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PubMed1997

Residential behavior therapy for children with conduct disorders.

Children with conduct disorders are often referred to residential treatment centers (RTCs). RTCs shorten the length of treatment and thus feel they need to reconceptualize the purpose and process of treatment. Two intervention strategies have been found to affect conduct disorder in outpatient settings: parent training programs that are based on operant learning principles and cognitive-behavioral programs that focus on the relation between cognition and behavior. These strategies should not be transferred to the RTC but adapted to the characteristics of residentially treated conduct disordered children and their parents. These methods should be used together to integrate and strengthen the various learning processes that residential treatment can foster. An outline is given of a comprehensive and integrated residential treatment program based on behavioral methods that have been proven to affect conduct disorder.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2002

A question for DSM-V: which better predicts persistent conduct disorder--delinquent acts or conduct symptoms?

BACKGROUND: Conduct disorder (CD), a psychiatric index of antisocial behaviour, shares similarities with delinquency, a criminological index. This study sought to examine which factors in childhood predict a repeated diagnosis of CD in adolescence, and whether self-reported delinquent acts enhance the utility of symptoms of CD in predicting later persistent CD. METHOD: Longitudinal data used in this paper come from a clinic-referred sample of 177 boys, along with their parents and teachers, who were assessed using a structured clinical interview. The boys also reported on their delinquent behaviours, as well as a broad range of other family and life events. RESULTS: Before age 13, 77 boys met criteria for CD according to their parent, 69 according to their own report, and 36 reported three or more delinquent acts. Forty-eight boys (29%) met criteria for CD three or more times between 13 and 17. In childhood, delinquency overlapped, but was distinct from CD. Both were present in 28 cases, while 41 cases had CD without delinquency, and eight had delinquency without CD. When tested as predictors of later persistent CD, child-reported CD was the strongest predictor of later persistent CD, but self-reported delinquency was stronger than parent-reported CD. A final model of significant predictors included child-reported CD, delinquency, poor child communication with parents, and maternal prenatal smoking. CONCLUSIONS: It appears that delinquency does add uniquely to the prediction of persistent CD. It may be useful to expand the diagnostic criteria for CD accordingly.

Adolescent↗
PubMed2001

Doing better with "bad kids": explaining the policy-research gap with conduct disorder in Canada.

Conduct disorder (severe and persistent antisocial behaviour in children and youth) is an important community mental health problem in Canada and has been the focus of considerable recent public policy debate. Good research evidence is available on effective (and ineffective) interventions for conduct disorder. Paradoxically, however, relatively little of the research evidence is incorporated into policy decision-making. There is a policy-research gap. An example (Hamilton, Ontario) is used to illustrate this gap. The gap is then explained using a framework for health policy analysis that incorporates values, institutional structures, and information. Values and institutional structures greatly outweigh research evidence in influencing current Canadian policy-making for the problem of conduct disorder. Possibilities for improving the situation are suggested.

Canada↗
PubMed2004

Gun carrying and conduct disorder: a highly combustible combination? Implications for juvenile justice and mental and public health.

OBJECTIVES: To examine concealed gun carrying between the ages of 12 and 17 years in a population of clinic-referred boys, many of whom qualified for a disruptive behavior disorder, including conduct disorder (CD); to identify factors and diagnoses related to concealed gun carrying; and to examine the extent to which gun carrying is associated with crime in adulthood. DESIGN: Longitudinal follow-up study. SETTING: Pittsburgh, Pa, and Athens and Atlanta, Ga. PARTICIPANTS: One hundred seventy-seven clinic-referred boys, first assessed between the ages of 7 and 12 years and followed up yearly until the age of 19 years. MAIN OUTCOME MEASURES: Violence, property offenses, and drug charges in adulthood. RESULTS: Between the ages of 12 and 17 years, 1 in 5 participants carried a concealed gun, and the annual prevalence increased linearly with age. More than half (61.1%) carried a gun for 1 year only. Gun carrying was significantly (incident rate ratio, 3.93%; 95% confidence interval, 1.60-9.60) associated with CD. Conduct disorder, maternal psychopathy, victimization, and parental monitoring increased the risk of gun carrying by a factor of 8. Adult crime was best predicted by gun carrying, CD, and parental monitoring. Gun carrying predicted drug charges, but not violence or property offenses. CONCLUSIONS: Even though the carrying of handguns by juveniles is prohibited, young men with symptoms of CD are more likely to carry guns than young men without CD. The findings are discussed in terms of the need for the inclusion of gun carrying among the symptoms of CD.

