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PubMed1996

Comorbidity of major depression and conduct disorder.

The association of depression and conduct disorder is common and often perplexing in child psychiatry. Using a systematic retrospective chart review, various symptom, demographic and family history variables were compared between depression with comorbid conduct disorder and depression alone. Variables which differed between groups were entered into a stepwise discriminative function analysis. The four variables which discriminated between groups were anxiety, witness to family violence, illegal behavior, and impulsive behavior. The strongest discriminating variable, anxiety, was associated with depression without comorbid conduct disorder. These results emphasize the heterogeneity of childhood depression and potential importance of anxiety.

Adolescent↗
PubMed2006

The lay concept of conduct disorder: do nonprofessionals use syndromal symptoms or internal dysfunction to distinguish disorder from delinquency?

BACKGROUND: Conduct disorder (CD) must be distinguished from nondisordered delinquent behaviour to avoid false positives, especially when diagnosing youth from difficult environments. However, the nature of this distinction remains controversial. The DSM-IV observes that its own syndromal CD diagnostic criteria conflict with its definition of mental disorder, which requires that symptoms be considered a manifestation of internal dysfunction to warrant disorder diagnosis. Previous research indicates that professional judgments tend to be guided by the dysfunction requirement, not syndromal symptoms alone. However, there are almost no data on lay conceptualizations. Thus it remains unknown whether judgments about CD are anchored in a broadly shared understanding of mental disorder that provides a basis for professional-lay consensus. OBJECTIVE: The present study tests which conception of CD, syndromal-symptoms or dysfunction-requirement, corresponds most closely to lay judgments of disorder or nondisorder and compares lay and professional judgments. We hypothesized that lay disorder judgments, like professional judgments, tend to presuppose the dysfunction requirement. METHOD: Three lay samples (nonclinical social workers, nonpsychiatric nurses, and undergraduates) rated their agreement that youths described in clinical vignettes have a mental disorder. All vignettes satisfied DSM-IV CD diagnostic criteria. Vignettes were varied to present syndromal symptoms only, symptoms suggesting internal dysfunction, and symptoms resulting from reactions to negative circumstances, without dysfunction. RESULTS: All lay samples attributed disorder more often to youths whose symptoms suggested internal dysfunction than to youths with similar symptoms but without a likely dysfunction. CONCLUSIONS: The dysfunction requirement appears to reflect a widely shared lay and professional concept of disorder.

Attitude to Health↗
PubMed1997

Conduct disorder and antisocial personality in adult primary care patients.

BACKGROUND: Conduct disorder has been linked to substance use disorders in clinical populations. This study examined the relationships of conduct disorder and antisocial personality (ASP) disorder to substance use, substance abuse problems, depression, and demographic factors in primary care settings. METHODS: As part of a larger clinical trial, a survey of 1898 patients in the offices of 64 primary care physicians was conducted using a self-administered health habits questionnaire. Childhood conduct disorder and adult antisocial personality disorder were assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. RESULTS: Eight percent of men and 3.1% of women met criteria for a diagnosis of ASP disorder. The frequency of a history of childhood conduct disorders was higher, with 13.4% for men and 4% for women. Antisocial personality disorder was predicted by male sex, being unmarried (single, separated, divorced), lifetime history of depression, binge drinking, self-reported history of drug problems, current smoking, and younger age. The predictors of a history of child conduct disorder were similar to those of ASP. CONCLUSIONS: Primary care physicians treat many patients who have personality disorders and other conditions such as alcohol problems and depression. These patients need to be identified because of the high potential for comorbidity and the barriers to treatment inherent in these disorders.

Adolescent↗
PubMed2004

A new look at inter-informant agreement on conduct disorder using a latent class approach.

