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PubMed2006

Familial risks, conduct disorder and violence: A Finnish study of 278 adolescent boys and girls.

OBJECTIVE: The aim was to investigate the impact of familial risk factors on the development of violent behaviour and conduct disorder (CD) by gender in a sample of adolescent psychiatric patients. METHODS: The study sample consisted of 278 adolescents (age 12-17) consecutively admitted to psychiatric inpatient care between April 2001 and January 2004. DSMIV psychiatric diagnoses were obtained from the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime (K-SADS-PL). RESULTS: Logistic regression analyses revealed that girls who had been physically abused at home had a 4.2-fold risk of having conduct disorder with violent behaviour (95% CI 1.4-12.2) compared to those not exposed to domestic violence. A broken primary family also increased the risk for having both violent CD (OR 7.8 95 % CI 1.7-36.4) and non-violent CD (OR 7.0 95% CI 1.5-33.5) among girls. Among boys, no statistically significant association was found between any familial risk factors and later CD. CONCLUSIONS: The results suggest that being physically abused by parents may influence the development of conduct disorder including violent behaviour among girls. This emphasizes the importance of early recognition of domestic violence. In girls, the absence of primary family seems to associate strongly with the development of CD, and should be taken into consideration by physicians and other professionals working with young people.

Conduct Disorder↗
PubMed2006

Adolescents' responses to peers with depression or conduct disorder.

OBJECTIVE: To determine how young people are likely to respond to a peer with mental illness, or who has severe behavioural problems. METHOD: A mental health literacy survey was conducted with 1137 adolescents in years 8, 9 and 10 in South Australia and the Australian Capital Territory. Respondents were presented with a vignette of either a 16-year-old boy meeting criteria for conduct disorder or a 16-year-old girl meeting criteria for major depression. As part of the survey, respondents were asked to write in words what they would do if the person in the vignette was a friend of theirs and they wished to help. Responses were coded into categories. RESULTS: Over half the sample (53%) described positive social support as the only action they would take to help. A further 23% said they would engage an adult such as a parent, teacher or school counsellor to help with the situation. Those responding to the conduct disorder vignette were more likely to describe engaging an adult to help and males were more likely to say they would do nothing. Female students tended to answer differently to the conduct disorder and depression vignettes, while male students responded similarly to the two vignettes. CONCLUSIONS: Many adolescents do not respond to friends' distress in ways which are likely to facilitate appropriate help. Mental health education in schools should include skills for offering help and encouraging peers to seek help.

Adolescent↗
PubMed1988

Conduct disorder and cognitive functioning: testing three causal hypotheses.

The sample consisted of black adolescents who were members of the Columbia-Presbyterian chapter of the Collaborative Perinatal Project from birth to age 7. At age 17, subjects and their parents were administered a battery of instruments that included standardized psychiatric diagnostic interviews as part of a call-back study. Results from least-squares and logistic regression analyses were compatible with the hypothesis that deficiencies in cognitive functioning are causally related to adolescent conduct disorder as defined by DSM III. The results suggested that the relation of cognitive functioning to psychiatric status appears to be specific to conduct disorders. The results were incompatible with a "third" variable hypothesis (third factors included neurological status and environmental disadvantage) and the hypothesis that conduct problems lead to deficits in cognitive functioning. The 3 most (and equally) important factors in accounting for age-17 conduct disorder were cognitive functioning, parent psychopathology, and early aggression. A closer look at the data tentatively suggested that a broad deficiency in acculturational learning, rather than narrowly focused social cognitive differences or native endowment, constitutes a key element in the link between cognitive functioning and conduct disorder. Test bias was ruled out as a possible explanation for the results.

Adolescent↗
PubMed2005

Family correlates of oppositional and conduct disorders in children with attention deficit/hyperactivity disorder.

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.

Attention Deficit Disorder with Hyperactivity↗
PubMed1991

The classification of conduct disorders.

