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Problem of item overlap between the psychopathy screening device and attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder rating scales.

Content validity requires a clear definition of the construct of interest and the delineation of the construct from similar constructs. Content validity also requires that the items be representative of the construct as well as specific to the construct. An examination of the items on the Psychopathy Screening Device (PSD), a parent- and teacher-rating scale of childhood psychopathy, indicates significant overlap with the symptoms and associated features of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). The failure of the PSD to have unique items results in poor discriminant validity with ADHD, ODD, and CD rating scales. More careful attention to content validation guidelines is required to develop a more useful measure of childhood psychopathy.

Antisocial Personality Disorder↗

[Family functioning and psychosocial characteristics in children with attention deficit hyperactivity disorder with comorbid oppositional defiant disorder or conduct disorder].

OBJECTIVE: To compare the parental sociodemographic characteristics, prenatal and postnatal developmental variables, IQ and behavioral disturbances as well as family functioning and current psychiatric disorders in the parents of children with attention deficit hyperactivity disorder (ADHD) and the parents of children with ADHD and comorbid oppositional defiant disorder (ODD) or conduct disorder (CD). METHOD: The sample consists of 92 children in the 6-11 age range, diagnosed with ADHD and ADHD with comorbid ODD/CD using DSM-IV diagnostic criteria. Parents completed the Child Behavior Checklist (CBCL) 4-18 and the Family Assessment Device (FAD) and were interviewed for current psychiatric treatment and alcohol consumption. RESULTS: 69.6% of the sample was diagnosed with ADHD and 30.4% with ADHD + ODD/CD. There were no differences between the two groups with respect to age, intelligence, characteristics of the neonatal period, age of walking and age of speech. Children with ADHD and comorbid ODD/CD had high CBCL subscale scores except for the social withdrawal and sexual problems subscales. Maternal depression and paternal drinking problems were high in the ADHD+ODD/CD group. The families of children with ADHD+ODD/CD also scored high at the level of 'unhealthy functioning' in the Roles and Behaviour Control subscales of the FAD. CONCLUSION: The treatment of children diagnosed with ADHD with comorbid ODD / CD should include parental treatment and intervention addressing parental skills.

Adult↗

The relationship of attention deficit hyperactivity disorder and conduct disorder to juvenile delinquency: legal implications.

Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are both disorders of childhood and adolescence that all too frequently extend into adulthood. But just what is the relationship between these two disorders? This study explores the overlap between these two disorders as they relate to juvenile delinquency; both are significant risk factors for the development of antisocial behavior. But there is more significance to the presence or absence of ADHD or CD in later antisocial behavior. Higher levels of defiant and/or aggressive behavior lead to antisocial acts as compared with lower levels of defiance and antisocial acts. Boys diagnosed with ADHD have higher felony rates than normal control boys, yet ADHD is not nearly as strong a predictor of offending behavior as is CD in study subjects. The presence of both CD and ADHD contributes to illegal behavior, and it is likely that early intervention in both disorders will reduce the prevalence of antisocial behavior.

Adolescent↗

Adult outcomes of attention deficit hyperactivity disorder and conduct disorder: are the risks independent or additive?

METHODS: Data were obtained from a longitudinal study sample of 754 adoptees and categorized based on review of the available adoption agency, medical, and psychiatric records of the biological parents. Categorical data were analyzed using chi2 or Fisher's exact tests, as appropriate. Logistic regression analyses were used to assess the relative contribution of variables. RESULTS: There was not a statistically significant difference in the frequency or type of self-reported adult disruptive behavior, arrests, jail stays, felony arrests, or frequency of conduct disorder (CD) when inattentiveness, impulsivity, and hyperactivity were analyzed individually. The contributions of attention deficit hyperactivity disorder (ADHD) were independent and no additional increased risk for future illegal behavior was conferred by the combination of the disorders. While the effect of CD on illegal behavior was correlated with substance abuse and dependence, ADHD continued to be a significant contributor after controlling for substance abuse and dependence. CONCLUSIONS: Data indicated that ADHD and CD are related but different disorders conferring risk for adult illegal behavior or arrest. In this sample, inattention was the most common domain impaired among those with ADHD, followed closely by hyperactivity, with impulsivity reported least often among those endorsing symptoms of ADHD.

