Treatment Of Behavioral Disorders Research Articles

Platelet poor plasma serotonin level in delinquent adolescents diagnosed with conduct disorder

Objective Accumulating data indicate the involvement of the serotonergic system in adolescent aggression. The aim of this study was to examine the platelet-poor plasma (PPP) serotonin (5-HT) levels among delinquent adolescent boys with conduct disorder (CD) in comparison with normal controls. Method PPP 5-HT levels were measured in 16 male delinquent CD adolescents from a correctional facility and in 14 normal male adolescent controls. Severity of aggressive behavior was assessed by the Child Behavior Checklist (CBCL) and the Overt Aggression Scale (OAS). Results Delinquent CD adolescents had higher PPP 5-HT levels (about 3-fold) than the normal controls (27.68 ± 32.29 vs. 7.76 ± 4.23 ng/ml, respectively, p = 0.027). In the delinquent CD adolescents a significant correlation was found between the PPP 5-HT levels and the CBCL and OAS aggressive scores ( r = 0.68, p = 0.0034 and r = 0.59, p = 0.016, respectively). Conclusions Juvenile delinquency is associated with high PPP 5-HT levels. Modulation of 5-HT neurotransmission may have a role in the symptomatology and treatment of severe adolescent CD.

Study on the effect of behavior therapy on conduct disorder of adolescent inpatients

Objective To study the curative effect of behavior therapy(military training and growth eduction)on conduct disorder of adolescent inpatients. Methods Using a random grouping and control-study method，87 inpatients with conduct disorder were divided into the study group and the control group. On the basis of drug therapy，the study group adopted the behavior therapy(military training and growth education),and was assessed 1 week and 12 weeks after admission using Achenbach's Child Behavior Checklist(CBCL). The assessment results were statistically treated. Results After 12 weeks of behavior tllerapy. the CBCL scores of the study group and the control group were(13.46±3.28)and(18.41±4.26)in anxiety and obsession,(8.65±3.34)and(12.57 4-3.28)in schizophrenia like，(11.87±3.21)and(14.85±3.55)in depression and withdrawn，(8.62±3.67)and(15.74±2.21)in immaturity，(9.23±2.41)and(15.62±2.51)in violation of discipline，(15.24±3.62)and(26.54±3.11)in aggressiveness，(7.16±3.32)and(11.89±2.65)in hyperactive syndrome. There Was a statistical meaning between the two groups(P<0.01).In addition，there Was a statistical meaning between before and after the therapy in the study group(P<0.01). Conclusions Behavior therapy(military training and growth education)is an effective method in the treatment of conduct disorder of adolescent inpatients. Key words: Behavior therapy:Conduct disorder:Curative effect

Implementing child mental health interventions in service settings: lessons from three pragmatic randomised controlled trials in Wales

This article reports on three pragmatic randomised controlled trials (RCTs) to help children at risk of conduct disorder (CD): two involved the Incredible Years (IY) BASIC parent programme and the other concerned the IY teacher programme. All three interventions took place in regular service settings in North‐ and Mid‐Wales. In all three studies, staff from the provider agency delivered the programme and participated in RCT evaluations in which participants were randomly allocated to intervention or waitinglist control conditions. After a brief introduction to research into the prevention or treatment of CD, and the issues to be considered by services in selecting and delivering interventions, this article summarises the structure, content and evidence base of the IY programmes. The three Welsh studies are briefly described before exploring what factors contributed to service participation in the trials and the benefits and lessons learned in undertaking them.

Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

Research on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD. We conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6-18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16.7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews. Baseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5.8, 95% confidence interval (CI) 2.9-11.5, p<0.001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up. ADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.

Diagnosis and Treatment of Conduct Disorder

As many as 5 percent of preadolescent boys, 8 percent of adolescent boys and a quarter to a half that percentage of girls of those same ages fulfill criteria for a diagnosis of conduct disorder [1]. In contrast to isolated behavior problems, this diagnosis requires a repeated, persistent pattern of violating the rights of others and age-appropriate societal rules for six months or more. Multiple factors are probably responsible for this developmental pathway [2]. The primary features of conduct disorder are:

Symptom-based subfactors of DSM-defined conduct disorder: Evidence for etiologic distinctions.

