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PubMed1995

Preadolescent conduct disorder behaviors predict relapse and progression of addiction for adolescent alcohol and drug abusers.

Increased awareness of the heterogeneity among alcohol and drug abusers has led to examination of the influence of concomitant psychopathology on the course of addiction and addictive relapse. Research among adult alcohol and drug abusers has found a detrimental influence of comorbid psychopathology on treatment outcome. Evidence exists for prevalent comorbidity, in particular conduct disorder (CD), among clinical samples of teen alcohol and drug abusers. However, little information is currently available on the relation and influence of psychopathology on outcome after treatment for adolescent alcohol and drug abuse. The current study examines the relation between CD, as assessed by the extent of preadolescent CD behaviors occurring before the initiation of drug use, and outcome for 131 adolescents over 2 years after inpatient treatment for alcohol and drug abuse. Drawing on recent conceptualizations of the process of relapse and progression of addictive behavior, CD is hypothesized to influence the process of relapse by altering coping efforts and intentions and increasing exposure to potential relapse situations. Results reveal that the extent of preadolescent CD behaviors is positively related to alcohol involvement in the 2 years after treatment, and that much of this relation is accounted for by posttreatment cognitive coping, motivation for alcohol abstinence, interpersonal problems, and exposure to alcohol use. Contrary to expectations, preadolescent CD behaviors did not predict posttreatment drug use. These findings provide evidence for the influence of psychopathology on the process of relapse and progression of addiction after treatment for adolescent alcohol and drug abuse, and suggest that teens with early life CD behaviors may be at greater risk for continued alcohol abuse.

Adolescent↗
PubMed2002

Conversational behaviour of children with Asperger syndrome and conduct disorder.

BACKGROUND: Social communication problems in individuals who have Asperger syndrome constitute one of the most significant problems in the syndrome. This study makes a systematic analysis of the difficulties demonstrated with the use of language (pragmatics) in adolescents who have Asperger syndrome. METHOD: Recent advances in discourse analysis were applied to conversational samples from a group of children with Asperger syndrome and a matched control group of children with severe conduct disorder. Two types of conversation were sampled from each group, differing in emotional content. RESULTS: The results showed that in these contexts children with Asperger syndrome were no more verbose as a group than controls, though they showed a tendency to talk more in more emotion-based conversations. Children with Asperger syndrome, as a group, performed similarly to control subjects in ability to respond to questions and comments. However, they were more likely to show responses which were problematic in both types of conversation. In addition, individuals with Asperger syndrome showed more problems in general conversation than during more emotionally and socially loaded topics. The group with Asperger syndrome was found to contain a small number of individuals with extreme verbosity but this was not a reliable characteristic of the group as a whole.

Adolescent↗
PubMed1996

Distractibility in hyperactive and conduct-disordered children.

Hyperactive children are often said to be inattentive and distractible. However, the results from a number of experimental studies are equivocal. To examine this discrepancy, a Chinese version of the Stroop Test was devised. Four groups of subjects recruited from a community sample of 1479 Chinese boys living in Hong Kong took part in the investigation. These were: (1) a pure hyperactive (HA) group; (2) a mixed hyperactive/conduct-disordered (HA + CD) group; (3) a pure conduct-disordered (CD) group; and (4) a normal (N) control group. The results revealed that HA children were more markedly affected by the introduction of distracting stimuli. This distractibility was probably a function of both stimulus potency and the random order in which stimuli were presented. The specificity of a greater distractibility to HA children indicates its diagnostic value with regard to hyperactivity. The failure to find a similar deficit in HA + CD children raises questions about the clinical identity of this mixed diagnostic group.

Attention Deficit Disorder with Hyperactivity↗
PubMed1995

Aggressivity in adolescent alcohol abusers: relationship with conduct disorder.

Several longitudinal and retrospective studies have documented an association between premorbid aggression and an increased risk for an alcohol-use disorder in adulthood. However, few data are available examining the relationship between trait aggressivity, alcohol use behavior, and the presence of an early-onset alcohol use disorder diagnosis among the adolescent population. To address this deficiency, this study had three goals. First, the relationship between aggressivity and adolescent alcohol consuming behavior was examined. Second, the presence and magnitude of trait aggressivity were determined among adolescents who met psychiatric diagnostic criteria for alcohol abuse/dependence (ALC), while controlling for the presence of a conduct disorder (CD). Third, because CD is overrepresented among adolescent alcohol abuse cases and is a priori defined by the presence of certain aggressive behaviors, the simultaneous contributions of CD and ALC on trait aggressivity were also investigated through structural equation modeling. The results confirm the salience of heightened aggressivity as an essential feature of this early-onset alcohol-abusing population and indicate the importance of addressing this behavioral domain in prevention and treatment efforts.