Adolescent↗
PubMed2005

Baseline predictors of response to divalproex in conduct disorder.

BACKGROUND: Successful treatment of conduct disorder remains difficult. On the basis of a positive response to divalproex among adolescent boys with conduct disorder, we conducted an analysis of the impact of baseline comorbid diagnoses and personality factors on the likelihood of treatment response to divalproex. METHOD: Seventy-one adolescent boys with conduct disorder (DSM-IV) and a history of at least 1 offense against persons were randomly assigned to receive high- or low-dose divalproex for 7 weeks. Evaluations included best estimate diagnoses, the Clinical Global Impressions-Severity of Illness scale (CGI-S) and CGI-Improvement scale (CGI-I), the 62-item Weinberger Adjustment Inventory (WAI-62) assessment of distress and restraint, the Response Evaluation Measure assessment of immature and mature defenses, and the Achenbach Youth Self-Report assessment of overall psychopathology. All were conducted at study entry and exit, and the WAI-62 was conducted weekly throughout the 7-week study period. Treatment response was defined as a rating of much improved or very much improved on the CGI-I. Data were collected from June 1997 to April 1998. RESULTS: Fifty-eight subjects completed the study and were eligible for inclusion in the analysis. Plasma divalproex level (p = .003) and immature defenses (p = .004) were significant positive predictors of treatment response, while restraint (p = .01) and level and range of psychopathology (p = .04) were significant predictors of nonresponse. Comorbidities or distress (p = .06) were not significantly associated with treatment outcome. CONCLUSION: Predictors of response to divalproex treatment for conduct disorder were identified, despite the small sample size in this study. The pattern of positive and negative predictors of response to divalproex, an antikindling agent, tends to support a model of kindling-reinforced reactive/affective/defensive/impulsive aggression among adolescent boys with conduct disorder. Additional studies are needed to identify more subtle predictors of treatment response and to clarify the mechanisms contributing to the development of conduct disorder.

Adaptation, Psychological↗
PubMedDate not supplied

Coercion theory: application to the inpatient treatment of conduct-disordered children.

TOPIC: Conduct disorders in children are a phenomenon of concern in child and adolescent psychiatric nursing. PURPOSE: To review the major principles of coercion theory, provide an analysis of the relevant research, and discuss implications for inpatient nursing care. SOURCES: Published literature from the fields of medicine, nursing, psychology, sociology, and clinical experience. CONCLUSIONS: The principles of coercion theory are conceptually relevant in developing intervention strategies to treat conduct disorders and to interrupt escalation of aggressive behavior patterns in inpatient settings.

Adolescent↗
PubMed2003

The effects of anxiety, substance use and conduct disorders on risk of major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is highly co-morbid with other Axis I disorders, which commonly precede its onset. We sought to determine the level and periods of risk for MDD posed by prior or co-occurring psychiatric disorders. METHOD: Using retrospective data from a longitudinal, population-based sample of 2926 male and 1929 female adult twin subjects, we predicted the hazard rates for MDD from a Cox proportional hazards model with same-year or prior onsets of co-morbid Axis I disorders as time-dependent covariates. RESULTS: All axis I disorders studied (generalized anxiety disorder, panic disorder, phobia, alcohol dependence, psychoactive substance use disorders and conduct disorder) significantly predicted increased risk for developing MDD. The highest hazard rates occurred for MDD onsets that co-occurred with those of the co-morbid disorder. However, the risk for onset of MDD subsequent to that of prior disorders is also significantly increased and remains relatively unchanged over time. Although the risk for onset of MDD is significantly higher in women than men, this was not explained by gender differences in prior disorder prevalence or increased sensitivity in women to the effects of prior disorders on risk for depression. CONCLUSIONS: Prior psychiatric disorders are significant risk factors for the development of MDD, independent of the length of the intervening period between the onset of the first disorder and that of MDD.

