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PubMed1998

Conduct disorder and mania: what does it mean in adults.

OBJECTIVE: Because of the relationship between childhood behavior disorders and adult substance abuse, we hypothesized that substance abusing adult bipolars were more likely to have had behavior disorders as children than nonabusing bipolar adults. METHODS: Conduct disorder (CD) symptoms in 132 bipolar adults were compared by age and presence of comorbid substance use problems using data from the Epidemiologic Catchment Area study. RESULTS: Rates of CD were higher in bipolar subjects under age 30 (32.6%) versus those over (16.3% P<0.05). Young BPs with substance use problems (SUBST) had CD rates three times those without SUBST (52% vs. 14.8%) (P < 0.01). Young subjects without mania or SUBST had CD rates of 7.75%. CONCLUSION: Substance abuse in bipolar adults may be more related to childhood conduct disorder than uncomplicated bipolar disorder.

Adolescent↗
PubMedDate not supplied

Demons or diamonds: a study to ascertain health professionals' attitudes toward children with conduct disorder.

PROBLEM: In the United Kingdom, 10% of children referred to child psychiatry services are diagnosed with a conduct disorder. Of these, 45% may grow up to be psychopaths or have personality disorders. Attitudes of professionals to both these diagnoses are shown to be negative. METHODS: A Likert-scale questionnaire and semistructured interview completed by a purposive sample of doctors, nurses, psychologists, and therapists (N=32) in an outpatient child and adolescent mental health department. FINDINGS: Positive regard is maintained toward these children despite negative expectations for prognosis and treatment. Negative attitudes were attributed to lack of resources, medically led services with research-based practice agendas, and ethical issues of utilitarianism. CONCLUSIONS: If children with conduct disorder continue to be seen as "demons," as untreatable and resource intensive, they will continue to be ignored by the agencies who purport to help them. Search terms: Attitudes, conduct disorders, personality disorder

Adult↗
PubMed2000

Comparison of conduct-disordered behavior in crack-dealing versus nondealing juvenile offenders.

Currently, little research has investigated psychosocial functioning among juvenile crack dealers, and there appear to be few studies comparing dealers to nondealing juvenile offenders. The current study examined whether juvenile crack dealers display more severe conduct-disordered behavior than their nondealing delinquent peers. The records of 130 adolescent males committed to a residential training school were studied. Analyses indicated that crack dealers were younger when first arrested, had more arrests and commitments, and met more DSM-III-R conduct-disorder criteria than their nondealing delinquent peers. In addition, the DSM-III-R conduct-disorder criteria met by dealers were more severe, and dealers were more likely to be rearrested within six months following release. Overall, significant differences between crack dealers and nondealing juvenile offenders were found; dealers displayed a more delinquent history and a more serious and violent conduct disorder than their nondealing yet delinquent peers.

Adolescent↗
PubMed1989

[Calcified aortic valve stenosis in adults. Analysis of supra- and infra-hissian conduction disorders].

The association of intraventricular or atrio-ventricular conductive disorders with a calcified aortic stenosis, is a classical notion demonstrated by the close anatomical relationships between aortic valve and conduction pathways. These conductive disorders have been, for quite some time, analyzed on standard electrocardiograms, but, since a few years, the recording of the bundle of His potential has become the technique of choice. However, studies regarding this subject are few, based on very small and sometimes heterogeneous groups of patients. Sixty six consecutive patients hospitalized for a narrow aortic stenosis have agreed to be subjected, before valve replacement, to a recording of the bundle of His potential. Thirteen of them (19.7%) show a HV interval exceeding 55 ms or a pathological H deflexion (twisted and lasting 35 ms). None of the pre-operative parameters that were analyzed (black-out, left ventricular function, ventriculo-aortic gradient, calculated valvular area, magnitude of valvular and ring calcifications), seem correlated with the increased HV interval. These results cross-check those reported in most of the literature.

Adolescent↗
PubMed2003

Subfactors of DSM-IV conduct disorder: evidence and connections with syndromes from the Child Behavior Checklist.

