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PubMed2000

Attention-deficit disorder and conduct disorder in girls: evidence for a familial subtype.

BACKGROUND: The frequent comorbidity between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) raises the possibility that ADHD+CD is a distinct and separate condition. METHODS: We tested hypotheses about patterns of familial association between ADHD, CD, oppositional defiant disorder (ODD) and adult antisocial personality disorder (ASPD). Using family study methodology in a sample of girls, we found 11 children with diagnoses of ADHD+ CD, 39 with ADHD+ODD, and 90 with ADHD only. These were compared with 122 non-ADHD, non-CD control probands. Familial risk analysis was utilized. RESULTS: Relatives of each ADHD proband subgroup were at significantly greater risk for ADHD, and the relatives of ADHD-only subjects were at a greater risk of ODD than relatives of control subjects. Also, rates of CD were elevated among relatives of ADHD+CD probands only, and the coaggregation of ADHD and the antisocial disorders could not be accounted for by marriages between ADHD and antisocial spouses. Both ADHD and antisocial disorders occurred in the same relatives more often than expected by chance. CONCLUSIONS: These findings suggest that ADHD with and without antisocial disorders may be etiologically distinct disorders and provide evidence for the nosologic validity of ICD-10 hyperkinetic conduct disorder.

Adolescent↗
PubMed2003

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: individuals with symptoms of attention-deficit/hyperactivity disorder and conduct disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully account for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes.

Adult↗
PubMed1993

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↗
PubMed2002

Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II.

OBJECTIVE: To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD). METHOD: Selected summaries of the literature over the past decade are presented. RESULTS: Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models. Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains. CONCLUSIONS: Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD.

Achievement↗
PubMed2003

Clinical recovery in cognitive functioning and self-image among adolescents with major depressive disorder and conduct disorder during psychiatric inpatient care.

This prospective study examined psychosocial and cognitive functioning among adolescents with major depressive disorder and conduct disorder under comprehensive psychiatric inpatient care. Nonverbal and general cognitive performance, self-image, and overall psychosocial functioning improved in both groups. Nevertheless, more changes in self-image and family functioning were found among patients with major depressive disorder. Mental health services should still have the capability of offering long-term residential care for adolescents with the most severe mental disturbance.

Adolescent↗
PubMed1992

Current Perspectives on Adolescent Conduct Disorder.

Conduct disorder is a common biopsychosocial problem in children and adolescents. It is important for clinicians to recognize this condition in their patients so that timely evaluation and treatment strategies can be initiated.

Journal Article↗
PubMed2005

Gender appropriateness of symptom criteria for attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder.

We examined the gender appropriateness of the DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). In Study 1, 100 mothers (35 of children with and 65 of children without ADHD) rated how gender-typical and problematic they saw DSM-IV symptoms of ADHD, ODD, and CD; feminine descriptions of ADHD, ODD, and CD behaviors that we created; and relationally and overtly aggressive behaviors. Mothers rated the DSM-IV symptoms and overt aggression as boy-descriptive, and the feminine items that we created and relational aggression as girl-descriptive. Mothers saw the feminine items as less problematic than the masculine items. In Study 2, for 80 girls (40 with and 40 without ADHD), mothers' ratings on the feminine items were related to the corresponding DSM-IV symptoms, and to general psychopathology and impairment. Most correlations were significant and support the construct validity of the feminine items.

Adolescent↗
PubMed2001

Sources of covariation among attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder: the importance of shared environment.

Research has documented high levels of covariation among childhood externalizing disorders, but the etiology of this covariation is unclear. To unravel the sources of covariation among attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), the authors studied 11-year-old twins (N = 1,506) from the Minnesota Twin Family Study. Symptom counts for each of these disorders were obtained from interviews administered to the twins and their mothers. A model was fit that allowed the parsing of genetic, shared environmental (factors that make family members similar to each other), and nonshared environmental (factors that make family members different from each other) contributions to covariation. The results revealed that although each disorder was influenced by genetic and environmental factors, a single shared environmental factor made the largest contribution to the covariation among ADHD, ODD, and CD.

Attention Deficit Disorder with Hyperactivity↗
PubMed1998

An open trial of bupropion for ADHD in adolescents with substance use disorders and conduct disorder.

OBJECTIVE: Adolescents with conduct disorder (CD) and substance use disorders (SUD) have higher rates of comorbid attention-deficit/hyperactivity disorder (ADHD) than those without CD and SUD. Comorbid ADHD may contribute to more severe SUD. Treatment of ADHD may enhance effective treatment of substance abuse and behavior problems, yet there are few data regarding pharmacological treatment of ADHD in such youths. METHOD: Pilot data are presented from a 5-week, open-label bupropian trial in 13 nondepressed adolescent boys in a residential treatment program focusing on substance and behavioral treatments. All had diagnoses of ADHD, CD, and SUD. Patients' doses were titrated to a maximum fixed daily dose of 300 mg of bupropion. The Conners Hyperactivity Index and Daydream Attention scores, along with Clinical Global Impressions Severity of Illness (CGI-S) ratings, were obtained at baseline and at the fifth week of treatment. RESULTS: Subjects' mean Conners Hyperactivity Index score declined from 75.5 to 65.4 (p < .01, Wilcoxon signed rank test) (13% decline). The mean Daydream Attention score declined from 59.5 to 53.6 (p < .02, Wilcoxon signed rank test) (10% decline). Mean CGI-S declined from 4.9 to 3.0 (p < .002, Wilcoxon signed rank test) (39% decline). CONCLUSIONS: These preliminary data suggest that bupropion may be a useful treatment for ADHD in adolescents with CD and SUD; they suggest the need for a controlled trial of bupropion in such youths.

