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PubMed2001

Effective interventions for children and adolescents with conduct disorder.

Many different types of interventions have been used to treat children and adolescents with conduct disorder (CD). Unfortunately, most have had very limited effectiveness and, in some cases, have even shown iatrogenic effects. A primary reason for this limited effectiveness has been the failure of most treatments to directly address the causal mechanisms implicated in the development of CD. A few exceptions that have based interventions on the available research and that have proven to have some efficacy in reducing the conduct problems in youths with CD are reviewed. More important, a model for intervention is presented. This model emphasizes that interventions for youths with CD need to be comprehensive. That is, they need to take into account the myriad factors both within the child and within his or her social context that can cause and maintain CD symptoms. Further, interventions need to be individualized; they need to take into account the different pathways along which children may develop CD. Two intervention approaches that are consistent with these principles are reviewed, as are important directions for advancing treatment technology for youths with this disorder.

Adolescent↗

PubMed2000

Comorbidity in ADHD-children: effects of coexisting conduct disorder or tic disorder on event-related brain potentials in an auditory selective-attention task.

In children with attention-deficit hyperactivity disorder (ADHD) some deficits in auditory information processing seem to exist. Further, comorbidity of ADHD with conduct disorder (CD) and tic disorder (Tic) is quite common but not yet fully understood. Thus, we investigated the effects of these two disturbances, when combined with ADHD, on electrophysiological correlates of auditory information processing. An auditory selective-attention task was used, and temporal as well as frontal lobe sensitive event-related electrical brain activity indicators like mismatch negativity (MMN) and negative difference wave (Nd), as well as P300 were registered in four groups of children (healthy controls, ADHD-only, and combined ADHD + CD as well as ADHD + Tic; total number 42). Performance measures showed that ADHD + CD had a higher impact on errors and reaction times than ADHD + Tic. The MMN effect indicated that all ADHD groups showed lower MMN amplitudes compared to normals, but only the group with ADHD + CD suffered from a significant deficiency in automatic auditory information processing. Nd and P300 amplitudes showed no significant group differences. It may be assumed that neurodynamic sufficiency in ADHD-only and ADHD + Tic children seems to be similarly impaired while there might be a greater deficit in ADHD + CD.

Attention↗

PubMed2002

Childhood behavioral profiles leading to adolescent conduct disorder: risk trajectories for boys and girls.

OBJECTIVE: To examine the link between childhood behavioral dimensions and adolescent conduct disorder (CD) among a large sample of boys and girls monitored longitudinally. METHOD: Teachers rated the behaviors of 1,569 children every year between kindergarten and grade 6. On the basis of these seven yearly ratings, groups of children who followed distinct trajectories on three behavioral dimensions--hyperactivity, fearfulness, and helpfulness--were identified with a semiparametric statistical analysis. Children were then categorized into one of eight behavioral profiles, representing different combinations of the trajectories. Logistic regressions were used to estimate the relation between the profiles and CD in adolescence (mean = 15.7 years). RESULTS: Boys had a significant risk for CD if they were hyperactive (odds ratio [OR] = 4.27; 95% confidence interval [CI], 1.8-10.16); hyperactive and unhelpful (OR = 2.83; CI, 1.07-7.46); or hyperactive, fearless, and unhelpful (OR = 3.93; CI, 1.27-12.17). Girls had a significant risk for CD only if they were both hyperactive and unhelpful (OR = 4.61; CI, 1.31-16.24). More boys than girls exhibited profiles of risk and met criteria for CD in adolescence. CONCLUSIONS: Sex-specific childhood behavioral profiles that represented risk for CD in adolescence were identified. There were sex differences in the prevalence of the childhood profiles representing risk for CD.

Adolescent↗

PubMed2006

A long-term follow-up of conduct disorder adolescents into adulthood.

This study focuses on young male and female adults (n=290) who were diagnosed with conduct disorder (CD) during adolescence at the inpatient child and adolescent psychiatric unit in Lund, Sweden. Their adulthood is described using seven outcome variables: in custody, crime, illicit drug use, mental health, teenage parenthood, transference income and educational attainment. Together, the seven outcome variables represent a wide perspective of individual life and known risks for both genders. The variables are compared, scaled and described in an outcome that identifies successful outcome. Although this was a severe clinical inpatient group of adolescents, a relatively large number-about a third of the males and close to half of the females-exhibit a successful outcome by their early twenties. This study highlighted the merits use gender-sensitive outcome variables. The take-home message from a societal perspective is that many improvements are needed, a message that has been voiced in several Swedish commissions.

