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.     

Sustained attention and visual processing speed in children and adolescents with bipolar disorder and other psychiatric disorders

To investigate the cognitive functioning of children and adolescents with bipolar illness, 112 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital were administered the Wechsler Intelligence Scale for Children-III (WISC-III) as part of an admission psychological assessment. There were 22 patients with Bipolar Disorder and 90 with other psychiatric disorders; all were between 8 and 17 years of age. The patients with Bipolar Disorder had a mean age of 14 yr., a mean Verbal IQ of 78, a mean Performance IQ of 76, and a mean Full Scale IQ of 75. When their WISC-III scores were compared with those who had Schizophrenia Spectrum disorders (Schizophrenia and Schizoaffective Disorder), Psychosis Not Otherwise Specified, Attention Deficit Hyperactivity Disorder, and Conduct Disorder and Oppositional Defiant Disorder, there were no significant between-group mean differences for Verbal IQ, but patients with Bipolar Disorder had a significantly lower mean Performance IQ than those with ADHD and those with Conduct Disorder and Oppositional Defiant Disorder. Contrary to the expectation that the patients with Bipolar Disorder might have better sustained attention (higher Digit Span scores) than those with Schizophrenia Spectrum disorders and worse visual processing speed (lower Coding scores) than the other diagnostic groups, the bipolar patients' Digit Span and Coding scores did not differ significantly from those of the other groups. The patients with Psychosis, Not Otherwise Specified had significantly lower mean Performance IQ, Full Scale IQ, and Coding than the ADHD and the Conduct Disorder and Oppositional Disorder groups.     

Family Impact of Tourette's Syndrome

Tourette's syndrome (TS) is a neuropsychological disorder characterized by vocal and motor tics. TS is also associated with several behavior disorders such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, conduct disorder, and Obsessive-Compulsive Disorder. We examined the impact of Tourette's syndrome with and without comorbid psychiatric disorders on the family. TS complicated by comorbid disorders had a greater impact on the family than uncomplicated TS. Tourette's symptom severity was significantly correlated with the level of impact on the family and with the number of comorbid disorders. TS is a disorder with effects that extend beyond motor and vocal tics.     

Neuropsychological Dysfunction in Children with Borderline Personality Disorder Features: A Preliminary Investigation

Borderline personality disorder (BPD) is often linked to neuropsychological deficits, yet few studies have examined BPD or its features and concomitant neuropsychological dysfunction in childhood. This study examined children with borderline features (n = 21) using the Coolidge Personality and Neuropsychological Inventory for Children and compared them to controls (n = 21) with features of at least one personality disorder, but not BPD. As hypothesized, the BPD group scored significantly higher than the control group on the Attention Deficit/Hyperactivity Disorder, Executive Functions Deficits, Mild Neurocognitive Disorder, Conduct Disorder, and Oppositional Defiant Disorder scales. It appears that behavioral disturbances associated with BPD are linked strongly with neuropsychological dysfunction. Because none of the children with BPD features in the present sample had a history of traumatic brain injury (TBI), it appears likely that TBI in the histories of adult BPD patients may not be the cause of BPD, but traits such as anger and impulsivity in BPD may cause TBI. Clinical implications and future research directions are discussed.     

Reliability and Validity Analyses of the Self-Management Questionnaire

The authors developed a parent-report measure to enhance findings for diagnoses and evaluations, and therefore, improve on the assessments currently being widely used for this purpose. Data were gathered on 322 clients (4–18 years old) seeking treatment at a private practice setting. Factor analysis revealed 18 subscales. Scores were internally consistent and distinct from other subscales. In addition, the questionnaire showed good diagnostic utility for depression, Oppositional Defiant Disorder (ODD), and Pervasive Developmental Disorder (PDD). This study provides sufficient evidence of the reliability and validity of the Self-Management Questionnaire (SMQ) to recommend its use for skills and needs assessment with children and adolescents.     

The Role of Irritability in the Treatment of Behavior Disorders: A Review of Theory,Research, and a Proposed Framework

Clinical Child and Family Psychology Review - Research provides strong evidence that the symptoms of Oppositional Defiant Disorder (ODD) are comprised of at least two dimensions: irritability and...     