Empirical data comparing DSM-III and DSM-III-R criteria on conduct disorders were obtained from 100 adolescent juvenile justice center residents. The importance of an ongoing classification of childhood and adolescent psychiatric disorders, with primary emphasis on the diagnosis of conduct disorders, was stressed. Demographic and associated features were presented. DSM-III-R seemed superior to its predecessor in some respects and the severity index in particular may be useful. Direction for further classification modification was suggested.

Adolescent↗
PubMed2003

[Multisystemic therapy of adolescents with conduct disorders].

This paper reviews the main features of conduct disorder (CD), as well as the principles for diagnosis and multisystemic treatment (MST). MST includes biological, psychological and social interventions, and considers the ecological environment of conduct manifestations. Some outcomes of MST delivery are discussed, along with its advantages and potential applications.

Adolescent↗
PubMed1989

Person perception in children with conduct disorders.

In his object-relations theory, O. Kernberg discerns different levels of personality organization. From a structural point of view these are described with respect to the object-relations. So, according to Kernberg, the antisocial personality is more primitively organized (so-called borderline) than most patients with neurotic disorders, as manifested by his object-relations. We hypothesize that this also applies to children with conduct disorders in comparison with emotionally disturbed children. In this explorative study, we investigated whether suppositions concerning the object/self representations (i.e. the internal object-relations) of children with conduct disorders can be tested using a research method from empirical psychology. We chose the method of the free (written) description of persons, which in the psychology of social cognitions is used to study person perception. The results indicate that person perception (i.e. the conscious part of the object/self representations) in children with conduct disorders differs characteristically from that in a normal age- and intelligence-matched control group.

Acting Out↗
PubMed2003

Can a subtype of conduct disorder linked to bipolar disorder be identified? Integration of findings from the Massachusetts General Hospital Pediatric Psychopharmacology Research Program.

Our intent was to investigate systematically the overlap between conduct disorder (CD) and bipolar disorder (BPD). We hypothesized that neither CD nor manic symptoms were secondary to the other disorder and that children with the two disorders would have correlates of both. Results from a series of programmatic studies examining phenotypic features of bipolar and conduct disorder alone or combined in probands and relatives were evaluated within and without the context of ADHD. Examination of the clinical features, patterns of psychiatric comorbidity, functioning in multiple domains, and familiality showed that children with CD and BPD had similar features of each disorder irrespective of the comorbidity with the other disorder. Our data suggest that when BPD and CD co-occur in children, both are correctly diagnosed. In these comorbid cases, CD symptoms should not be viewed as secondary to BPD, and manic symptoms should not be viewed as secondary to CD.

Adolescent↗
PubMed2001

Associations of past conduct disorder with personality disorders in 'non-psychotic' psychiatric inpatients.

The aim was to investigate associations of a history of features of DSM-III-R conduct disorder (CD) with features of DSM-III-R personality disorders (PDs) and psychopathy, in inpatient psychiatric practice. Fifty-six psychiatric inpatients, without a history of specified 'psychoses', were assessed by the SCID structured interview for DSM-III-R PDs and the 'Psychopathy Checklist Revised' (PCL-R). In a sample in which 59% had borderline PD, significant associations between a history of CD criteria and the adult features of antisocial PD (APD) were relatively specific compared with other PDs, but were weaker in women. However, significant correlations between the number of positive CD criteria and PCL-R scores were similar in both genders. The relatively specific associations between CD and adult features of APD are likely to be relevant to psychiatric patients who show various presentations of PD, if these include some adult features of APD. The findings inform the understanding of the development and classification of PDs.

Adolescent↗
PubMed2005

The natural history of conduct disorder symptoms in female inmates: on the predictive utility of the syndrome in severely antisocial women.

