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PubMed1996

Carbamazepine in aggressive children with conduct disorder: a double-blind and placebo-controlled study.

OBJECTIVE: To assess critically the short-term efficacy and safety of carbamazepine in the reduction of aggressiveness in children with diagnosed conduct disorder. METHOD: Subjects were children aged 5 to 12 years who were hospitalized for treatment-resistant aggressiveness and explosiveness and who had diagnosed conduct disorder. The study was double-blind and placebo-controlled, using a parallel-groups design. Following a 2-week placebo baseline period, children who met the aggression criteria were randomly assigned to treatments for 6 weeks; the study ended with a 1-week posttreatment placebo period. Multiple raters rated the children independently, using multiple rating scales under four conditions. The main outcome measures included the Overt Aggression Scale, the Global Clinical Judgments (Consensus) Scale, and the Children's Psychiatric Rating Scale. RESULTS: Twenty-two children, aged 5.33 to 11.7 years, completed the study. Carbamazepine was not superior to placebo at optimal daily doses ranging from 400 to 800 mg, mean 683 mg, at serum levels of 4.98 to 9.1 micrograms/mL. Untoward effects associated with administration of carbamazepine were common. CONCLUSIONS: In this modest sample of children, the superiority of carbamazepine over placebo in reducing aggressive behavior was not demonstrated.

Aggression↗

PubMed2000

The recovery potential of central conduction disorder in hypothyroid rats.

In an aim to detect the dysfunction of central nervous system among rats with varied durations of hypothyroidism and to elucidate the recovery potential after thyroxine replacement, a series of BAEP were conducted and compared with age-matched controls. BAEP was performed in five groups of the hypothyroid animals 1, 3, 5, 7, and 9 months after thyroidectomy respectively. Following initial electrophysiological assessment, thyroxine replacement was administered to each group of hypothyroid rats, and BAEP was performed at two month intervals, up to two successive normal studies or six months after the initiation of therapy, whichever came first. Before thyroxine treatment, prolonged I-V interpeak latency was the most consistent abnormal finding in all groups of hypothyroid rats, and longer hypothyroid state correlated well with more severe central conduction disorder. Hearing impairment was also noted among those with long duration of hypothyroidism. After thyroxine replacement, the central conduction dysfunction usually returned to normal if the hypothyroid state was not more than 5 months in duration. However, when hypothyroid state persisted over 7 months or more, there would be an incomplete recovery for central conduction disorder. The present study brings out the concept of 'therapeutic window' in reversing the central nervous dysfunction caused by hypothyroidism in adult rats.

Age Factors↗

PubMed2002

Effects of paternal drinking, conduct disorder and childhood home environment on the development of alcohol use disorders in a Thai population.

AIMS: To identify influences on the development of alcohol use disorders in a Thai population, particularly parental drinking and childhood environment. DESIGN: Case-control study. SETTING: A university hospital, a regional hospital and a community hospital in southern Thailand. PARTICIPANTS: Ninety-one alcohol-dependents and 77 hazardous/harmful drinkers were recruited as cases and 144 non- or infrequent drinkers as controls. MEASUREMENTS: Data on parental drinking, family demographic characteristics, family activities, parental disciplinary practice, early religious life and conduct disorder were obtained using a structured interview questionnaire. The main outcome measure was the subject's classification as alcohol-dependent, hazardous/harmful drinker or non-/infrequent drinker. FINDINGS: A significant relationship was found between having a drinking father and the occurrence of hazardous/harmful drinking or alcohol dependence in the subjects. Childhood factors (conduct disorder and having been a temple boy, relative probability ratios, RPRs and 95% CI: 6.39, 2.81-14.55 and 2.21, 1.19-4.08, respectively) also significantly predicted alcohol dependence, while perceived poverty and ethnic alienation was reported less frequently by hazardous/harmful drinkers and alcohol-dependents (RPRs and 95% CIs=0.34, 0.19-0.62 and 0.59, 0.38-0.93, respectively) than the controls. The relative probability ratio for the effect of the father's infrequent drinking on the son's alcohol dependence was 2.92 (95% CI=1.42-6.02) and for the father's heavy or dependent drinking 2.84 (95% CI=1.31-6.15). CONCLUSIONS: Being exposed to a light-drinking father increases the risk of a son's alcohol use disorders exhibited either as hazardous-harmful or dependent drinking. However, exposure to a heavy- or dependent-drinking father is associated more uniquely with an increased risk of his son being alcohol-dependent. The extent to which this is seen in other cultures is worthy of exploration.

