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PubMed1992

Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: a review.

Child and adult general population studies of psychiatric disorder were systematically reviewed for data on the co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders. For both sexes, both depressive and anxiety disorders co-occurred with conduct disorder (and its adult outcomes) far more than expected by chance in childhood, adolescence, and adulthood. Most women with conduct disorder and an antisocial adult outcome also developed a depressive or anxiety disorder by early adulthood. For both sexes, increasing severity of antisocial behavior was associated with an increasing risk of an emotional disorder. Age and sex affected the rates of co-occurrence. Possible reasons for this co-occurrence and implications for classification and the nature of conduct disorder are discussed.

Adolescent↗
PubMed1998

Alcohol dependence and domestic violence as sequelae of abuse and conduct disorder in childhood.

OBJECTIVES: To examine in the Navajo population: (1) the importance of childhood abuse as a risk factor for conduct disorder; (2) the importance of each form of abuse and conduct disorder as risk factors for alcohol dependence; and (3) the relative importance of each form of abuse, conduct disorder, and alcohol dependence as risk factors for being a perpetrator and/or victim of domestic violence. METHOD: The study is based on a case-control design. Cases (204 men and 148 women) between the ages of 21 and 65 were interviewed in alcohol treatment program and matched to community controls. There were two groups of controls: alcohol dependent (374 men, 60 women) and nonalcohol dependent (157 men, 143 women). When adjusted for stratification by age, community of residence, and sex, the combined control groups comprise a representative sample of the Navajo male and female population 21-65 years of age. RESULTS: The prevalence of physical and sexual abuse before age 15 is within limits observed in other populations. Each form of abuse is a risk factor for conduct disorder. Along with conduct disorder, physical abuse is a risk factor for alcohol dependence. Physical abuse and alcohol dependence are independent risk factors for being involved in domestic violence as both perpetrator and victim. There appears to have been no secular trend in the incidence of childhood abuse over the past several generations, but there is suggestive evidence that domestic violence has become more common. CONCLUSIONS: Physical abuse is a significant risk factor for alcohol dependence as well as for domestic violence independent of the effects of alcohol abuse. The effects of sexual abuse with regard to both domestic violence and alcohol dependence do not appear to be significant.

Adult↗
PubMed1990

Social problem-solving in depressed, conduct-disordered, and normal adolescents.

Although past theory and research implicate social problem-solving deficits in both depression and aggressive disorders, research examining carefully diagnosed groups of adolescent depressed and conduct-disordered groups had not previously been conducted. In the current study three groups of adolescents (major depression, conduct-disordered, and normal) were studied using two social problem-solving measures. Both the Means-Ends Problem-Solving task (MEPS) and the Social Situations Analysis measure (SSA) failed to show social problem-solving problem deficits in the depressed group relative to their normal age peers, but did provide corroborative evidence for social problem-solving deficits in the conduct-disordered sample. Relative to the other two groups, the conduct-disordered adolescents were found to generate fewer means to a social end, to anticipate fewer obstacles in the pursuit of solutions to interpersonal situations, and to generate fewer assertive behavioral solutions to difficult social situations. The results are discussed in relation to other work with depressed and aggressive youth, and directions for future research are given.

Adolescent↗
PubMed1998

Depression and conduct disorder in native and non-native children.

OBJECTIVE: To compare depression and conduct disorder symptoms between North American Native and non-Native children as rated by teacher, parent, and self-reports. METHOD: The sample included 1,251 Native children in grades 2 and 4 in four different settings across North America and comparison samples of 457 non-Native children. Parents, teachers, and children rated children's mental health using culturally sensitive measures of depression and conduct disorder symptoms. RESULTS: According to parent ratings and child self-reports, there were no Native/non-Native differences in levels of conduct disorder symptoms. However, non-Native teachers rated higher levels of conduct disorder symptoms among Native children compared with non-Native students. Children reported higher levels of depression than the adults rating them. CONCLUSIONS: Results challenge assertions about high levels of psychopathology among Native youngsters. Cultural distance may introduce a negative bias in teacher evaluations of Native children's mental health.

Child↗
PubMed1991

Confirmatory factor models of attention deficit and conduct disorder.

