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PubMed2004

A salutogenic investigation and treatment of conduct disorder (CD).

This article reports results from a long-term follow-up of adolescents with conduct disorder who have been patients at an inpatient child psychiatric unit in Lund, Sweden. Up to now, a total of 186 adolescents have participated in the follow-up study. The subjects are a heavily symptom-loaded group with many problems during their childhood. The study includes self-rating that describe psychiatric symptoms, sense of coherence, family climate and an interviewer rating on health. The follow-up paints a relatively positive picture; approximately 30-50% of the subjects have improved their lives and have an acceptable life situation according to the concepts of "love well", "play well", "work well" and "expect well".

Adolescent↗
PubMed2003

Acute effects of gabapentin on laboratory measures of aggressive and escape responses of adult parolees with and without a history of conduct disorder.

RATIONALE: The possible role of GABA in human aggression was evaluated by administering gabapentin to subjects with and without a history of conduct disorder and comparing the effects on laboratory measures of aggression and escape. METHODS: Eighteen male and two female subjects with a history of criminal behavior participated in experimental sessions, which measured aggressive and escape responses. Ten subjects had a history of childhood conduct disorder (CD+) and ten subjects with no history (non-CD controls). Aggression was measured using the Point Subtraction Aggression Paradigm (PSAP), which provided subjects aggressive, escape and monetary reinforced response options. RESULTS: Acute doses (200, 400 and 800 mg) of gabapentin had similar effects on aggressive responses among CD+ subjects compared to non-CD control subjects. Aggressive responses of CD+ and non-CD control subjects increased at lower gabapentin doses, and decreased at the highest 800 mg gabapentin dose. Gabapentin increased escape responses for both CD+ and non-CD controls CD- subjects at the lowest dose, but then produced dose-related decreases at the two higher doses in both groups. No changes in monetary reinforced responses were observed, indicative of no CNS stimulation or sedation. CONCLUSIONS: Gabapentin produced similar bitonic effects upon aggressive and escape responses in subjects with and without a history of childhood conduct disorder. This is in marked contrast to prior differential effects of baclofen on aggressive responses between CD+ and non-CD control subjects in a previous study.

Acetates↗
PubMedDate not supplied

[Family dysfunction in adolescents with suicidal behavior and in adolescents with conduct disorders].

INTRODUCTION: The period of life known as adolescence generally refers to transition from childhood to adulthood. Adolescents' progress toward autonomy involves remaining connected with, as well as separated from parents. Young people and their parents usually have mixed feelings about adolescent autonomy and attachment. An estimated 50% of children born in the 80-s have spent part of their developmental years in single-parent households. Divorce is almost always a stressful event in children's lives. Youthful suicide rate has increased dramatically and is the third leading cause of death among 15-19 year olds. Conduct disorder is one of the mostfrequently diagnosed conditions in adolescents. Suicidal adolescents and adolescents with conduct disorder are much more likely than their peers to have grown up in disrupted, disorganized homes with lack of attachment between parents and their children. MATERIAL AND METHODS: This prospective study was carried out during 2002, 2003, and 2004. The research included 60 adolescents treated at the Center for Child and Adolescent Psychiatry in Novi Sad, 30 with diagnosed conduct disorder and 30 with suicidal behavior. RESULTS: Along with other kinds of distress, suicidal adolescents have experienced an escalation of family problems a few months prior to attempted suicide. DISCUSSION: Divorce and life in singe-parent households is almost always a stressful period in children's lives. Conduct disorder and suicidal behavior represent a desperate cryfor help. Conclusion Most adolescents in both groups live in single-parent households. These young people have frequently passed into adolescence with little reason to feel that they could rely on their parentsfor support, or on their home as a place of sanctuary.

Adolescent↗
PubMed2006

Swedish validation of the Early Assessment Risk List for Boys (EARL-20B), a decision aid for use with children presenting with conduct-disordered behaviour.

