Conduct disorder in referred children and adolescents: clinical and therapeutic issues.
OBJECTIVE
Studies on referred children and adolescents with conduct disorder (CD) have relevant implications for prevention and treatment. We addressed this issue in a large sample of youths with CD, considering age at onset, sex, and response to treatments as variables.


METHODS
The sample consisted of 198 patients (153 males and 45 females; age range, 8-18 years; mean age, 13.2 +/- 2.6 years), consecutively diagnosed as having CD during a 5-year period. The diagnoses were based on fulfillment of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, according to historical information, prolonged observations, and a clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). Three subtypes of aggressive behaviors-"predatory" (controlled, planned, and goal-oriented), "affective" (impulsive, explosive, and unprofitable), and "mixed" (with both the features)-were considered in this study.


RESULTS
Patients with prepubertal onset were younger at referral and had a poorer socioeconomic status. Their condition was more severe at the baseline, but their response to treatments did not differ from those with adolescent onset. Predatory and affective aggression and attention deficit hyperactivity disorder comorbidity were higher in children with prepubertal-onset CD. Regarding to sex, females were older and had a lower socioeconomic status. Their condition was more severe at the baseline and presented higher scores in self-aggression, but they responded better to treatments. Rates of attention deficit hyperactivity disorder were significantly lower in females, whereas other comorbidities (including substance abuse) were similar between sexes. Nonresponders to treatments received less frequently a psychosocial intervention, have more severe condition at the baseline, presented a more severe verbal and physical aggression, a lower affective/predatory index, and a higher rate of substance abuse.


CONCLUSIONS
Age at onset and sex may be critical variables for prognosis of CD. Psychosocial intervention can significantly improve the treatment response.
Masi
Gabriele
G
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, 56018 Calambrone (Pisa), Italy. gabriele.masi@inpe.unipi.it
Milone
Annarita
A
Manfredi
Azzurra
A
Pari
Cinzia
C
Paziente
Antonella
A
Millepiedi
Stefania
S
D000293:Adolescent; D017668:Age of Onset; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D019955:Conduct Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D016651:Lithium Carbonate; D014635:Valproic Acid