Conduct Problem Behaviors Research Articles

The Effects of Childhood ADHD Symptoms on Early-onset Substance Use: A Swedish Twin Study

Research has documented that children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of substance use problems. Few studies, however, have focused on early-onset substance use. This study therefore investigated how the two symptom dimensions of ADHD (hyperactivity/impulsivity and inattention) are associated with early-onset substance use, the role of persistent ADHD for the association, and to what extent the association is influenced by genetic and environmental factors. Twins (1,480 pairs) in the Swedish Twin Study of Child and Adolescent Development were followed from childhood to adolescence. ADHD symptoms were measured at age 8-9 and age 13-14 via parent-report, whereas substance use was assessed at age 13-14 via self-report. Results revealed that hyperactive/impulsive symptoms predicted early-onset "sometimes" tobacco use (adjusted odds ratios, 1.12, for one symptom count), controlling for inattentive symptoms and conduct problem behaviors. There is no independent effect of inattentive symptoms on early-onset substance use. Children with persistent hyperactivity/impulsivity (defined as scoring above the 75th percentile at both time points) had a pronounced risk of both early-onset tobacco and alcohol use (adjusted odds ratios from 1.86 to 3.35, compared to the reference group). The associations between hyperactivity/impulsivity and early-onset substance use were primarily influenced by genetic factors. Our results indicated that hyperactivity/impulsivity, but not inattention, is an important early predictor for early-onset substance use, and a shared genetic susceptibility is suggested to explain this association.

Predictive validity of callous–unemotional traits measured in early adolescence with respect to multiple antisocial outcomes.

This study investigated the predictive validity of youth callous-unemotional (CU) traits, as measured in early adolescence (Grade 7) by the Antisocial Process Screening Device (APSD; Frick & Hare, 2001), in a longitudinal sample (N = 754). Antisocial outcomes, assessed in adolescence and early adulthood, included self-reported general delinquency from 7th grade through 2 years post-high school, self-reported serious crimes through 2 years post-high school, juvenile and adult arrest records through 1 year post-high school, and antisocial personality disorder symptoms and diagnosis at 2 years post-high school. CU traits measured in 7th grade were highly predictive of 5 of the 6 antisocial outcomes-general delinquency, juvenile and adult arrests, and early adult antisocial personality disorder criterion count and diagnosis-over and above prior and concurrent conduct problem behavior (i.e., criterion counts of oppositional defiant disorder and conduct disorder) and attention-deficit/hyperactivity disorder (criterion count). Incorporating a CU traits specifier for those with a diagnosis of conduct disorder improved the positive prediction of antisocial outcomes, with a very low false-positive rate. There was minimal evidence of moderation by sex, race, or urban/rural status. Urban/rural status moderated one finding, with being from an urban area associated with stronger relations between CU traits and adult arrests. Findings clearly support the inclusion of CU traits as a specifier for the diagnosis of conduct disorder, at least with respect to predictive validity.

The latent structure of childhood aggression: A taxometric analysis of self-reported and teacher-rated aggression in Israeli schoolchildren.

The purpose of this study was to determine whether the latent structure of childhood aggression, like the latent structure of adult antisocial behavior, is dimensional. One thousand and five Israeli schoolchildren completed a translation of the Buss-Perry Aggression Questionnaire (AQ; Buss & Perry, 1992) and were rated by their homeroom teachers on the Eyberg Child Behavior Inventory (ECBI; Robinson, Eyberg, & Ross, 1980). The AQ Physical Aggression and Verbal Aggression scales were combined to form the 1st indicator, the AQ Anger and Hostility scales were combined to form the 2nd indicator, the 10-item ECBI Oppositional Defiant Behavior Toward Adults scale composed the 3rd indicator, and the 8-item ECBI Conduct Problem Behavior scale composed the 4th indicator. Subjecting these indicators to taxometric analysis revealed consistent support for dimensional latent structure in the full sample as well as in 5 of the 6 subsamples. Childhood aggression, it would seem, differs quantitatively along a dimension (degree of aggression) rather than bifurcating into qualitatively distinct categories (aggressive vs. nonaggressive).

