Early predictors of conduct disorder.
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Adolescent↗
Biomedical subjects
R Loeber
Publications and source records attributed to R Loeber.
Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study.
OBJECTIVE: This article addresses the following questions: What are the best demographic and psychiatric predictors of the onset of conduct disorder (CD)? Does physical fighting play a role in the transition from oppositional defiant disorder (ODD) to CD? And what are the predictors of an earlier compared with a later onset of CD? METHOD: Data are presented on the follow-up of a clinic-referred sample of 177 preadolescent boys who were studied for a period of 6 years. Psychiatric assessments were based on information from the boys, their parent, and their teacher. RESULTS: Of all CD symptoms, physical fighting best predicted the onset of CD in bivariate analyses. Logistic regression showed that low socioeconomic status of the parent, ODD, and parental substance abuse best predicted the onset of CD. In addition, attention-deficit hyperactivity disorder (ADHD) predicted an early onset of CD. CONCLUSIONS: Parental substance abuse, low socioeconomic status, and oppositional behavior are key factors in boys' progression to CD. Physical fighting, although not a symptom of ODD, should be targeted in preventive interventions along with ODD symptoms. ADHD is implicated in the early onset of CD, but not in later-onset CD.
Adolescent↗
Problems and solutions in longitudinal and experimental treatment studies of child psychopathology and delinquency.
This article identifies questions in child psychopathology and delinquency that can best be answered by using longitudinal data and discusses the advantages and problems of longitudinal studies. The article also reviews methodological issues arising in longitudinal research on child psychopathology and proposes solutions to problems. Retrospective and prospective designs are contrasted with the accelerated longitudinal design. It is concluded that more longitudinal studies of child psychopathology including experimental treatment interventions are needed, with repeated data collection from a variety of sources and several years of data before and after the interventions. Such studies, in addition to the traditional longitudinal studies, are likely to improve the understanding of child psychopathology and of factors that influence and reduce serious outcomes for children and adolescents.
Adolescent↗
Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder.
This paper compares the validity of DSM-III-R diagnoses of oppositional defiant disorder (ODD) and conduct disorder (CD) and an alternative option which is subdivided into three levels according to developmental sequence and severity: modified oppositional disorder (MODD), intermediate CD (ICD), and advanced CD (ACD). Using a sample of 177 boys followed over 3 years, both the DSM-III-R and the alternative diagnostic constructs are evaluated on three criteria: symptom discriminative validity, and diagnostic external and predictive validity. Most DSM-III-R ODD and CD symptoms discriminated between ODD and CD, but exceptions are noted. Additional analyses demonstrated considerable overlap among DSM-III-R oppositional symptoms. The majority of the symptoms proposed for the alternative option could be assigned to a specific level based on acceptable symptom discrimination. External validity lent support to the distinctions between DSM-III-R ODD and CD, and between MODD, ICD, and ACD. MODD was a better predictor than ODD of which MODD, ICD, and ACD. MODD was a better predictor than ODD of which boys received a later diagnosis of CD. Suggestions are made for the inclusion and exclusion of symptoms for developmentally based diagnoses of oppositional and conduct disorders.
Antisocial Personality Disorder↗
Longitudinal study of delinquency, drug use, sexual activity, and pregnancy among children and youth in three cities.
Using data from a collaborative program of research, this paper examines the prevalence of delinquency, alcohol and drug use, sexual intercourse, and pregnancy among youth in three urban settings. The findings indicate that a substantial portion of adolescents are involved in these behaviors. There are indications that for many youth the initiation of delinquency and drug use is occurring before the teenage years. There are also indications that all of these behaviors are often co-occurring, suggesting that comprehensive intervention programs may be required. Importantly, the high rate of sexual activity and pregnancy, combined with alcohol and drug use, suggests that greater attention to this combination of behaviors is needed.
Adolescent↗
Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting.
In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.