Adolescent↗

PubMed2002

Waxing and waning in concert: dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 7 years among clinic-referred boys.

Six waves of structured diagnostic assessments were conducted of 168 clinic-referred 7- to 12-year-olds, over 7 years. Wave-to-wave changes in the number of conduct disorder (CD) behaviors were paralleled by correlated changes in the numbers of symptoms of oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. In addition, CD in Wave 1 predicted levels of ODD, ADHD, depression, and anxiety in later waves when initial levels of those symptoms were controlled, but only ODD in Wave 1 predicted CD in later waves when initial CD levels were controlled. These findings indicate a striking degree of dynamic comorbidity between CD and other types of psychopathology and provide an initial empirical framework for needed developmental models of comorbidity.

Affective Symptoms↗

PubMedDate not supplied

Substance refusal skills in a population of adolescents diagnosed with conduct disorder and substance abuse.

The present study examined substance refusal skills of 44 conduct-disordered male adolescents. Fifty percent of these adolescents were dually diagnosed with substance abuse/dependence. Substance refusal skills were assessed utilizing a role-play test that consisted of four interpersonal scenarios in which a confederate prompted youths to engage in illicit drug and alcohol activity. The test demonstrated adequate interrater agreement and validity. Overall skill in refusing alcohol was positively related to adolescents' perceptions of belonging and attention, and overall skill in refusing illicit drugs was positively related to school performance and social competence. Contrary to expectations, substance refusal skills of dually diagnosed adolescents were comparable to their non-substance-abusing counterparts. Clinical implications of this study are discussed.

Adolescent↗

PubMed1993

Biodevelopmental aspects of conduct disorder in boys.

The association between biochemical parameters and conduct disorder (CD) was studied in 22 boys admitted to a residential center. Three-methoxy-4-hydroxyphenylglycol (MHPG) levels were significantly higher in prepubertal CD youth than in pubertal/post pubertal CD youth. Homovanillic acid (HVA) levels were significantly lower in CD youth under age 12.0 years than in non CD youth under age 12.0 years. The implications of these biodevelopmental findings in the study of CD are discussed.

Age Factors↗

PubMed1994

Trends in appropriate adult functioning and biasing risks in longitudinal follow-ups of boys with conduct disorders.

Multiple telephone follow-up interviews have been conducted for a number of years for boys with conduct disorders treated at the Saint Francis Academy. These follow-ups are done 2 years and 5 years after treatment completion and again after the boy's 24th birthday. An overall appropriate adult functioning (AAF) score is obtained for each boy contacted. Because the attrition rate is very low, these data provide an opportunity to investigate the stability of treatment effects over time. A substantial attempt was made to investigate the possibility that mean group changes in AAF over time might be due to differential attrition effects. Two separate analyses indicated that an attrition effect was not a major influence in AAF score changes. AAF was relatively stable between the 2- and 5-year follow-ups and showed some improvement.

Adolescent↗

PubMed2004

Gender differences in childhood onset conduct disorder.

The present study tested several predictions related to the theory that girls with conduct disorder (CD) follow a single delayed onset pathway. The following hypotheses were tested among a high-risk, stratified random sample of youth who used public services during a 6-month period: boys will be more likely to have childhood onset CD (COCD) than girls; girls with COCD will be less common than girls with adolescent onset CD (AOCD); COCD girls. AOCD girls, and COCD boys will be similar in terms of risk profiles and AOCD boys will have a less severe risk profile than COCD girls; and risk factors that differentiate between COCD and AOCD among males will not differentiate between COCD and AOCD among females. Among those youth who met the criteria for CD, males were significantly more likely to have COCD than females. However, close to half of females with CD met the criteria for the COCD subtype. Of the seven risk factors that were examined, girls with COCD scored higher than COCD boys on three factors and higher than AOCD girls on four factors; however, only one significant difference was found between AOCD girls and COCD boys. Finally, risk factors appeared to differentiate between COCD and AOCD groups in a similar way among males and females. These findings suggest that COCD is not rare among females in public service sectors, COCD girls can be distinguished from AOCD girls in terms of risk factors, and risk factors for COCD among males are also relevant to females.