The paper presents four alternative confirmatory factor models to represent the structure of measures of attention deficit and conduct disorder obtained from multiple sources. These models range in complexity from a simple one-factor model with no method effects to a two-factor model with method effects. These models were fitted to data gathered on maternal, teacher and self-report of attention deficit and conduct disorder for a sample of New Zealand children studied at ages 9 and 10 years. The analysis strongly suggests that the best representation of the data was a two-factor model in which there were distinct factors of attention deficit and conduct disorder with these factors being highly correlated (r = 0.87-0.88). It is suggested that the most suitable clinical nomenclature may be to describe conduct disorder and attention deficit generically as externalizing disorders, subscripting this classification with clauses which describe the relative contributions of conduct disorder and attention deficit. The implications of this finding for the measurement, classification and explanation of conduct disorder and attention deficit disorder are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Severe conduct disorder--some key issues.

OBJECTIVE: To examine the state of knowledge about clinically severe conduct disorder and identify key issues. METHOD: This paper surveys the literature on conduct disorder and delineates and discusses the critical issues. RESULTS: Conduct disorder is the subject of a vast and growing amount of research on taxonomy, correlates, etiology, outcome, management, and prevention. There are 2 distinctive types: childhood and adolescent onset. Comorbidity with other disorders is common. It remains a costly disorder, however, with a generally poor prognosis for the childhood-onset type. The validity of the separation of conduct and antisocial personality disorder is questionable. CONCLUSIONS: In view of its huge cost, chronicity, and generally poor outcome, childhood-onset or severe conduct disorder should be considered one of if not the major public health problems of our time, and resources for its study and management should reflect this. The disorder is poorly defined and inadequately studied in females.

Adolescent↗
PubMed1998

Genetic and environmental influences on subtypes of conduct disorder behavior in boys.

Oppositional and conduct disorders are a heterogeneous collection of disruptive behaviors associated with diverse risk factors and varying outcomes. Data from males in the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) are used to explore the relative importance of genetic and environmental influences on four previously described disruptive subtypes: property violations, status violations, oppositional behavior, and aggression. Striking differences between results according to mother and child ratings are found, indicating the need to consider carefully the origin of rater differences. Child ratings indicate support for a general genetic liability, with greatest influence on property violations, oppositional behavior and aggression. Maternal ratings suggest that the genetic factors influencing conduct disorder behavior are more specific to the behavioral area, with the stronger genetic influence on property violations and aggression.

Adolescent↗
PubMed2000

One-year outcome of adolescent females referred for conduct disorder and substance abuse/dependence.

We investigated whether substance abuse/dependence, conduct disorder, and other psychiatric disorders improved in adolescent females who were referred to outpatient treatment and which variables were related to 1-year outcome. Forty-six out of 60 conduct-disordered (CD) adolescent females with substance abuse or dependence were re-evaluated approximately 1 year after discharge. Treatment length averaged 16 weeks. Significant improvements were seen in three areas: (1) criminality and CD; (2) attention deficit hyperactivity disorder (ADHD); and (3) educational and vocational status. However, neither substance involvement nor depression improved, regardless of length of stay in treatment, and these females demonstrated significant risky sexual behaviors. In contrast to our previous work with adolescent males (Crowley, T.J., Mikulich, S.K., Macdonald, M., Young, S.E., Zerbe, G.O., 1998. Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome. Drug Alcohol Depend. 49, 225-237), we were not able to identify pre-intake variables, other than performance IQ, that were related to substance use and conduct outcomes. Only two post-treatment factors (peer problems and number of ADHD symptoms at follow-up) were found to be related to CD and substance use disorders outcomes. The overall lack of pre- and post-treatment predictors presents interesting challenges for future research on adolescent females with these disorders.

Adolescent↗
PubMed2005

[Conduct disorder--early detection and intervention].

Conduct disorder (CD) is a serious psychiatric disorder of children and adolescents. A common association is the presence of attention-deficit hyperactivity disorder. The present paper reviews empirical findings on CD. The correlative factors were analyzed according to their bio-psycho-social aspects. To be effective, early detection and intervention on CD must be multimodal. We should address treatments on multiple foci, and continue them over an extensive period of time.

Child↗
PubMed2006

Effects of the history of conduct disorder on the Iowa Gambling Tasks.

