Diagnosis and Treatment of Attention Deficit and Conduct Disorders in Children and Adolescents

Abstract

The three diagnostic categories in DSM-III of attention deficit disorders (ADD), oppositional disorder, and conduct disorders (CD) were grouped together in DSM-III-R into a subclass, disruptive behavior disorders. These disorders are characterized by disruptive behavior distressing to others and not to the person with the disorder. Research has demonstrated that the symptoms of these disorders covary to a high degree. For example, Cantwell (1977), Connors (1969), and Quay (1979) have demonstrated strong relationships between aggressive and hyperactive behavior. The dimension of aggressivity has been added to hyperactivity and inattention to differentiate children with ADD and to predict long-term outcome (Langhorne & Loney, 1979; Loney, Langhorne & Paternite, 1978; Milich, Loney, & Landau, 1982). Werry, Reeves, and Elkind (1987) have reviewed the literature comparing attention deficit hyperactivity disorder (ADHD) and conduct disorder. They conclude that there are remarkable similarities across diagnostic groups. They further suggest that ADHD is primarily a disorder of cognitive impairment, more impulsive responding, and poorer achievement in school, and that it is associated with increased motor activity and neurodevelopmental abnormalities. Conduct disorder, on the other hand, is characterized by egocentricity and higher degrees of hostility. Association between ADHD and CD increases the severity of the handicap. Reeves, Werry, Elkind, and Zametkin (1987) found, in a clinic sample, that conduct and oppositional disorders resembled each other and rarely occurred in the absence of ADHD.