Adolescent↗

PubMed2002

Early-onset alcoholism with conduct disorder: go/no go learning deficits, working memory capacity, and personality.

BACKGROUND: Two studies were conducted to investigate the disinhibitory mechanisms that (1) discriminate early-onset alcoholism (EOA) with conduct disorder (CD; antisocial EOA) from a non-antisocial subtype of EOA and (2) are associated with novelty-seeking and low harm avoidance. METHODS: Young adults with antisocial EOA (n = 96), with non-antisocial EOA (without CD; n = 80), with CD alone (n = 50), and controls (n = 125) were given two go/no go tasks (one with monetary loss and the other with shock punishment), the Digit Span test (working memory capacity), and personality measures of harm avoidance, novelty-seeking/impulsivity, excitement-seeking, and negative affectivity. RESULTS: Study 1 revealed that antisocial EOA subjects had poor behavioral inhibition compared with non-antisocial EOAs and controls on both go/no go tasks and with the CD-alone group on the monetary-loss task. Low Digit Span scores accentuated poor inhibition in antisocial EOAs on the monetary loss, but not the shock task. EOA with low Digit Span was associated with higher hit rates on the shock task. Study 2 revealed that antisocial EOAs had high novelty-seeking/impulsivity and low harm avoidance compared with both non-antisocial EOAs and controls. Low harm avoidance was associated with poor inhibition with shock punishment, and this association was mediated by CD. For subjects with low Digit Span scores, novelty-seeking/impulsivity was associated with poor inhibition to monetary-loss punishment and higher hit rates to shock punishment. CONCLUSIONS: The results suggest two disinhibitory mechanisms that distinguish antisocial from non-antisocial EOA: an increased sensitivity to reward in nonaversive contexts associated with novelty-seeking/impulsivity and a decreased sensitivity to punishment in aversive contexts associated with low harm avoidance. Results also suggest that EOA and novelty-seeking/impulsivity are associated with a greater response to rewards in those with low working memory capacity.

Adolescent↗

PubMed2003

Major depression and conduct disorder in a twin sample: gender, functioning, and risk for future psychopathology.

OBJECTIVE: Major depression (MDD) and conduct disorder (CD) co-occur in adolescents at rates higher than would be expected by chance. This study described the functioning of adolescents with histories of these disorders and examined whether these patterns of association differed by gender. METHOD: Subjects with a lifetime diagnosis of MDD and/or CD were selected from a sample of 17-year-old twins; control subjects had no history of either disorder. The domains of school success, substance dependence, peer relationships, and age of first sexual intercourse were examined. RESULTS: Overall, each disorder separately and especially both disorders together related to increased maladjustment in the domains of school success and substance dependence. For school behavior problems, nicotine dependence, and drug dependence, the combination of MDD and CD related to particularly problematic functioning. Results were similar for males and females. Longitudinal data indicated that the occurrence of these disorders by late adolescence was predictive of subsequent depression and antisocial behavior in early adulthood. CONCLUSIONS: The combination of CD and MDD relates to more serious maladjustment, especially relating to school success and substance dependence, than would be expected given the adjustment associated with each disorder alone.

Adolescent↗

PubMed1997

Predictors of adolescent psychopathy: oppositional and conduct-disordered symptoms.

Psychopathy is an important clinical construct in the evaluation and treatment of adolescent offenders. In this study, predictors of adolescent psychopathy are explored in 81 adolescents from a residential treatment program for dually diagnosed offenders. The number of aggressive conduct disorder symptoms and total rate (number x frequency of symptoms) of deceit/theft symptoms are predictive of adolescent psychopathy. Although age of onset for conduct disorder symptoms is associated with psychopathy, its interpretation appears to be confounded by gender and ethnicity correlates. Unexpectedly, adolescent psychopathy was only modestly associated with institutional infractions. Past research and current findings are summarized with reference to their forensic implications.

Adolescent↗

PubMed2005

Neuropsychological deficits in adolescents with conduct disorder and comorbid bipolar disorder: a pilot study.