Adolescent↗
PubMed2002

Childhood mania, attention deficit hyperactivity disorder and conduct disorder: a critical review of diagnostic dilemmas.

OBJECTIVES: Significant debate exists on whether early onset bipolar disorder is mistakenly attributed to attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD), or whether ADHD and CD are frequently misdiagnosed as mania. We review the literature on the extent to which these disorders can be reliably differentiated, and describe the diagnostic confusion that may be the result of features common to both classes of disorders. METHODS: The review focuses on research studies that have examined whether overlapping symptoms of bipolar disorder, ADHD, and CD contribute to misdiagnosis of the two classes of disorders, the prevalence of early onset bipolar disorder with comorbid ADHD or CD, and theories regarding the origins of this comorbidity. RESULTS: Reliable and accurate diagnoses can be made despite the symptom overlap of bipolar disorder with ADHD and CD. Children with bipolar disorder and ADHD may have a distinct familial subtype of bipolar disorder. Some findings suggest that manic symptoms may represent 'noise' that indicates the general severity of psychopathology in a child or adolescent. CONCLUSIONS: Further prospective studies may confirm whether early onset bipolarity can be successfully differentiated from ADHD or CD, whether all three types of disorders can be recognized in comorbid cases, or whether comorbid cases represent a distinct subtype of bipolar disorder.

Adolescent↗
PubMed2002

The relationship between DSM-IV oppositional defiant disorder and conduct disorder: findings from the Great Smoky Mountains Study.

BACKGROUND: We examine models of the relationship between oppositional defiant disorder (ODD) and conduct disorder (CD) in a community sample. Particular attention is paid to the generalisability of findings based on clinic-referred boys. METHODS: The analyses were based on four waves of data from the Great Smoky Mountains Study covering children in the community aged 9-16 years. Child and parent reports of DSM-IV symptoms, diagnoses, and a range of family and environmental adversities were collected using the Child and Adolescent Psychiatric Assessment. RESULTS: Cross-sectional analyses indicated that CD and ODD largely shared similar correlates, although some aspects of parenting appeared more related to CD than ODD. This pattern was broadly similar in boys and girls. Longitudinal analyses confirmed that ODD was a strong risk factor for CD in boys and there was a suggestion that ODD was a stronger risk factor for CD than for other common disorders. Atypical family structure was an important factor in the transition between ODD and CD in boys. In girls ODD provided no increased risk for later CD but was associated with increased risk for continued ODD, depression, and anxiety. CONCLUSIONS: These results are more consistent with a developmental relationship between ODD and CD in boys than girls.

Adolescent↗
PubMed2002

Attention-deficit/hyperactivity disorder and conduct disorder symptomatology in adolescents with alcohol use disorder.

This study tested the hypothesis that attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) comorbidity is associated with substance use and deviance severity in 395 adolescents with alcohol use disorder. Thirty percent of the adolescents had high ADHD symptom counts, and 73% had 3 or more CD symptoms. ADHD-CD was associated with nonalcohol substance use disorder, drinking levels, and CD severity, but in general substance use was not uniquely elevated or problematic among the comorbid cases. In general, CD and CD severity were more important. The findings did not differ between boys and girls, revealing that in a treatment sample of adolescents, ADHD-CD comorbidity may need to be assessed and treated, but it is not broadly indicative of severity.

Adolescent↗
PubMed1997

Attention deficit disorder and conduct disorder: longitudinal evidence for a familial subtype.

BACKGROUND: An obstacle to the successful classification of attention deficit hyperactivity disorder (ADHD) is the frequently reported co-morbidity between ADHD and conduct disorder (CD). Prior work suggested that from a familial perspective, ADHD children with CD may be aetiologically distinct from those without CD. METHODS: Using family study methodology and three longitudinal assessments over 4 years, we tested hypotheses about patterns of familial association between ADHD, CD, oppositional defiant disorder (ODD) and adult antisocial personality disorder (ASPD). RESULTS: At the 4-year follow-up, there were 34 children with lifetime diagnoses of ADHD + CD, 59 with ADHD + ODD and 33 with ADHD only. These were compared with 92 non-ADHD, non-CD, non-ODD control probands. Familial risk analysis revealed the following: (1) relatives of each ADHD proband subgroup were at significantly greater risk for ADHD and ODD than relatives of normal controls; (2) rates of CD and ASPD were elevated among relatives of ADHD + CD probands only; (3) the co-aggregation of ADHD and the antisocial disorders could not be accounted for by marriages between ADHD and antisocial spouses; and (4) both ADHD and antisocial disorders occurred in the same relatives more often than expected by chance alone. CONCLUSIONS: These findings suggest that ADHD with and without antisocial disorders may be aetiologically distinct disorders and provide evidence for the nosologic validity of ICD-10 hyperkinetic conduct disorder.

