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PubMed2004

Risks for conduct disorder symptoms associated with parental alcoholism in stepfather families versus intact families from a community sample.

BACKGROUND: It is not known if the prevalence of parental psychiatric disorders is higher in stepfather than intact families, or if parental alcoholism is differentially associated with risk for conduct disorder (CD) symptoms in stepfather families versus intact families. METHOD: The sample comprised 839 girls and 741 boys from 792 intact families and 99 girls and 67 boys from 83 stepfather families from a population-based registry of twins aged between 8 and 17 years. Children's current psychiatric symptoms were assessed at personal interview with the child, mother and father. Parental histories of psychiatric disorder were assessed at personal interview with each residential parent. Associations between CD symptoms and parental alcoholism were characterized using both linear and Poisson regression, and results are presented with and without adjustment for maternal drug use during pregnancy, parental conflict, and estimated socioeconomic status (SES) based on census tract data. RESULTS: Mothers from stepfather families had a higher lifetime prevalence of alcoholism, antisocial personality disorder, depression and social phobia than mothers from intact families. Stepfathers had a higher lifetime prevalence of alcoholism and depression than biological fathers from intact families. Children from stepfather families had more externalizing (CD/ODD) symptoms than children from intact families. Girls who lived with an alcoholic stepfather had significantly more CD symptoms than girls who lived with an alcoholic biological father. Boys who lived with an alcoholic stepfather had significantly fewer CD symptoms than boys who lived with an alcoholic biological father. This sex difference was statistically significant. Adjustment for maternal drug use during pregnancy, parental conflict, and estimated SES based on census tract data did not change these findings. CONCLUSIONS: Children living in stepfather families are exposed to more parental psychiatric risk factors than children from intact families. The increased risk for CD symptoms in girls (but not boys) from stepfather families is partly mediated by or associated with the stepfather's history of alcoholism.

Adolescent↗
PubMed2006

Adrenal androgen and gonadal hormone levels in adolescent girls with conduct disorder.

There are few data on the biological correlates of female antisocial behavior. This study compared adrenal androgen and gonadal hormone levels in adolescent girls with conduct disorder (CD) to girls without any psychiatric disorder (NC). We studied 87 girls, (47 CD; 36 NC), ages 15-17 years, obtaining three blood samples, drawn 20 min apart between 8 and 9 AM in the first 72 h of the onset of menstrual flow. Plasma was assayed for testosterone, estradiol, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S), sex hormone binding globulin (SHBG), and cortisol; area under the curve (AUC) for each of the three samples was used in the data analysis. We also calculated the Free Testosterone Index, Free Estrogen Index, Index of Hyperandrogenism and cortisol to DHEA ratio. In addition to receiving a full psychiatric interview, each girl completed a self-report questionnaire on general aggression. Main hormone analyses controlled for potentially confounding variables such as psychiatric comorbidity and race. Girls with CD had significantly lower cortisol to DHEA ratios, but did not differ from NC girls on any other hormone variable. Girls with symptoms of aggressive CD had significantly higher mean free testosterone indexes, lower SHBG levels, and lower cortisol to DHEA ratios than girls with non-aggressive CD. Girls with CD scored higher on the aggression questionnaire, but there was no association between general aggression and any hormone variable for the sample. Our data suggest that girls with CD, particularly aggressive CD, have lower cortisol to DHEA ratios, higher levels of free testosterone, and lower levels of SHBG. Clinical and research implications of these findings are discussed.

Adolescent↗
PubMed2006

Female conduct disorder: health status in young adulthood.