OBJECTIVE: We report pilot data on neuropsychological deficits in aggressive juvenile offenders with and without bipolar disorder compared with each other and healthy controls. METHOD: We assessed 52 adolescents and their parent or guardians: 36 incarcerated juvenile offenders and 16 community controls using the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Life-Time Version and a neuropsychological testing battery. All incarcerated subjects (n=34) met criteria for Conduct Disorder (CD); 26 are classified as Non-BD-CD, and eight with CD and Bipolar disorder (CD-BD). These subjects were compared to community controls (n=16) matched for age, gender, SES and ethnicity. RESULTS: Relative to controls, the Non-BD-CD subjects' impairments (p<0.05) were in cognitive ability, set shifting/inhibition, planning and verbal memory-language functioning. The CD-BD group displayed impairments (p<0.05) relative to controls in cognitive ability, set shifting, verbal memory-language functioning, and visuospatial tasks. The Non-BD-CD and CD-BD groups however did not display significant differences on most neuropsychological measures compared with each other. When we controlled for Attention Deficit Hyperactivity Disorder, the Non-CD-BP subjects continued to show deficits on Verbal measures where the CD-BD subjects maintained deficits in measures of cognitive ability, verbal measures and visual spatial tests. CONCLUSIONS: Juvenile offender with CD displayed a wide range of deficits on neuropsychological testing compared with controls. Although juvenile offenders with and without BD differed on their clinical presentation, differences on neuropsychological measures are not specific and may be related to comorbid diagnoses.

Adolescent↗

PubMed2001

Patterns of remission and symptom decline in conduct disorder: a four-year prospective study of an ADHD sample.

OBJECTIVE: To evaluate systematically the longitudinal course of conduct disorder (CD) in a sample of youths with attention-deficit hyperactivity disorder (ADHD) to determine the effects of a persistent course on outcome. METHOD: One hundred forty children with ADHD and their nuclear families were assessed at baseline and again at 1 and 4 years. Subjects were examined by means of DSM-III-R-based structured interviews. They were also evaluated for cognitive and social functioning. Persistent (exhibiting symptoms of CD at either follow-up) and desistent (symptoms of CD at neither follow-up) cases were identified. RESULTS: Forty-two percent of CD cases followed a persistent course. Although both persistent and desistent subjects had high rates of antisocial disorders in relatives, increased family conflict and decreased family cohesion were selectively associated with a persistent course. In addition, subjects with persistent symptoms of CD exhibited more impaired ratings on the Aggression and Delinquency subscales of the Child Behavior Checklist, as well as higher rates of bipolar, oppositional defiant, and substance use disorders. CONCLUSIONS: These findings suggest that the poor prognosis associated with CD is limited to an identifiable subgroup with a persistent course.

Adolescent↗

PubMed1998

The dominance of behavioural activation over behavioural inhibition in conduct disordered boys with or without attention deficit hyperactivity disorder.

On the basis of Gray's theory, Quay suggested that conduct disorder (CD) is associated with a Behavioural Activation System (BAS) that dominates over the Behavioural Inhibition System (BIS), whereas attention deficit hyperactivity disorder (ADHD) is characterised by an underactive BIS. Two studies were conducted to test the hypothesis that the dominance of the BAS over the BIS is more pronounced in CD comorbid with ADHD (CD/ADHD) than in CD alone. First of all, a response perseveration task was used, i.e. the door-opening task (Daugherty & Quay, 1991). In this game, the subject chooses either to open the next door or to stop playing; there is a steadily increasing ratio of punished responses to rewarded responses and a large number of doors opened is indicative of response perseveration. As expected, a steady increase in the number of doors opened was found across normal control (NC) boys, CD boys, and CD/ADHD boys (NC < CD < CD/ADHD). Second, the dominance of the BAS over the BIS was examined by observing the social behaviour of the child in interaction with a research assistant who alternately activated the BAS and the BIS while a game was played. The behaviour of the children was analysed according to ethological methods. Group differences in the frequencies of three out of five behavioural categories were in line with the results of the door-opening task (NC < CD < CD/ADHD).

