Childhood and adolescent onset conduct disorder: a test of the developmental taxonomy

Hypotheses generated by a developmental taxonomy that distinguishes between childhood and adolescent onset conduct disorders were tested. Hypotheses predicted that (1) individual and familial factors would be more strongly related to childhood onset conduct disorder, whereas ethnic minority status and exposure to deviant peers would be more strongly related to adolescent onset conduct disorder and (2) individuals with childhood onset disorder would be more likely to commit violent and victim oriented offenses than individuals with adolescent onset conduct disorder. The first hypothesis was strongly supported and the second hypothesis was partially supported. Implications for early identification of youth at risk for chronic offending are discussed.     

Age and gender differences in oppositional behavior and conduct problems: a cross-sectional household study of middle childhood and adolescence

Behavior problems among youths cannot be understood without explaining their age and gender differences, but age and gender differences cannot be explained until they have been accurately described. In a household survey of 1,285 youths aged 9 to 17 years, there were no gender differences in oppositional behavior, but aggression, property offenses, and status offenses were more common among boys. Levels of oppositional behavior were greater at younger ages, aggression peaked near the middle of this age range, and property and status offenses were more prevalent at older ages. These findings are generally consistent with developmental models of conduct problems but are inconsistent with a recent model of gender differences and raise questions about the external validity of current taxonomies.     

Exploring the Relationship Between Conduct Disorder and Residential Treatment Outcomes

We examined the differential outcomes in residential treatment for youths with conduct disorder (CD)—with special attention paid to interactions with age and gender—in a sample of children and adolescents in 50 residential treatment centers and group homes across Illinois. Multi-disciplinary teams rated youths ages 6–20 (N = 457) on measures of mental health and other factors within 30 days of admission, about 7 months after admission, and at discharge. While both groups initially responded similarly to treatment, the CD group performed better relative to the non-CD group over the full course of treatment, showing healthier relative change on five outcomes variables and more significant improvement. Age range moderated the relationship between CD group membership and change in work/school performance. There were significant between groups differences within the youngest age group (6–11 years) in which the CD group worsened relative to the non-CD group.     

Mental Health, Social Environment and Sexual Risk Behaviors of Adolescent Service Users: A Gender Comparison

We examined individual mental health problems (depression, conduct disorder, and substance abuse) and social environment (family, peer, and neighborhood) factors associated with the sexual risk behaviors of male and female adolescents. Interviews with 778 adolescents, aged 14 to 18, showed that both mental health problems and social environment were related to adolescents' involvement in sexual risk behaviors. Conduct disorder symptoms, substance abuse or dependence symptoms, and the interaction between peer misbehavior and neighborhood problems were significantly associated with risky sexual behaviors. Peer misbehavior was a particularly strong factor related to sexual risk behaviors for youths who lived in neighborhoods with multiple problems. The only gender differences were found in age, with older males more likely to report engaging in high risk sexual behaviors. This study suggests the utility of multidimensional intervention strategies to deal with various adolescent problem behaviors, including risky sexual behaviors, within the context of their social environment.     

The relationship between early development and psychosexual behaviors in adolescent females

The relationship between early sexual maturation and the psychosexual behaviors of dating and sexual intercourse was investigated using a national sample of adolescent females aged 15 to 19. Among both black and nonblack subjects, early-maturing girls were more likely to have experienced earlier dating and coital onset than were their later-maturing peers. Blacks experienced menarche and first intercourse at earlier ages, yet dating onset at later ages. Early menarche was also associated with marriage at an early age for nonblacks, but not for blacks. These racial differences were explained in terms of diverse socialization patterns or cultural expectations. For both blacks and nonblacks, those with earlier coital experience were found to have had menarche and dating onset at earlier ages.     

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.     