PURPOSE: One of the risk factors for poor adult health may be adolescent antisocial behavior, especially in girls. This study was conducted to determine if negative young adult health outcomes in girls who previously had adolescent antisocial behavior could be explained by demographic factors and pre-existing health problems. METHODS: This 3-year longitudinal study recruited 93 girls, ages 15-17 years (52 with conduct disorder [CD]; 41 with no psychiatric illness [normal controls; NC]) from the community. Baseline interviews of girls and parents collected demographic, psychiatric, and medical history data. Three annual interviews collected data about medical problems, health care service utilization, and reproductive health. In addition, the final follow-up included a standardized self-report questionnaire about young adult health status. RESULTS: CD and NC groups did not differ in age, racial composition, social class, proportion of smokers, or drug and alcohol experimentation. They were qualitatively different in baseline medical histories. Controlling for age at follow-up and baseline medical problems, the CD group as young adults had worse overall health, more discomfort, higher rates of unhealthy habits, lower rates of healthy behaviors, and more pregnancies at earlier ages. There were no group differences in rates of disorders, injuries, or health care usage. CONCLUSIONS: Adolescent girls with CD as young adults have poorer overall health, more discomfort, more health risk behaviors, and earlier onset of adult reproductive behaviors, even when controlling for demographic factors and pre-existing health history. Clinical and research implications are discussed.

Adolescent↗
PubMed1991

Anxiety, inhibition, and conduct disorder in children: II. Relation to salivary cortisol.

The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Gray's biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.

Adolescent↗
PubMed1984

Subgrouping conduct disordered adolescents by early risk factors.

An analysis aiming to functionally subgroup seriously conduct disordered adolescents identified grade of onset of persistent classroom misconduct as the single most useful and discriminating variable for this purpose. Students whose misconduct began in the early elementary school were characterized by a prominent degree of developmental-educational limitations, whereas those with a later onset were--like the control group--remarkably free of early risk factors.

Adolescent↗
PubMed1985

Diagnostic criteria for aggressive conduct disorder.

The purpose was to develop operational criteria for the diagnosis of aggressive conduct disorder. The necessary symptoms were found in discriminant analyses of data from a series of boy patients. A formula based on 8 key symptoms succeeded in accurately diagnosing a series of girl patients.

Adolescent↗
PubMed1990

Conduct disorders (CD): the reliability and validity of the new ICD-10-categories.

The conduct disorders (CD) were re-grouped in the 10th revision of the International Classification of Diseases (ICD-10), that comes into force in 1990. The new categories and the empirical findings based upon them are presented. The interrater reliability for the CD was satisfactory at 48.5%, but was clearly lower for the CD with emotional disorders with a correspondence of 33.3%. In a longitudinally examined field random test the total amount of CD increased clearly between 8 and 13 years, whilst it remained more or less constant between 13 and 18 years. The symptom load as parameter for the degree of severity of a disorder was significantly different to the disadvantage of the unsocialized in the 13 year olds between the CD without and with socialization, but was not so in the children and young adults. In the long-term, as far as the symptom load is concerned, there were no important group differences.

Adolescent↗
PubMed1981

[New diagnostic method in arrhythmias and heart conduction disorders].

The authors developed a method for recording spike potentials of the heart conduction system from the body surface on a curve of differentially intensified spike potential (DISP). They examined 187 patients and 60 healthy persons. The spike potentials of the sinoatrial node, atria and the bundle of His recorded on the DISP curves coincide exactly in time with spike potentials on intracardiac ECG recorded by microcatheterization of the heart through the subclavian vein, which makes it possible to distinguish on the DISP curve reference points for determining conductivity on definite areas of the heart conduction system. DISP recording allows the diagnosis of conductivity disorders and atrial overloading, arrhythmias of the heart, the diagnosis of which cannot be made from the ordinary ECG. In some cases this method can substitute for intracardiac ECG.

Action Potentials↗
PubMed2006

Screening for conduct disorder in an adolescent male sample from Colombia.