Adolescent↗

PubMed1997

Conduct disorder and HIV risk behaviors among runaway and homeless adolescents.

This study was designed to assess the prevalence of conduct disorder (CD) among runaway and homeless adolescents and to investigate associations between CD and HIV risk behaviors. The Diagnostic Interview Schedule for Children and a standardized HIV risk assessment questionnaire were administered to 219 runaway and homeless adolescents recruited from a drop-in center serving high-risk youth. One-half of the males and 60% of the females were diagnosed with CD. In multivariate analyses, CD was the strongest predictor of lifetime use of heroin and/or cocaine and exchanging sex for money, drugs, food or shelter, as well as the number of drugs used and the number of sex partners in the 3 months preceding the interview. The high rate of CD in this population, and the association between CD and both drug and sex-related HIV risk behaviors, indicate a need for interventions that consider the influence of this psychiatric diagnosis on high-risk behaviors.

Adolescent↗

PubMed2006

Effectiveness, safety, and pharmacokinetics of quetiapine in aggressive children with conduct disorder.

OBJECTIVE: To provide an initial description of the effectiveness and pharmacokinetics (PK) of quetiapine in aggressive children with conduct disorder (CD). METHOD: This 8-week, open-label outpatient trial, enrolled patients ages 6 to 12 years with CD. Outcome measures included the Rating of Aggression Against People and/or Property Scale (RAAPPS), Nisonger Child Behavior Rating Form (NCBRF), and the Conners Parent Rating Scale (CPRS-48). Blood sampling for PK analyses occurred at the end of weeks 2 and 8. RESULTS: Seventeen children (16 boys, mean age 8.9 years) were treated. The mean dose at week 8 was 4.4 mg/kg (SD = 1.1 mg/kg). Significant decreases in the baseline scores of the RAAPPS, and several subscales of the NCBRF and the CPRS were found by the end of the study (p <.05). No patients discontinued because of an adverse event. No patients experienced extrapyramidal side effects. Quetiapine disposition was linear over the dose range studied. The elimination half-life of the drug averaged 3.9 and 2.9 hours and total body clearance averaged 3.5 and 3.0 L/hr/kg after study weeks 2 and 8, respectively. CONCLUSIONS: These preliminary data suggest that aggressive children with CD may benefit from quetiapine. The PK of quetiapine supports twice-daily dosing in children with CD.

Aggression↗

PubMed1984

[Conduction disorders in infarction. Prognosis and therapeutic impact].

The natural history of conduction disorders in infarction and their prognostic significance are now well known and determine the choice of treatment. In the acute phase of inferior infarction without bundle branch block, temporary pacing is only indicated in cases with poor clinical tolerance or with a bradycardia of less than 50. Prophylactic pacing, on the other hand, appears to be necessary in cases of anterior infarction with branch block, at least in the high risk group in which the block is recent and bifascicular. In this case, the pacemaker is only permanent in cases of high degree atrio-ventricular block in the acute phase. The subsequent prognosis of anterior infarction with branch block and without high degree atrio-ventricular block in the acute phase carries a high incidence of sudden death. Primary delayed ventricular fibrillation during the first eight weeks seems to be the cause for this sudden death. Prolonged hospital surveillance of these patients would appear to be indicated.

Arrhythmias, Cardiac↗

PubMed2001

Conduct disorder: a biopsychosocial review.

OBJECTIVE: To review published works on the epidemiology, risk factors, protective factors, typologies, and genetic aspects of conduct disorder (CD). METHOD: Findings from refereed journal articles and current texts in the field are briefly summarized. RESULTS: CD is commonly encountered in clinical practice. Factors strongly predictive of future delinquency include past offenses, antisocial peers, impoverished social ties, early substance use, male sex, and antisocial parents. Factors that moderately predict recidivism include early aggression, low socioeconomic status (SES), psychological variables such as risk taking and impulsivity, poor parent-child relationships, poor academic performance, early medical insult, and neuropsychological variables such as poor verbal IQ. Mildly predictive variables include other family characteristics such as large family size, family stress, discord, broken home, and abusive parenting, particularly neglect. Protective factors include individual factors such as skill competence (in social and other arenas), adult relationships, prosocial and proeducational values, and strong social programs and supports. CONCLUSIONS: We know a great deal about psychosocial risk factors for CD. Some research into protective factors and genetic contributions exists but is in its early stages. Future work will increase our knowledge about subtypes, developmental pathways, and CD treatment.