This study examined agreement on aggressive and nonaggressive conduct disorder in a general population sample of 14- to 17-year-old adolescents (n=1165) and their mothers. We collected diagnostic interview data and applied latent class analyses to estimate inter-informant agreement. The preferred model for aggressive conduct disorder for both males and females was a one-latent-variable/two-class model specifying no inter-informant disagreement beyond chance expectations. This model estimated the prevalence of aggressive conduct disorder to be 13% for males and 0.4% for females. For nonaggressive conduct disorder, a one-latent-variable/three-class model specifying asymmetric agreement was preferred for both males and females. This model estimated the prevalence of nonaggressive conduct disorder in adolescents to be 18% according to males and 13% according to mothers. Prevalence estimates were 12% according to females and 7% according to mothers. Symptom sensitivity estimates for all models were poor whereas specificity estimates were near perfect to perfect. Males had higher rates of aggressive and nonaggressive conduct disorder across informants. There was a high level of adolescent-mother agreement on both types of conduct disorder. However, there were some differences, suggesting that aggressive and nonaggressive are two valid subtypes of conduct disorder with different prevalence estimates and agreement levels.

Adolescent↗
PubMedDate not supplied

Conduct disorder in childhood and adolescence: an update.

Conduct disorder is a diagnostic entity that has elicited controversy throughout the years. Classified as a psychiatric disorder of childhood and adolescence, the syndrome of conduct disorder recently was revised from four to three categories in the DSM-III-R (Revised). This article presents an overview of conduct disorders, including diagnostic criteria, epidemiology, etiology, treatment approaches and implications for nursing practice.

Adolescent↗
PubMed1990

Oppositional disorder in children: a validation study comparing conduct disorder, oppositional disorder and normal control children.

Subjects with oppositional disorder (OD, N = 21) and conduct disorder (CD, N = 22) were compared with normal controls (NC, N = 20) to determine whether OD is a distinct disorder. OD subjects exhibited high rates of associated attention deficit, emotional and learning disorders. Compared with NC, OD subjects had high rates of problems in social relationships and came from families characterized by marital fights, dysfunction, and paternal psychopathology. Compared with CD, OD was less often characterized by undersocialization and separations from fathers and more often characterized by dissatisfaction in the marital relationship. These results suggest that OD is a variant of CD rather than of normality.

Achievement↗
PubMed1992

Childhood depression and conduct disorder: I. Behavioral, affective, and cognitive aspects of family problem-solving interactions.

We assessed the family interactions of depressed, conduct-disordered, mixed depressed-conduct-disordered, and nonclinic children, ages 7-14 years, during a standardized family problem-solving discussion in the clinic. The child's and the mother's problem-solving proficiency, aversive behavior, and associated affective behavior (depressed and angry-hostile) were observed. The child and mother also rated each other's affect during the interaction for the dimensions sad, angry, critical, and happy on Likert-type scales. The child's and mother's cognitive constructions about the interaction were assessed using video-mediated recall. Although all clinic groups had lower levels of effective problem solving than did nonclinic children, their deficiencies were somewhat different. Mixed and depressed children displayed high levels of depressed affect and low levels of angry affect, whereas conduct-disordered children displayed both angry and depressed affect. In addition, conduct-disordered children had lower levels of positive problem solving and higher levels of aversive content than did non-conduct-disordered children. Depressed and conduct-disordered children had higher levels of self-referent negative cognitions than did mixed and comparison children, and depressed children also had higher other-referent negative cognitions than did all other groups. The study provides support for theories and treatment that stress the importance of family problem-solving and conflict resolution skills in child psychopathology.

Affect↗
PubMed1987

A two-year follow-up of boys with aggressive conduct disorder.

53 boys with aggressive conduct disorder (ACD) and 36 with other psychiatric disorders were followed up after 2 years. Twenty-nine of the former (55%) still met the criteria for ACD; 24 did not. Persistence of the conduct disorder was predicted by the symptoms of hyperactivity and inattention. The data suggest that there are two types of ACD: one short-lived and quite benign, the other more likely to persist and more serious.

Adolescent↗
PubMed1996

The effect of a history of conduct disorder in adult major depression.