Is conduct disorder (CD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) a unitary entity, or do variants of CD exist? We addressed this question, using data collected from the parents of 1,669 Australian boys, aged 6-17. Parents were interviewed to assess DSM-IV Conduct Disorder (DSM-IV CD) criteria. Results revealed 2 subfactors of DSM-IV CD symptoms, made up of overt behaviors (e.g., initiating physical fights) and covert behaviors (e.g., stealing without confrontation). Ordinary least squares regressions showed the 2 CD subfactors to be significantly and uniquely predicted by Child Behavior Checklist (CBCL; T. M. Achenbach, 1991a, 1991b) syndromes labeled Aggressive Behavior and Delinquent Behavior, respectively. The results are discussed in terms of the utility of differentiating these 2 variants of CD in future editions of the DSM.

Antisocial Personality Disorder↗
PubMed2006

Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication.

BACKGROUND: Prior research indicates that conduct disorder (CD) is associated with a range of co-morbid mental disorders. However, the actual prevalence, subtypes and patterns of co-morbidity of DSM-IV-defined CD in the general US population remains unknown. METHOD: Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents (n=3199) in the National Comorbidity Survey Replication (NCS-R). RESULTS: The estimated lifetime prevalence of CD in the US is 9.5% (12.0% among males and 7.1% among females), with a median age-of-onset of 11.6 (0.2) years. Latent class analysis (LCA) identified five CD subtypes characterized by rule violations, deceit/theft, aggression, severe covert behaviors, and pervasive CD symptoms. A dose-response relationship was revealed between CD subtype severity and risk of subsequent disorders. Results also indicated that CD typically precedes mood and substance use disorders, but most often occurs after impulse control and anxiety disorders. Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders, remitted CD is associated with significantly lower risk of subsequent disorders. CONCLUSIONS: CD is prevalent and heterogeneous in the US population, and more severe subtypes and the presence of active CD are associated with higher risk of co-morbid disorders. Future prospective studies using general population samples will further inform the nature and course of this disorder.

Adolescent↗
PubMed2000

The OADP-CDS: a brief screener for adolescent conduct disorder.

OBJECTIVES: To examine the ability of a very brief (6-item) self-report screener, the Oregon Adolescent Depression Project Conduct Disorder Screener (OADP-CDS), to identify adolescents with a lifetime diagnosis of conduct disorder and to examine its ability to predict antisocial personality disorder by age 24. Relevant scales from the Yough Self-Report and the Child Behavior Checklist were examined for comparison purposes. METHOD: A total of 1,709 high school students completed an initial questionnaire and diagnostic interview assessment (T1); 1,507 participants returned approximately 1 year later for a second assessment (T2). A third (T3) assessment was conducted with selected T2 participants (n = 940) after they had turned 24 years of age. RESULTS: The OADP-CDS had good internal consistency, test-retest stability, and screening properties. Differences in the screening ability of the OADP-CDS as a function of gender and social desirability were nonsignificant. The efficacy of the measure as a screener did not differ significantly from that of longer adolescent- and parent-report measures. Perhaps most importantly, the OADP-CDS was able to identify future cases of antisocial personality disorder in young adulthood. CONCLUSIONS: Results suggest that self-report screening for conduct disorder with older adolescents is possible and should be explored further.

Adolescent↗
PubMed1993

Attachment and conduct disorder: the Response Program.

An increasing number of youths are being identified as suffering from behavioural problems that cause difficulties in their family and peer relations which in turn reduces their chances of academic and vocational success. There is growing concern regarding their level of aggressiveness. The common diagnosis given to these disaffiliated youths is conduct disorder. To date, most treatment programs for conduct disorder have been unsuccessful. A review of recent studies indicates that the disruption of attachment may be an important feature that underlies the wide range of symptoms that are typically found in youths with conduct disorder. A community-oriented program designed to ensure long term care for these youths is described in this paper, and the findings of a six month follow-up evaluation are presented. Results indicated that communities, caregivers, and youths responded positively to the program; caregivers reported significant reductions in a broad range of psychiatric symptoms in youths, and youths reported a significant reduction in symptoms of conduct disorder.