Conduct Disordered Youth in Group Care: An Examination of Negative Peer Influence

We examined the potential impact of negative peer influence within a treatment-focused residential care setting. Subjects were 712 youth consecutively admitted to a large residential treatment program (9–19 years of age). Based on Diagnostic Interview Schedule for Children (DISC) scores, 247 (35%) of these youth qualified for a Conduct Disorder diagnosis at admission. The dependent measures were the number of DISC Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD) symptoms and the sum of Conduct Problem behaviors observed daily for each youth. Both the Conduct Problem Behaviors and the ODD/CD symptoms for both CD and non-CD groups decreased over time. Youth with a CD diagnosis or who were female improved at a faster rate than their peers. The data analyzed in this study do not support a negative peer influence effect for antisocial youth placed in a treatment-focused residential care setting.

ADHD Status and Degree of Positive Illusions;Moderational and Mediational Relations with Actual Behavior

Objective Past research suggests that many children with behavior problems display overly positive self-views (“positive illusions”); some researchers have hypothesized that these positive illusions may prevent these children from improving their behavior. This research investigates positive illusions in the behavioral domain as a moderator and mediator of the relation between ADHD status and behavior in a summer program setting. Method Boys with ADHD and comparison boys rated their own behavioral competence; discrepancies between these self-ratings and the reports of boys’ teachers served as an index of behavioral positive illusions. Dependent variables were derived from a behavioral point system that provided specific data about boys’ positive and negative behaviors and from counselor ratings of behavior. Results/Conclusion Hierarchical multiple regression analyses revealed no evidence supporting a moderational association, although ADHD status and behavioral positive illusions were additive predictors of the dependent variables. Post hoc analyses revealed a pattern of mediational effects that were strongest for dependent variables assessing conduct problem behaviors. (J. of Att. Dis. 2008; 12(3) 227-238)

Testing an Idealized Dynamic Cascade Model of the Development of Serious Violence in Adolescence

A dynamic cascade model of development of serious adolescent violence was proposed and tested through prospective inquiry with 754 children (50% male; 43% African American) from 27 schools at 4 geographic sites followed annually from kindergarten through Grade 11 (ages 5-18). Self, parent, teacher, peer, observer, and administrative reports provided data. Partial least squares analyses revealed a cascade of prediction and mediation: An early social context of disadvantage predicts harsh-inconsistent parenting, which predicts social and cognitive deficits, which predicts conduct problem behavior, which predicts elementary school social and academic failure, which predicts parental withdrawal from supervision and monitoring, which predicts deviant peer associations, which ultimately predicts adolescent violence. Findings suggest targets for in-depth inquiry and preventive intervention.

ADHD Status and Degree of Positive Illusions: Moderational and Mediational Relations With Actual Behavior

Past research suggests that many children with behavior problems display overly positive self-views ("positive illusions"); some researchers have hypothesized that these positive illusions may prevent these children from improving their behavior. This research investigates positive illusions in the behavioral domain as a moderator and mediator of the relation between ADHD status and behavior in a summer program setting. Boys with ADHD and comparison boys rated their own behavioral competence; discrepancies between these self-ratings and the reports of boys' teachers served as an index of behavioral positive illusions. Dependent variables were derived from a behavioral point system that provided specific data about boys' positive and negative behaviors and from counselor ratings of behavior. Hierarchical multiple regression and analyses revealed no evidence supporting a moderational association, although ADHD status and behavioral positive illusions were additive predictors of the dependent variables. Post hoc analyses revealed a pattern of mediational effects that were strongest for dependent variables assessing conduct problem behaviors.

Developmental Pathways to Conduct Problems: A Further Test of the Childhood and Adolescent-Onset Distinction

This study tested several theoretically important differences between youth with a childhood-onset and youth with an adolescent-onset to their severe conduct problems. Seventy-eight pre-adjudicated adolescent boys (ranging in age from 11 to 18) housed in two short-term detention facilities and one outpatient program for youth at risk for involvement in the juvenile justice system participated in the current study. The sample was divided into those with a childhood-onset to their serious conduct problem behavior (n = 47) and those with an adolescent-onset (n = 31). The childhood-onset group showed greater levels of dysfunctional parenting, callous-unemotional traits, and affiliation with delinquent peers. The only variable more strongly associated with the adolescent-onset group was lower scores on a measure of traditionalism.