Risk and needs assessment of children with conduct-disordered behaviour has been hampered by a lack of validated and easy-to-use decision-support tools. In this study, we investigated reliability and concurrent validity of the Swedish translation of the Early Assessment Risk List for Boys (EARL-20B). Parents to 76 boys aged 6-12 years old, referred to child psychiatric clinics, completed questionnaires about child symptoms and were thereafter administered the EARL-20B. Good to excellent inter-rater agreement and moderate concurrent validity was found. We also investigated possible subgroups of children based on the assessment with the EARL-20B. Cluster analysis yielded a tentative four-cluster solution, where subgroups of boys differed with respect to external measures. Although further study of predictive validity and usefulness for treatment planning is needed, the findings suggest that the EARL-20B is a promising tool for structured assessment of boys presenting with antisocial behaviour in clinical child psychiatry.

Aggression↗
PubMed2006

Examination of the causes of covariation between conduct disorder symptoms and vulnerability to drug dependence.

Conduct disorder (CD) symptoms and substance dependence commonly co-occur. Both phenotypes are highly heritable and a common genetic influence on the covariation has been suggested. The aim of this study was to determine the extent to which genes and environment contribute to the covariance between CD and drug dependence using twins from the Colorado Longitudinal Twin Sample and the Colorado Twin Registry. A total of 880 twin pairs (237 monozygotic [MZ] female, 195 MZ male, 116 dizygotic [DZ] female, 118 DZ male and 214 DZ opposite-sex) aged 13 to 18 (mean = 15.65) were included in the analysis. CD was assessed by lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) symptom count and a polysubstance dependence vulnerability index was developed from responses to the Composite International Diagnostic Interview--Substance Abuse Module. A bivariate Cholesky Decomposition model was used to partition the cause of variation and covariation of the two phenotypes. No sex-limitation was observed in our data, and male and female parameter estimates were constrained to be equal. Both CD symptoms and dependence vulnerability were significantly heritable, and genes, shared environment and nonshared environment all contributed to the covariation between them. Genes contributed 35% of the phenotypic covariance, shared environment contributed 46%, and nonshared environmental influences contributed the remaining 19% to the phenotypic covariance. Therefore, there appears to be pleiotropic genetic influence on CD symptoms and dependence vulnerability.

Adolescent↗
PubMed1998

Antisocial patients: a comparison of those with and those without childhood conduct disorder.

The purpose of this study was to compare persons with antisocial personality disorder (ASP) with those who meet the adult criteria for ASP but fail to meet the criteria for childhood conduct disorder. Sociodemographic data, medical history, and psychiatric symptoms exhibited during a recent hospital admission were compared in the two groups by chart review. The two groups were virtually indistinguishable, except that patients without childhood conduct disorder were less likely to smoke or consume alcohol, were less likely to have spent time in a training school/boot camp as a child or adolescent, were less likely to have been admitted for a recent suicide attempt, and were less likely to have conned others. We conclude that persons meeting the adult criteria for ASP but not the childhood conduct disorder criteria essentially suffer the same disorder as those who meet full ASP criteria but are less severely affected.

Adult↗
PubMed1993

Animistic thinking in psychotic versus conduct-disordered hospitalized adolescents.

25 adolescents showing a Psychotic-spectrum Disorder were compared with 24 adolescents showing Conduct Disorder on a task eliciting reasons for attributing life to an ambiguous pictorial stimulus (dough on a beach). Consistent with expectations from earlier research, the psychotic adolescents showed greater modes of animistic thinking (attributions of life to nonlife forms) than conduct-disordered youth, associated with theorized merging between self and the nonhuman environment. Implications are discussed.

Adolescent↗
PubMed2005

The high costs of aggression: public expenditures resulting from conduct disorder.

OBJECTIVES: We explored the economic implications of conduct disorder (CD) among adolescents in 4 poor communities in the United States. We examined a range of expenditures related to this disorder across multiple public sectors, including mental health, general health, school, and juvenile justice. METHODS: We used self- and parental-report data to estimate expenditures during a 7-year period in late adolescence of a sample of youths. We contrasted expenditures for youths with CD and youths with oppositional defiant disorder, elevated symptoms (no CD diagnosis), and all others. Diagnosis was determined with a structured assessment. RESULTS: Additional public costs per child related to CD exceeded $70000 over a 7-year period. CONCLUSIONS: Public expenditures on youths with CD are substantially larger than for youths with closely related conditions, reflecting the importance of prevention and early treatment for the disorder.

