Conduct Disorder In Adolescents Research Articles

The Rorschach Extended Aggression Scores

The Extended Aggression Scores were developed to quantify the aggressive Rorschach imagery produced by violent Antisocial Personality Disordered (ASPD; American Psychiatric Association, 1980 ) offenders. Despite their histories of real world violence, these subjects produced few Aggressive Movement (AG; Exner, 1993 ) responses. Why didn’t violent children, adolescents, and adults produce more AG responses? Considering their expression of uncensored pleasurable affect when relating their aggressive acts during their interviews, conscious censoring ( Exner, 1993 ; Meloy, 1988 ) did not adequately explain the paucity of AG responses among sentenced adults. Why would they describe their violent acts with pride and bravado during an interview and subsequently censor AG on the Rorschach? Conscious censoring among the Conduct Disorder (CD) children and adolescents, who frequently produced sexual content, seemed an equally unlikely explanation ( Gacono, 1997 ). Earlier Rorschach research ( Holt & Havel, 1960 ; Rapaport, Gill, & Schafer, 1946 , 1968 ; Schafer, 1954 ) provided clues to understanding the discrepancies between Rorschach production and the interview/historical data. Direct or implicit aggressive content was thought to imply tensions of aggressive impulse ( Rapaport et al., 1946 \ 1968 ). Initial findings ( Gacono, 1988 , 1990 ; Heaven, 1988 ) suggested that the paucity of symbolized aggression, represented by AG movement, might be due, in part, to the ego-syntonic nature of aggression in ASPD and psychopathic subjects. The clinical logic was that AG symbolized tensions of ego-dystonic aggression when produced by violent, antisocial patients. In the absence of binding the aggressive impulse, the violent individual would, instead, act it out, thus vitiating the need to symbolize it. Existing data supported this hypothesis: Exner’ ;s (1995) character disordered sample produced lower AG frequencies than his adult nonpatients; violent children and adolescents produce lower AG frequencies than child and adolescent nonpatients; and the majority of the forensic subjects with known histories of violence produce less AG than nonpatients and the Gacono and Meloy clinical samples without histories of violence ( Gacono, 1997 ; Gacono & Meloy, 1994 ). Despite the paucity of AG responses in ASPD records, other aggression imagery was not absent. Rather, the presence of other potentially scoreable aggressive imagery (see Gacono, 1988 , 1990 , 1997 ) allowed for the development ( Gacono, 1988 ) and refinement ( Gacono & Meloy, 1994 ; Meloy & Gacono, 1992 ) of five additional scoring categories: Aggressive Content (AgC), Aggressive Past (AgPast), Aggressive Potential (AgPot), Aggressive Vulnerability (AgV), and Sado-Masochism (SM). Since their introduction ( Gacono, 1988 ), the Extended Aggression Scores have received considerable clinical interest and empirical study. As noted in the Rorschach Workshops’ Alumni Newsletter (2000) concerning the work of the Rorschach Research Council, “Another project on which there has been good progress is the special score for Aggressive Content (AgC). Council has reviewed the criteria and guidelines for its applications and has evaluated the literature concerning it .. . A more precise interpretation of AgC responses will probably hinge on findings for other variables .. .” (p. 13). Additionally, the ROR-SCAN Version 6 Rorschach Interpretive Scoring System ( Caracena, 2002 ) now includes AgC, AgPast, AgPot and SM.. What began as an attempt to expand the scoring of Rorschach aggressive imagery in CD and ASPD subjects, has evolved into a larger study of aggression on the Rorschach. In this article we present information concerning the reliability, psychometric properties, and construct validity of the scores and discuss their clinical meanings. We conclude that while AgPotential, AgVulnerability and Sado-masochism need additional research, the current research supports inclusion of the more frequently appearing AgContent and AgPast scores in the Comprehensive System.

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.

Conduct disorder and other disruptive behaviors: Pediatric psychopharmacology

Conduct disorder in children and adolescents arises from multiple causes. Treatment strategies involve a number of different drug classes. Newer information suggests that atypical antipsychotics such as risperidone are especially helpful. Mood-regulating agents such as lithium, valproate, and carbamazepine, as well as antidepressants, stimulants, and antihypertensive agents can be of use. Integration of previous information about medication response into the hypothesis of etiology is important to achieving success.

Psychometric evaluation of self- and collateral timeline follow-back reports of drug and alcohol use in a sample of drug-abusing and conduct-disordered adolescents and their parents.

One hundred eighty-eight drug-abusing and conduct-disordered adolescents and their parents provided retrospective reports of the youths' frequency of alcohol and illicit drug use for each of the 6 months preceding their initial session in an outpatient treatment program. Youths' and parent reports of youths' drug and alcohol use for each month were similar. For marijuana and alcohol, frequency reports were related for each month, whereas hard drug reports were related only for the 4 months preceding intake. Relationships among alcohol and hard drug reports were strong during Months 1, 2, and 4 preceding intake, whereas strength of relationship among marijuana reports was similar throughout the 6 months.

