Paediatric Neurologist Perspective on Conduct Disorder – Cadabams CDC
Raising a child with repeated aggression, defiance or rule-breaking can feel overwhelming. Seeing events only through a behavioural lens often leaves parents asking, “What is happening inside my child’s brain?” A paediatric neurologist perspective on conduct disorder helps decode the neurodevelopmental roots of these behaviours and shows clear, hopeful paths forward. At Cadabams CDC, our paediatric neurology team partners with parents to move from confusion to confident action.
What Paediatric Neurologists Say About Conduct Disorder
Conduct disorder (CD) is not simply “bad behaviour.” Neurologists view it as a brain-based condition in which circuits controlling impulse, emotion and foresight develop atypically.
Neurodevelopmental Basis of Early-Onset Conduct Disorder
- Begins before age 10.
- Linked to delayed maturation of the pre-frontal cortex and amygdala.
- Higher risk of persistent antisocial behaviour into adulthood without early support.
Adolescence-Onset Conduct Disorder: Brain Maturation Factors
- Emerges after age 10.
- Often tied to accelerated reward-circuit maturation outpacing self-control regions.
- Greater brain plasticity means faster response to structured interventions.
Core Neurological Findings in Conduct Disorder
Understanding the biology reassures parents that behaviour is not a moral failing but a medical puzzle that can be solved.
Structural Brain Imaging (MRI) Insights
- MRI studies show 5–10 % smaller volume in the anterior cingulate and insula.
- Reduced white-matter integrity in the uncinate fasciculus (the “brake cable” between limbic and frontal lobes).
Functional & Electrophysiological Markers (EEG, fMRI)
- EEG reveals low frontal theta power, indicating weaker top-down control.
- fMRI demonstrates hyper-reactive amygdala to threat and hypo-reactive prefrontal cortex during moral decision tasks.
Executive Function & Impulse-Control Circuitry
- Working memory, response inhibition and cognitive flexibility are consistently impaired.
- These deficits map onto under-activation of dorsolateral prefrontal networks.
When to Consult a Paediatric Neurologist for Conduct Disorder
Red Flags: Early-Onset vs Adolescence-Onset Symptoms
| Age of Onset | Early Warning Signs |
|---|---|
| Before 10 yrs | Cruelty to animals, fire-setting, persistent bullying |
| After 10 yrs | Sudden truancy, gang involvement, severe rule violations |
Step-by-Step Referral Actions for Parents & Paediatricians
- Track behaviours for 4 weeks using a daily log.
- Share results with the child’s paediatrician.
- Request a neurologist referral if red flags persist.
What to Expect in the First Neurology Consultation
- Detailed birth, developmental and seizure history.
- Quick, child-friendly cognitive games to gauge executive function.
- Clear explanation of any recommended tests.
Diagnostic Process at Cadabams CDC
Neurological History & Standardised Questionnaires
- Parents complete the Swanson, Nolan and Pelham (SNAP-IV) and Eyberg Child Behaviour Inventory.
- Children perform the NIH Toolbox executive-function tasks on a tablet.
Neuroimaging & Laboratory Work-Up Protocol
- 3-Tesla MRI for structural anomalies.
- Optional 24-hour EEG if seizures are suspected.
- Blood tests to rule out thyroid or metabolic issues.
Multidisciplinary Team Review & Case Discussion
- Neurologists, psychiatrists, psychologists and special educators meet weekly to craft an individualised care plan.
Evidence-Based Neurological Interventions
Neurofeedback & Cognitive Training
- 30-minute sessions twice a week for 12 weeks.
- Real-time brainwave feedback to strengthen frontal theta rhythms.
Medication Review for Comorbid ADHD or Mood Dysregulation
- Careful titration of stimulants or mood stabilisers only when clinically indicated.
- Regular ECG and growth monitoring to ensure safety.
Family Psychoeducation & School Liaison Support
- Evening workshops for parents.
- Letter to school outlining classroom strategies (e.g., movement breaks).
Parent & Caregiver Resources
Downloadable Guides & Action Plans
- “Daily Behaviour Tracker” PDF.
- “How to De-escalate Meltdowns” video series.
Recommended Reading & Collections
- “The Explosive Child” – Dr. Ross Greene.
- Cadabams CDC curated blog list on executive function hacks.
Support Groups for Families
- Monthly online meet-ups moderated by a parent-mentor.