Current Perspectives On Conduct Disorder

Behavioral Health Update
BHSI Newsletter Vol. 3, no. 2


Gary Muchow Ph.D. LMFT

There has been a long-standing belief that the early age diagnosis of ADHD frequently leads to the progression to diagnoses of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and finally as an adult, Anti-Social Personality Disorder. Research over the past few years has offered some support for this path, but has also been able to identify some factors that contribute to or prevent this progression.

One of the first discriminating factors in the CD diagnosis is age of onset. Research has clearly shown that boys diagnosed adolescent onset (meet criteria for the diagnosis after the age of 12) have a much improved chance of moving away from the deviant behaviors as they approach adulthood. Adolescent onset CD appears to largely be a developmental stage that is viewed as an exaggeration of the normal adolescent process. Those in this category make up about half of the juvenile offenders, but they exhibit less violent and aggressive behaviors when compared to those with child onset CD.

Factors that appear to contribute to the adolescent development of CD symptoms include a deviant peer group, a deficit in affiliation with pro-social institutions, poor parental supervision and a rebellious personality. Interventions with this group lean towards preventing the progression of the behaviors long enough so that natural development processes allow for maturation away from the deviant behaviors.

Conduct disorder diagnosed before the age of 12 (child onset) becomes a bit more complicated. Research headed by Paul Frick, at the University of New Orleans , has identified two general types that make up this group. First are those that appear most similar to the progression noted above, which they labeled as the Primarily Impulsive type. This type is marked by high occurrence of ADHD, increased levels of reactive anger, a hostile attribution bias, lower verbal intelligence and elevated rates of family dysfunction.

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