This study assessed the validity, reliability, and utility of a screening measure for detecting the signs or symptoms of Conduct Disorder in male adolescents from schools in Medellín, Colombia. A first study examined the differences between 70 male offender adolescents (aged 12-16 years) attending alternative education institutions, and 68 (sex, age, and socioeconomic status (SES)-matched) adolescent controls attending regular schools. A CD checklist (CD-CL) was constructed to be used by mothers (CD-CL-M) and for self-report by adolescents (CD-CL-SR). The validity of the screener for CD diagnosis was supported by significant differences between groups (ANOVA, p<.001). The CD-CL-SR had better sensitivity/specificity with a diagnostic cut-off point of 5 (sensitivity=95.3% and specificity=90.5%) than the CD-CL-M. A second study used the CD-CLSR with a random sample of 190 male adolescents (aged 12 to 16 years) from schools of low, middle and high SES. Reliability as assessed by Cronbach's alpha was 0.86. An epidemiological cut point of 5 classified 35.5% of the adolescents assessed as probable CD cases. A psychometric cut point at T score>59 (85th percentile) estimated 16.8% of the sample as probable CD cases. A psychometric cut point at T score>64 (90th percentile) revealed that 10.5% of the sample would be severe CD cases. Some significant differences (p<0.001) in proportions of CD adolescents were found between age and SES groups. It was concluded that such a high frequency of conduct problems in adolescence argues for the need for preventive programs in Colombian schools.

Adolescent↗
PubMed2001

Decreased cortisol levels in adolescent girls with conduct disorder.

BACKGROUND: Female adolescent antisocial behavior is increasing, but little is known about the neuroendocrinologic aspects of this disorder. On the basis of reports of decreased cortisol levels in antisocial males, we investigated morning plasma cortisol levels in adolescent girls with conduct disorder (CD). METHODS: Three plasma samples for cortisol levels were taken every 20 minutes between 8 and 9 AM in 47 adolescent girls with CD (mean +/- SD age, 16.5 +/- 0.9 years) and 37 normal control girls (mean age, 16.0 +/- 0.8 years). All blood was drawn within 72 hours after the onset of menstrual flow. RESULTS: Girls with CD had significantly lower cortisol levels than girls in the normal control group at all 3 sampling times. This finding was not due to procedural factors, demographic characteristics, or the use of medications. The girls with CD who had no other psychiatric problems had lower cortisol levels than girls with other disorders or those in the normal control group. In the multiple regression analysis, having CD predicted 10% of the variance in cortisol levels. CONCLUSIONS: Morning plasma cortisol levels were significantly diminished in adolescent girls with CD. Decreased cortisol levels appear to be most strongly associated with antisocial girls who do not have other psychiatric disorders.

Adolescent↗
PubMed2004

Learning, Enjoying, Growing, Support model: an innovative collaborative approach to the prevention of conduct disorder in preschoolers in hard to reach rural families.

OBJECTIVE: To develop, implement and evaluate a pilot program targeting rural families with preschool aged children at risk of conduct disorder. DESIGN: A prospective single group repeated measures design. SETTING: Communities in four local government areas in the Mid Western Area Health Service, New South Wales. SUBJECTS: A total of 33 families were referred to the program through community services where they were established clients. INTERVENTIONS: The Learning, Enjoying, Growing, Support model comprised a parenting program (Incredible Years; Kids Challenge and Change); a children's social skills program (Playing and learning to Socialise) and a transition to school component. Group programs were run simultaneously over 5-10 weeks. MAIN OUTCOME MEASURES: Measures of positive parenting and child problem behaviour and social skills were conducted on referral, and at completion of the program. RESULTS: There was a self-reported increase in utilisation of all positive parenting skills with significant increases in rewarding (median score on referral: 4 (range: 4-6); at completion of program 6 (4-6); (P = 0.02)) and ignoring (2 (0-6) to 3 (1-8); (P = 0.02)). Children increased their levels of social skills. Significant improvement was reported in cooperation: (median score: 24 (18-33) to 27 (19-33); (P = 0.02)); interaction (24 (6-9) to 26 (11-32); (P = 0.03)) and independence(25 (16-33) to 28 (20-33); (P = 0.008)). There was a downward trend in problem behaviour exhibited with a significant reduction in internalising behaviour (median score 19 (3-30) to 12 (0-32); (P = 0.04)). CONCLUSIONS: The positive impact of the model on parenting skills and child behaviour is promising and communities are continuing to run the programs. We recommend a broader adoption through rural communities.

Child Health Services↗
PubMed1999

Platelet dense granule secretion and aggregation in adolescents with conduct disorder: effects of marijuana use.