Association between adolescent rough-and-tumble play and conduct problems,substance use,and risk-taking behaviors: Findings from a school-based sample

Rough-and-tumble play (RTP), also known as play fighting, is a common form of play frequently reported and studied by researchers. However, one important limitation of past research in the area of RTP has been the neglect of the adolescence period. Consequently, little is known about the function of adolescent RTP as well as about clinical characteristics of youth who engage in this activity after childhood. In a school-based sample of 1,771 middle school students (ages 9–16 years), the current study sought to address this gap by examining, via bivariate and multivariate logistic regression analyses, the potential cross-sectional associations of adolescent RTP with (a) selected demographic variables, (b) conduct problem symptoms, (c) substance use, and (d) risk-taking behaviors, including adjustment for several demographic confounders. Results indicated that adolescents reporting higher rates of conduct problem symptoms were more likely to report a recent participation in RTP. In addition, substance use (experimentation and current consumption of tobacco, alcohol, and marijuana) and risk behaviors assessed all were strongly associated with an increased likelihood of reporting an engagement in RTP. This finding suggests that participation in this activity probably implicates particular phenotypic characteristics including the propensity to engage in health-damaging behaviors. But the most profound issue raised by this research concerns the strong relationship between RTP and great levels of conduct disorder symptoms, suggesting a possible significant change in the functional significance of RTP in the adolescence period.     

Age of onset of child maltreatment predicts long-term mental health outcomes

The authors tested the hypothesis that children who are maltreated earlier in life are at greater risk for poor psychological functioning in adulthood than those maltreated later in life. Age of onset of maltreatment was assessed with 3 classifications: (a) continuous (ages 0-11 years); (b) dichotomous (early [ages 0-5 years] vs. later [ages 6-11 years]); and (c) developmental (infancy [ages 0-2 years], preschool [ages 3-5 years], early school age [ages 6-8 years], and school age [ages 9-11 years]). Individuals with documented cases of physical and sexual abuse and neglect prior to age 12 (N=496) were followed up and assessed in adulthood. Results indicated that an earlier onset of maltreatment, measured dichotomously and developmentally, predicted more symptoms of anxiety and depression in adulthood, while controlling for gender, race, current age, and other abuse reports. Later onset of maltreatment, measured continuously or developmentally, was predictive of more behavioral problems in adulthood. Implications for the assessment of maltreated children, the prevention of adult psychopathology, and the classification of age of maltreatment onset are discussed.     

Assessment of Behavior Problems in Childhood and Adolescence as Predictors of Early Adult Depression

Behavior and psychological problems assessed prospectively by teachers and parents and by youths’ self-reports through late childhood and adolescence were examined as possible predictors of early adult depression. Data were from 765 participants in the Seattle Social Development Project, a multiethnic and gender-balanced urban sample. Analyses examined 7 waves of data from ages 10 to 21, and included measures from the Achenbach Child Behavior Checklist and assessments of past-year depressive episode based on the Diagnostic Interview Schedule. Self-reported conduct problems as early as age 10 (Mason et al. 2001) and throughout adolescence consistently predicted depression at age 21. Parent reports of conduct and other externalizing problems in adolescence also significantly predicted adult depression. None of the available teacher reports through age 14 were significant predictors. Results suggest that externalizing problems can be useful indicators of risk for adult depression. Prevention efforts that target externalizing problems in youth may hold promise for reducing later depression.     

Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

This study aimed to describe the course of early onset eating disorders in a population-based sample followed from 14 to 20 years; identify variables that could account for the persistence of eating disorders from 14 to 20 years; and describe outcome of early onset eating disorders with reference to general and psychological functioning at age 20. Participants (N?=?1,383; 49 % male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to young adulthood. Eating disorder symptoms were assessed using an adapted version of the Eating Disorder Examination-Questionnaire, at ages 14, 17 and 20. At age 14, 70 participants met DSM-IV criteria for a binge eating or purging eating disorder. Nearly half (44 %) of these adolescents ceased to meet criteria for an eating disorders at ages 17 and 20, whilst one-quarter still met criteria for an eating disorder at age 20 and one-fifth met criteria for an eating disorder at all three time points. Purging at age 17 and externalising behaviour problems at age 14 were the strongest predictors of eating disorder persistence to age 20. Participants who experienced a persistent eating disorder were less likely to complete high school than other participants, and reported pronounced depressive and anxiety symptoms at age 20. This study provides new data the course and outcome of early onset eating disorders at a population level. Behavioural difficulties in early adolescence and purging in middle adolescence may predict persistent eating pathology to young adulthood.     