Past research investigating the structure of conduct disorder (CD) symptoms has provided evidence of a phenotypic distinction between aggressive and rule-breaking subfactors of CD. However, evidence of etiologic distinctions between these subfactors has not been reported to date. In the current study, the authors investigated this issue in a sample of 1,151 male twins who were 17 years of age. The results indicate that aggressive and rule-breaking CD subfactors have both common and distinct etiologic influences, with shared environmental influences playing a significant role in rule-breaking behaviors. The authors discuss implications of these findings for the assessment and treatment of CD.

Parent Management Training and the Treatment of Conduct Disorder

ABSTRACT This commentary examines the effectiveness of Parent Management Training (PMT) as an intervention for children with conduct disorder (CD). Included is a discussion of the difficulties inherent in treating CD, the conceptual relevancy of PMT in treating conduct disordered children, the empirical support for PMT's effectiveness, and comments regarding the limitations of PMT in treating CD. It is proposed that in regard to the treatment of CD, PMT is a conceptually sound approach that has strong empirical support regarding effectiveness and by nature is highly amenable to community dissemination. Given the complexities of CD, however, it is suggested that a multisystemic approach to care will likely be needed in which PMT represents an important component.

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.

Annotated abstracts

Annotated abstracts

Attachment and affect regulation: a framework for family treatment of conduct disorder.

Conduct disorder (CD), a pervasive adolescent disorder with clinically significant antisocial behaviors, has been a difficult syndrome to treat successfully. Recently, research on affect regulation and attachment has suggested that attachment and affect regulation strategies may underlie the development of conduct disorder in adolescents, implying that attention to these factors might improve family treatment for CD. In this review of the research literature, I discuss the role of attachment and affect regulation in the development and treatment of CD. In addition, I present information about the framework, intervention protocol, and preliminary evidence of effectiveness of an attachment- and affect regulation-based intervention that has been developed and implemented with multiple-family groups of parents and incarcerated adolescents.

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.

Sex differences in shared genetic and environmental influences between conduct disorder symptoms and marijuana use in adolescents

The association between conduct disorder (CD) symptoms and marijuana use (MU) was assessed in 1,480 adolescent twins participating in the National Longitudinal Study on Adolescent Health. A strong association was found between CD and MU for both males (r = .38, P < .01) and females (r = .31, P < .01). Structural equation modeling on age-corrected rank normalized scores using the program Mx indicated significant gender differences in the genetic and environmental contributions to MU. Additive genetic influences were comparable in size for males (29%) and females (24%). However, for females the influence of common environmental influences was greater (58%) than for males (36%). There was also evidence of greater common environmental influences for females, as well as greater genetic influences for males for CD, but these differences did not reach significance. In addition, for CD common environmental influences did not differ significantly from zero. Additive genetic influences accounted for 61% of the variance in CD, with the remainder being of unique environmental origin. Bivariate genetic analyses suggested a moderate genetic correlation between CD and MU (rg = .28) and a low unique environmental correlation (re = .14). These results suggest that CD and MU share genetic influences, while environmental influences tend to be more specific to each behavior. These findings may have implications for the prevention and treatment of CD and substance use among adolescents. © 2002 Wiley-Liss, Inc.