BACKGROUND: Recent research conducted with the Iowa Gambling Task (GT) suggests decision-making impairments in substance dependence, as well as behavior disorders such as conduct disorder and attention-deficit/hyperactivity disorder. However, little is known about the past history of conduct disorder on decision making. The purpose of this study was to test the possible effect of past history of conduct disorder on GT performance and how this factor could contribute to the performance on GT in alcohol-dependent patients. METHODS: Four subject groups were tested: (1) alcohol-dependent patients with (n = 28) and (2) alcohol-dependent patients without (n = 28), a history of conduct disorder and (3) normal controls with (n = 10) and (4) normal controls without (n = 30) a history of conduct disorder. Demographic and alcohol-related variables were evaluated, and a decision-making task, "Iowa GT," both original and variant version, were applied. RESULTS: As a whole, normal controls with a history of conduct disorder and alcohol-dependent patients with or without a history of conduct disorder show impaired decision making because of hypersensitivity to reward and hyposensitivity to punishment. However, no significant differences were noted between alcohol-dependent patients either with or without a history of conduct disorder on gambling performance. CONCLUSIONS: These results indicate that the history of conduct disorder may contribute to impaired decision making on GT. Furthermore, this kind of decision-making pattern may represent one of common underlying mechanisms in both conduct disorder and alcohol dependence.

Adult↗
PubMed2006

[Conductive disorders following open-heart valvular surgery. Concerning 230 operated patients].

AIMS: Conductive disorders following open-heart valvular surgery represent serious complications that may require definitive pacemaker implantation. The natural history of these troubles is not well established thus, controversy persist concerning the timing of pacemaker implantation. In this study we identify the predictive factors of permanent conductive disorders in order to assess the optimal time of pacing. METHODS AND RESULTS: Two hundred thirty valvular replacements were done between 1993 and 2003. The mean age of our patients was 42 +/- 13.4 years. Rheumatic valvulopathies accounted for 76% of cases, with 54% of multiple valvulopathies. Twenty-two patients (9,5%) had an early postoperative conductive disorder, 9 of them (4%) were definitively implanted after a mean delay of 31.8 days. Preoperative bifascicular bloc and early installation of postoperative high-grade conduction disturbances and its persistence for more than 48 hours are significantly associated with permanent postoperative conductive disorders (respectively P = 0.04 and = 0.03). Aortic valve surgery and infective endocarditis were more frequent in the implanted group but the difference was not significant. CONCLUSION: After open-heart valvular surgery; predictive factors of definitive conductive troubles justify an earlier pacemaker implantation. This attitude may accelerate the hospital discharge and decrease the disease cost effectiveness.

Adolescent↗
PubMed2001

Predicting girls' conduct disorder in adolescence from childhood trajectories of disruptive behaviors.

OBJECTIVE: To examine girls' developmental trajectories of disruptive behaviors during the elementary school years and to predict conduct disorder symptoms and diagnosis in adolescence with trajectories of these behaviors. METHOD: The sample was 820 girls from the province of Quebec followed over 10 years (1986-1996). A semiparametric mixture model was used to describe girls' developmental trajectories of teacher-rated disruptive behaviors between the ages of 6 and 12 years. The trajectories were used to predict conduct disorder symptoms and diagnosis when the girls were on average 15.7 years. RESULTS: Four groups of girls following trajectories with distinct levels of disruptive behaviors were identified: a low, medium, medium-high, and high trajectory. Prediction with the trajectories indicated that girls on the medium, medium-high, and high trajectories reported a significantly higher number of conduct disorder symptoms in adolescence. However, only the girls on the medium-high and high trajectories were at significantly higher risk to meet DSM-III-R criteria for conduct disorder, compared with girls in the low group (odds ratio: 4.46). More than two thirds of the girls with conduct disorder were in the medium or higher-level trajectories. CONCLUSION: The results suggest that there is an early-onset type of conduct disorder in girls.

Adolescent↗
PubMed1996

Family climate and behavior in families with conduct disordered children.

The aim of this exploratory study was to investigate mothers' perceptions of family climate in families with a conduct disordered child in comparison with families with a normal child. Mothers in 19 families with an independently diagnosed conduct disordered child and their 19 matched comparison mothers completed the Moos Family Environment Scale. In addition 9 mothers and their conduct disordered children and their matched comparisons were video-taped interacting in their homes. Mothers with a conduct disordered child perceived the family climate as less cohesive, less encouraging of the expression of feeling and more conflictual than their counterparts. The same mothers also perceived families to be more control oriented and less organized than their matched controls. Independent behavioural observations supported the view that the mothers with conduct disordered children were control oriented.

Child↗
PubMed2002

Drug treatment of conduct disorder in young people.