Adolescent↗
PubMed1996

Platelet dense granule secretion in adolescents with conduct disorder and substance abuse: preliminary evidence for variation in signal transduction.

Platelet aggregation responses to agonists have been employed as peripheral indices of the physiological responsiveness and density of neurotransmitter receptors, and in investigations of membrane functioning in psychopathological conditions. In particular, there are mechanistic similarities between neuronal secretory and receptor dynamics, and those involved in platelet dense granule secretion. Consequently, we have explored the platelet dense granule secretory responses to various agonists in abstinent male adolescents who meet current psychiatric diagnostic criteria for Conduct Disorder and Psychoactive Substance. Use Disorder (CD+/PSUD+) in contrast to controls (CD-/PSUD-). The results showed a significant hyporesponsivity among experimental subjects to collagen, thrombin, adenosine diphosphate (ADP), ADP plus 0.2 microgram of serotonin, and ADP plus 1.0 microgram of serotonin. Only dense granule responses to arachidonic acid did not differentiate the groups. Taken together, the lack of agonist specificity suggests that a variation in signal transduction mechanisms could account for the observed reduction in dense granule secretion among CD+/PSUD+ adolescents. Association between dense granule secretory responses and substance use behavior, and comorbid psychiatric conditions are also examined.

Adolescent↗
PubMed1993

Analyzing twin resemblance in multisymptom data: genetic applications of a latent class model for symptoms of conduct disorder in juvenile boys.

A model based on the latent class model is developed for the effects of genes and environment on multivariate categorical data in twins. The model captures many essential features of dimensional and categorical conceptions of complex behavioral phenotypes and can include, as special cases, a variety of major locus models including those that allow for etiological heterogeneity, differential sensitivity of latent classes to measured covariates, and genotype x environment interaction (G x E). Many features of the model are illustrated by an application to ratings on eight items relating to conduct disorder selected from the Rutter Parent Questionnaire (RPQ). Mothers rated their 8- to 16-year-old male twin offspring [174 monozygotic (MZ) and 164 dizygotic (DZ) pairs]. The impact of age on the frequency of reported symptoms was relatively slight. Preliminary latent class analysis suggests that four classes are required to explain the reported behavioral profiles of the individual twins. A more detailed analysis of the pairwise response profiles reveals a significant association between twins for membership of latent classes and that the association is greater in MZ than DZ twins, suggesting that genetic factors played a significant role in class membership. Further analysis shows that the frequencies of MZ pairs discordant for membership of some latent classes are close to zero, while others are definitely not zero. One possible explanation of this finding is that the items reflect underlying etiological heterogeneity, with some response profiles reflecting genetic categories and others revealing a latent environmental risk factor. We explore two "four-class" models for etiological heterogeneity which make different assumptions about the way in which genes and environment interact to produce complex disease phenotypes. The first model allows for genetic heterogeneity that is expressed only in individuals exposed to a high-risk ("predisposing") environment. The second model allows the environment to differentiate two forms of the disorder in individuals of high genetic risk. The first model fits better than the second, but neither fits as well as the general model for four latent classes associated in twins. The results suggest that a single-locus/two-allele model cannot fit the data on these eight items even when we allow for etiological heterogeneity. The pattern of endorsement probabilities associated with each of the four classes precludes a simple "unidimensional" model for the latent process underlying variation in symptom profile in this population. The extension of the approach to larger pedigrees and to linkage analysis is briefly considered.

Adolescent↗
PubMed1992

Utility of the SCL-90-R with depressed and conduct-disordered adolescent inpatients.

We assessed the diagnostic utility of the Symptom Checklist-90-Revised (SCL-90-R) in a sample of adolescent inpatients. In Part 1 (n = 79), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation. Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, and obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct disorder, sensitivity was low.

Adolescent↗
PubMed1996

Conduct disorder, enuresis and specific developmental delays in two types of encopresis: a case-note study of 63 boys.

Encopresis, defined as the passage of stool in an unacceptable place, may occur either as a failure to establish toilet training (primary encopresis), or as a subsequent breakdown in that training (secondary encopresis). A case-note study of sixty-three encopretic boys was undertaken to test the hypothesis that primary and secondary encopresis differed in their associated psychopathology. Boys with primary encopresis were more likely to have developmental delays (p<0.001) and enuresis (p<0.05) than boys with secondary encopresis. Those with secondary encopresis had excesses of psychosocial adversity (p <0.001) and conduct disorder (p <0.05) compared to those with primary encopresis. These results suggest that future research should clearly distinguish these two subtypes when investigating the associated psychopathology of encopresis in boys; research is needed to establish if these associations hold for girls also.

