Synopsis
Assess persistent oppositional or conduct problems developmentally and without blame, identify neurodevelopmental, trauma, family and safeguarding needs, distinguish immediate danger from chronic difficulty, and deliver evidence-based parent, child and multimodal interventions.
- Describe specific behaviours, frequency, settings, development and impact rather than calling a child difficult, manipulative, bad or antisocial.
- Oppositional behaviour involves a persistent pattern of angry or irritable mood, argument and defiance beyond developmental expectations; conduct disorder includes repeated violation of others' rights or major age-appropriate rules.
- Diagnosis requires persistence and impairment across context, not one conflict with an adult or a reaction to an unsafe, discriminatory or inaccessible environment.
- Assess ADHD, autism, learning or language needs, depression, trauma, attachment, substance use, psychosis, physical illness and child maltreatment before attributing behaviour to conduct disorder.
- A functional account maps antecedents, behaviour and consequences, including what the child communicates, obtains or escapes and how adults and peers respond.
- NICE recommends group parent training for parents or carers of children aged 3–11 at high risk of or with oppositional defiant or conduct disorder.
- For severe and complex problems aged 3–11, offer individual parent-and-child training; for ages 9–14 consider child-focused social and cognitive problem-solving.
- For young people aged 11–17, multimodal interventions coordinate family, school, peers and community rather than relying on office therapy alone.
- Do not routinely use medication for behavioural problems; treat coexisting ADHD appropriately and reserve short-term specialist risperidone consideration for narrowly defined severe aggression after psychosocial non-response.
Key red flags
Weapon access, credible threats, serious assault, strangulation, fire-setting or cruelty with immediate opportunity requires urgent safety assessment and restriction of access.
A sudden onset of aggression with reduced sleep, grandiosity, psychosis, confusion, seizure, head injury or intoxication suggests an acute disorder rather than a stable conduct pattern.
Criminal or sexual exploitation, trafficking, gang control, coercive older peers, unexplained money or repeated missing episodes are safeguarding concerns, not merely delinquency.
Injuries, fear of a carer, domestic abuse, harsh punishment, neglect or developmentally inappropriate responsibility requires private enquiry and safeguarding action.
Suicidal behaviour, severe self-harm, escalating substance use or profound school and relationship collapse can accompany externalising presentations and must be asked about directly.
Investigation priorities
Define onset, frequency, severity, setting, triggers, consequences, harm and developmental fit.
Management branches
Repeated conflict, aggression, rule breaking or irritability is reported by family, school or another service.
- Speak with the child and carers, define behaviours and developmental context, identify strengths and obtain cross-setting information with appropriate consent.
- Assess neurodevelopment, mental and physical health, trauma, substances, learning, family stress, school environment, exploitation and safeguarding.
- Share a non-blaming formulation that separates immediate safety action from longer-term skills, family and environmental intervention.