This study examined the utility of the conduct disorder (CD) diagnosis in predicting antisocial personality disorder (ASPD) among incarcerated women. It was surprising that most female inmates did not meet standard criteria for ASPD. This was due to a low occurrence of CD symptoms reported before age 15. Cluster analysis of CD symptoms revealed 4 types that characterized women with criminal histories. One type, which was characterized by a history of CD with interpersonal and physical aggression, was more predictive of ASPD than the traditional CD diagnosis. Yet another type, characterized by destruction of property, also represented an improvement over the traditional CD diagnosis. Overall, the results suggest that the types of CD behaviors, rather than their number, may be a more important indicator for identifying women at risk for future antisocial personality pathology.

Adult↗
PubMed2006

Adult antisocial behaviour without conduct disorder: demographic characteristics and risk for cooccurring psychopathology.

OBJECTIVE: Several studies note people who demonstrate adult antisocial behaviour (AAB) in the absence of conduct disorder (CD) before age 15 years. Perhaps because they do not meet diagnostic criteria for antisocial personality disorder (ASPD), this group of people exhibiting late-onset AAB has been underrecognized and understudied. Thus the goal of this study was to examine the demographic features and patterns of cooccurring psychopathology of people exhibiting late-onset antisocial behaviour (AB; AAB but not CD), compared with people suffering from ASPD (CD and AAB), people suffering from CD but not AAB, and members of a nonantisocial control group. METHOD: This study used the population-based sample of the National Comorbidity Survey (NCS). The demographic features examined were sex, percentage living in poverty, annual income, and years of formal education. The possibly cooccurring diagnoses examined were alcohol abuse and dependence, drug abuse and dependence, major depressive disorder, dysthymia, generalized anxiety disorder, social phobia, simple phobia, panic disorder, agoraphobia, and posttraumatic stress disorder. RESULTS: About 2.3% of participants exhibited AAB but not CD. These individuals had patterns of demographic characteristics and cooccurring psychiatric disorders quite similar to those of people diagnosed with full ASPD. CONCLUSION: Individuals who demonstrate this pattern of late-onset AB are at levels of risk comparable to those of individuals suffering from ASPD; therefore, they are equally in need of research and clinical attention.

Adolescent↗
PubMed1985

Dominance hierarchies in normal and conduct-disordered children.

Two groups of conduct-disordered children in day treatment and two groups of normal matched controls were observed over eight sessions in a free-play situation. The purpose of the study was to examine whether disturbed children formed dominance hierarchies, and to compare the power relations among disturbed children to those of normal peers. Results indicated that the hospitalized children did form dominance hierarchies, although their hierarchies were not as stable as those of their normal peers. Moreover, an inverse relation was noted between intragroup conflict and the hierarchy's stability. In addition, the pattern of targeting differed between the normal and disturbed youngsters. Conflict among the children in both control groups tended to be concentrated among members of adjacent ranks. The disturbed children, on the other hand, were less discriminating as to their target's rank, exhibited greater intragroup conflict, and lost more frequently in their agonistic encounters.

Agonistic Behavior↗
PubMed1996

Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents.

We examined adolescents with conduct disorder (CD) and substance problems to determine if those with attention deficit hyperactivity disorder (ADHD) symptomatology had more severe delinquency and substance involvement. ADHD symptomatology was assessed in two ways: (1) by self-reports using the Diagnostic Interview Schedule for Children (DISC) and (2) by use of DISC plus reports of others (parents, program staff, and program teacher). We divided boys into three ADHD groups based on DISC: those who met criteria, those who reported at least eight current symptoms, and those who reported fewer than eight symptoms. We also divided the same boys into two groups: those with reports of ADHD by two or more sources and those without this multisource ADHD. Examining these definitions of ADHD revealed that boys with either self- or multisource ADHD had more CD symptoms, earlier age of CD onset, more substance dependence diagnoses, and more comorbid depression and anxiety.

Adolescent↗
PubMed1997

Influences on adolescent substance dependence: conduct disorder, depression, attention deficit hyperactivity disorder, and gender.