BACKGROUND: We had previously reported a decrease in agonist-induced platelet dense granule secretion in blood samples from male adolescents with and without Conduct Disorder (CD). In an augmented sample, we have now employed multivariate modeling to examine the simultaneous effects of CD and regular monthly alcohol and marijuana use on both the dense granule secretion and aggregation phases of agonist-induced platelet responses. METHODS: Blood samples were obtained from adolescents with and without a CD diagnosis. Platelet dense granule secretion and aggregation responses to a variety of agonists were examined in the laboratory. RESULTS: Significant multivariate interactions of CD status with regular marijuana use were found for responses to collagen, ADP alone, and ADP plus 0.2 microgram. of serotonin. Responses in platelets from youth with CD, but without regular marijuana use differed from other subjects. Multivariate main effects of marijuana use alone on platelet responses to arachidonic acid and ADP plus 1.0 microgram. of serotonin were found. No effects of alcohol use were found. CONCLUSIONS: The results demonstrate an interaction between CD and the effects of chronic marijuana use for several agonists in this platelet model system, and further support the possibility of a variation in signal transduction mechanisms in CD.

Adenosine Diphosphate↗
PubMed2005

The consequences of Conduct Disorder for males who develop schizophrenia: associations with criminality, aggressive behavior, substance use, and psychiatric services.

Men with schizophrenia are at increased risk, as compared to the general population, for criminal offending and to have displayed Conduct Disorder (CD) before age 15. The present study examined the consequences of CD among a sample of 248 men with schizophrenia or schizo-affective disorder, aged, on average, 39 years old. Participants were intensively assessed at discharge from the hospital and four times during the subsequent two-year period. CD was associated with criminality and substance misuse among first-degree male relatives and substance misuse among female relatives. In childhood and adolescence, CD was associated with poor academic performance, substance abuse, and physical abuse. In adulthood, the diagnosis of CD and each CD symptom were associated with increased non-violent and violent criminal offending, after adjusting for life-time diagnoses of substance misuse disorders. CD was not associated with homicide. CD was associated with life-time diagnoses of alcohol and drug abuse and/or dependence. During the 24 month follow-up period, CD and the number of CD symptoms were associated with aggressive behavior, controlling for life-time diagnoses of substance use disorders, substance misuse measured objectively and subjectively, medication compliance, and obligatory care. CD was associated with an earlier age at onset of schizophrenia and at first admission to hospital, and with length of time spent in hospital. During the two-year follow-up period, neither the diagnosis of CD nor the number of CD symptoms was associated with levels of positive and negative symptoms assessed five times, compliance with medication, substance use, or readmission. The results are interpreted to suggest that CD is a distinct co-morbid disorder that runs parallel to the course of schizophrenia.

Adult↗
PubMed2002

ADHD and conduct disorder: an MRI study in a community sample.

MRI studies of children with Attention-Deficit Hyperactivity Disorder (ADHD) have consistently attributed core deficits of inattention and impulsivity to frontal-striatal-cerebellar abnormalities; however, no study has investigated the neuroanatomical characteristics of children with ADHD and Conduct Disorder (CD). This study examined a community sample of 12 children with combined subtype ADHD (aged 8-12, 7 with CD) and 19 healthy controls matched for age, gender, handedness and poverty. Volume measurements, including left/right asymmetries, were quantified from MRI of the total brain, caudate and cerebellar vermis. No significant differences in total brain volume, caudate volume, asymmetry of the hemispheres or asymmetry of the caudate were found between the groups. Measurements of the left and total posterior superior and inferior lobes of the vermis, however, indicated smaller volumes for both pure ADHD and co-morbid children compared to the controls. Analysis of variance demonstrated no significant volumetric differences between the pure ADHD and co-morbid types. Prolonged exposure to methylphenidate was associated with caudate volumes. These results suggest ADHD and ADHD co-morbid with CD have similar deviant cerebellar morphology and replicate previous studies with an epidemiologically derived sample.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

Common and specific genetic influences on aggressive and nonaggressive conduct disorder domains.