This paper examines the impact of a history of conduct disorder on major depression in adulthood, including its symptomatology, comorbidity and response to tricyclic antidepressants. 103 subjects with DSM-III-R major depression were assessed for DSM-III-R axis I and II comorbidity, severity of depression, social functioning, general psychiatric symptomatology, early familial environment and family psychiatric history. 18 patients (17%) had a history of conduct disorder, 32 (31%) were subthreshold, and 53 (51%) had no childhood symptoms of conduct disorder. Depressed adults with a history of conduct disorder had significantly higher lifetime alcohol and drug dependence and virtually all (17/18, 94%) met criteria for a personality disorder. Despite this, the current episode of depression did not differ in severity, symptoms or response to treatment except that those with a history of conduct disorder were more likely to be agitated when depressed. The authors conclude that a history of conduct disorder is depressed patients predicts the presence of adult personality disorders and psychoactive substance dependence. In most other ways, depressed subjects with a history of conduct disorder were similar to other subjects.

Adolescent↗
PubMed1990

Differences in heart rate and blood pressure in children with conduct disorder, major depression, and separation anxiety.

Heart rate and blood pressure of children and adolescents admitted to a psychiatric hospital were compared among those diagnosed conduct disorder, major depressive disorder, and separation anxiety disorder. Subjects with conduct disorder had a lower heart rate compared to subjects without a conduct disorder diagnosis; and subjects with separation anxiety disorder had higher heart rate and systolic blood pressure compared to subjects without an anxiety disorder diagnosis. Subjects with major depressive disorder had higher systolic blood pressure than subjects with conduct disorder but no difference in heart rate. The findings are consistent with conduct disorder being associated with decreased noradrenergic function and anxiety/depressive disorder being associated with increased noradrenergic function.

Adolescent↗
PubMed2001

Do early onset conduct disordered adolescents perform like brain injured or normal adolescents on cognitive tests?

In order to better understand whether adolescents with early onset conduct disorder are predisposed to this disorder because of neurological problems, the present study compared the performance of early onset conduct disordered adolescents to adolescents with left hemisphere and right hemisphere brain injuries and normal controls. It was hypothesized that adolescents with early onset conduct disorder would perform similar to adolescents with left hemisphere injury, confirming theories that neurological dysfunction may predispose children to the development of conduct disorder. Fifteen adolescents with conduct disorder were compared on a battery of cognitive tests to 12 left hemisphere brain injured, 11 right hemisphere brain injured, and 15 normal middle school adolescents. F-tests indicated that there were significant differences among the four groups on all measures (p < .01). According to a series of t-tests on each of the nine cognitive measures, there were no differences found between the early onset conduct disordered subjects and the left hemisphere subjects. The early onset conduct disordered group performed worse than the right hemisphere group on 7 of the 9 comparisons, and worse than the normals on 9 of 9 comparisons. The normal group performed better than all three of the other groups. These results demonstrate that the pattern of neuropsychological performance by early onset conduct disordered adolescents was similar to that of left hemisphere injured adolescents and different from that of the right hemisphere injured and normal adolescents. Potential applications of this research include describing new approaches to treatment of this disorder based on their similarity with the left hemisphere brain injured group.

Adolescent↗
PubMed1999

Alcohol dependence and conduct disorder among Navajo Indians.

OBJECTIVE: The purpose of this study is to examine the association between conduct disorder before age 15 and subsequent alcohol dependence, and to describe the lifetime prevalence of alcohol dependence among Navajo Indian women and men. METHOD: This was a case-control design which included both men (n = 735) and women (n = 351) and in which the Diagnostic Interview Schedule was used for the diagnosis of the lifetime history of alcohol dependence and conduct disorder. Alcohol dependent cases were selected from inpatient and outpatient treatment programs (204 men, 148 women). Whenever possible, controls were matched for age, sex and community of residence and were randomly selected and interviewed until a nonalcohol dependent individual was found. Among the men, there were 374 alcohol dependent controls and 157 nonalcohol dependent controls. Among the women, the figures were 60 and 143, respectively. When combined, the controls comprise samples of the adult male and female populations from which estimates of lifetime prevalence of alcohol dependence, and of the amount of alcohol dependence in the population attributable to conduct disorder, may be inferred. RESULTS: Conduct disorder is a risk factor for alcohol dependence among both men and women. Lifetime prevalence of alcohol dependence in this population is high (70.4% for men and 29.6% for women), but the amount of alcohol dependence in the population attributable to conduct disorder is low. On the other hand, among the alcohol dependent, those with conduct disorder had the most severe alcohol- and nonalcohol-related problems. CONCLUSIONS: The potential limitations of the study are those common to case-control designs, especially biased recall by cases. There are also potential sampling biases among the controls. It is shown that none of the potential biases invalidate the findings, which support the hypothesis that in this population conduct disorder is a risk for alcohol dependence. The implications for primary prevention of alcohol dependence are discussed.