Perceptions of Microaggressions: Implications for the Mental Health and Treatment of African American Youth

Race continues to be a salient and impactful component of psychological well-being in diverse modern societies. Significant race based disparities in mental health with respect to children and youth have been noted. Such disparities are evident in both access to and types of treatment. Confounding this issue are the race based phenomena that shape the dynamics between mental health and disorder for African American children and youth. While all races of children experience typical childhood mental health challenges such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder, African American children who report perceived racism are more than twice as likely to have such disorders using Winnicott’s True and False Self as a framework, the following qualitative study explored how African American seventh grade students perceived personal racist encounters. Implications for treatment will be discussed within the context of therapeutic strategies.     

Social Learning,Social Disorganization,and Psychological Risk Factors for Criminal Gangs in a British Youth Context

ABSTRACT

Using longitudinal data from a British longitudinal cohort study (ALSPAC), the current study examines “developmental domains” from individual, peer, and community risk factors. Using four logistic regression models, we looked at 10 correlations between children’s experience with risk factors outlined by the literature and criminal gang association. Gang membership was associated with drug use, delinquent peers, and disorganized neighborhoods. Further, early diagnoses of childhood aggression, ADHD, depression, and Oppositional Defiant Disorder, were not associated with later, adolescent youth gang membership. Our results suggest community based programs that stem from social learning policies and collective efficacy militate against gang growth.     

A Program Intervention for Pediatric Bipolar Disorder: Preliminary Results

The effectiveness of a behaviorally based day treatment program for young children diagnosed with Pediatric Bipolar Disorder (PBD) was evaluated using pretreatment and posttreatment mean scores from the Child Behavior Checklist (CBCL). Data were evaluated in aggregate and using the clinically significant change method for children diagnosed with PBD, Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Adjustment Disorder, and no diagnosis/clinical and subclinical groups. Significant effects were found for all groups except the no diagnosis/subclinical group on the Internalizing scale and for all groups on the Externalizing scale. Clinically significant change was supported for the PBD, ADHD, ODD, and Adjustment Disorder groups. Implications and limitations of the study are discussed.     

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.     

School psychology: a public health framework: III. Managing disruptive behavior in schools: the value of a public health and evidence-based perspective

Schools typically adopt individualistic approaches to address disruptive behavior and meet the needs of students with disruptive behavior disorders (DBD) [i.e., Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD)]. These approaches are often not the most effective and have a limited impact on overall school climate. This article emphasizes the value of an evidence-based and public health perspective in managing disruptive behavior. Information about comprehensive school-based programs and classroom management techniques for disruptive behavior disorders is presented and the important role school psychologists can play in implementing these programs discussed.     

Psychiatric and behavioral problems in aggressive drivers

Motor vehicle accidents (MVAs) are a leading cause of accidental death and injury, and aggressive driving has been identified as a risk factor for MVAs. Assessing psychiatric and behavioral disturbances in aggressive drivers is germane to the development of prevention and intervention programs for this population. The present study compared the prevalence of psychiatric diagnoses and behavioral problems in young adult drivers with self-reported high driving aggression to that of drivers with low driving aggression. Aggressive drivers evidenced a significantly higher current and lifetime prevalence of Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, and Cluster B Personality Disorders, and a significantly greater lifetime prevalence of Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. Aggressive drivers also had a significantly greater prevalence of self-reported problems with anger, as well as a greater family history of anger problems and conflict. The findings suggest that prevention and intervention programs designed to reduce aggressive driving may need to address the presence of psychiatric and behavioral problems that could potentially complicate treatment or impede responses to treatment.     

Confirmatory Factor Analyses of Self- and Parent- Report Inventory of Callous-Unemotional Traits in 8- to 10-Year-Olds

The factorial structure of the Inventory of Callous-Unemotional Traits (ICU; Frick 2004) has been inconsistent across various studies using different rater versions and samples. In this study the factorial structure of the self- and parent-report versions of the ICU was examined in a community sample of 340 boys and girls aged 8- to 10- years. A series of confirmatory factor analyses revealed that (1) for self-report ICU, a two-factor model comprising one Uncaring and one Callousness factor fit the data best; the factorial structure was invariant across sex, although boys showed higher scores than girls on the Uncaring factor; (2) for the parent-report ICU, a three-factor structure was supported, and boys and girls did not differ on factor structure or levels of the factors. For both versions, CU traits were positively associated with the count of Oppositional Defiant Disorder/Conduct Disorder and internalizing behavior symptoms, demonstrating ICU’s good convergent albeit unsatisfactory discriminant validity. Findings suggest further refinement of this instrument for the self-report and parent versions separately.     