Antisocial Personality Disorder↗
Oppositional defiant and conduct disorders: issues to be resolved for DSM-IV.
Oppositional defiant disorder (ODD) and conduct disorder (CD) are reasonably distinct both in terms of statistical covariation among symptoms and ages of onset. The two disorders are related in similar ways to impairment and family history of antisocial behavior, but the association is stronger for CD than ODD. Virtually all clinic-referred youths with prepubertal onset of CD have retained the symptoms of ODD that emerged at earlier ages. Furthermore, a set of serious antisocial behaviors characteristically emerges at later ages in some youths with CD, suggesting further developmental progression within CD. These findings are consistent with a conceptualization of ODD and CD as developmentally staged, hierarchically organized levels of severity of the same disorder, but two findings argue for distinguishing separate disorders in DSM-IV: (1) many youths with ODD never develop CD, and (2) CD that emerges for the first time in adolescence appears to be independent of ODD.
Acting Out↗
The nuts and bolts of implementing large-scale longitudinal studies.
Studies that assess large numbers of subjects for longitudinal research, for epidemiological purposes, or for the evaluation of prevention and intervention efforts, are very costly and should be undertaken with the greatest care to ensure their success. The success of a study, apart from its scientific merit, depends largely on the ability of the researcher to plan and set up a smoothly running operation. However, the skills required for such a task are often not acquired in academic training, nor do scientific journals abound with information on the practical aspects of running a large study. This paper summarizes the experience gained in executing a longitudinal study and covers aspects of planning, hiring of staff, training and supervision of interviewers, data collection and data entry and management. The importance of the use of the computer as a management tool is stressed.
Adolescent↗
Differences and similarities between children, mothers, and teachers as informants on disruptive child behavior.
Prevalence rates of disruptive child behaviors, based on structured psychiatric interviews, are presented for samples of clinic-referred prepubertal boys at two sites to investigate differences and similarities among reports of the behaviors from children, parents, and teachers. Children reported significantly less hyperactive/inattentive and oppositional behaviors than either parents or teachers. In contrast, children did not differ from parents or teachers in their report on the prevalence of more serious conduct problems. These results were well replicated across two sites, despite the fact that there were significant differences between the sites in the level of hyperactive/inattentive child behaviors and conduct problems. The ranking of parents' and teachers' reported prevalence of specific child behavior problems in each of the three domains of disruptive behavior was strikingly similar. With one exception, the concordance between the prevalence ranking based on the children's reports was lower than that based on adults' reports, Children's reports on their own behavior did not predict various child handicaps 1 year later as well as did adults' reports. The results are discussed in relation to the usefulness of certain child behaviors in symptom lists for diagnostic purposes; the reliability of children's reports on their own behavior; and the possible reasons why prevalence rankings, as perceived by adults, are so similar.
Attention Deficit Disorder with Hyperactivity↗
Disruptive boys with stable and unstable high fighting behavior patterns during junior elementary school.
Boys' fighting was assessed at ages six, eight, and nine. The boys (N = 69) had been selected from the 30% most disruptive children in kindergartens from low socioeconomic neighborhoods. Twenty-three percent of these disruptive boys were rated as high fighters on three assessments ("stable high fighters"), and 28% were rated as high fighters on two of the three assessments ("variable high fighters"). Forty-two percent were rated as high fighters only one out of three assessments ("occasional high fighters") and 7% were never rated as high fighters. Only high fighting in two successive years significantly increased the risk of being rated a high fighter in a following year. At age 10, stable high fighters (high fighters at ages 6, 8, 9) were perceived by teachers, peers, mothers, and the boys themselves as more disruptive and more antisocial than occasional high fighters. These results show an impressive self-other agreement in boys who have adopted a physically aggressive life style from an early age. The three groups did not differ on individual family demographic characteristics, but stable high fighters had a higher mean on an index of family socioeconomic disadvantage. Results indicate that the aggression scales which include only a few physical aggression items and many disruptive items (oppositional behavior, rejection, hyperactivity, inattention, etc.) probably aggregate two kinds of disruptive boys, the high-frequency fighters at high risk for stable disruptive, physically aggressive, and antisocial behaviors, and the disruptive low-frequency fighters who are at a lower risk of stable disruptive behavior and at a lower risk of early antisocial behavior.