Adolescent↗
PubMed2002

Behavioral and developmental disorders among conduct disorder.

The purpose of the present study was to clarify the percentage of children with conduct disorder (CD) who also have behavioral and developmental disorders. A survey of comorbidity observed in children with CD, was carried out on 33 subjects from a disciplinary facility for children. Female teachers as the mother were interviewed as regards the subjects' condition using the semistructured interview, and male teachers as the father were interviewed for their psychosocial problems. The subjects underwent the Wechsler Intelligence Scale for Children (WISC)-III and their conditions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV). Of the 33 children, 27 were diagnosed as having CD. Of the 27 CD children, 18 (67%) were diagnosed as having attention deficit hyperactivity disorder (ADHD), and 19 (70%) had oppositional defiant feature (ODF). Eight children (30%) were diagnosed as having mental retardation and in seven children (26%), the verbal IQ was significantly lower than the performance IQ. Two (7%) were diagnosed as having pervasive developmental disorders (PDD). Of 27 children diagnosed with CD, 23 (85%) had some behavioral and developmental disorders. The classification of these behavioral and developmental disorders into the following three types appeared to be clinically useful: type 1, ADHD and ODF; type 2, low intelligence, especially low verbal intelligence; and type 3, PDD. To understand and treat children with CD, the accurate diagnosis of these underlying behavioral and developmental disorders is indispensable.

Adolescent↗
PubMed2001

Looking for the disorder in conduct disorder.

Besides their well-known externalizing behavior, children with conduct disorder (CD) often have additional impairments outside the criteria for the CD diagnosis. In a 5-year study of 984 treated children (ages 5-17 years), those with CD had an average of 2.2 primary diagnoses. Children with CD showed the worst problem and impairment scores in comparison with 11 common diagnoses. Compared with other treated children, children with CD achieved worse scores on 14 of 15 syndromes, including internalizing problems such as withdrawal and major depression. The average child with CD had larger relapse scores in the 1.5- to 3-year period after admission to treatment. This pattern, pervasive at intake and chronic in course, resembles a global disability more than a circumscribed problem managed with a narrow range of treatments specific to it.

Adolescent↗
PubMed2001

Antecedents of opioid dependence and personality disorder: attention-deficit/hyperactivity disorder and conduct disorder.

Both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) were explored as possible antecedents of opioid dependence and personality disorder. One hundred adult opioid-dependent, treatment-seeking male inpatients were explored; an extended clinical semistructured interview to collect sociodemographic, drug use related, and clinical data and the Structured Clinical Interview for DSM-IV personality disorders SCID-II were carried out. Four groups of patients, namely ADHD alone (4 patients), ADHD + CD (7 patients), CD alone (47 patients) and no ADHD/no CD (42 patients) were identified and compared with each other. The results indicate that ADHD alone does not predispose to the development of opioid dependence in male inpatients. Childhood ADHD may nevertheless be found more frequently in male opioid addicts due to its comorbidity with CD, which was identified in more than half of our sample. Patients with ADHD history seemed to go through the drug abuse career earlier and to develop more frequently histrionic and obsessive-compulsive personality disorder. Over half of the CD patients developed borderline and/or antisocial personality disorder; both ADHD and CD predispose significantly to the PD development. Early substance use preventive measures are necessary in children and adolescents suffering from CD and from ADHD comorbid with CD.

Adolescent↗
PubMed1991

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↗
PubMed1995

Test of four hypotheses for the comorbidity of attention-deficit hyperactivity disorder and conduct disorder.

OBJECTIVE: To study the basis of the comorbidity of two common psychiatric disorders of childhood: attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD). METHOD: Subjects were 45 boys (aged 7 to 11 years) with either ADHD, CD, or ADHD + CD and 16 normal control children (NC) studied by means of a 2 (ADHD versus no ADHD) x 2 (CD versus no CD) design. We (1) tested whether similar or different patterns of cognitive, developmental risk, and psychosocial factors characterize the "pure" forms of the two disorders (i.e., ADHD and CD), and (2) compared the profile of the comorbid group (ADHD + CD) with those of the two pure groups. RESULTS: The ADHD group was significantly impaired on cognitive measures (inhibitory control and response alteration) and had greater delay in development and greater reading problems compared with CD and NC children; the CD group was exposed to significantly greater environmental adversity and had more severe problems in arithmetic than the ADHD and NC groups. The ADHD+CD group was similar to the ADHD group on cognitive, developmental, and reading measures and similar to the CD group on psychosocial and arithmetic measures. CONCLUSIONS: These results support the distinctiveness of ADHD and CD and the hypothesis that the comorbid condition of ADHD + CD is a hybrid of pure ADHD and pure CD.

Attention Deficit Disorder with Hyperactivity↗