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PubMed1995

Hyperactivity: prevalence and relationship with conduct disorder.

This paper reports the prevalence of situational and pervasive hyperactivity using different definitions of 'caseness', and explores the relationship between situational and pervasive hyperactivity and conduct disorder, using a large data base from the North of England. The prevalence of hyperactivity, and its relationship with conduct disorder, varied according to whether hyperactivity was pervasive or situational, according to the age of the child and to the definition of hyperactivity 'caseness'. Among younger children only, school based situational and pervasive hyperactivity had comparable comorbidity with other available evidence of psychiatric disorder and hyperactivity was virtually a prerequisite for conduct disorder. Among older children, pervasive hyperactivity had greater comorbidity with other psychiatric disorder than situational hyperactivity and, furthermore, displayed the strongest links with conduct disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Platelet serotonin measures in adolescents with conduct disorder.

Dysregulation of serotonergic function has been associated with aggression in several studies involving children, adolescents, and adults. This study investigated the relationship of platelet serotonergic measures to conduct disorder type, severity of aggression, and social skills impairment. Standardized assessments of diagnosis, aggression, impulsivity, and social skills were obtained from 43 male adolescents (ages 13-17) incarcerated at an involuntary residential treatment facility for juvenile offenders. Blood samples were collected and assayed for whole blood serotonin (5-HT) and platelet [3H]-paroxetine-labeled 5-HT-transporter binding. Whole blood 5-HT was higher in adolescents with conduct disorder, childhood type than in subjects with conduct disorder, adolescent type. Whole blood 5-HT was positively correlated with violence rating of the current offense and total offense points, and staff ratings of social skills impairment. Our findings are consistent with a relationship between 5-HT dysregulation and aggressive behavior in incarcerated adolescent boys with conduct disorder, particularly of childhood onset.

Adolescent↗
PubMed1999

Age-of-onset classification of conduct disorder: reliability and validity in a prospective cohort study.

OBJECTIVE: To test in a prospective clinical cohort study the reliability and validity of the age-of-onset subtyping of conduct disorder. METHOD: Participants were adolescents referred to psychiatric clinics who met DSM-III-R criteria for conduct disorder by structured diagnostic interview. Age of onset was the reported age of the first conduct disorder symptom. The reliability of age-of-onset report was tested by assessing agreement within informant on interviews 2 to 4 weeks apart. Age-of-onset groups were compared within informant on rates of correlates and symptom and social functioning outcomes over a period of 3 years. RESULTS: The reliability of age-of-onset report was low (kappa of 0.1 and 0.4 by adolescent and parent informant, respectively). Although the early-onset group had elevated rates of attention-deficit/hyperactivity disorder, family disadvantage, and aggressive and nonaggressive antisocial behaviors at inclusion, growth curve analysis showed that age-of-onset subtyping had no predictive validity. CONCLUSIONS: The reliability of ascertainment of age of onset of antisocial behavior requires further study. While age-of-onset subtyping has heuristic value with respect to the study of the causal pathways to conduct disorder, it is premature to use this system in clinic settings.

Adolescent↗
PubMed1988

A behavioral perspective on conduct disorders.

THIS paper provides a selective overview of behavioral approaches for conduct-disordered behavior. Although no definitive statement can be made regarding etiology, some empirical support exists for behavioral strategies. Assessment approaches discussed include the behavioral interview, behavioral observations, and behavioral checklists. Decisions regarding types of behavioral interventions to be employed directly follow from assessment data. Assessment information can be formulated in terms of a behavioral excess/skill deficit model. Hence, conduct-disordered behavior can be a function of excessive disruptive behavior and/or a lack of requisite skills necessary to obtain satisfaction. Parental training strategies in contingency management and contingency contracting are discussed regarding behavioral excesses. Relative to skill deficits, contingency procedures along with skills training in communication, problem-solving and self-control are reviewed, using parental training and cognitive-behavioral frameworks. In general, these interventions have empirically demonstrated efficacy. However, future research is required to identify specific factors that account for successful treatment, and attention should be directed toward preventive issues. Important data could be obtained from the identification of high-risk environmental situations. A predictive understanding of high-risk populations could result in the development of early intervention programs, which might to some extent obviate the occurrence of conduct disorders.