Although conduct disorder (CD) is the most common psychiatric disorder in youth from the community and encompasses one third to one half of all referrals to child and adolescent clinics, there is no licensed drug, to date, for treatment of CD, neither in Europe nor in the US. The aims of this paper are to review research data available on the use of medication for CD in young people and to identify future directions for research. We review 17 controlled studies and six open trials. Investigated compounds mainly belong to three classes of psychotropic drugs: mood stabilizers, neuroleptics and stimulants (six, five and six controlled studies, respectively). Lithium is the most documented treatment (3/4 positive studies). Conventional neuroleptics have been most commonly prescribed (3/3 positive studies), atypical neuroleptics appear promising (2/2 positive studies). Methylphenidate improves some CD symptoms, even in the absence of ADHD (6/6 positive studies). Sparse research has been conducted on response to antidepressants. The evidence for an effective role of pharmacotherapy in CD is still limited. Treatment should be multimodal and individualized to each patient's specific condition.

Adolescent↗
PubMed1992

Attention-deficit hyperactivity and conduct disorder: comorbidity and implications for treatment.

The distinguishing and overlapping features of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD) are discussed. Conclusions regarding comorbidity, treatment efficacy, and long-term outcome can be influenced by several factors, including diagnostic procedures and sample characteristics. The need to distinguish between referred and non-referred samples is particularly crucial when considering treatment and comorbidity issues. The efficacy of psychosocial and pharmacological treatments in ADHD and CD children is reviewed as are the few studies of psychostimulant medication in co-morbid youngsters. Suggestions regarding treatment planning and recommendations for treatment and research are described.

Adolescent↗
PubMed1992

Oppositional defiant and conduct disorders: issues to be resolved for DSM-IV.

Oppositional defiant disorder (ODD) and conduct disorder (CD) are reasonably distinct both in terms of statistical covariation among symptoms and ages of onset. The two disorders are related in similar ways to impairment and family history of antisocial behavior, but the association is stronger for CD than ODD. Virtually all clinic-referred youths with prepubertal onset of CD have retained the symptoms of ODD that emerged at earlier ages. Furthermore, a set of serious antisocial behaviors characteristically emerges at later ages in some youths with CD, suggesting further developmental progression within CD. These findings are consistent with a conceptualization of ODD and CD as developmentally staged, hierarchically organized levels of severity of the same disorder, but two findings argue for distinguishing separate disorders in DSM-IV: (1) many youths with ODD never develop CD, and (2) CD that emerges for the first time in adolescence appears to be independent of ODD.

Acting Out↗
PubMed1991

Differential effects of stimulant medication on reading performance of boys with hyperactivity with and without conduct disorder.

Controversy surrounding stimulant medication, particularly its effects on reading performance, continues to obscure the issue of the use of this drug in classroom situations. The present study emphasized careful differential diagnosis, double-blind and placebo approaches, and curriculum-based dependent measures to address these concerns. Methylphenidate was administered to two groups of boys, ages 8 through 11. The two groups included 27 subjects meeting criteria for attention deficit-hyperactivity disorder but not conduct disorder, known as hyperactive disorder (HD), and 28 subjects meeting criteria for both diagnostic categories, known as hyperactive-aggressive (HA). Only four subjects in each group met a discrepancy criterion for learning disabilities (LD). Methylphenidate was administered to both groups at three levels of dosage, along with baseline and placebo conditions. Dependent measures involved both reading recognition and reading comprehension, equivalent across all conditions. No significant results were found for the group with HD in either reading recognition or comprehension, due largely to unusual placebo reactions. Results were generally in the direction predicted for the group with HA, but only significantly so in reading comprehension, and no dose effect was found on this variable. Implications for reading as a dependent measure of medication effects are discussed.

Achievement↗
PubMed1995

The role of genetic factors in conduct disorder based on studies of Tourette syndrome and attention-deficit hyperactivity disorder probands and their relatives.

To examine the role of genetic factors in oppositional defiant disorder (ODD) and conduct disorder (CD), 38 variables relating to the relevant DSM-III-R criteria, as well as other angry and aggressive behaviors, were examined in 1177 Tourette syndrome (TS) and attention-deficit hyperactivity disorder (ADHD) probands, their first-degree relatives, and controls. Two techniques were used: (1) a genetic loading technique comparing the frequency of symptoms in groups with progressively less genetic loading for Gts and ADHD genes, and (2) comparison of the frequency of symptoms in relatives with, versus relatives without, TS or ADHD. When significant, the latter rules out ascertainment bias and inappropriate controls. For TS, the results were significant with most p values less than 10(-8). The same trends were seen in the smaller number of ADHD families. A polygenic model is proposed in which TS and ADHD alone represent lesser degrees of genetic loading and expression, and TS + CD not equal to ADHD represents a higher degree of genetic loading and expression of genes common to all three disorders. These studies emphasize the important role of genetic factors in ODD and CD. The therapeutic implications are discussed.

Adolescent↗