Measuring Emotion Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder: Revisiting the Factor Structure of the Emotion Regulation Checklist

Emotion dysregulation (ED) is prevalent among youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and significantly impacts functioning. Nuanced measurement of ED is central to understanding its role in this disorder and informing treatment approaches. The present study examined the factor structure of the Emotion Regulation Checklist (ERC) among children with ADHD with and without Oppositional Defiant Disorder (ODD). Exploratory factor analysis (EFA) conducted in a sample of 328 youth (mean age = 6.08) with ADHD indicated a four-factor solution, comprised of the following factors: Negative Emotion Lability, Positive Emotion Lability, Socially Appropriate Affect, and Socially Incongruent Affect. The Negative and Positive Emotion Lability subscales assess the reactivity of negatively and positively valenced emotions, respectively. The Socially Appropriate and Socially Incongruent Affect subscales provide an assessment of social-emotional functioning. All subscales discriminated between children with ADHD only and ADHD with co-morbid ODD, such that children with ODD had greater emotional lability and social-emotional difficulties. This revised factor structure of the ERC facilitates a uniquely brief, yet multifaceted and specific, assessment of emotional difficulties in children with ADHD that can inform treatment planning and operationalize emotional reactivity and social-emotional functioning in future research efforts.     

Relationship Between Specific Adverse Life Events and Psychiatric Disorders

This study examines whether certain psychiatric disorders are associated more closely with adverse life events than other disorders are, and whether some adverse life events are associated with a specific group of disorders (e.g., depressive disorders), but not with other disorders (e.g., anxiety disorders). A probability sample of youth aged 9–17 at 4 sites is used (N = 1,285). Univariate and multivariate logistic regressions identify specific relationships between 25 adverse life events and 9 common child and adolescent psychiatric disorders, measured by the Diagnostic Interview Schedule for Children. Conduct Disorder, Oppositional Defiant Disorder, Major Depressive Disorder, and Dysthymia are significantly associated with many of the adverse life events examined, whereas Attention Deficit/Hyperactivity Disorder, Agoraphobia, and Social Phobia are related to very few. This study suggests that certain psychiatric disorders may be more closely associated with adverse life events than other psychiatric disorders are, and that some adverse life events seem to be related to specific types of disorders.     

Screening for Behavioral Disorders With the Dyadic Parent-Child Interaction Coding System: Sensitivity,Specificity, and Core Discriminative Components

We assessed the ability of the Dyadic Parent-Child Coding System to discriminate between Norwegian children with Oppositional Defiant Disorder and/or Conduct Disorder (n = 36) and community controls with no diagnosis (n = 122). All children were diagnosed by the Preschool Age Psychiatric Assessment. Results showed that a composite score of three negative parent codes—Negative Talk, Indirect Commands with No Opportunity for Compliance, and Direct Command with Compliance—as well as one child code, Command, evidenced excellent screening efficiency. Results are discussed in light of possible cultural differences in parent-child interaction and revisions of the coding system.     

Findings on Disruptive Behavior Disorders from the First Decade of the Developmental Trends Study

The paper summarizes the first decade of the Developmental Trends Study, a prospective longitudinal study of 177 boys. Initially, they were referred to mental health clinics in Pennsylvania (Pittsburgh), and Georgia (Athens and Atlanta). Since 1987, the boys, their parents, and their teachers have been followed up almost annually. The study is unique because the cooperation rate of participants has remained very high over the years, psychiatric diagnoses were derived from structured interviews (especially disruptive behavior disorders), and many risk factors were measured over the years. The present paper summarizes key findings on the development of disruptive behavior, especially Oppositional Defiant Disorder, Conduct Disorder, and Attention Deficit-Hyperactivity Disorder. The paper also highlights results on risk factors and comorbid conditions of disruptive behaviors.     

Parenting Disruptive Preschoolers: Experiences of Mothers and Fathers

This study examined parental functioning and interactions with young children with Oppositional Defiant Disorder (ODD), with emphasis on differences between mothers and fathers in their responses to their child and in their unique contributions to the prediction of child disruptive behavior. Participants were 53 3- to 6-year olds with ODD who presented for treatment with two parents. Mothers reported more severe disruptive behavior and higher parenting stress than fathers. During parent-child interactions, mothers showed more responsiveness than fathers, even though children were more compliant during interactions with fathers. Regression analyses showed that fathers' parent-related stress was predictive of both mothers' and father's reports of disruptive child behavior; mothers' marital satisfaction was predictive of behavioral observations of child compliance with both mothers and fathers. This study revealed several important differences in the experiences of mothers versus fathers of disruptive children and indicates the importance of including the father in the child's assessment and treatment.