Child↗
PubMed1994

Long term outcome of an attachment-based program for conduct disorder.

There is increasing concern among professionals and the public about the level of violence and antisocial behaviour among our youth. This has been coupled with confusion and a sense of helplessness about which types of interventions are most effective in responding to these difficulties. Some professionals and advocacy groups are calling for tougher disciplinary responses to violence and antisocial behaviour, including changes in the Young Offenders Act. Yet, such interventions are rarely effective in producing the desired reductions in these behaviours. Other professionals have called for better forms of treatment. However, few treatments have been shown to be effective in bringing about long term reductions either in aggressive behaviour or in the concomitant psychological difficulties experienced by these youths. In this paper, a description is presented of an approach to understanding conduct disorder that focuses on attachment as an organizing principle of behaviour and affect. Also, a description is presented of a community-oriented program that is based on attachment theory, as well as the results of the program evaluation at six, 12 and 18 months following discharge. The findings replicate and extend earlier findings reported by Holland et al (1) on the effectiveness of this approach.

Adolescent↗
PubMed2005

Evidence-based management of conduct disorders.

PURPOSE OF REVIEW: It is becoming increasingly apparent that antisocial children often grow up to inflict considerable damage on others at a high cost, and also lead very impoverished lives themselves. There is rising public and governmental concern to get on top of aggressive and criminal behaviour, which is especially prevalent in the socially and economically disadvantaged. RECENT FINDINGS: While parent training has been around for some 30 years, it has now been supplemented by efficacious child problem-solving and teacher-training programmes. For severe delinquency, community-based multisystemic interventions are reasonably effective when applied diligently. They cover social skills, and keep youths very closely supervised while giving them immediate rewards for compliance. SUMMARY: Despite popular impressions to the contrary, a lot is known about the causes of antisocial behaviour and conduct disorders, and now there are effective interventions to reduce it. However, many policymakers and commissioners are still unaware that effective programmes exist, or that when implemented, insufficient attention is paid to the need for fidelity to the model used and to the development of therapist skill. Effectiveness is then often disappointing in 'real life' conditions. However, when these factors are addressed, the evidence is clear that substantial gains can be made.

Journal Article↗
PubMed2006

[Using fairy tales and narrative strategies with the help of a sandpit with children suffering from conduct disorders].

Our research, focussed on art therapy with primary school children, guided us to the footsteps of women pioneers in the research about children's psyche, like Anna Freud, Melanie Klein, Margaret Loewenfeld, Dora Kalff. We have been inspired by their very personal but nevertheless somehow similar type of research, to work with the children in a blue sand pit, where they could construct and play their personal fairy tales. Thus they share with us their momentary preoccupations, without being forced to talk about them. They are revealing their internal structures, and are integrating, by narration and projection on those figurines in action, their deficient defense mechanisms as well as their negative tendencies. Based on this approach, we expect that there will by an amelioration of their social skills, an enhancement of their intrinsic motivation, and a diminution of their conduct disorders. The analyze will be done by questionnaires and rating scales constructed especially for this research, as well as by sociograms, with the help of descriptive non parametric statistics.

Art Therapy↗
PubMed1986

Conduct disorder and hyperactivity: II. A cluster analytic approach to the identification of a behavioural syndrome.

Sixty boys, aged from 6 to 10 years, were studied after their referral to psychiatric clinics for antisocial or disruptive behaviour. Their scores on reliable measures of hyperactivity, defiant behaviour, emotional disorder and attention deficit were taken for the home, school and clinic settings; and subjected to two techniques of cluster analysis. Both gave a similar set of clusters, one of which had high scores on all measures of hyperactivity and attention deficit. Membership of this cluster was associated with a lower IQ, a younger age of problem onset and referral, an abnormal neurological examination, a history of developmental delay, smaller family size, poor peer relationships and a high rate of accidental injuries; and it predicted a good response to stimulant medication in a controlled trial. Other research on the classification of hyperactivity is discussed, and proposals are made for the criteria of a rather narrow definition of 'hyperkinetic conduct disorder'.

Antisocial Personality Disorder↗
PubMed2000

Comparison of the role of dopamine, serotonin, and noradrenaline genes in ADHD, ODD and conduct disorder: multivariate regression analysis of 20 genes.