Sex differences in shared genetic and environmental influences between conduct disorder symptoms and marijuana use in adolescents

The association between conduct disorder (CD) symptoms and marijuana use (MU) was assessed in 1,480 adolescent twins participating in the National Longitudinal Study on Adolescent Health. A strong association was found between CD and MU for both males (r=.38, P<.01) and females (r=.31, P<.01). Structural equation modeling on age-corrected rank normalized scores using the program Mx indicated significant gender differences in the genetic and environmental contributions to MU. Additive genetic influences were comparable in size for males (29%) and females (24%). However, for females the influence of common environmental influences was greater (58%) than for males (36%). There was also evidence of greater common environmental influences for females, as well as greater genetic influences for males for CD, but these differences did not reach significance. In addition, for CD common environmental influences did not differ significantly from zero. Additive genetic influences accounted for 61% of the variance in CD, with the remainder being of unique environmental origin. Bivariate genetic analyses suggested a moderate genetic correlation between CD and MU (r(g)=.28) and a low unique environmental correlation (r(e)=.14). These results suggest that CD and MU share genetic influences, while environmental influences tend to be more specific to each behavior. These findings may have implications for the prevention and treatment of CD and substance use among adolescents.

A Double-Blind Pilot Study of Risperidone in the Treatment of Conduct Disorder

To examine whether risperidone is superior to placebo in the treatment of youths with conduct disorder. This was a 10-week, randomized, double-blind, placebo-controlled study with 2 parallel arms. Ten youths were randomly assigned to receive placebo and 10 youths were randomly assigned to receive risperidone. Patients were seen weekly throughout the trial. Medications could be increased at weekly intervals during the first 6 weeks of the study from an initial dose of 0.25 mg or 0.50 mg each morning, depending on patient weight. Patients weighing less than 50 kg had a maximum total daily dose of risperidone of 1.5 mg. Patients weighing 50 kg or greater had a maximum total daily dose of risperidone of 3.0 mg. The primary outcome measure was the Rating of Aggression Against People and/or Property Scale. Risperidone was superior to placebo in ameliorating aggression on most measures. Risperidone was reasonably well tolerated, with none of the risperidone-treated patients developing extrapyramidal side effects. These data provide preliminary evidence that risperidone may have efficacy in the treatment of youths with conduct disorder. Because of the small sample size and the brief length of this study, further research is necessary to confirm these findings.

Cognitive Rehabilitation in Clinical Neuropsychology

Within the broad discipline of psychology, clinical psychology has estab-lished a tradition of providing services in the assessment and treatment ofbehavioral disorders. More recently, clinical neuropsychology emerged inresponse to a need to describe neurocognitive impairment associated withbrain damage and relate deficits to specific forms of brain dysfunction. Asthe field developed, interest in rehabilitation increased and programs aimedat directly improving basic cognitive function began to appear.The most frequent complaints of patients with brain damage are memory

Avoidance of responsibility in conduct disordered adolescents

The association between conduct disorder (CD) and the construct of avoidance of responsibility was investigated in a sample of junior and senior high school-aged adolescents. Each adolescents CD symptomatology was determined using a self-report checklist keyed to DSM-IV symptoms. In addition, participants completed an avoidance of responsibility measure which assessed strategies adolescents utilize to avoid responsibility for their inappropriate behaviors. Participants also completed the Nowicki–Strickland Locus of Control Scale. Based on analysis of the avoidance of responsibility measure the Powell Avoidance of Responsibility Scale (PARS) was constructed. The results indicated that adolescents identified as CD endorsed significantly more avoidance of responsibility strategies and significantly more external locus of control responses compared to non-CD participants. The PARS accounted for 32% of the variance in the number of CD symptoms. Implications for the treatment and prevention of CD are discussed.

Conduct disorder in girls: a review of the literature.

The study of Conduct Disorder (CD) has primarily been limited to boys. The lack of research resulted from a premise that CD in girls was rare. However, CD in girls is a relatively common psychiatric diagnosis, and appears to be associated with several serious outcomes, such as Antisocial Personality Disorder and early pregnancy. Understanding gender differences in the course and severity of CD may lead to important information about etiology. Empirical studies on precursors, developmental course, risk factors and treatment for CD in girls are reviewed, while highlighting similarities and differences between girls and boys. Generally, CD symptoms in girls are stable. Precursors to CD in girls probably include Oppositional Defiant Disorder and temperamental factors, but also may include certain negative cognitions. What distinguishes CD in girls is the high risk they have to develop comorbid conditions, especially internalizing disorders. Risk factors for CD in girls partly overlap with those known for boys, but some factors appear to be highly salient for girls. Finally, there may be some significant effects of gender on treatment efficacy. Implications of these findings for future etiologic research are discussed.

Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome

Most delinquent youths have conduct disorder (CD), often with comorbid substance use disorder (SUD), attention-deficit/hyperactivity disorder (ADHD) and depression. Some youths' conduct problems later abate, while those of others persist into adult antisocial personality disorder. Earlier CD onset and ADHD reportedly predict persisting antisocial problems, but predictors of persisting SUD are poorly understood. Males aged 13–19 years ( n=89), most referred by criminal justice and social service agencies, received residential treatment for comorbid CD and SUD. They had diagnostic assessments for SUD at intake and for CD, ADHD, and depression (as well as drug-use assessments) at intake and 6, 12 and 24 months later. At intake nearly all had DSM-III-R substance dependence (usually on alcohol and marijuana) and CD with considerable violence and criminality. The 2-year follow-ups revealed improvements in criminality, CD, depression and ADHD, but substance use remained largely unchanged. Various aspects of conduct, crime and substance outcomes at 2 years were predicted by intake measures of intensity of substance involvement, and by CD severity and onset age, but not by severity of either ADHD or depression, nor by treatment duration. Earlier CD onset, more severe CD and more drug dependence predicted worse outcomes, supporting the validity of these diagnoses in adolescents.

Social Learning Family Therapy and the Treatment of Conduct Disorder in Early Childhood: Premise, Procedures and Prospects

Social learning family therapy hypotheses on the development and sustenance of conduct disorder in early childhood are presented, together with treatment approaches that use parents as the primary agents of change. Research that shows that parent training procedures hold much promise for the treatment of conduct disorder in childhood is briefly reviewed. The prospects of social learning family therapy as a treatment of children with conduct disorder could be significantly enhanced with some attention to methodological and conceptual issues in social learning family therapy research and practice.

Affective Comorbidity in Psychiatrically Hospitalized Adolescents with Conduct Disorder or Oppositional Defiant Disorder: Should Conduct Disorder Be Treated with Mood Stabilizers?

Two hundred and twenty-three consecutively admitted adolescent inpatients were systematically assessed for conduct disorder (CD) and oppositional defiant disorder (ODD), using the Schedule for Affective Disorders and Schizophrenia in School-Aged Children (K-SADS) and DSM-III-R criteria. In this suburban private psychiatric hospital, 26% of adolescents met criteria for CD, and 12% met criteria for ODD. Whether they had CD or not, about two-thirds of these hospitalized adolescents had a mood disorder. In examining specific mood disorders associated with CD, bipolar disorder was significantly more common in patients with CD (25%) than in patients without CD (10%). No other mood disorder, including major depression or dysthymia, was more concentrated in the CD sample (compared to the non-CD sample). CD patients were also significantly more likely to have attention-deficient hyperactivity disorder (ADHD) and substance abuse, and significantly less likely to have anxiety disorders. In contrast, hospitalized adolescents with ODD had a much different pattern of comorbidity, with only a quarter having a mood disorder. In fact, adolescents with ODD were less likely to have a diagnosis of mood disorder than patients without ODD (27% versus 76%). No association was observed between ODD and the presence of ADHD, anxiety disorder, or substance abuse. These patterns of comorbidity cannot be generalized to adolescents in other settings or to children. However, pending direct pharmacological trials of efficacy, empirical trials of lithium or anticonvulsants in the adolescents with CD appear to be justifiable in our sample of psychiatrically hospitalized adolescents, since 25% appeared to have bipolar disorder. There was no diagnostic evidence to encourage attempts at antidepressant treatment of adolescents with CD, apart from the high rate of mood disorders generally seen in hospitalized adolescents. The pharmacological treatment of CD cannot be based purely on comorbidity findings, and must still be subjected to controlled studies of efficacy.