Adolescent↗

Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting.

In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.

Antisocial Personality Disorder↗

The adolescent with conduct disorder.

Conduct disturbances are some of the most prevalent, enduring, impairing, and costly problems of childhood and adolescence. Despite many advances in our understanding of these disorders, they still remain a problem for the individuals, families, and society alike. Large-scale, multifaceted efforts are needed within our schools and communities if we are to have an impact on the prevalence and progression of these very problematic disturbances.

Adolescent↗

Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family-genetic study of American child psychiatric patients.

Using family study methodology and assessments by blind raters, this study tested hypotheses about patterns of familial association between DSM-III attention deficit disorder (ADD) and antisocial disorders (childhood conduct (CD) and oppositional disorder (OPD) and adult antisocial personality disorder) among 457 first-degree relatives of clinically referred children and adolescents with ADD (73 probands, 264 relatives), psychiatric (26 probands, 101 relatives) and normal controls (26 probands, 92 relatives). Among the 73 ADD probands, 33 (45%) met criteria for OPD, 24 (33%) met criteria for CD, and 16 (22%) had no antisocial diagnosis. After stratifying the ADD sample into those with CD (ADD + CD), those with OPD (ADD + OPD) and those with neither (ADD) familial risk analysis revealed the following: (1) relatives of each ADD proband subgroup were at significantly greater risk for ADD than relatives of both psychiatric and normal controls: (2) the morbidity risk for ADD was highest among relatives of ADD + CD probands (38%), moderate among relatives of ADD + OPD (17%) and ADD probands (24%) and lowest among relatives of psychiatric and normal controls (5% for both); (3) the risk for any antisocial disorder was highest among relatives of ADD + CD (34%) and ADD + OPD (24%) which were significantly greater than the risk to relatives of ADD probands (11%), psychiatric (7%) and normal controls (4%); and (4) both ADD and antisocial disorders occurred in the same relatives more often than expected by chance alone. Although these findings suggest that ADD with and without antisocial disorders may be aetiologically distinct disorders, they are also consistent with a multifactorial hypothesis in which ADD, ADD + OPD and ADD + CD fall along a continuum of increasing levels of familial aetiological factors and, correspondingly, severity of illness.

Adolescent↗

Schizophrenia, conduct disorder and depressive disorder: neuropsychological, speech sample and EEG results.

The relationship between degree of schizophrenia and neuropsychological impairment was investigated in 24 adolescent and adult hospitalized and non-hospitalized psychiatric patients with diagnoses of depressive disorder, conduct disorder, and schizophrenia. Schizophrenic adults and conduct disordered adolescents showed greater cognitive impairment than depressed patients on a neuropsychological test of rhythm perception and attention and showed greater frequency of EEG abnormality. Schizophrenics were differentiated from other groups by their impaired abstraction ability on the Halstead-Reitan Category Test. Use of these tests for prediction of adolescents at high risk for schizophrenia was discussed.

Adolescent↗

Conduct disorder, substance use disorders, and coexisting conduct and substance use disorders in adolescent inpatients.

OBJECTIVE: The authors examined the association between conduct disorder and substance use disorders in adolescent inpatients. METHOD: Structured diagnostic interviews were given to 165 adolescent inpatients to assess the presence of DSM-III-R axis I disorders and personality disorders from axis II. Patients with conduct disorder (N = 25), substance use disorders (N = 24), and coexisting conduct and substance use disorders (N = 54) were compared to determine whether additional axis I and axis II disorders presented at significantly different rates. RESULTS: The groups with conduct disorder and coexisting conduct and substance use disorders had a higher proportion of male subjects than the group with substance use disorders alone. Patients with conduct disorder had an earlier age at first psychiatric contact and were diagnosed significantly more often with attention deficit hyperactivity disorder than the other two groups. Borderline personality disorder was diagnosed more frequently in the patients with substance use and coexisting conduct and substance use disorders than in the patients with conduct disorder. These differential co-occurrence patterns were observed for both male and female subjects. CONCLUSIONS: Conduct disorder and substance use disorders have high comorbidity rates with other psychiatric disorders in adolescent inpatients. The additional psychiatric comparison group (patients with coexisting conduct and substance use disorders) allowed for finer distinctions regarding psychiatric comorbidity. The validity of subtyping conduct disorder on the basis of the presence of a coexisting substance use disorder is suggested; conduct disorder patients without a coexisting substance use disorder are more likely to have attention deficit hyperactivity disorder.