Profiles of current disruptive behavior: Association with recent drug consumption among adolescents

Instead of using scale thresholds and standard diagnostic criteria, latent class analysis was used to elucidate distinct subgroups of adolescents based on symptom profiles of the 24 Youth Self-Report items assessing attention-deficit hyperactivity, oppositional and conduct problem behaviors. We then investigated the extent to which being classified into different classes of disruptive behavior was associated with drug consumption in the month prior to the survey assessment. Three latent classes of disruptive behavior emerged along a continuum of severity. Youth classified into a class representing multiple and more serious behavior problems were found to have the highest rates of drug use, particularly involving inhalants and marijuana. Contrary to our hypotheses, younger adolescent females in this class reported a higher rate of past month drug use than similarly aged males. Drug use also was found to be common among youth in a class with a greater proportion of subclinical levels of behavior problems. Adolescents evidencing multiple behavior problems, particularly emerging conduct problems, need to be thoroughly assessed for recent drug involvement.

Factor Structure and Discriminative Validity of the Eyberg Child Behavior Inventory With Young Children

This study examined the factor structure and discriminative validity of the Eyberg Child Behavior Inventory (ECBI) with community-based and clinic-referred samples of young children (2–6 years). In the community sample, confirmatory factor analysis indicated a three-factor structure with components reflecting Inattentive, Oppositional Defiant, and Conduct Problem Behavior. In the clinic sample, component scores differentiated children with specific behavior problems from children without significant externalizing symptoms. However, component scores did not differentiate within the externalizing spectrum. The data suggest that ECBI components may be useful to screen community-based and clinic-referred young children for externalizing symptoms, but may be less useful to identify children with specific behavior problems.

Violence Related Injuries in the Emergency Room: Alcohol, Depression, and Conduct Problems

Objective. The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October–November, 1996 and June–July, 1997. Method. The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group. Results. Patients reporting drinking within 6 h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5–66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5–15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables. Conclusions. In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.

Brain Maturation and Subtypes of Conduct Disorder: Interactive Effects on P300 Amplitude and Topography in Male Adolescents

Adolescents with conduct disorder problems are, on average, at increased risk for a variety of unfortunate adult outcomes, including substance dependence. This study was designed to identify the neurophysiological correlates of different categories of conduct disorder problems as well as the relationship between these correlates and the maturational status of the brain. The subjects were 94 males, aged 14-19 years, recruited from the community. None were recruited from treatment or juvenile justice programs. The subjects varied in the type and number of conduct problem behaviors exhibited prior to age 15. Groups were operationally defined by the relative number (0 versus > or =1) of DSM-IV conduct disorder diagnostic criteria within each of four categories: rules violations, aggression, deceitfulness/theft, and destructiveness. Age was included as an additional grouping factor. P300 electroencephalographic potentials were recorded while subjects performed a task in which rare auditory stimuli were used to signal a change in stimulus-response mapping during a succeeding set of trials. Analyses revealed that boys with a history of rules violations failed to exhibit the normal maturational increase in P300 amplitude found in boys without a history of rules violations. Topographic analyses of current source densities suggest that the source of the maturational deficit involved P300 generators within the frontal brain. Parietal generators of P300 matured normally. The present results are interpreted as reflecting a decrement in frontal brain maturation among boys potentially at risk for substance dependence, antisocial personality disorder, or other forms of adult psychopathology.