OBJECTIVE: In adolescents, conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and depression are frequently comorbid with substance dependence (SD). We hypothesized that the prevalence and severity of CD, major depressive disorder (MDD), and ADHD would differ by gender, and that these conditions would associate differentially with severity of SD in males and females. METHODS: We examined these issues, using standardized diagnostic interviews, in 285 male and 82 female adolescents referred for comorbid CD and SD. RESULTS: Males and females did not differ significantly in severity of substance involvement, MDD, or ADHD, but males had more severe CD. MDD severity was the only variable significantly associated with SD severity for females, while for males, severity of CD combined with MDD and ADHD was significantly associated with SD severity. CONCLUSIONS: Among referred adolescents, CD, MDD, and ADHD may all be important concomitants of SD in males, while in females, depression may be the primary variable related to SD.

Adolescent↗
PubMed1995

Maternal attachment status, psychosocial stressors and problem behaviour: follow-up after parent training courses for conduct disorder.

37 Mothers of children with conduct disorder who had received Parent Management Training (PMT) were interviewed using the Adult Attachment Interview, 13-43 months after treatment. Child behaviour levels at follow-up were strongly associated with the scores at referral in the unresolved attachment group, but not in the resolved group. This was reflected in a statistical interaction between referral behaviour score and resolved/unresolved attachment status in a regression model. This model, which also included a strong independent contribution from a composite psychological stress index, explained 66% of the variance in follow-up behaviour scores. The implications of these results for predicting the outcome of PMT are discussed.

Child↗
PubMed1990

[Multidisciplinary assistance in a case of conduct disorder. A three-year project].

Conduct disorders are common. They concern many people inside and outside the health service. They are often a cause of despair in individuals, in the family and among professionals. This article describes the situation of a young boy. In 1985 everybody was about to give up and said there was nothing more that could be done for him. In this situation a municipal multidisciplinary team, with a three-year programme of treatment was organized. The purpose was to find out if it was possible to create new meanings in his surroundings, to give him a new start. The result is promising.

Adolescent↗
PubMed2006

Personality trait differences in boys and girls with clinical or sub-clinical diagnoses of conduct disorder versus antisocial personality disorder.

This study tested differences in personality traits measured by the Multidimensional Personality Questionnaire (MPQ) in a community sample of adolescents with definite or probable conduct disorder (CD) diagnoses that did not progress to a diagnosis of antisocial personality disorder (ASPD) by early adulthood (n=43), those with definite or probable ASPD that persisted into early adulthood (n=68), or controls with neither a CD nor an ASPD diagnosis (n=716) to examine whether antisocial behaviour disorders that differed in course were associated with differences in personality traits. As expected, boys and girls with ASPD were significantly different from controls on constraint, and those with ASPD were significantly lower on constraint than those with only CD. The results suggest that individual differences in certain personality traits may contribute to differences in the type of antisocial behaviour disorder that emerges and thereby to the course of antisocial behaviour.

Adolescent↗
PubMed1999

Further evidence of a bidirectional overlap between juvenile mania and conduct disorder in children.

OBJECTIVE: To investigate systematically the overlap between mania and conduct disorder (CD) in a sample of consecutively referred youths. It was hypothesized that neither CD nor manic symptoms were secondary to the other disorder and that children with the 2 disorders would have correlates of both. METHOD: Subjects were consecutively referred children and adolescents meeting DSM-III-R diagnostic criteria on structured diagnostic interview for CD (n = 116), mania (n = 110), and CD + mania (n = 76). RESULTS: Of 186 children and adolescents with mania and of 192 with CD, 76 satisfied criteria for both CD and mania, representing 40% of youths with CD and 41% of youths with mania, respectively. Examination of the clinical features, patterns of psychiatric comorbidity, and functioning in multiple domains showed that children with CD and mania had similar features of each disorder irrespective of the comorbidity with the other disorder. CONCLUSIONS: The data suggest that when mania and CD co-occur in children, both are correctly diagnosed. In these comorbid cases, CD symptoms should not be viewed as secondary to mania and manic symptoms should not be viewed as secondary to CD.

Adolescent↗