Adolescent↗
PubMed1989

Secondary enuresis in institutionalized conduct-disordered children.

The incidence of secondary enuresis in 16 institutionalized conduct-disordered children was examined. In contrast to a control group of 16 noninstitutionalized conduct-disordered children, the former showed significantly more enuretic behaviour. Also, enuresis began within 6 mo. of the children's separation from their families, suggesting this problem is very likely related to the emotional trauma surrounding the change in living conditions. However, the small number of subjects limits further interpretation of the findings.

Adolescent↗
PubMed1997

Practitioner review: psychosocial treatments for conduct disorder in children.

The present paper reviews promising treatments for conduct disorder among children and adolescents. The treatments include problem-solving skills training, parent management training, functional family therapy and multisystemic therapy. For each treatment, conceptual underpinnings, characteristics and outcome evidence are highlighted. Limitations associated with these treatments (e.g. paucity of long-term follow-up evidence and of evidence for the clinical significance of the change) are also presented. Broader issues that affect treatment and clinical work with conduct-disordered youths are also addressed, including retaining cases in treatment, what treatments do not work, who responds well to treatment, comorbidity, the use of combined treatments and the need for new models of treatment delivery.

Behavior Therapy↗
PubMed1999

Callous-unemotional traits and subtypes of conduct disorder.

There has been growing consensus that children with conduct disorder (CD) constitute a very heterogeneous group containing children who vary substantially on the development, course, and causes of the disorder. While many have recognized the importance of this heterogeneity for developing better causal theories and for developing more effective treatments, there has been little consensus as to the best way to subtype children with CD. In this paper, we review a number of approaches to subtyping, each with some evidence for its validity for certain purposes. We focus on two recent approaches that have great potential for integrating past subtyping approaches and for advancing causal theory. The first approach is the division of children with CD into those with a childhood onset to their severe antisocial behavior and those with an adolescent onset to their behavior. The second approach is to designate children within the childhood-onset group who show callous and unemotional traits, which is analogous to adult conceptualizations of psychopathy. Both approaches help designate children who many show different causal processes underlying their severe aggressive and antisocial behavior, and who may warrant different approaches to treatment.

Adolescent↗
PubMed1999

Conduct disorder, antisocial personality disorder and substance use disorders in schizophrenia and major affective disorders.

OBJECTIVE: To examine the relationships between childhood conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (substance abuse or substance dependence) in psychiatric patients with severe mental illness. METHOD: Substance use-related problems on screening instruments, lifetime and recent prevalence of substance use disorders, and family history of substance use disorder were evaluated in four groups of 293 patients with mainly schizophrenia-spectrum and major affective disorders: No ASPD/CD, CD Only, Adult ASPD Only, Full ASPD. RESULTS: Full ASPD was strongly related to all measures of substance use problems and disorders, as well as fathers' history of substance use disorder. The odds ratios for Full ASPD and substance use disorders ranged between 3.96 (lifetime cannabis use disorder) to 11.35 (recent cocaine use disorder). To a lesser extent, patients with CD Only or Adult ASPD Only were also at increased risk for having substance use disorders compared to the No ASPD/CD patients. CONCLUSIONS: Childhood CD and adult ASPD represent significant risk factors for substance use disorders in patients with schizophrenia-spectrum and major affective disorders. Considering other research indicating that CD and ASPD have a higher prevalence in patients with severe mental illness, the present findings suggest that CD and ASPD could reflect a common factor that independently increases patients' vulnerability to both psychiatric and substance use disorders.

Adult↗
PubMed2000

Familial aggregation for conduct disorder symptomatology: the role of genes, marital discord and family adaptability.