Adolescent↗
PubMedDate not supplied

Alcohol expectancies among adolescents with conduct disorder: prediction and mediation of drinking.

Among adolescents with conduct disorder, alcohol expectancies were examined for both predictive utility and mediation of other predictors of alcohol use (i.e., delinquency, family history, demographic and psychopathology variables). Data were collected from 260 adolescents with conduct disorder 11-18 years of age, who had been in either mental health residential facilities or community-based special education programs for adolescents with serious emotional disturbances. Zero-order correlations and structural path models assessed relationships between expectancies, alcohol use, and other predictors of alcohol use. Results indicated: (a) expectancies of enhanced social and cognitive behavior were significant (p < .05) univariate predictors of drinking, (b) among all of the selected predictors, expectancies of enhanced social behavior (i.e., Subscale 2 of the Alcohol Expectancy Questionnaire--Adolescent Form; AEQ-A) had the strongest association with alcohol use (r = .54) and mediated between 31% to 44% of the drinking variance associated with other significant predictors (p < .01). Results were discussed as supporting similar expectancy-drinking relationships among CD and nonclinical youth.

Adolescent↗
PubMed1991

Personality characteristics of a community sample of adolescents with conduct disorders.

The Millon Adolescent Personality Inventory (MAPI) was used to compare the personality styles, expressed concerns, and behavioral correlates of a community sample of conduct-disordered (n = 13) and non-conduct-disordered (n = 137) adolescents. Structured interviews with adolescents and parents were used to classify subjects using DSM-III criteria. Significant differences were found between groups. Conduct-disordered youth reported being very critical, harsh, and not respectful of others. They tended to seek out the unpredictable and to be moody and pessimistic. They expressed a lack of confidence in school performance and dissatisfaction with family life. These results support the usefulness of self-report measurements with troubled adolescents in general, and the validity of the MAPI in particular. Implications for diagnosis and treatment are discussed.

Adaptation, Psychological↗
PubMed1992

Childhood depression and conduct disorder: II. An analysis of family interaction patterns in the home.

Few researchers have assessed family interaction patterns associated with childhood depression, especially using observations in natural settings. We directly sampled the interaction patterns of families with depressed, conduct-disordered, mixed depressed-conduct-disordered, and comparison children ages 7-14 years in their homes during the evening meal. Observational measures were taken of positive and aversive behaviors and affect expression for both parents, the referred children, and their siblings. Results replicated previous research showing that conduct-disordered children express high levels of aversive behavior and anger and are part of a family system marked by conflict and aggression. The depressed children were exposed to maternal aversiveness but did not show any evidence of elevated levels of anger or aversiveness in their own behavior. Surprisingly, this was also true for the mixed-disorder children. High levels of depression in both groups of depressed children were associated with low levels of conflict and anger in family members. Overall, siblings showed very similar patterns of behavior, and were exposed to similar patterns of parental behavior, as the referred children. Results are discussed in terms of family models that emphasize the function of aggression and depression in the maintenance of child psychopathology.

Affect↗
PubMed1990

Frontal-lobe cognitive dysfunction in conduct disorder adolescents.

Behavioral similarities between antisocial behavior disorders and frontal-lobe cerebral impairment have led to suggestions that conduct disorders are attributable to disinhibition deficit associated with frontal-lobe cerebral functions. This study compared the performance of 21 conduct disorder adolescents on measures of cognitive processes associated with frontal-lobe functions with that of a matched comparison sample. Conduct disorder adolescents performed more poorly on measures sensitive to frontal-lobe dysfunction (conceptual perseveration, poorly sustained attention, impaired sequencing on memory and motor tasks), but not on non-frontal-lobe specific cognitive measures. Although the findings support a neurobehavioral explanation of antisocial behavior as a product of cerebral disinhibition, caution is urged in overinterpreting causal relationships through neurobehavioral data.