The Relevance of Age of Onset to the Psychopathology of Social Phobia

The present study aimed to examine the relevance of age of onset to the psychopathology of social phobia using a large clinical sample of 210 patients with social phobia. The two most common periods of onset were during adolescence (ages 14–17) and early childhood (prior to age 10). Structural regression modeling was used to test predictions that early onset social phobia would be associated with greater severity of the disorder, stronger current symptoms of depression and anxiety, greater functional impairment, and more pronounced levels of emotional disorder vulnerabilities (e.g., neuroticism/behavioral inhibition, extraversion, perceptions of control). Logistic regression was used to evaluate relationships between age of onset and the presence of acute and chronic stress at the time of onset. Results showed that earlier age of social phobia onset was associated with stronger current psychopathology, functional impairment, and emotional disorder vulnerabilities, and that later age of onset predicted the presence of an acutely stressful event around the time of disorder emergence. These results are discussed in regard to their clinical implications and congruence with prominent etiological models of the emotional disorders.     

Developmental sequences in the age of onset of disruptive child behaviors

Retrospective and prospective reports of the onset of disruptive child behaviors were analyzed in a sample of clinic-referred boys. The younger boys (ages 7–9 years), compared with the older boys (ages 10–12 years), showed the highest level of disruptive behavior and, judging from mothers' reports, had the fastest progression of onsets from less serious to more serious problem behaviors. Despite some overlap, developmental sequences in problem behavior within the domains of hyperactivity/inattention, oppositional behavior, and conduct problems were similar across the two age groups. This was also the case for developmental sequences of overt or confrontive problem behaviors and covert or concealing conduct problems. Sequences of the onset of oppositional behavior and conduct problems were validated through prospective data, based on the information from mothers, teachers, and boys themselves. The implications of the findings are discussed for the formulation of developmental pathways of behavior and the analysis of causal factors.     

Timing of Onset and Correlates of Severe Conduct Problems in Adjudicated Girls and Boys

An influential model for explaining the development of conduct disorder (CD) in boys proposed that there are two distinct trajectories through which boys develop CD that differ on the timing of onset, correlates, and outcome. In this study, the applicability of this two trajectory approach to the development of CD in girls was tested. Participants were 72 adolescents (mean = 15.17 years of age; SD = 1.32) who were adjudicated for serious patterns of illegal behavior in a secure detention facility, nearly all of whom (94.4%) met criteria for a diagnosis of CD. Based on a combination of youth self-report and file review, boys in the sample were fairly evenly split between a childhood-onset to their CD symptoms and an adolescent-onset to their symptoms. In contrast, girls more uniformly exhibited an adolescent-onset to their severe antisocial behavior. Despite this later age of onset, the antisocial girls tended to resemble the childhood-onset boys on personality traits such as showing problems of impulse control and showing combination of both a callous and unemotional interpersonal style and poor impulse control. These findings suggest modifications of or alternatives to the two-trajectory model may be needed to explain the development of CD in girls.     

State Hospital Reentry Among Youth with Serious Emotional Disturbance: A Longitudinal Analysis

We investigated the demographic, service history, and clinical factors associated with readmission to state operated inpatient psychiatric hospitals by children and adolescents. Using computerized administrative data records for 3,969 consecutive index admissions of individuals between the ages of 7 and 17 inclusive, we examined hospital reentry among youth receiving services at these facilities. The univariate analysis comparing youths who reentered the hospital with those who did not reenter indicated that reentry was more likely to occur among African American youths and among those who were diagnosed with psychotic disorders. Reentry occurred less frequently among youths diagnosed with depressive disorders. Reentry also occurred less frequently among youths living in areas having an organized array of community-based mental health services. Youths who reentered the hospital were significantly older and had longer prior hospitalizations than those not reentering. The proportional hazards model used in the analysis indicated several factors associated with increased likelihood of hospital reentry. African American youths and individuals diagnosed with a psychotic disorder were more likely to reenter the hospital. Younger youths and those having lengthy prior hospitalizations were at increased risk for reentering the hospital. Youths living in urban, white, higher income communities were less likely to reenter the hospital.     

The Relationship Between Parental Alcoholism and Adolescent Psychopathology: A Systematic Examination of Parental Comorbid Psychopathology

The relationship between parental alcohol dependence (with and without comorbid psychopathology) and adolescent psychopathology was examined in a sample of 665 13-17 year-old adolescents and their parents. Results indicated that adolescents who had parents diagnosed with alcohol dependence only did not significantly differ from adolescents who had parents with no psychopathology in regard to any of the measures of psychological symptomatology (substance use, conduct disorder, and depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or depression) assessed. In contrast, adolescents who had parents diagnosed with alcohol dependence and either comorbid drug dependence or depression were more likely to exhibit higher levels of psychological symptomatology. In addition, adolescents who had parents diagnosed with alcohol dependence, depression, and drug dependence were most likely to exhibit psychological problems. These findings underscore the importance of considering parental comorbid psychopathology when examining the relationship between parental alcoholism and offspring adjustment.     