Explanations for Conduct Disorder

Conduct Disorder (CD) in children and adolescents has the potential to affect every aspect of the individual's functioning including their community, family, and educational environments. Young people who with CD need to be well understood in terms of the factors that make up their diagnosis so that those who work with them will be better equipped. The contributing factors related to Conduct Disorder in children comprise a compounding set of experiences that can have life long implications for the young person's ability to function as a healthy and positively socialized member of society. This paper provides the reader with an overview of the contributing factors and a discussion of conduct disorder in children and adolescents.

Gender differences in childhood onset conduct disorder.

The present study tested several predictions related to the theory that girls with conduct disorder (CD) follow a single delayed onset pathway. The following hypotheses were tested among a high-risk, stratified random sample of youth who used public services during a 6-month period: boys will be more likely to have childhood onset CD (COCD) than girls; girls with COCD will be less common than girls with adolescent onset CD (AOCD); COCD girls. AOCD girls, and COCD boys will be similar in terms of risk profiles and AOCD boys will have a less severe risk profile than COCD girls; and risk factors that differentiate between COCD and AOCD among males will not differentiate between COCD and AOCD among females. Among those youth who met the criteria for CD, males were significantly more likely to have COCD than females. However, close to half of females with CD met the criteria for the COCD subtype. Of the seven risk factors that were examined, girls with COCD scored higher than COCD boys on three factors and higher than AOCD girls on four factors; however, only one significant difference was found between AOCD girls and COCD boys. Finally, risk factors appeared to differentiate between COCD and AOCD groups in a similar way among males and females. These findings suggest that COCD is not rare among females in public service sectors, COCD girls can be distinguished from AOCD girls in terms of risk factors, and risk factors for COCD among males are also relevant to females.

Defense Mechanisms in Adolescent Conduct Disorder and Adjustment Reaction

The use of defense mechanisms by male and female adolescents with a diagnosis of conduct disorder was compared with the defense use of adolescents with a diagnosis of adjustment reaction. Because conduct disorder has been shown to be associated with a developmental lag in several areas of psychological functioning, we expected that these adolescents would show immaturity in the use of defenses. This expectation was confirmed. As compared with adjustment reaction, conduct disordered youths were more likely to use the immature defense of denial and less likely to use the mature defense of identification.

Major depression and conduct disorder in youth: associations with parental psychopathology and parent-child conflict.

This study examined conduct disorder (CD) and major depression (MDD) in adolescents in relationship to parent-child conflict and psychopathology in their parents. Participants were drawn from a population-based sample of twins and their families. Affected participants had lifetime diagnoses of CD and/or MDD; controls had no history of either disorder. The presence of CD or MDD in an adolescent was related to increased rates of maternal MDD and paternal antisocial behavior. Both CD and MDD in adolescents were directly associated with high parent-child conflict. This association appeared unrelated to whether the father had a history of antisocial behavior; however, the association between mother-child conflict and psychopathology in the child was related to the mother having a history of MDD as well. The implications of these findings for the complex relationship between parental diagnoses, child diagnoses, and parent-child conflict are discussed.

Psychopharmacology of conduct disorder: current progress and future directions

Behavioural manifestations of conduct disorder (CD) among children and adolescents are one of the most common referrals to community psychiatrists. Patients with CD are difficult to treat. The patterns of maladaptive behaviours they exhibit are diverse and can vary as a function of age and gender. Although different pharmacological interventions have been reported as potentially promising options in the treatment of CD, no medication has yet received a formal approval from the licensure authorities, either in the US or Europe. This article reviews efficacy results and associated adverse effects from selected clinical trials that have the strongest outcome evidence for the treatment of CD in children and adolescents. Critical issues in the effectiveness of the evidence-based pharmacotherapy for CD are raised and future directions of the psychopharmacology of CD are examined.

Tobacco use across the formative years: a road map to developmental vulnerabilities.

Different vulnerabilities are launched or play a more active role at different developmental stages and different ages. Furthermore, the interplay between developmental and biological, psychosocial, and environmental vulnerabilities is expected to differ across stages of smoking. This article focuses on the intersection of vulnerability associated with adolescence with tobacco-use vulnerability resulting from biological, psychological, and environmental characteristics of an adolescent. Recommendations include the following: (a) Effectively treat childhood and adolescent behavioral and emotional disorders that place adolescents at risk; (b) target programs toward specific high-risk subgroups; (c) incorporate training in self-control, affect regulation, and healthy coping strategies into educational programs and extracurricular activities; (d) encourage youth to develop healthy sources of success and satisfaction; (e) encourage communities and states to launch environmental, policy, and regulatory initiatives to protect youth from tobacco; (f) consider bold initiatives that will require fundamental changes in public attitudes, including monetary rewards for nonsmoking, heightened penalties for facilitating and engaging in underage smoking, and government subsidies for substitute pharmacological agents.