Adult↗
PubMed1990

Childhood psychiatric disorders. Focus on conduct disorders.

The high prevalence of child and adolescent psychiatric disorders in general and of aggressive behaviors in particular presents a serious problem. Recent social, economic and demographic trends suggest that the problem is likely to grow in degree of seriousness. It is recommended that the broad social and economic policies that impact on risk factors be evaluated and that greater emphasis be placed upon prevention efforts. These efforts need to particularly strengthen the social, emotional, and economic supports that provide an important protective factor for children and families. Practices in education, employment, health, and human services need to be examined to insure that they provide support. Perhaps the most encouraging development is the growth of children's services councils. There needs to be support for their continuing growth and for the development of more effective partnerships between state and local government. A particular focus should be upon strengthening neighborhoods and local communities, involving schools and school-based services as a source of support for families, and the increasing involvement of local civic and religious groups.

Adolescent↗
PubMed2001

Disinhibitory psychopathology in male adolescents: discriminating conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states.

T. P. Beauchaine recently proposed a model of autonomic nervous system functioning that predicts divergent patterns of psychophysiological responding across disorders of disinhibition. This model was tested by comparing groups of male adolescents with attention-deficit/hyperactivity disorder (ADHD) and attention-deficit/hyperactivity disorder plus conduct disorder (CD/ADHD) with controls while performing a repetitive motor task in which rewards were administered and removed across trials. Participants then watched a videotaped peer conflict. Electrodermal responding (EDR), cardiac pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA) were monitored. Compared with controls, the ADHD and CD/ADHD participants exhibited reduced EDR. The CD/ADHD group was differentiated from the ADHD and control groups on PEP and from the control group on RSA. Findings are discussed in terms of the motivational and regulational systems indexed. Implications for understanding rates of comorbidity between CD and ADHD are considered.

Adolescent↗
PubMed2003

Treatment of aggression in children and adolescents with autism and conduct disorder.

The optimal clinical management of aggression in children and adolescents involves both behavioral and pharmacologic intervention strategies. This article reviews medication treatments for youngsters with autistic disorder and conduct disorder, conditions for which the pharmacologic management of aggression is often necessary. Efficacy results and associated adverse effects from selected clinical trials of most classes of psychotropic medications are discussed. While preliminary progress has been made in the development of medication treatments for these serious disorders of youth, additional controlled research and longitudinal studies are needed to better understand the efficacy and tolerability of currently available compounds within each diagnostic group.

Adolescent↗
PubMed1993

Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population.

OBJECTIVE: Youths with conduct disorder extract an inordinate amount of time and money from the U.S. judicial system and taxpayers, yet studies pertaining to this population have been few. This study was undertaken to examine the co-occurrence of personality disorders and conduct disorder in a group of incarcerated children and adolescents and to raise the issue of the possibility of antisocial personality disorder in persons under the age of 18 years. METHOD: One hundred incarcerated juvenile offenders aged 11-17 years were randomly selected and then interviewed with the Diagnostic Interview for Children and Adolescents--Revised and the Structured Clinical Interview for DSM-III-R Personality Disorders to establish their psychiatric diagnoses. RESULTS: Eighty-seven percent of the group met the criteria for conduct disorder. Among those diagnosed as having conduct disorder, the only comorbid personality disorder that was present with significant frequency was antisocial personality disorder. The other comorbid personality disorder diagnoses that appeared most frequently were the borderline, narcissistic, paranoid, passive-aggressive, and dependent types. Borderline personality disorder was observed more frequently in the females than in the males with conduct disorder. CONCLUSIONS: The findings suggest that by using DSM-III-R criteria for adult personality disorders, one finds a considerable number of personality disorders in a young population with conduct disorder. The findings also show that youths manifest signs of antisocial personality disorder before they are 18 years of age, raising the question of how age should be incorporated into the diagnosis of personality disorder as DSM-IV is being prepared.

Adolescent↗
PubMed1979

The diagnosis and treatment of conduct disorders in young people.