Diffuse-Avoidance,Normative, and Informational Identity Styles: Using Identity Theory to Predict Maladjustment

Expanding on the identity status paradigm, this investigation uses 3 forms of identity styles (diffuse-avoidance, normative, and informational) to assess the association among identity and maladjustment. A sample of 2,001 junior and senior high school students in Calgary and Edmonton, Canada completed a self-report that included, among other questions, items assessing the 3 identity styles and degree of adjustment or maladjustment in conduct, hyperactivity, and emotional states. Avariety of analyses indicate that adolescents who are escaping identity formation through a diffuse-avoidance identity style are more likely to manifest conduct and hyperactivity disorders. In contrast, adolescents who establish commitments from prior generations through a normative-identity style, or who engage in an active informational-identity style, are less likely to manifest conduct and hyperactivity problem behavior. Few gender or age differences were observed, suggesting that the technique applied here can be useful with both genders and all ages of adolescents. This study is an initial investigation of contemporary adolescents attempts to escape the self.     

A General Population Twin Study of Conduct Problems and the Auditory P300 Waveform

Reduced amplitude of the P300 event-related potential has been consistently associated with a variety of externalising problems, including conduct disorder. The few available genetically-informative studies of these relationships, however, were conducted among adolescents/adults (i.e., at an age when conduct disorder has typically already become manifest). Among 200 general population twins with a mean age of 9 years (range 6–14 years), we studied the relationship between the P300 waveform elicited by an auditory oddball task and the DSM-oriented conduct problems scale of the Child Behavior Checklist 6–18. Conduct problems scores were negatively and significantly correlated (r?=??0.19, p?=?0.01) with P300 amplitude; correlations between P300 amplitude and the other DSM-oriented Child Behavior Checklist scales were non-significant, except for oppositional defiant problems (p?=?0.01). We found moderate heritability estimates for both P300 amplitude (0.58, CI:0.37;0.73) and conduct problems (0.52, CI:0.25;0.70). Bivariate twin analyses indicated that the covariation between these two phenotypes can be explained by additive genetic factors only, with a genetic correlation of ?0.33. An association between reduced P300 amplitude and conduct problems can be substantiated already in childhood, at an age that precedes the most typical onset of conduct disorder. This relationship appears to be genetic in nature. Reduced P300 amplitude can represent a valuable marker for conduct problems, and can contribute to the early identification of children at high-risk for conduct disorder.     

Sex and age effects on the inheritance of alcohol problems: a twin study.

Male monozygotic cotwins of probands with Alcohol Abuse-Dependence (n = 85) were more likely than male same-sex dizygotic cotwins (n = 96) to report alcohol, drug, and conduct disorder problems. For women, rates of problem behavior did not differ between monozygotic (n = 44) and same-sex dizygotic (n = 43) cotwins. Opposite-sex dizygotic twin data (n = 88) revealed significant cross-sex transmission; alcohol problems were greatest among male cotwins of female probands. For men, proportion of liability variance associated with additive genetic factors was significantly greater when proband had an early (h2 = .73 +/- .18) rather than late (h2 = .30 +/- .26) age of onset. For women, heritability did not vary as a function of proband's age of onset, and the pooled estimate suggested little genetic influence (h2 = .00, SE not computable). Findings suggest that genetic influences may be substantial only in the etiology of early-onset male alcoholism.     

Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex.

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.     

Diagnostic conundrum of oppositional defiant disorder and conduct disorder

Evidence for a diagnostic distinction of oppositional defiant disorder (ODD) and conduct disorder (CD) is reviewed, and alternative conceptualizations and definitions for the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders are considered. Studies suggest that CD and ODD are strongly and developmentally related but clearly different. Factor analyses indicate that distinct covarying groups of ODD and CD symptoms can be identified, but certain symptoms relate to both (particularly mild aggression and lying). Age of onset for ODD is earlier than for most CD symptoms. Nearly all youths with CD have a history of ODD, but not all ODD cases progress to CD. The disorders demonstrate the same forms of parental psychopathology and family adversity but to a greater degree for CD than for ODD. Alternative conceptualizations for the disorders are presented for further study before the introduction of the DSM-IV.