Intergenerational transmission of partner violence: a 20-year prospective study.

An unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents (ETDV), maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner. Conduct disorder (CD) was the strongest risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. The effect of child abuse was attributable to these 3 risks. ETDV conferred the greatest risk of receiving partner violence; CD increased the odds of receiving partner violence but did not mediate this effect. Child physical abuse and CD in adolescence were strong independent risks for injury to a partner. SUD mediated the effect of adolescent CD on injury to a partner but not on injury by a partner. Prevention implications are highlighted.

Treating Attachment Disorders: From Theory to Therapy

KARL HEINZ BRISCH: Treating Attachment Disorders: From Theory to Therapy. Guilford Press, New York, 2002, 294 pp., $36.90, ISBN 1-57230-681-5. The author, a German psychoanalyst, attempts to demonstrate the applicability and efficacy of attachment-theory concepts in a wide variety of clinical situations. Brisch discusses consultation in hospitals, schools, social welfare agencies, and in psychoanalytic psychotherapeutic encounters with pregnant mothers about to miscarry, parents of premature infants, children with school phobias, addicted and conduct-disordered adolescents, and adults with various emotional problems. Only some of the patients suffered from what are typically considered attachment disorders, thus the book's title is something of a misnomer. The first third of the book provides the reader with an excellent overview of attachment theory. Along the way, the author integrates other developmental theories, particularly psychoanalytic ones, with attachment concepts, demonstrating how they often overlap to enrich one another. The strange situation and adult attachment interview, two of attachment theory's principal research tools, are described in detail along with the rich postdictive and predictive research findings that have emerged over the years. These introductory chapters are worth the price of the book and would in themselves be useful for teaching developmental theory to residents, candidates, and graduate students. However, these theoretical chapters are to provide an introductory framework for the treatment chapters in which Brisch briefly describes 26 clinical situations in which he highlights his use of attachment concepts. He warns the reader that the focus on attachment concepts in his discussion of these highly complex clinical encounters may at times seem strained and awkward. Indeed, this is so. Perhaps if there were fewer clinical cases, this could have allowed more in-depth discussion of each, which in turn could have ameliorated some of the awkwardness. But, perhaps, there is some inherent awkwardness when attempting to translate well-researched, meticulously defined attachment concepts and configurations into the subtle complexities of the therapist-patient interaction. The author is clearly a sensitive psychoanalytic clinician. Thus, it is surprising when he uses psychoanalytic clinical theory as a strawman to highlight an attachment concept. For instance, one of his case studies involves a 17-year-old promiscuous, addicted girl who was neglected and abandoned by her parents. …

Adolescent Conduct Disorder, Substance Use, and Traumatic Injury

ABSTRACT This study prospectively examines die relationship of two types of common behavioral problems of adolescence, substance involvement (SI) and Conduct Disorder Behavior (CDB), to traumatic injury related health problems (TRHP) during adolescence and young adulthood. We followed a sample of 212 youths over 6 years with assessments of SI, CDBs and symptoms, and TRHPs at 2, 4, and 6 years post baseline. We hypothesized that SI and CDB would be associated with an increased incidence of TRHPs and that males would exhibit more SI and CDB than females. We also examined both the independent and combined impact of SI and CDB on TRHP. We found that males reported more SI, CDB, and TRHP than females. Regression analyses suggest that early SI places females at risk for TRHP, while CDB is more related to TRHP for males. Specifically, CDB was directly associated with increased TRHPs in male adolescents and young adults. We suggest that SI impacts TRHPs through its association with CDB; however, the relationships between SI, CDB, and TRHPs appear to be complex. Injury prevention strategies should include consideration of the social and developmental context in which SI and CDB occur in order to be maximally effective.

Risperidone in Children and Adolescents with Conduct Disorder: A Single-Center, Open-Label Study