Adolescent↗

Heterogeneity of childhood conduct disorder: further evidence of a subtype of conduct disorder linked to bipolar disorder.

BACKGROUND: Although a small literature suggests that conduct disorder (CD) co-occurs with bipolar disorder (BPD), little is known about this overlap. Thus, we investigated the familial association of antisocial disorders (CD and/or antisocial personality disorder (ASPD)) and BPD among the first degree relatives of children with CD with and without comorbid BPD. METHODS: We compared relatives of four proband groups defined by the presence or absence of CD and BPD in the proband: (1) CD+BPD (N=26 probands, 92 relatives; (2) BPD without CD (BPD) (N=19 probands, 53 relatives); (3) CD without BPD (CD) (N=16 probands, 58 relatives); and (4) controls without BPD or CD (N=102 probands, 338 relatives). All subjects were evaluated with structured diagnostic interviews. Diagnoses of relatives were made blind to the diagnoses of probands. RESULTS: The results show high rates of antisocial disorders and BPD in relatives of children with CD+BPD. Moreover, antisocial disorders and BPD cosegregated among the relatives of children with CD+BPD. While relatives of both CD proband groups with and without BPD had high rates of CD/ASPD, the combined condition CD/ASPD+BPD was found exclusively among relatives of probands with CD+BPD. LIMITATIONS: Since we pooled two datasets, subjects were not all evaluated at the same time. Also, the lack of direct psychiatric interviews with children younger than 12 may have decreased the sensitivity of some diagnoses. CONCLUSIONS: These family-genetic findings suggest that CD and BPD represent separate disorders. Furthermore, they suggest that the comorbid condition of CD+BPD may be a distinct nosological entity. This suggests that clinicians treating CD or BPD children should consider the treatment implications of this comorbid condition.

Adolescent↗

Internal validity of attention deficit hyperactivity disorder, oppositional defiant disorder, and overt conduct disorder symptoms in young children: implications from teacher ratings for a dimensional approach to symptom validity.

Uses a dimensional approach to evaluate the internal validity of the attention deficit hyperactivity disorder (ADHD) inattention (I) and hyperactivity/impulsivity (H/I), oppositional defiant disorder (ODD), and overt conduct disorder (CD) symptoms (i.e., whether a symptom has a stronger correlation with its own dimension than the other three dimensions). In Study 1, teachers rated 1,445 children on the DSM-III-R I, H/I, ODD, and overt CD symptoms. In Study 2, teachers rated 1,711 children on the DSM-IV I, H/I, ODD, and overt CD symptoms. All the I symptoms showed internal validity in both studies. In contrast, the H/I symptoms and the ODD symptoms, especially the H/I symptoms, showed weaker internal validity. All the overt CD symptoms showed internal validity except the DSM-IV bullies others symptom, with this symptom being more strongly related to the ODD dimension. Confirmatory factor analysis provided support for a 4-factor model consisting of I, H/I, ODD, and overt CD factors. Finally, the importance of internal validity for the construct validation of the disruptive behavior symptoms is discussed.

Adolescent↗

The trait and method components of ratings of conduct disorder--Part I. Maternal and teacher evaluations of conduct disorder in young children.

A theoretical model designed to estimate the trait and method specific components of maternal and teacher ratings of childhood conduct disorder is presented. The model was applied to data collected on a birth cohort of New Zealand children. The model produced evidence to indicate that maternal and teacher ratings of childhood behaviour were contaminated by method variance. It was estimated that one-third of the variance in these scores reflected variance attributable to child behaviour traits. When the data were adjusted for the effects of method specific factors, the model suggested that conduct disorder measures were highly stable over time.

Child↗