Adolescent↗

PubMed2006

A joint genomewide linkage analysis of symptoms of alcohol dependence and conduct disorder.

BACKGROUND: A large linkage peak for alcohol dependence (AD) was detected on chromosome 4q in the Irish Affected Sib Pair Study of Alcohol Dependence (IASPSAD). Are the susceptibility genes underlying this peak specific for AD or do they increase risk for externalizing disorders more generally? Can we, in the IASPSAD, replicate prior evidence for linkage to conduct disorder (CD)? METHODS: The 733 all possible sibling pairs in IASPSAD were typed for 1,020 short-tandem-repeat genetic markers. Univariate and bivariate linkage analyses were conducted by the program sequential oligogenic linkage analysis routines (SOLAR), for both the raw and the transformed number of symptoms of AD (ADsx) and number of symptoms of CD (CDsx). In the bivariate analyses, specificity was assessed by the ratio of the variance accounted for in ADsx and CDsx by the quantitative trait locus. RESULTS: In the univariate linkage analyses, no evidence for linkage to CDsx was found under the 4q peak for ADsx and the largest peaks for CDsx were seen on chromosomes 1q (LOD=3.16) and 14p (LOD=2.36). In the bivariate linkage analysis, the 4q peak had high specificity for AD (AD/CD ratio of 39.9). Several smaller peaks, on chromosomes 1, 7, and 10, had moderate specificity for CD but also impacted on risk for AD, with AD/CD ratios of 0.18 to 0.32. CONCLUSIONS: Genes under the 4q linkage peak for AD in the IASPSAD impact specifically on risk for AD rather than more broadly on risk for externalizing syndromes. Suggestive linkages were found in several locations for CD, 2 of which broadly replicate prior findings. The bivariate analyses identified genomic locations containing susceptibility loci that impacted on risk for both CDsx and ADsx.

Alcohol-Related Disorders↗

PubMed2005

Genetic and environmental influences on conduct disorder: symptom, domain and full-scale analyses.

BACKGROUND: We used variable threshold models which accounted for age and gender differences to investigate the genetic and environmental influences on DSM-IV conduct disorder (CD) at the level of symptoms, aggressive versus non-aggressive domains, and full-scale. METHOD: A community sample of 1100 twin pairs (age 11-18) was interviewed using the Diagnostic Interview Schedule for Children. RESULTS: Behavior genetic model fitting suggested that genetic and environmental influences on individual symptoms varied by symptom. The best-fitting models for aggressive and non-aggressive domains, and full-scale CD included additive genetic effects and unique environmental effects only (AE models). These effects could be constrained across age cohorts and sex. The results suggest that using models that incorporate age- and gender-appropriate thresholds specific to each subject we can account for prevalence differences between cohorts. Heritability estimates were .49, .55 and .53 for the aggressive domain, non-aggressive domain, and full-scales, respectively. These results are in contrast to previous research on antisocial behavior measured with the CBCL reporting higher heritability for aggressive versus non-aggressive domains. CONCLUSIONS: Results suggest that individual symptoms of CD may be differentially heritable. Additionally, CD assessed using DSM-IV criteria may show differing patterns of heritability compared with estimates obtained for other measures of antisocial behavior such as the CBCL.

Adolescent↗

PubMed2005

The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children.