Adolescent↗
PubMed2006

Olanzapine treatment in adolescents with severe conduct disorder.

The most severe forms of conduct disorder (CD) are highly stable and disabling disorders, more likely to persist in time and to evolve into disruptive or antisocial behaviors. One crucial issue in the prognosis of these forms of CD is the high resistance to both non-pharmacological and pharmacological treatments, with antipsychotic drugs being frequently used in refractory cases. Aim of this study was: (1) to explore efficacy and tolerability of olanzapine treatment in adolescents with severe CD; (2) to identify predictors of olanzapine treatment outcome. This was a retrospective study, based on clinical records of the first 23 adolescents diagnosed as having a CD, diagnosed with a clinical interview (K-SADS), either pure or with comorbid diagnoses, and treated with olanzapine. All these patients did not respond satisfactorily to non-pharmacological intervention and to adequate dosages of mood stabilizers (lithium and/or valproate). The sample consisted of 16 males and seven females, 16 inpatients and seven outpatients (mean age 13.6 +/- 1.9 years, range 11-17.2 years), followed-up for a period ranging from 6 to 12 months (mean 8.8 +/- 2.7 months). Outcome measures included the Modified Overt Aggression Scale (MOAS), Clinical Global Impression-Improvement (CGI-I) and Children Global Assessment Scale (CGAS). During the follow-up, all patients were involved in non-pharmacological treatments (psychotherapy, family therapy, or day-hospital group treatments). Based on both an improvement of at least 50% at MOAS and a score 1 or 2 at CGI-I, 14 out of 23 patients (60.9%) were classified as responders at the end of the follow-up. Significant improvement at the last observation was found in MOAS (P < 0.001) and CGAS (P < 0.001) scores. Olanzapine dosage was 8 +/- 3.2 mg/day (range 5-20 mg/day). Mean weight gain at the end of the follow-up was 4.6 +/- 3 kg. The predictors of a positive treatment response was an impulsive-affective versus controlled-predatory type of aggression. Age at onset of CD and comorbid disorders did not affect treatment response. These preliminary findings suggest that olanzapine may improve behavior in adolescents with severe and treatment-refractory CD and impulsive aggression.

Adolescent↗
PubMed2004

Theories of conduct disorder: a causal modelling analysis.

BACKGROUND: If a clinician has to make decisions on diagnosis and treatment, he or she is confronted with a variety of causal theories. In order to compare these theories a neutral terminology and notational system is needed. The Causal Modelling framework involving three levels of description - biological, cognitive and behavioural - has previously been used to compare causal accounts for dyslexia and autism. METHOD: In this article we present this framework and explore its application to four causal theories of conduct disorder. We discuss the problems we encountered in this application and evaluate both the framework and the theories of conduct disorder. CONCLUSIONS: It was possible to capture parts of the theories of conduct disorder in the Causal Modelling framework but a multi-model approach may be necessary for the alternative theories of conduct disorder we evaluate. The application of the framework helps to see the relationships among the various theories of aspects of conduct disorder and demonstrates the need for more explicitness in the causal theories.

Child↗
PubMed2004

The effect of childhood conduct disorder and cognitive functioning on adolescent substance use.

OBJECTIVE: To assess the impact of childhood conduct disorder (CD) and intelligence quotient (IQ) on later substance use in adolescence. METHODS: Neuropsychological and structured diagnostic evaluations were initially administered to 32 children with disruptive behavior disorder when they were 7-11 years of age. They were then re-evaluated on average 6.7 years later using an array of interviews and rating scales with a focus on substance use. RESULTS: Early CD and IQ scores together accounted for a significant proportion of the variance in later substance use (R2=.248). In addition, there was a significant CD and Verbal IQ interaction (R2=.164) such that high Verbal IQ was linked to increased substance use in adolescents who had childhood CD. CONCLUSION: These data indicate that the presence of conduct disorder may interact with high Verbal IQ during childhood in such a way as to predict later adolescent substance use in disruptive behavior disorder populations.