Adolescent↗
PubMed2003

Intellectual ability in adolescents with conduct disorder.

A U.K. population of young offenders show the typical deficits in Verbal IQ reported in conduct disordered populations. Performance IQs are generally lower than those of previous studies from the 1970s, raising a question about decline in intellectual ability.

Adolescent↗
PubMed2003

Association of ADHD and conduct disorder--brain electrical evidence for the existence of a distinct subtype.

BACKGROUND: To evaluate the impact of psychopathological comorbidity with oppositional defiant/conduct disorder (ODD/CD) on brain electrical correlates in children with attention deficit hyperactivity disorder (ADHD) and to study the pathophysiological background of comorbidity of ADHD+ODD/CD. METHOD: Event-related potentials (ERPs) were recorded during a cued continuous performance test (CPT-A-X) in children (aged 8 to 14 years) with ICD-10 diagnoses of either hyperkinetic disorder (HD; n = 15), hyperkinetic conduct disorder (HCD; n = 16), or ODD/CD (n = 15) and normal children (n = 18). HD/HCD diagnoses in all children were fully concordant with the DSM-IV diagnosis of ADHD-combined type. ERP-microstates, i.e., time segments with stable brain electrical map topography were identified by adaptive segmentation. Their characteristic parameters and behavioral measures were further analyzed. RESULTS: Children with HD but not comorbid children showed slower and more variable reaction times compared to control children. Children with HD and ODD/CD-only but not comorbid children displayed reduced P3a amplitudes to cues and certain distractors (distractor-X) linked to attentional orienting. Correspondingly, global field power of the cue-CNV microstate related to anticipation and preparation was reduced in HD but not in HCD. Topographical alterations of the HD occurred already in the cue-P2/N2 microstate. In sum, the comorbid group was less deviant than both the HD-group and the ODD/CD-group. CONCLUSIONS: The findings suggest that HD children (ADHD-combined type without ODD/CD) suffer from a more general deficit (e.g., suboptimal energetical state regulation) including deficits of attentional orienting and response preparation than just a responseinhibitory deficit, backing the hypothesis of an involvement of a dysregulation of the central noradrenergic networks. The results contradict the hypothesis that ADHD+ODD/CD represents an additive co-occurrence of ADHD and ODD/CD and strongly suggest that it represents a separate pathological entity as considered in the ICD-10 classification system, which differs from both HD and ODD/CD-only.

Adolescent↗
PubMed1990

Enhancement of social learning family interventions for childhood conduct disorder.

Social learning family intervention (SLFI) is the treatment of choice for young children exhibiting severe conduct disorder and antisocial behavior. Despite the reported success of this intervention, high levels of resistance, poor engagement, and inadequate maintenance of improvements are observed for a substantial proportion of distressed families. These obstacles have inspired enhancement efforts to improve basic social learning family-intervention models. The present review identifies promising approaches for maximizing treatment gains for the conduct-disordered child. Relevant studies were organized into 3 approaches: enhancements and expansions (a) within a dyadic (parent-child) interaction model, (b) within a broad-based model that acknowledges a wider range of family influences, and (c) through a multisystems model. SLFI enhancements within the dyadic model have centered on either the strengthening of parental skills already included in the SLFI regimen or the adding of new interactional strategies. Some gains, but only partial success, have been achieved with the dyadic model supplements. SLFI expansions from a broad-based model have focused on parental adjustment, parental expectations during treatment, and social-environmental stressors. The multisystems adjuncts to SLFI include cognitive-behavioral interventions to affect peer relations and ecological approaches to sweep across domains. The broad-based and multisystems expansions have produced promising but undertested treatment regimens. Related areas of investigation included therapy process research, medication combined with SLFI, and the involvement of fathers in treatment. Recommendations are offered for improvement of SLFI research. The apparent theoretical crossroads for SLFI treatment of childhood conduct disorder are discussed.