Aggression↗
Diagnostic conundrum of oppositional defiant disorder and conduct disorder.
Evidence for a diagnostic distinction of oppositional defiant disorder (ODD) and conduct disorder (CD) is reviewed, and alternative conceptualizations and definitions for the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders are considered. Studies suggest that CD and ODD are strongly and developmentally related but clearly different. Factor analyses indicate that distinct covarying groups of ODD and CD symptoms can be identified, but certain symptoms relate to both (particularly mild aggression and lying). Age of onset for ODD is earlier than for most CD symptoms. Nearly all youths with CD have a history of ODD, but not all ODD cases progress to CD. The disorders demonstrate the same forms of parental psychopathology and family adversity but to a greater degree for CD than for ODD. Alternative conceptualizations for the disorders are presented for further study before the introduction of the DSM-IV.
Aggression↗
Stability of mothers' recall of the age of onset of their child's attention and hyperactivity problems.
The stability of mothers' recall of age of onset of attention deficit and hyperactive behaviors was assessed over a 1-year interval. The paper reports on which behaviors have the highest stability and the stability of a psychiatric diagnosis of attention deficit hyperactive disorder using different age cut-offs. The data showed a moderate degree of stability over a 1-year period, with school-related symptoms showing the least amount of change. An argument is made for keeping the current DSM-III-R diagnostic cut-off at age 6.
Attention↗
Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment.
Jeffrey A. Gray has proposed a model in which conduct disorder (CD) is viewed as the result of both excessive activity of a behavioral activation system that mediates appetitive and aggressive behavior and deficient activity of a behavioral inhibition system that mediates both anxiety and the inhibition of behavior in the presence of cues signalling impending punishment or frustration. The relation of anxiety to antisocial behavior was examined in 177 clinic-referred boys, aged 7 to 12 years, 68 of whom met DSM-III-R criteria for CD. As predicted by Gray's model, boys with CD and comorbid anxiety disorder were markedly less impaired than boys with CD alone.
Aggression↗
Anxiety, inhibition, and conduct disorder in children: II. Relation to salivary cortisol.
The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Gray's biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.
Adolescent↗
Antisocial behavior: more enduring than changeable?
This paper challenges the notion that many children outgrow early conduct problems. It explores factors that may have led to researchers' underestimating the stability of antisocial behaviors, especially because these behaviors manifest themselves differently in various phases of the life course. In addition, data suggest that the malleability of child behaviors decreases as children grow older, contributing to a higher continuity of antisocial behavior possibly from early adolescence onward. Implications are discussed for the study and intervention of antisocial behavior.
Adolescent↗
Pervasive and situational hyperactivity--confounding effect of informant: a research note.
Several studies of children with problems of hyperactivity, impulsivity, and inattention (HIA) have suggested that when such behaviour occurs in more than one setting, associated conduct problems, emotional symptoms, and functional impairment are more serious than when HIA problems are seen in one situation only. Analyses of parent and teacher reports on a community sample of 480 children aged 7-11 are presented to show that in some cases this conclusion may have resulted from a confound between informant and information. When children with situational HIA were divided into 'home situational' and 'school situational' subgroups, their scores on other measures of psychopathology and impairment varied, depending on whether the informant was the parent or the teacher. When the source of information was independent of parents' or teachers' judgments, no differences were found between situationally and pervasively HIA children. Implications for future studies of situational and prevasive HIA are discussed.
Affective Symptoms↗
Oppositional defiant disorder and conduct disorder.
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Age Factors↗