Treating Juvenile Delinquents With Conduct Disorder, Attention-Deficit/ Hyperactivity Disorder, and Oppositional Defiant Disorder

Abstract

Abstract Juvenile delinquents with externalizing disorders are a challenging, yet rewarding, population to treat. The externalizing disorders—namely, attention-deficit/ hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD)—are some of the most common encountered by practitioners working with juvenile delinquents (Kazdin, 2002; Kronenberger & Meyer, 2001). In studies of community and clinic samples, a large percentage of youths with CD or ADHD (e.g., 45% to 70%) also met criteria for the other disorder (Fergusson, Horwood, & Lloyd, 1991), and comorbidity between CD and ODD, anxiety disorders, and depression is common as well (Kazdin, 2002). In a recent epidemiological study that examined psychiatric disorders in juvenile delinquents (Teplin, Abram, McClelland, Dulcan, & Mericle, 2002), the most common disorders were substance use disorders and disruptive behavior disorders (ODD and CD), with more than 40% of males and females meeting criteria for a disruptive behavior disorder. Accordingly, this chapter presents a case exemplar of treating a juvenile delinquent dually diagnosed with conduct disorder and alcohol abuse. First, it is important to highlight the difference between juvenile delinquency and CD. Many readers may be aware of the behaviors associated with a diagnosis of CD, such as aggressive behavior toward others, using a weapon, fire setting, cruelty to animals or persons, vandalism, lying, truancy, running away, and theft (American Psychiatric Association [APA], 2000). The DSM-IV-TR allows for coding a client with one of two subtypes of CD: childhood-onset type (at least one criterion characteristic occurs prior to age 10) and adolescent-onset type (absence of any criteria prior to age 10). While an adolescent may be considered a “juvenile delinquent” after only one delinquent act, to warrant a diagnosis of CD, that same adolescent must be engaged over an extended period (at least 6 months) in a pattern of behavior that consistently violates the rights of others and societal norms. It is critical, therefore, that practitioners take painstaking care in their diagnostic assessments of conduct disorder, as both false positives and false negatives carry potentially serious consequences for both the offender and society (Springer, McNeece, & Arnold, 2003).