Adolescent↗
PubMed1999

Subtypes of family history and conduct disorder: effects on P300 during the stroop test.

The goal of the present study was to identify neurophysiological differences associated with a family history of substance dependence, and its subtypes (paternal alcohol, cocaine, or opiate dependence), and with conduct disorder, and its subtypes (aggression, deceitfulness/theft, and rules violations). P300 event-related brain potentials were recorded from 210 males and females, aged 15-20 years while they performed the Stroop color-word compatibility test. Analyses revealed no significant effects of familial substance dependence on P300. However, an elevated number of conduct disorder problems was associated with a statistically significant reduction in P300 amplitude. The P300 amplitude reduction was related to the severity of the "rules violation" subtype, but was unrelated to aggression or deceitfulness and theft. It is concluded that conduct disorder can explain many of the P300 findings previously attributed to a family history of alcohol dependence. Furthermore, it appears that conduct disorder may be a heterogenous classification comprised of neurophysiologically different subtypes.

Adolescent↗
PubMed2003

[Children with conducts disorder and using psychoeducational services: a social, psychological and family portrait].

Contemporary studies suggest that most of the children who manifest conducts disorder also present personal as well as family problems. This is particularly true for children whose disorder is precocious. The identification of personal characteristics as well as social and family risk and protection factors associated with children with such problems are of great use for intervention planning and service organization for them and their families in Québec. In consequence, the objectives of this study are to identify the social, family and psychological factors that characterize children presenting conducts disorder. To do so, 62 children in treatment between the ages of 7 and 12 and with a diagnosis of conducts disorder are compared with 36 children of the same age without such diagnosis. Results show that children with conduct problems come from less stable and cohesive families as well as a lower socio-economic level. Moreover, their network of social support is less developed. The study reveals that the parents of children with conducts disorder use punishment more often. Finally, the research demonstrates that the children of this group have a much higher probability of presenting an exteriorized disorder (66 %) than the children of the other group (8 %). All these distinctive characteristics allows to correctly classify 93,8 % of the children of this study in the 2 groups. The results indicate the need to improve the parents'educational practices, increase the child's social network as well as reduce the conducts of opposition and inattention of the child. Finally, the complexity of the problems raised with the child and families commands a concerted professional intervention.

English Abstract↗
PubMedDate not supplied

[Prevalence of mental retardation in teenagers with dissocial conduct disorder].

INTRODUCTION: Prevalence of adolescents with conduct disorder (CD) has been calculated between 4 y 10%. OBJECTIVE: To estimate the prevalence of mental retardation in Colombian adolescent offenders, using the Wechsler Intelligence Scales for Children Revised (WISC R). PATIENTS AND METHODS: 106 male adolescent offenders with CD, aged 12 to 16 years, and attending to institutions of re education in Medell n Colombia were selected in a randomized approach. WISC R Hispanic version was administered to the sample, using 4 verbal (information, vocabulary, similarities and arithmetic) and 4 performance (Picture completion, block design, picture arrangement, and digit symbol) subtests for calculating verbal, performance and full scale IQs (VIQ, PIQ, and FSIQ), according to the manual instructions. RESULTS: 43 participants (40.6%) obtained a FSIQ < 70, then they were categorized as mild mental retardation. 34 offenders (32.1%) had a FSIQ between 70 and 84, then they were classified as people with borderline intellectual functioning, only 29 participants (27.4%) obtained a FSIQ over 85. CONCLUSION: 72.7% of the institutionalized adolescents offenders had low intellectual functioning, which may be interfere with the re education programs.

Adolescent↗
PubMed2004

Specificity in the familial aggregation of overt and covert conduct disorder symptoms in a referred attention-deficit hyperactivity disorder sample.