Evidence Builds for Prefrontal Cortex Abnormality in Conduct Disorder

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessEvidence Builds for Prefrontal Cortex Abnormality in Conduct DisorderJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:5 Apr 2002https://doi.org/10.1176/pn.37.7.0024It’s looking more and more as though the prefrontal cortex—that region of the brain above the eyes and behind the forehead involved in judgment, planning, and decision making—is not working right in criminals and potential criminals. For instance, Adrian Raine, Ph.D., a professor of psychology at the University of Southern California, found that prefrontal cortex volume was significantly smaller in violent, antisocial men than in controls (Psychiatric News, March 3, 2000).And now yet another investigation implicating the prefrontal cortex with criminality has been conducted by Lance Bauer, Ph.D., and Victor Hesselbrock, Ph.D., professors of psychiatry at the University of Connecticut School of Medicine in Farmington. The results were published in the October 15, 2001, Biological Psychiatry.Bauer and Hesselbrock selected 158 boys and girls aged 14 to 20 years as their subjects. Half had exhibited conduct disorder according to DSM-III-R criteria, and half had not. They placed 32 electrodes in various locations on their subjects’ scalps. The subjects were then given a memory task—they were asked to judge whether various stimuli had been presented. While they were engaging in the memory task, the electrodes on their scalps were recording brain-wave responses in various areas of their brains. Bauer and Hesselbrock measured these brain-wave responses.Bauer and Hesselbrock then compared brain-wave responses of the subjects who had conduct disorder with those of subjects who had not. They found that subjects without the disorder had exhibited robust brain-wave responses in the prefrontal cortex during the memory task, whereas subjects with the disorder did not. There were no significant differences in brain-wave responses between the two groups of subjects in brain areas other than the prefrontal cortex. Also of interest, the results localized the brain-wave deficits to the left prefrontal cortex. However, a similar experiment conducted by the researchers in 1999 localized the brain-wave deficits to the right prefrontal cortex.Bauer and Hesselbrock concluded that “the neurophysiologic substrate underlying conduct-problem behaviors is bilaterally represented within the prefrontal cortex.”Psychiatric News asked Peter Finn, Ph.D., a psychologist at Indiana University doing similar kinds of research, for his comments on the study.“I have high regard for Drs. Bauer and Hesselbrock,” he said. “They are well known in the field of the psychobiological bases of conduct problems and social pathology, and their work is very rigorous.”As for this particular study, Finn said, he believes that its strength lies in the fact that Bauer and Hesselbrock took a topographical approach to identifying the biological origins of prefrontal cortex abnormalities in youngsters with conduct problems.“The fact that the study had a pretty large sample size and was collected for the most part from the community was also important,” he added. “It was a sample that you could be confident was representative to some degree of the individuals who have these kinds of conduct problems.”This study was supported in part by a Public Health Service grant. ▪ ISSUES NewArchived

Factor Structure of the Eyberg Child Behavior Inventory: A Parent Rating Scale of Oppositional Defiant Behavior Toward Adults, Inattentive Behavior, and Conduct Problem Behavior

Used the Eyberg Child Behavior Inventory (ECBI) to measure disruptive behavior problems in children and adolescents. A controversy exists, however, on the dimensional structure of the ECBI. To evaluate this issue, an exploratory factor analysis was first performed on a sample of 1,263 children and adolescents. This analysis identified 3 meaningful factors (i.e., Oppositional Defiant Behavior Toward Adults, Inattentive Behavior, and Conduct Problem Behavior) and a fourth, poorly defined factor. A confirmatory factor analysis (CFA) evaluated the fit of the 3 meaningful factors in a second sample of 1,264 children and adolescents. The 3-factor model with 2 correlated errors provided a excellent fit. This 3-factor model also provided a significantly better fit than 2- and 1-factor models. Multiple group CFA indicated that the factor pattern, item-factor loadings, factor correlations, and correlated errors were equivalent across the samples. The CFA on sex yielded similar results. Initial normative information is presented for boys (n = 1,322) and girls (n = 1,205) within 4 age ranges (i.e., 2-5, 6-9, 10-13, 14-17) for the 3 factors. The use of these 3 factors, especially Oppositional Defiant Behavior and Conduct Problem Behavior, should make the ECBI more useful as a screening and outcome measure.

Age Trends in the Association between Parenting Practices and Conduct Problems

The authors studied the association between parenting practices and conduct problem behavior in a sample of 179 clinic-referred children and adolescents. Parenting practices were assessed using a multi-informant and multimethod assessment system. Conduct problems were the DSMIII-R criteria for oppositional defiant disorder and conduct disorder assessed by a structured psychiatric interview with multiple informants. Results indicated that parents” involvement in their children”s activities was most strongly predictive of conduct problems in the adolescent age group (ages 13-17), whereas corporal punishment was most strongly associated with conduct problems in the middle age group (ages 9-12). Parents’ monitoring and supervision of their children”s behavior was moderately predictive of conduct problems in both of these age groups but only weakly predictive in the youngest age group (ages 6-9). Finally, parental consistency in using disciplinewas highly predictive of conduct problems in the adolescent age group and moderately predictive in the youngest age group.