Conduct disorders are among the most prevalent psychiatric disorders currently encountered in young people. The condition 'conduct disorder' is, however, an 'umbrella concept' which affects divergent personality subtypes. Treatment in the past, based on such an 'umbrella concept', has often proved itself prognostically dubious. This article stresses the need for the direction of management towards differential diagnosis and treatment of the various conduct disorder subtypes.

Adolescent↗
PubMed2000

Neuropsychological deficits in female adolescents with a substance use disorder: better accounted for by conduct disorder?

OBJECTIVE: To determine whether neuropsychological deficits in female adolescents are more closely related to a diagnosis of a substance use disorder (SUD) or a conduct disorder (CD). METHOD: Subjects were 470 female adolescents between the ages of 14 and 18 years. They were categorized into one of four groups: (1) SUD-only (n = 63), (2) CD-only (n = 58), (3) SUD+CD (n = 239) and (4) normal controls (n = 110). The groups were compared on multiple neuropsychological measures covering four cognitive domains: general intelligence, executive functioning, language competence and academic achievement. RESULTS: The findings were consistent across all measures. Multivariate analyses of variance revealed significant group differences for all four neuropsychological domains. Univariate tests indicated that the two CD groups equally exhibited the poorest performance of all four groups on nearly all measures of intelligence, executive functioning, language competence and academic achievement. The SUD-only group performed better than the two CD groups but not as well as the control group. Socioeconomic status and chronological age were statistically controlled for in all analyses. CONCLUSIONS: These data suggest that the neuropsychological deficits found in our sample of female adolescents with SUD are more closely related to CD, or antisociality in general, than to SUD. Future studies assessing the neuropsychological functioning of persons with SUD should make efforts to measure comorbid antisociality.

Adolescent↗
PubMed2006

[Conduct disorder in childhood].

Conduct disorder is a repetitive and persistent pattern of behaviour in which the basic rights of others or societal rules are violated. It is at the junction of psychiatry, social field and law. The early diagnosis of this disorder and the identification of risk factors must go to preventive programs and psycho-educational treatments, to prevent juvenile delinquency.

Adolescent↗
PubMed1996

Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD.

OBJECTIVE: To evaluate the overlap between attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), addressing whether ODD is subsyndromal form of conduct disorder (CD) and, if so, whether it is a precursor or prodrome syndrome of CD. METHOD: Assessments from multiple domains were used to examine 140 children with ADHD and 120 normal controls at baseline and 4 years later. RESULTS: Of children who had ADHD at baseline, 65% had comorbid ODD and 22% had CD. Among those with ODD, 32% had comorbid CD. All but one child with CD also had ODD that preceded the onset of CD by several years. ODD+CD children had more severe symptoms of ODD, more comorbid psychiatric disorders, lower Global Assessment of Functioning Scale scores, more bipolar disorder, and more abnormal Child Behavior Checklist clinical scale scores compared with ADHD children with non-CD ODD and those without ODD or CD. In addition, ODD without CD at baseline assessment in childhood did not increase the risk for CD at the 4-year follow-up, by midadolescence. CONCLUSIONS: Two subtypes of ODD associated with ADHD were identified: one that is prodromal to CD and another that is subsyndromal to CD but not likely to progress into CD in later years. These ODD subtypes have different correlates, course, and outcome.

Adolescent↗
PubMed2004

Significance of childhood conduct problems to later development of conduct disorder among children with ADHD: a prospective follow-up study.

This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.

Adolescent↗
PubMed2004

A genome-wide screen for genes influencing conduct disorder.

While behavioral genetic studies have suggested that childhood conduct disorder is under genetic influence, studies aimed at gene identification are lacking. This study represents the first genome-wide linkage analysis directed toward identifying genes contributing to conduct disorder. Genome screens of retrospectively reported childhood conduct disorder and conduct disorder symptomatology were carried out in the genetically informative adult sample collected as part of the Collaborative Study on the Genetics of Alcoholism (COGA). The results suggest that regions on chromosomes 19 and 2 may contain genes conferring risk to conduct disorder. Interestingly, the same region on chromosome 2 has also been linked to alcohol dependence in this sample. Childhood conduct disorder is known to be associated with the susceptibility for future alcohol problems. Taken together, these findings suggest that some of the genes contributing to alcohol dependence in adulthood may also contribute to conduct disorder in childhood.

Adult↗