OBJECTIVES: To assess the clinical and cost-effectiveness of parent training programmes for the treatment of children with conduct disorder (CD) up to the age of 18 years. DATA SOURCES: Electronic databases. REVIEW METHODS: For the effectiveness review, relevant studies were identified and evaluated. A quantitative synthesis of behavioural outcomes across trials was also undertaken using two approaches: vote counting and meta-analysis. The economic analysis consisted of reviewing previous economic/cost evaluations of parent training/education programmes and the economic information within sponsor's submissions; carrying out a detailed exploration of costs of parent training/education programmes; and a de novo modelling assessment of the cost-effectiveness of parent training/education programmes. The potential budget impact to the health service of implementing such programmes was also considered. RESULTS: Many of the 37 randomised controlled trials that met the review inclusion and exclusion criteria were assessed as being of poor methodological quality. Studies were clinically heterogeneous in terms of the population, type of parent training/education programme and content, setting, delivery, length and child behaviour outcomes used. Both vote counting and meta-analysis revealed a consistent trend across all studies towards short-term effectiveness (up to 4 months) of parent training/education programmes (compared with control) as measured by a change in child behaviour. Pooled estimates showed a statistically significant improvement on the Eyberg Child Behaviour Inventory frequency and intensity scales, the Dyadic Parent-Child Interaction Coding System and the Child Behaviour Checklist. No studies reported a statistically significant result favouring control over parent training/education programmes. There were few statistically significant differences between different parent training/education programmes, although there was a trend towards more intensive interventions (e.g. longer contact hours, additional child involvement) being more effective. The cost of treating CD is high, with costs incurred by many agencies. A recent study suggested that by age 28, costs for individuals with CD were around 10 times higher than for those with no problems, with a mean cost of 70,019 pounds sterling. Criminality incurs the greatest cost, followed by educational provision, foster and residential care and state benefits. Only a small proportion of these costs fall on health services. Using a 'bottom-up' costing approach, the costs per family of providing parent training/education programmes range from 629 pounds sterling to 3839 pounds sterling depending on the type and style of delivery. Using the conservative assumption that there are no cost savings from treatment, a total lifetime quality of life gain of 0.1 would give a cost per quality-adjusted life-year of between 38,393 pounds sterling and 6288 pounds sterling depending on the type of programme delivery and setting. CONCLUSIONS: Parent training/education programmes appear to be an effective and potentially cost-effective therapy for children with CD. However, the relative effectiveness and cost-effectiveness of different models (such as therapy intensity and setting) require further investigation. Further research is required on the impact of parent training/education programmes on the quality of life of children with CD and their parents/carers, as well as on longer term child outcomes.

Adolescent↗

PubMed1979

[Conduction disorders during cardiac sarcoidosis (author's transl)].

The authors report 2 observations of auriculoventricular blockage developed during a mediastino-pulmonary sarcoidosis, requiring a heart pacer in the first case and corticosteroid treatment in the second. The frequency of the disorders of intracardiac conduction was evaluated by a retrospective study of 412 cases of mediastino-pulmonary sarcoidosis. Seventy two ECG were considered abnormal, a frequency of 17.2%. The disorders of auriculo-ventricular and intra-ventricular conduction represented a third of cases. What is known on the risk of lethal evolution of cardiac sarcoidosis in which those abnormalities are significant, justifies an electrophysiological investigation. The indications for a definitive cardiac stimulation and corticosteroid treatment are debated. On this final point, it seemed necessary to plan a prospective study to confirm the merits of the treatment and to define its modalities.

Adult↗

PubMed2000

The use of laboratory and performance-based measures in the assessment of children and adolescents with conduct disorders.

Provides a review of laboratory and performance-based assessment techniques that have been used in research with children who have severe conduct problems. Many of these techniques have proven useful for monitoring the effects of interventions, which seems to be their most immediate clinical use. With further development, several of these techniques have the potential for assessing clinically important processes that may be involved in the development and maintenance of conduct problems in youth, especially processes that may differ across subgroups of children with conduct disorders (CDs). The assessment of such processes could contribute to the development of individualized treatment plans for children and adolescents with CDs. However, a number of theoretical, methodological, and ethical issues limit the clinical utility of these laboratory and performance-based techniques in their current stages of development, especially in their contribution to making initial diagnoses of CDs. These limitations lead to very cautious recommendations for their clinical use.

Adolescent↗

PubMed1983

WISC-R incentives and the academic achievement of conduct disordered adolescent females: a validity study.

Selected and randomly assigned 51 institutionalized conduct disordered adolescent females to one of three treatment conditions. Ss' responses to a short form of the WISC-R were followed by examiner praise, neutral feedback, or token reinforcement. A series of Pearson product-moment correlations were calculated between the scaled scores of the three treatment groups and their GPAs. The results revealed that the identified subtests, regardless of treatment condition, were poor predictors of achievement. The correlations were discussed in view of the association between the selected subtests and the curricula of the special education classes, observed variations between the WISC-R treatment scores, and the special characteristics of the Ss.

Achievement↗

PubMed2003

The relationship of conduct disorder to attempted suicide and drug use history among methadone maintenance patients.