BACKGROUND: To examine the familial associations of overt and covert antisocial behavior within the diagnosis of conduct disorder (CD) in families ascertained by referred children with attention-deficit hyperactivity disorder (ADHD), and to test if these familial associations differed between male and female probands. METHOD: Subjects were clinically-referred male and female ADHD children (n = 273) and their first-degree biological relatives (n = 807). Scores for overt and covert conduct problems were calculated by summing the DSM-III-R conduct disorder symptoms, as derived from structured diagnostic interviews. Familial aggregation analyses were conducted with multivariate regression modeling methodology. RESULTS: Proband overt scores significantly predicted the overt scores of their relatives, and proband covert scores significantly predicted the covert scores of their relatives. There was no evidence of covert symptom scores predicting overt scores or vice versa. There was some evidence that the aggregation of covert symptoms was stronger in the families of female probands. CONCLUSIONS: These results provide preliminary evidence that overt and covert conduct disorder symptoms are independently transmitted through families and may represent distinct familial syndromes.

Adolescent↗
PubMed2004

Defense mechanisms in adolescent conduct disorder and adjustment reaction.

The use of defense mechanisms by male and female adolescents with a diagnosis of conduct disorder was compared with the defense use of adolescents with a diagnosis of adjustment reaction. Because conduct disorder has been shown to be associated with a developmental lag in several areas of psychological functioning, we expected that these adolescents would show immaturity in the use of defenses. This expectation was confirmed. As compared with adjustment reaction, conduct disordered youths were more likely to use the immature defense of denial and less likely to use the mature defense of identification.

Adaptation, Psychological↗
PubMed2004

Cocaine addicts with conduct disorder are typified by decreased cortisol responsivity and high plasma levels of DHEA-S.

There is evidence that children with antisocial behaviors have increased plasma levels of the adrenal androgen dehydroepiandrosterone sulfate (DHEA-S) and either a decreased level of another adrenal steroid, cortisol, or a decreased cortisol responsivity to stress. Low levels of cortisol have also been reported in antisocial adults but their levels of DHEA-S have not been studied. The present study was designed to perform in adult cocaine addicts simultaneous assessments of DHEA-S and cortisol as a function of a diagnosis of antisocial personality disorder (adult symptoms) and of a retrospective diagnosis of conduct disorder (CD). Basal cortisol and DHEA-S were determined in the plasma samples of 40 hospitalized men. The patients' cortisol responsivity was also assessed while they were being exposed to a stressful situation. Patients who had a retrospective CD diagnosis had significantly increased DHEA-S levels and secreted less cortisol when stressed. Comparisons between patients who did and did not meet the antisocial personality disorder adult criteria did not reveal any significant difference in DHEA-S or in cortisol responsivity. This could be attributed to the nature of the criteria used to define the adult disorder, which focus mostly on a failure to conform to social norms, whereas a number of CD criteria involve displays of some degree of violence. In conclusion, adults who retrospectively qualified for a CD diagnosis had increased DHEA-S levels and a decreased cortisol reactivity, confirming observations made in children and indicating that mechanisms underlying adrenal steroid alterations in childhood could still be at play in adulthood.

Adult↗
PubMed2004

ALDH2 status and conduct disorder mediate the relationship between ethnicity and alcohol dependence in Chinese, Korean, and White American college students.

This study examined aldehyde dehydrogense (ALDH2) gene status, alcohol dehydrogense (ADH2) gene status, conduct disorder, and alcohol dependence in Chinese, Korean, and White American college students. Chinese had a lower rate of alcohol dependence (5%) than Koreans (13%) and Whites (17%). Koreans had a higher rate of conduct disorder (15%) than Whites (9%) and Chinese (6%). The relationship of ethnicity to alcohol dependence was mediated by ALDH2 status and conduct disorder, although Chinese ethnicity remained significant. ADH2 status was not related to alcohol dependence with ALDH2 included, and no interactions were significant. Results suggest that different rates of risk (e.g., conduct disorder) and protective (e.g., ALDH2 status) factors partially account for ethnic differences in rates of alcohol dependence.