Antisocial Personality Disorder↗
PubMed1990

Frontal lobe functioning in conduct disordered juveniles: preliminary findings.

This investigation assessed the hypothesis that conduct disordered juveniles may suffer from a maturational lag in the development of behaviors believed associated with the frontal cortex. Twenty conduct disorder (CD) juveniles and 20 normal comparison subjects were compared on nine Lurian tasks that measure behavior attributed to frontal lobe functioning. A three-way ANOVA, with gender, race, and group as factors of interest, revealed significant differences on the verbal conflict task, verbal retroactive inhibition task, and on a measure of receptive vocabulary. Using receptive vocabulary as a covariate, an ANCOVA showed no significant differences between the groups on any of the tasks. These findings appear to support the potential impact that language dysfunction can have in the development of disinhibitory behavior. Other interpretations of the findings are presented.

Journal Article↗
PubMed1992

The pharmacologic treatment of conduct disorders and rage outbursts.

Although this article focuses on psychopharmacology, pharmacotherapy is only part of a comprehensive treatment program. Treatment should be individualized to the patient's condition and level of intellectual functioning (e.g., conduct disorder, mental retardation). Clinicians should be acquainted with the Food and Drug Administration's regulations and the Physician's Desk Reference's guidelines. Psychoactive agents should be prescribed judiciously under careful clinical and laboratory monitoring, especially when given on a long-term basis. Knowledge of potential short- and long-term side effects is imperative to minimize impairment (cognitive, sedation) and to maximize achievement of adaptive behaviors. Aggressiveness is a low-frequency behavior and therefore difficult to assess. Aggressiveness with an explosive affective component and rage seems to be more responsive to pharmacotherapy than aggressiveness alone. Children who present with covert conduct disorder symptoms, such as stealing and lying, might not be as responsive to psychoactive agents as the conduct disorder with explosive characteristics. The neuroleptics are considered the standard drugs for the treatment of aggression but sedation and concern over tardive dyskinesia have led investigators to explore and study other classes of drugs. Lithium carbonate has been studied in short-term clinical trials and has been shown to be an effective alternative to the neuroleptics. Carbamazepine and propranolol seem to be promising agents but require further critical assessment in children and adolescents. Stimulants should be considered the first choice of treatment in coexisting conduct disorder and ADHD or in milder forms of aggression. In conclusion, there is a need for systematic investigation of the effectiveness and safety of psychoactive agents in children and adolescents with aggressiveness, explosiveness, and rage outbursts. There is some supportive evidence that some patients with these target symptoms are good responders to certain drugs. Future research should compare pharmacotherapy to psychosocial treatment and the combination of both.

Animals↗
PubMed2006

Interaction between MAO-A genotype and maltreatment in the risk for conduct disorder: failure to confirm in adolescent patients.

OBJECTIVE: Childhood maltreatment is a potent risk factor for subsequent aggressive and criminal behavior. A recent study suggested that the relationship between maltreatment and antisocial behavior may be moderated by a genetic vulnerability conferred by a functional polymorphism in the MAO-A gene. The authors investigated whether these findings would generalize to a clinical cohort of adolescents, examining whether there was a stronger association between maltreatment and conduct disorder severity in patients carrying the low MAO-A activity allele. METHOD: Male adolescent patients (N=247) entering residential or intensive day treatment for persistent conduct and substance use problems were examined. Conduct disorder severity was indexed by a lifetime count of DSM-IV criteria obtained through structured psychiatric interviews. Maltreatment scores were derived from summing neglect and abuse events reported to have occurred before age 11. RESULTS: Neglect, verbal/psychological abuse, physical abuse, and sexual abuse were prevalent among patients. Although level of maltreatment and lifetime conduct disorder symptoms were significantly correlated, no genetic-environmental interaction with genotype for maltreatment was found. CONCLUSION: The results of the current study do not support the hypothesis that a polymorphism in the gene encoding MAO-A contributes to the genetic risk for conduct disorder.

Adolescent↗