OBJECTIVE: To explore the genetic and environmental influences on DSM-IV conduct disorder (CD) aggressive and nonaggressive subscales, taking into account age and sex differences. METHOD: A community sample of 1,100 twin pairs (ages 11-18) was interviewed using the Diagnostic Interview Schedule for Children. Bivariate analyses, using variable threshold models accounting for age and sex differences, were used to determine the extent to which the genetic and environmental influences on aggressive and nonaggressive CD domains are shared or unique. RESULTS: The phenotypic correlation between aggressive and nonaggressive CD domains was 0.32. The most parsimonious bivariate model included additive genetic effects and nonshared environmental effects only (AE model). CONCLUSIONS: The results of behavior genetic model fitting suggest that the DSM-IV CD domains are influenced by unique genetic and environmental factors, but also share some common genetic and environmental influences. A large percentage of the covariation (61%) is caused by genetic factors. These results are consistent with a previous report on the bivariate heritability of aggressive and nonaggressive antisocial behavior, but extend the findings to DSM-IV domains.

Adolescent↗
PubMed1997

Lithium treatment of conduct disorders in adolescents.

OBJECTIVE: The authors examined the efficacy of lithium carbonate for treating conduct disorder in adolescents. METHOD: The subjects were 33 inpatients aged 12-17 years. Lithium or placebo was administered in a double-blind fashion for 2 weeks. RESULTS: On several measures of clinical change the groups showed no significant differences. Of the patients who completed the study, 8.3% of those receiving placebo (one of 12) versus 21.4% (three of 14) of those receiving lithium were considered responders. CONCLUSIONS: Lithium does not appear beneficial for this indication.

Adolescent↗
PubMed2005

Abnormal neural responses to emotional visual stimuli in adolescents with conduct disorder.

BACKGROUND: It is widely held that aggression and antisocial behavior arise as a consequence of a deficiency in responding to emotional cues in the social environment. We asked whether neural responses evoked by affect-laden pictures would be abnormal in adolescents with conduct disorder (CD). METHODS: Functional magnetic resonance imaging during passive viewing of pictures with neutral or strong negative affective valence was performed in 13 male adolescents with severe CD aged 9 to 15 years and in 14 healthy age-matched control subjects. RESULTS: Main effects for negative-neutral affective valence included activations in the amygdala and hippocampus, ventral extrastriate visual cortex, and intraparietal sulcus bilaterally. There was a significant group-by-condition interaction in the right dorsal anterior cingulate cortex that was due to a pronounced deactivation in the patient group during viewing of negative pictures. When correcting for anxiety and depressive symptoms, we additionally found a reduced responsiveness of the left amygdala to negative pictures in patients compared with control subjects. CONCLUSIONS: We suggest that these findings reflect an impairment of both the recognition of emotional stimuli and the cognitive control of emotional behavior in patients with CD, resulting in a propensity for aggressive behavior.

Adolescent↗
PubMed2004

SCN5A mutation associated with dilated cardiomyopathy, conduction disorder, and arrhythmia.

BACKGROUND: We studied a large family affected by an autosomal dominant cardiac conduction disorder associated with sinus node dysfunction, arrhythmia, and right and occasionally left ventricular dilatation and dysfunction. Previous linkage analysis mapped the disease phenotype to a 30-cM region on chromosome 3p22-p25 (CMD1E). This region also contains a locus for right ventricular cardiomyopathy (ARVD5) and the cardiac sodium channel gene (SCN5A), mutations that cause isolated progressive cardiac conduction defect (Lenegre syndrome), long-QT syndrome (LQT3), and Brugada syndrome. METHODS AND RESULTS: Family members were studied, and the positional candidate gene SCN5A was screened for mutations. We identified, by direct sequencing, a heterozygous G-to-A mutation at position 3823 that changed an aspartic acid to asparagine (D1275N) in a highly conserved residue of exon 21. This mutation was present in all affected family members, was absent in 300 control chromosomes, and predicted a change of charge within the S3 segment of domain III. CONCLUSIONS: Our findings expand the clinical spectrum of disorders of the cardiac sodium channel to include cardiac dilation and dysfunction and support the hypothesis that genes encoding ion channels can be implicated in dilated cardiomyopathies.

Amino Acid Substitution↗