Background: Risperidone is one of the most commonly used atypical antipsychotic drugs in the treatment of children and adolescents. However, the data about its use in children and adolescents with conduct disorder (CD) are limited. Objective: The aim of this study was to investigate the effectiveness and tolerability of risperidone in controlling major symptoms of CD in children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and severe CD. Methods: Children and adolescents were eligible for this single-center, open-label study if they met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) diagnostic criteria for ADHD and ODD and also were diagnosed with severe CD. The patients were treated with risperidone in an open-label fashion for 8 weeks, starting at a daily dosage of 0.25 mg or 0.5 mg (depending on their body weight) in 2 divided doses. Results: The study population comprised 21 children and adolescents (17 boys, 4 girls) with a mean (SD) age of 10.8 (3.6) years. The mean (SD) dosage of risperidone at the end of 8 weeks of treatment was 1.27 (0.42) mg/d (range, 0.75–2.0 mg/d). On the basis of the global improvement subscale of the Clinical Global Impression scale, 16 of 20 patients (80%) were classified as responders. Significant improvements were observed after risperidone treatment in the inattention, hyperactivity/impulsivity, ODD, and CD subscales of the Turgay DSM-IV–Based Child and Adolescent Behavior Disorders Screening and Rating Scale (parent and teacher forms). No severe adverse events were reported. Conclusions: The results of this study are consistent with previous findings and suggest that risperidone may be an effective and well-tolerated atypical antipsychotic drug for the treatment of children and adolescents with CD. However, further studies, particularly placebo-controlled and double-blinded, are needed to better define the clinical use of risperidone in children and adolescents with CD.

Sex Differences in Conduct Disorder in Children and Adolescents

Abstract Conduct disorder is the most common reason of referral of boys for mental health services; the second most common reason for girls. The “state of the art” in research in conduct disorder is presented, highlighting the important diferences between genders. The changing criteria for conduct disorder and its impact on the treatment of girls is discussed.

Psychopharmacology in the Treatment of Conduct Disorder Children and Adolescents: Rationale, Prospects, and Ethics

The rationale for psychopharmacological treatments of conduct disorder (CD) in children and adolescent is discussed with reference to the presumed neurophysiological basis of the disorder. Specific psychopharmacological treatments for children with CD are identified and briefly evaluated in terms of their empirical foundations. The lack of a secure knowledge base on the biochemical basis of CD and the efficacy of psychopharmacological treatments with children and adolescents suggests the need for caution in the wide use of pharmacotherapy with these populations. Psychopharmacological treatments with children and adolescents with CD are particularly indicated for reactive aggression, and CD with comordid conditions. Conceptual and methodological improvements in use of psychotropic medications with children and adolescents are discussed as well as the associated ethical considerations.

Childhood Behavioral Profiles Leading to Adolescent Conduct Disorder: Risk Trajectories for Boys and Girls

To examine the link between childhood behavioral dimensions and adolescent conduct disorder (CD) among a large sample of boys and girls monitored longitudinally. Teachers rated the behaviors of 1,569 children every year between kindergarten and grade 6. On the basis of these seven yearly ratings, groups of children who followed distinct trajectories on three behavioral dimensions--hyperactivity, fearfulness, and helpfulness--were identified with a semiparametric statistical analysis. Children were then categorized into one of eight behavioral profiles, representing different combinations of the trajectories. Logistic regressions were used to estimate the relation between the profiles and CD in adolescence (mean = 15.7 years). Boys had a significant risk for CD if they were hyperactive (odds ratio [OR] = 4.27; 95% confidence interval [CI], 1.8-10.16); hyperactive and unhelpful (OR = 2.83; CI, 1.07-7.46); or hyperactive, fearless, and unhelpful (OR = 3.93; CI, 1.27-12.17). Girls had a significant risk for CD only if they were both hyperactive and unhelpful (OR = 4.61; CI, 1.31-16.24). More boys than girls exhibited profiles of risk and met criteria for CD in adolescence. Sex-specific childhood behavioral profiles that represented risk for CD in adolescence were identified. There were sex differences in the prevalence of the childhood profiles representing risk for CD.

Book Review: Conduct Disorders in Childhood and Adolescence

Jonathon Hill and Barbara Maughan (eds)Cambridge: Cambridge University Press, 2000ISBN 0 52178 639 8 pp.546 $123.27Psychiatry is ambivalent toward Conduct Disorder. We dignify the condition with li...

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

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. 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. 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. 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.

Behavior therapy in children with aggressive dyssocial disorders

Conduct disorder in children and adolescents is prevalent and has a poor prognosis: it is now considered to be a chronic condition that requires treatment as well as life-long monitoring. Two forms of behavior therapy, parent management training and training in problem-solving skills are currently seen as the most effective treatment. Parent management training is the treatment of choice for younger children, while for older children it should be supplemented with training in problem-solving skills. Parent management training is one of the best-researched therapy techniques for conduct disorder, deserving the criterion "empirically supported treatment" defined by the American Psychological Association. Training in problem-solving skills has led to therapeutic change in clinical samples and is qualified as "probably efficacious treatment". Limitations of both treatments include the high drop-out rate among parents and the fact that many youth improve but remain outside the range of normative functioning. To optimize treatment effectiveness, complex prevention programs have been developed in recent years. Results to date are mixed; however, two large ongoing studies, the FAST and the LIFT study, report positive first outcomes. A higher priority of conduct disorder and related problems in child-psychiatric and psychotherapeutic services would be desirable.