Adolescent↗
PubMed2005

Validity of DSM-IV conduct disorder in 41/2-5-year-old children: a longitudinal epidemiological study.

OBJECTIVE: This longitudinal study of a nonreferred, population-based sample tested the concurrent, convergent, and predictive validity of DSM-IV conduct disorder in children 4(1/2)-5 years of age. METHOD: In the Environmental Risk Longitudinal Twin Study, a representative birth cohort of 2,232 children, the children's mothers were interviewed and the teachers completed mailed questionnaires to assess the children's past 6-month conduct disorder symptoms. Children with three or more symptoms were diagnosed with conduct disorder, and a subset with five or more symptoms was diagnosed with "moderate-to-severe" conduct disorder. RESULTS: The prevalence of conduct disorder and moderate-to-severe conduct disorder were 6.6% and 2.5%, respectively. Children diagnosed with conduct disorder were significantly more likely than comparison subjects to self-report antisocial behaviors, to behave disruptively during observational assessment, and to have risk factors known to be associated with conduct disorder in older children (effect sizes ranging from 0.26 to 1.24). Five-year-olds diagnosed with conduct disorder were significantly more likely than comparison subjects to have behavioral and educational difficulties at age 7. Increased risk for educational difficulties at age 7 persisted after control for IQ and attention deficit hyperactivity disorder diagnosis at age 5. CONCLUSIONS: Behavioral problems of preschool-age children meeting diagnostic criteria for conduct disorder should not be ignored. Appropriate intervention should be provided to prevent ongoing behavioral and academic problems.

Adult↗
PubMed1992

A Rorschach study of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents.

We investigated the constructs of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Texture, diffuse shading, and pure human content (Exner, 1986) Rorschach indices were compared between 48 subjects who met the criteria for conduct disorder and 30 subjects who met the criteria for dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). We also compared mild, moderate, and severe conduct-disorder groups on the three selected Rorschach variables and investigated certain family characteristics for the two groups. We found a lower frequency of texture and pure human content responses in conduct-disordered subjects and a greater frequency of diffuse shading responses in the dysthymic subjects. The conduct-disordered subjects also came from homes in which the mother figure was significantly less present. Our psychometric findings of lessened attachment and diminished anxiety in the conduct-disordered adolescents are similar to adult psychopaths. We urge that an attachment or socialization disturbance criterion be reintroduced into the forthcoming DSM-IV conduct-disorder diagnosis.

Adolescent↗
PubMed2006

The role of conduct disorder in explaining the comorbidity between alcohol and illicit drug dependence in adolescence.

BACKGROUND: Conduct disorder (CD), alcohol dependence (AD), and illicit drug dependence (IDD) frequently co-occur. This paper describes the result of an investigation of the extent to which comorbid alcohol and illicit drug dependence in adolescents are explained by etiological factors in common with conduct disorder. METHODS: Participants were 645 MZ twin pairs, 702 DZ twin pairs, 429 biological sibling pairs, and 96 adoptive sibling pairs, aged 12-18 years, from a community based sample. Conduct disorder was measured using the Diagnostic Interview Schedule for Children-IV. Alcohol and illicit drug dependence were assessed using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). For each outcome, subjects were categorized into those with no symptoms, those with one or more symptoms but no diagnosis, and those with a diagnosis. RESULTS: The heritability estimates for CD, AD, and IDD were 58, 66, and 36%, respectively. The genetic correlation between AD and IDD was partially explained by the genetic risk they both share with conduct disorder. CONCLUSIONS: We conclude that conduct disorder in adolescents explains, in part, the co-occurrence of alcohol and illicit drug dependence. Specifically, the genetic contribution to their covariation is explained partially by the genetic contribution in common with conduct disorder.