Adult↗
PubMed1989

Subgrouping conduct disorder by psychiatric family history.

The family history of psychiatric disorders, and clinical and demographic characteristics of boys with pervasive aggressive conduct disorder (PACD) were compared to those of boys with situational aggressive conduct disorder and controls. Boys with PACD came from lower socioeconomic backgrounds, had an earlier age of onset, and higher rates of hyperactivity and inattention than boys in the other two groups. Their mothers abused drugs more often than those of boys in the other two groups, while their fathers had more frequent antisocial behavior. Alcohol abuse was more prevalent among fathers of both conduct disorder groups, compared to the fathers of controls.

Aggression↗
PubMed2004

Childhood adversity, monoamine oxidase a genotype, and risk for conduct disorder.

BACKGROUND: Very little is known about how different sets of risk factors interact to influence risk for psychiatric disorder. OBJECTIVE: To replicate a recent report of a genotype-environment interaction that predicts risk for antisocial behavior in boys. DESIGN: Characterizing risk for conduct disorder in boys in association with monoamine oxidase A genotype and exposure to familial adversity, defined by interparental violence, parental neglect, and inconsistent discipline. SETTING: A community-based sample of twin boys. PARTICIPANTS: Five hundred fourteen male twins aged 8 to 17 years. MAIN OUTCOME MEASURE: Conduct disorder. RESULTS: There was a main effect of adversity but not of monoamine oxidase A on risk for conduct disorder. Low monoamine oxidase A activity increased risk for conduct disorder only in the presence of an adverse childhood environment. Neither a passive nor an evocative genotype-environment correlation accounted for the interaction. CONCLUSION: This study replicates a recent report of a genotype-environment interaction that predicts individual variation in risk for antisocial behavior in boys.

Adolescent↗
PubMed2002

Should the DSM-IV diagnostic criteria for conduct disorder consider social context?

OBJECTIVE: The text of the DSM-IV states that a diagnosis of conduct disorder should be made only if symptoms are caused by an internal psychological dysfunction and not if symptoms are a reaction to a negative environment. However, the DSM-IV diagnostic criteria are purely behavioral and ignore this exclusion. This study empirically evaluated which approach--the text's negative-environment exclusion or the purely behavioral criteria--is more consistent with clinicians' intuitive judgments about whether a disorder is present, whether professional help is needed, and whether the problem is likely to continue. METHOD: Clinically experienced psychology and social work graduate students were presented with three variations of vignettes describing youths whose behavior satisfied the DSM-IV criteria for conduct disorder. The three variations presented symptoms only, symptoms caused by internal dysfunction, and symptoms caused by reactions to a negative environment. The clinicians rated their level of agreement that the youth described in the vignette had a disorder, needed professional mental health help, and had a problem that was likely to continue into adulthood. RESULTS: Youths with symptoms caused by internal dysfunction were judged to have a disorder, and those with a reaction to a negative environment not to have a disorder. The difference was not explained by the clinicians' judgments of the youths' need for professional help or the expected duration of symptoms. CONCLUSIONS: The clinicians' judgments supported the validity of the DSM-IV's textual claim that a diagnosis of conduct disorder is valid only when symptoms are due to an internal dysfunction.

Adolescent↗
PubMed1997

Temperament, CNS problems and maternal stressors: interactive predictors of conduct disorder in 9-yr.-olds.

Conduct disorder in a sample of 565 9-yr.-olds, half of whom were 'at risk' at birth was best predicted by a combination of CNS disorder, difficult temperament at age 2, maternal stressors, chronic poverty, and child's separation from a parent. Qualitative study of interactive effects in the data confirms the New York Longitudinal Study's concept of 'spiralling up' and 'spiralling down' (disadvantage kindling yet further disadvantage, with poor behavioural outcomes in child).

Central Nervous System Diseases↗