Parent-Child Interaction Therapy: A Guide for Clinicians

This article focuses on Parent-Child Interaction Therapy (PCIT), a treatment program for young children with conduct problem behavior and their families. In Part One, PCIT is presented as an interactional approach to parent training and discussed in the context of other behavioral parent training programs. In Part Two, PCIT is described and empirical support for the program's effectiveness is presented. Given the importance of adapting programs to meet the needs of individual families and demonstrating treatment efficacy, Part Three is devoted to the presentation of strategies for modifying PCIT and measuring treatment outcome.

Revision of the Sutter-Eyberg Student Behavior Inventory: Teacher Ratings of Conduct Problem Behavior

The Sutter-Eyberg Student Behavior Inventory (SESBI), a brief teacher-rating scale of externalizing, or conduct problem behavior at school, was completed by 38 teachers for 726 5th- through 12th-grade students. The inventory contained the original 36 items plus 17 experimental items. Item analyses led to retention of 10 experimental items and deletion of 8 original items with weaker psychometric properties. Scores on this revised, 38-item version of the SESBI had a high coefficient alpha. Factor analyses yielded a two-factor solution representing (a) oppositional behavior and (b) attentional difficulties.

Maintaining the treatment effects of parent training: The role of booster sessions and other maintenance strategies.

In light of the persistent nature of conduct problem behavior in children, and its enormous cost to families and society, the importance of developing effective interventions that foster lasting changes is discussed. Parent-management training (PMT) and studies of its associated long-term gains are reviewed. Although studies have demonstrated short-term gains for PMT, evidence for the long-term maintenance of treatment gains is limited. Strategies designed to promote the maintenance of treatment gains are drawn from both the adult and child treatment literature and applied to parent training. The need to reduce dropout and to examine the content and timing of booster sessions using randomized control group designs is emphasized. Future research must address the course of children's conduct problem behaviors, as well as the behaviors of parents and others (e.g., peers, teachers) who influence the child following treatment.

The growth of conduct problem behaviors from middle childhood to early adolescence: sex differences and the suspected influence of early alcohol use.

This study investigates the levels and rates of growth of conduct problem behaviors over time in an urban sample of American youth. Our hypotheses focused on differences between the sexes and between youths with and those without early use of alcohol without parental permission. Data for this study are from an ongoing epidemiologic study of urban public school students, recruited originally at the time of their entry into Grades 1-2 between 1985 and 1987. Each spring, from 1991 to 1993, a total of 1,212 students were interviewed privately for this study. A total of 408 (54.2% female, 84.7% black) respondents met study criteria as either an "early unsanctioned alcohol user" or an "abstainer." These youths constitute the analytic subsample. Estimates from longitudinal growth modeling analyses showed that boys and girls had different initial levels of conduct problem behaviors, but similar rates of growth. Both the initial level of conduct problem behaviors and the rates of growth were greater for early unsanctioned alcohol users as compared to abstainers. In a combined analysis the difference between early unsanctioned alcohol users and abstainers seemed to offset the initially observed sex difference. Early alcohol use without parental permission was associated with higher levels of conduct problem behaviors by the ages of 10-12 years and higher rates of growth in those behaviors during the transition from late childhood to early adolescence for both boys and girls, although the levels differed by sex. It may be that unsanctioned early alcohol use puts youths on an accelerated pathway of conduct problem behaviors and development of conduct disorder in adolescence.

Teachers' ratings of disruptive behaviors: the influence of halo effects.

This study evaluated the accuracy of teachers' ratings and examined whether these ratings are influenced by halo effects. One hundred thirty-nine elementary school teachers viewed videotapes of what they believed were children in regular fourth-grade classrooms. In fact, the children were actors who followed prepared scripts that depicted a child engaging in behaviors characteristic of an attention-deficit hyperactivity disorder (ADHD), an oppositional defiant disorder or a normal youngster. The findings provide support for a bias that was unidirectional in nature. Specifically, teachers rated hyperactive behaviors accurately when the child behaved like an ADHD youngster. However, ratings of hyperactivity and of ADHD symptomatic behaviors were spuriously inflated when behaviors associated with oppositional defiant disorder occurred. In contrast, teachers rated oppositional and conduct problem behaviors accurately, regardless of the presence of hyperactive behaviors. The implications of these findings regarding diagnostic practices and rating scale formats are discussed.