The present study is based on the proposal that complex disorders resulting from the effects of multiple genes are best investigated by simultaneously examining multiple candidate genes in the same group of subjects. We have examined the effect of 20 genes for dopamine, serotonin, and noradrenergic metabolism on a quantitative score for attention deficit hyperactivity disorder (ADHD) in 336 unrelated Caucasian subjects. The genotypes of each gene were assigned a score from 0 to 2, based on results from the literature or studies in an independent set of subjects (literature-based scoring), or results based on analysis of variance for the sample (optimized gene scoring). Multivariate linear regression analysis with backward elimination was used to determine which genes contributed most to the phenotype for both coding methods. For optimized gene scoring, three dopamine genes contributed to 2.3% of the variance, p = 0.052; three serotonin genes contributed to 3%, p = 0.015; and six adrenergic genes contributed to 6.9%, p = 0.0006. For all genes combined, 12 genes contributed to 11.6% of the variance, p = 0.0001. These results indicate that the adrenergic genes play a greater role in ADHD than either the dopaminergic or serotonergic genes combined. The results using literature-based gene scoring were similar. An examination of two additional comorbid phenotypes, conduct disorder and oppositional defiant disorder (ODD), indicated they shared genes with ADHD. For ODD different genotypes of the same genes were often used. These results support the value of the simultaneous examination of multiple candidate genes.

Adolescent↗
PubMed2006

The role of GABRA2 in risk for conduct disorder and alcohol and drug dependence across developmental stages.

We use findings from the behavior genetics literature about how genetic factors (latently) influence alcohol dependence and related disorders to develop and test hypotheses about the risk associated with a specific gene, GABRA2, across different developmental stages. This gene has previously been associated with adult alcohol dependence in the Collaborative Study of the Genetics of Alcoholism (COGA) sample [Edenberg, H. J., Dick, D. M., Xuei, X., Tian, H., Almasy, L., Bauer, L. O., Crowe, R., Goate, A., Hesselbrock, V., Jones, K. A., Kwon, J., Li, T. K., Nurnberger Jr., J. I., O'Connor, S. J., Reich, T., Rice, J., Schuckit, M., Porjesz, B., Foroud, T., and Begleiter, H. (2004). Am. J. Hum. Genet. 74:705-714] and other studies [Covault, J., Gelernter, J., Hesselbrock, V., Nellissery, M., and Kranzler, H. R. (2004). Am. J. Med. Genet. B Neuropsychiatr. Genet. 129B:104-109; Lappalainen, J., Krupitsky, E., Remizov, M., Pchelina, S., Taraskina, A., Zvartau, E., Somberg, L. K., Covault, J., Kranzler, H. R., Krystal, J., and Gelernter, J. (2005). Alcohol. Clin. Exp. Res. 29:493-498]. In a sample of children and adolescents ascertained as part of the COGA project, we find that GABRA2 is significantly associated with childhood conduct disorder symptoms, but not with childhood alcohol dependence symptoms. A consistent elevation in risk for alcohol dependence associated with GABRA2 is not evident until the mid-20s and then remains throughout adulthood. GABRA2 is also associated with other drug dependence in our sample, both in adolescence and adulthood.

Adolescent↗
PubMed2003

Conduct disorder and delinquency.

Overviews evidence-based family treatments for adolescent conduct problems. Three treatments succeed in meeting recommendations for treatment development set forth in recent evaluations by reviewers and federal entities. These treatments (Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care) have achieved their success by using the science base of known risk factors, providing an effective alternative to restrictive placements, and using scientific methods to evaluate effectiveness. Major features of these three treatments are presented, including clinical and quality assurance procedures, controlled outcome research support, cost analyses, and process research. Bases of treatment success and parallels among the three approaches are summarized, as is their transport and dissemination to practice settings. Finally, suggestions for future research and clinical implications are discussed.

Adolescent↗
PubMed2005

Temperament and parenting: implications for understanding developmental pathways to conduct disorder.

This article reviews research linking a number of temperamental vulnerabilities that can place a child at risk for developing severe conduct problems. One primary focus of this article is on how certain temperamental vulnerabilities can disrupt normal developmental processes during early childhood, such as the development of emotional regulatory abilities and the development of the affective components of conscience, to place a child at risk for acting in an antisocial and aggressive manner. A second focus of the paper is on how the quality of parenting that a child experiences interacts with the child's temperament to either increase or decrease the child's risk for problem behavior. Identifying those parent factors that can enhance the development of children at risk for conduct problems due to temperamental vulnerabilities could be very important for enhancing interventions for children with severe behavior problems.

Affect↗