Adolescent↗
PubMed1982

Aggressive conduct disorder of children.

We studied 58 children with aggressive conduct disorder who had been admitted to a psychiatric ward and 33 with other disorders, excluding autism and organic syndromes, who were also inpatients. Nurses's observations of the children's behavior on the ward sharply separated the two groups and confirmed the parents' and teachers' descriptions of the conduct disorder children's behavior at home and in school. Items in the clinical history also separated the two groups; for example, conduct disorder began at a much earlier age than the other disorders. Our evidence gives further support to the validity of aggressive conduct disorder as a psychiatric syndrome.

Aggression↗
PubMed2006

Case-control and within-family tests for an association between conduct disorder and 5HTTLPR.

Several lines of research have suggested that serotonin dysfunction is associated with aggression, impulsivity, and antisocial behavior. A functional polymorphism in the promoter region (s, short and l, long allele variant) of the serotonin transporter gene (SLC6A4) that results in decreased transcription of the serotonin transporter gene has been linked with such serotonin dysfunction. To test for an association between 5HTTLPR genotype and conduct disorder diagnosis/aggression. Analysis for association between 5HTTLPR and conduct disorder/aggression using a case-control design and the transmission disequilibrium test. Conduct-disordered adolescents, who were drawn from admissions to a program that treats adolescents with serious substance and behavior problems, and conduct-disordered siblings of these patients (n, 297) were compared with non-conduct-disordered control adolescents and non-conduct-disordered siblings of these controls (n, 93). Second, using patient families where parental DNA was available, transmission disequilibrium tests were conducted for two phenotypes: (1) conduct disorder (74 trios), and (2) conduct disorder with at least one aggressive symptom (57 trios). Case-control analyses suggested a strong association between the ss genotype and conduct disorder (chi2(2) = 14.3; P < 0.01). Within-family analyses for conduct disorder with at least one aggressive symptom significantly favored greater transmission of the s-allele to affected offspring (chi(tdt)(2) = 4.13; P = 0.04); for conduct disorder, without aggressive symptoms, however, results were non-significant (chi(tdt)(2) = 1.61; P = 0.20). These data suggest that the s-allele may confer some risk for aggressive behavior or may be in linkage disequilibrium with such an allele.

Adolescent↗
PubMed2000

The peer relations of disruptive children with reference to hyperactivity and conduct disorder.

Literature reviews indicate that children with disruptive behaviour disorders have peer relationship problems, but little information is available concerning the differential effects of hyperactivity and conduct disorder on peer relationships. Using a database from North of England research, this paper uses standard frequency analysis complemented by multivariate analyses to explore the independent effects of pervasive hyperactivity and conduct disorder on the sociometry of peer relations among 7- to 8- and 11- to 12-year-olds. The findings suggest that (a) social isolation in 7-8-year-olds shows no significant association with hyperactivity. However there is a significant association with conduct disorder in 11-12-year-olds. (b) Rejection is not significantly associated with hyperactivity alone nor with conduct disorder alone in 7-8-year-olds. However, it is associated with a combination of hyperactivity and conduct disorder. In 11-12-year-olds rejection is associated with conduct disorder alone and with conduct disorder and hyperactivity in combination. It is also associated with low cognitive ability alone and in combination with conduct disorder. Overall, these findings provide some limited evidence of adverse sociometric responses to both hyperactivity and below average cognitive ability. However, in the at-risk samples analysed here, conduct disorder emerges as the most powerful independent predictor of isolation and rejection, and this is especially so among older children.

Attention Deficit Disorder with Hyperactivity↗