHD and conduct disorder are more likely to suffer from depression, use drugs or other substances, or get into trouble. It may help to intervene early before other problems arise.

Show Sources

SOURCES:

Centers for Disease Control and Prevention: “Attention-Deficit/Hyperactivity Disorder.”

Johns Hopkins Medicine: “Conduct Disorder.”

Behavioral Sciences: “Understanding the Demographic Predictors and Associated Comorbidities in Children Hospitalized with Conduct Disorder.”

Case Reports in Psychiatry: “ADHD, ODD, and CD: Do They Belong to a Common Psychopathological Spectrum? A Case Series.”

DSM-5: “Conduct Disorder.”

American Family Physician: “Conduct Disorder: Diagnosis and Treatment in Primary Care.”

Chadd.org: “ADHD and Disruptive Behavior Disorders.”

Child Mind Institute: “Quick Guide to Conduct Disorder,” “ADHD and Substance Abuse,” “When Depression Co-occurs with ADHD.”

Beth Israel Lahey Health Winchester Hospital: “Risk Factors for Attention Deficit Hyperactivity Disorder (ADHD).”

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