Antisocial Personality Disorder↗

PubMed2004

Psychometric evaluation of self- and collateral timeline follow-back reports of drug and alcohol use in a sample of drug-abusing and conduct-disordered adolescents and their parents.

One hundred eighty-eight drug-abusing and conduct-disordered adolescents and their parents provided retrospective reports of the youths' frequency of alcohol and illicit drug use for each of the 6 months preceding their initial session in an outpatient treatment program. Youths' and parent reports of youths' drug and alcohol use for each month were similar. For marijuana and alcohol, frequency reports were related for each month, whereas hard drug reports were related only for the 4 months preceding intake. Relationships among alcohol and hard drug reports were strong during Months 1, 2, and 4 preceding intake, whereas strength of relationship among marijuana reports was similar throughout the 6 months.

Adult↗

PubMed1986

Peer interactions of conduct-disordered, anxious-withdrawn, and well-adjusted black adolescents.

The relationship between behavior problems and adolescent peer relations was examined in 30 black male adolescents divided into three equal-sized groups on the basis of individual psychosocial functioning (conduct-disordered, anxious-withdrawn, well-adjusted). Groups were matched on age, IQ, and father absence. An observational method was used to evaluate dominance, conflict, affect, and social competence manifested with a friend and with a well-adjusted stranger. Conduct-disordered and anxious-withdrawn adolescents displayed less social competence and less positive affect than well-adjusted adolescents when interacting with both friends and strangers. Anxious-withdrawn adolescents evidenced more personal apprehension than their well-adjusted counterparts. All groups showed greater leadership ability, talked more, and showed less personal apprehension with friends than with strangers. The findings support the role of peer relations in the maintenance and exacerbation of adolescent psychosocial difficulties.

Adolescent↗

PubMed2005

Ankylosing spondylitis and heart abnormalities: do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population?

The objective of this study was to determine the rate of selected cardiac pathologies (conduction disorders, valve regurgitation and diastolic dysfunction) in patients with long-standing ankylosing spondylitis (AS) and compare the results with the prevalence in the normal population. A rheumatologic (structured questionnaire interview) and cardiac evaluation (resting electrocardiography and echocardiography) was performed in 100 male subjects with AS and a disease duration of more than 15 years. The rates for conduction disorders, aortic and mitral valve regurgitation and diastolic dysfunction were compared with the corresponding results in the literature among the normal population. In patients with long-standing AS there was no increased rate for valve regurgitation (mitral and aortic valve) and for arrhythmia. Diastolic dysfunction occurred more often in patients with long-standing AS. However, this might be caused by the presence of other cardiovascular risk factors such as age and hypertension. According to these results, a cardiologic evaluation with echocardiography should not be recommended routinely in patients with long-standing AS. To confirm these results, a large prospective study with patients with long-standing AS and with a matched control group should be performed in the future.

Adult↗

PubMed2004

Genetic and environmental effects on conduct disorder and alcohol dependence symptoms and their covariation at age 14.

BACKGROUND: Alcohol misuse and conduct disorder (CD) are strongly associated in adolescents. Is their association due to shared genetic and environmental liabilities? We addressed that question with data obtained from structured interviews of 14-year-old Finnish twins. METHODS: A total of 1854 twins completed face-to-face interviews. Univariate models, allowing for sex limitation, were fit to symptom counts for Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised diagnoses of CD and alcoholism to examine their genetic and environmental influences. Then, bivariate models evaluated the extent to which genetic and environmental influences contributed to the covariation between symptom counts for the two disorders. RESULTS: A total of 822 twins (44% of the sample) reported one or more symptoms of CD; alcohol dependence symptoms were much less common, reported by only 12%. The correlation between the two symptom counts was 0.50. Models fit to the twin data demonstrated that CD symptoms were under significant genetic influence in both boys and girls, although those influences were predominantly sex specific. In contrast, alcohol dependence symptoms were, at this age, under sex-specific effects of common environments, with no evidence of genetic influences. Accordingly, the substantial covariation between alcohol dependence symptoms and those of CD was attributed entirely to shared environmental effects. CONCLUSIONS: At age 14, genetic influences on alcohol dependence symptoms are negligible, and the correlated liabilities between these symptoms and those of CD are to be found in environmental factors that are common to both.

Adolescent↗