BACKGROUND: There is extensive evidence of statistical associations between family discord/ maladaptation and antisocial behaviour in the children, but questions remain on the extent to which the psychopathological risks are genetically or environmentally mediated. METHODS: Twin pairs (N = 1,350), aged 8 to 16 years, in the general population-based Virginia Twin Study of Adolescent Behavioral Development were assessed using the Child and Adolescent Psychiatric Assessment interview administered separately to both twins and both parents. Structured interviews for parental lifetime psychiatric disorders were also administered to the mothers and fathers. Maternal reports on Olsson's Family Adaptability and Cohesiveness questionnaire and the Dyadic Adjustment Scale were used as indices of the family environment. A path analytical model based on an extended twin-family design was used to test hypotheses about parent offspring similarity for conduct disorder symptomatology. RESULTS: Family discord and maladaptation, which intercorrelated at 0.63, were associated with a roughly two-fold increase in risk for conduct disorder symptomatology. When parental conduct disorder was included in the model the environmental mediation effect for family maladaptation remained, but that for family discord was lost. CONCLUSION: It is concluded that there is true environmental mediation from family maladaptation, operating as a shared effect, which accounts for 3.5 % of the phenotypic variance. The assumptions underlying this genetic research strategy are made explicit, together with its strengths and limitations.

Adaptation, Psychological↗
PubMed1987

Relation of attention deficit and conduct disorder to vigilance and reading lag.

The relationship between DSM-III Axis I diagnoses 'attention deficit disorder with hyperactivity' (ADDH), 'conduct disorder' (CD) and 'anxiety disorder' (AD) and measures of attention and reading were studied in 158 children. Children diagnosed as having severe or moderate ADDH were found to be younger at referral and to have a lower IQ than were children with CD and AD. When age, IQ, social class and sex were controlled, children with severe ADDH were found to perform significantly worse than other diagnostic groups on some tests of vigilance and reading age. The data suggest that children with severe ADDH form a distinct group, and those with mild ADDH overlap symptomatically and on tests of vigilance with children with CD.

Achievement↗
PubMed2000

The effect of systematic variation in retrospective conduct disorder reports on antisocial personality disorder diagnoses.

A diagnosis of antisocial personality disorder (ASPD) requires a conduct disorder (CD) diagnosis. A CD diagnosis is often obtained retrospectively. This study tested the influence of current behavior on CD recall and the association between recent behavior change and inconsistencies in contemporaneous and retrospective CD reports. Five hundred young adults reported ASPD; retrospective CD; current problem behavior; and, at ages 12 to 15 years, contemporaneous CD. True-positive, true-negative, false-positive, and false-negative CD and ASPD groups were identified. The results supported the hypotheses. Participants whose current behavior agreed with past behavior provided reliable retrospective CD reports. Inaccurate diagnoses occurred among participants whose current behavior was inconsistent with past behavior, either becoming more problematic (CD and ASPD false positives) or less problematic (CD and ASPD false negatives) over time.

Adolescent↗
PubMed1992

Psychometric differentiation of conduct disorder and attention deficit disorder with hyperactivity.

Using a retrospective chart review procedure, children diagnosed as having attention deficit disorder with hyperactivity (ADDH), conduct disorder (CD), and ADDH+CD, as defined by DSM-III, were compared on measures of cognitive and academic functioning as well as on a continuous performance test (CPT). The groups did not differ in age or IQ, but children in the ADDH and ADDH+CD groups missed significantly more target stimuli on the CPT and performed significantly poorer on measures of academic achievement than did the pure CD group. However, poor CPT performance was not accounted for by learning problems. These findings in clinically referred patient groups are consistent with dimensional and epidemiological studies that suggest that ADDH may be a cognitively based disorder, whereas CD children are characterized by behavioral symptoms with fewer cognitive and learning deficits.

Attention↗
PubMed1984

Obsessive-compulsive neurosis with conduct disorder in adolescence: a report of two cases.

Two adolescents are described presenting with obsessive-compulsive neurosis and conduct disorder. The presence of conduct disorder is in marked contrast to the compliance and over-control characteristic of obsessionality, and was found to give rise to great difficulties in instigating and carrying through a programme of response-prevention for the obsessive-compulsive symptoms.

Adolescent↗