In order to examine the effects of a diagnosis of childhood conduct disorder (CD) on history of attempted suicide and drug use, unconfounded by early onset heroin use, 181 methadone maintenance patients who commenced heroin use after the age of 15 were interviewed. CD was diagnosed in 54% of patients. Compared to other patients, CD patients were younger and less educated. The onset of drug use, injecting drug use and heroin use occurred, on average, 2 years earlier than in other patients, and they had broader histories of injecting polydrug use. CD patients were more likely to have attempted suicide and to have been hospitalized after an attempt, and to have attempted suicide while enrolled in their current treatment. The current study indicates that a history of CD increases the risk of attempted suicide over and above the higher risks associated with injecting drug use per se.

Adolescent↗

PubMed1998

Validity of DSM-IV subtypes of conduct disorder based on age of onset.

OBJECTIVE: To present data from the DSM-IV field trials that led to the distinction between subtypes of conduct disorder (CD) that emerge in childhood or adolescence. In addition, data from a household sample were used to attempt to cross-validate these findings. METHOD: Differences between youths who met criteria for the two subtypes of CD were examined in the field trials sample of 440 youths aged 4 through 17 years and in a household sample of 1,285 youths aged 9 through 17 years. RESULTS: In both samples, there was a steep decline in aggression occurring around an age of onset of 10 years, but the number of nonaggressive behaviors was unrelated to the age of onset of CD. In the field trials sample, youths who met criteria for the adolescent-onset type were more likely to be girls, less likely to meet criteria for oppositional defiant disorder, and less likely to have a family history of antisocial behavior than the childhood-onset type, but these latter findings were not confirmed in the household sample. CONCLUSIONS: The DSM-IV approach to subtyping CD distinguishes subgroups that differ markedly in level of physical aggression. The advantages of a developmental approach to subtyping are discussed.

Adolescent↗

PubMed2001

Psychophysiological responses in ADHD boys with and without conduct disorder: implications for adult antisocial behavior.

OBJECTIVE: Several studies have demonstrated that the presence of attention-deficit/hyperactivity disorder (ADHD) in childhood increases the risk of antisocial behavior developing in adulthood. However, because previous research did not consider comorbid conduct disorder (CD), the question of whether ADHD by itself or only the association of ADHD with CD implies a risk of adult antisocial behavior developing is still under discussion. METHOD: Because several characteristics of psychophysiological response had been shown to be associated with future increased likelihood of adult antisocial behavior, autonomic arousal as well as electrodermal responses to orienting and aversive stimuli were assessed in 26 boys with ADHD+CD compared with 21 boys with ADHD alone and 21 controls. RESULTS: Boys with a comorbid condition of ADHD+CD showed a decrement of autonomic responses and a more rapid habituation to orienting and aversive startling stimuli compared with age-matched children with ADHD alone. CONCLUSIONS: Boys with ADHD+CD show a psychophysiological response pattern that is very similar to that reported in antisocial personalities. These findings give further support for a high persistence of antisocial behavior from childhood to adulthood, while no evidence was found that ADHD itself is associated with a predisposition to antisocial behavior.

Adolescent↗

PubMed2003

Total plasma l-tryptophan, free l-tryptophan and competing amino acid levels in a homicidal male adolescent with conduct disorder.

OBJECTIVE: Several studies have shown abnormal findings in human serotonin metabolism, such as increased total plasma l-tryptophan and free l-tryptophan levels among habitually violent antisocial offenders. It is not clear if these increased l-tryptophan levels are associated with adult antisocial personality disorder (ASP) or history of substance abuse, or if these levels are already present in adolescent subjects with conduct disorder (CD). METHOD: Total plasma and free l-tryptophan and competing amino acids (CAAs) were measured in a 15-year-old adolescent offender, who was convicted for two homicides, and in 10 healthy male controls of similar age and body mass index (BMI). RESULTS: In the juvenile offender, plasma total l-tryptophan/CAA was 84% and free l-tryptophan/CAA 143% higher than average mean among controls. CONCLUSION: From this very aggressive boy with CD, findings of free l- and total l-tryptophan/CAA values were similar to those of habitually violent adult ASP offenders. As severe CDs in adolescence tend to develop into adults with ASP, increased l-tryptophan/CAA and free l-tryptophan/CAA values may serve as early indicators for the development of habitually violent adult offenders.

Adolescent↗