Stephanie M. Green

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.

Anxiety, Inhibition, and Conduct Disorder in Children: I. Relations to Social Impairment

Jeffrey A. Gray has proposed a model in which conduct disorder (CD) is viewed as the result of both excessive activity of a behavioral activation system that mediates appetitive and aggressive behavior and deficient activity of a behavioral inhibition system that mediates both anxiety and the inhibition of behavior in the presence of cues signalling impending punishment or frustration. The relation of anxiety to antisocial behavior was examined in 177 clinic-referred boys, aged 7 to 12 years, 68 of whom met DSM-III-R criteria for CD. As predicted by Grays model, boys with CD and comorbid anxiety disorder were markedly less impaired than boys with CD alone.

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.

A sensation seeking scale for children: Further refinement and psychometric development

A revision of the Sensation Seeking Scale for Children (SSSC) was standardized and validated on a community sample of 660 elementary- and middle-school children and 168 clinic-referred male children. Factor analysis of the combined samples yielded three unique factors, entitled Thrill and Adventure Seeking, Drug and Alcohol Attitudes, and Social Disinhibition. Psychometric indices of reliability and validity were acceptable, but test-retest reliability was only moderate. Differences in SSSC scores according to sex, ethnic group, age, and intellectual status were similar to those found previously with the adult Sensation Seeking Scales. Consistent with documented relations between adult antisocial personality and sensation seeking, the SSSC distinguished boys with conduct disorder (CD) from clinic controls, but the SSSC scores of boys with CD did not differ from those of the community sample boys. Discussion includes suggestions as to the continued study of the assessment of sensation seeking in children.

Comparison of DSM-III and DSM-III-R diagnoses for prepubertal children: changes in prevalence and validity.

A structured and reliable diagnostic procedure based on a revised version of the Diagnostic Interview Schedule for Children for children, parents, and teachers was used to assign both DSM-III and DSM-III-R diagnoses to 177 outpatient boys aged 7 to 12 years. Compared to their DSM-III counterparts, DSM-III-R oppositional defiant disorder was 25.5% less prevalent, DSM-III-R dysthymia was 37.8% less prevalent, and DSM-III-R conduct disorder (CD) was 44.3% less prevalent. However, DSM-III-R attention deficit hyperactivity disorder was 14.4% more prevalent than DSM-III attention deficit disorder with hyperactivity. The two definitions of CD were compared to exemplify an empirical approach to diagnostic validation. The DSM-III-R diagnosis of CD appears to be more valid as it is more strongly associated with police contacts, school suspensions, and history of antisocial personality disorder in the biological father, but both CD diagnoses are associated with family histories of criminal convictions.

Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder

This paper compares the validity of DSM-III-R diagnoses of oppositional defiant disorder (ODD) and conduct disorder (CD) and an alternative option which is subdivided into three levels according to developmental sequence and severity: modified oppositional disorder (MODD), intermediate CD (ICD), and advanced CD (ACD). Using a sample of 177 boys followed over 3 years, both the DSM-III-R and the alternative diagnostic constructs are evaluated on three criteria: symptom discriminative validity, and diagnostic external and predictive validity. Most DSM-III-R ODD and CD symptoms discriminated between ODD and CD, but exceptions are noted. Additional analyses demonstrated considerable overlap among DSM-III-R oppositional symptoms. The majority of the symptoms proposed for the alternative option could be assigned to a specific level based on acceptable symptom discrimination. External validity lent support to the distinctions between DSM-III-R ODD and CD, and between MODD, ICD, and ACD. MODD was a better predictor than ODD of which boys received a later diagnosis of CD. Suggestions are made for the inclusion and exclusion of symptoms for developmentally based diagnoses of oppositional and conduct disorders.

Preliminary development of a sensation seeking scale for children

Abstract A sensation seeking scale designed for use with school-aged children (SSSC) was standardized on an elementary school population. Test-retest reliability was adequate and gender differences were comparable to the adult sensation seeking scale. The SSSC was administered to 176 clinic-referred boys aged 7–12 years. Factor analysis of the scores of the combined school and clinic samples yielded two factors which corresponded to the Boredom Susceptibility (BS) and Thrill and Adventure Seeking (TAS) factors of the adult Sensation Seeking Scales. Boys with diagnoses of conduct disorder (CD), childhood anxiety disorders (ANX), and attention deficit-hyperactivity disorder (ADHD) were compared to a clinic control group in a 2 × 2 × 2 factorial design. Main effects for ADHD and CD were significant for the BS subscale, reflecting higher scores in children with CD and lower scores in children with ADHD. A marginally significant CD × ANX interaction for total SSSC score may indicate a moderating effect of anxiety on sensation seeking in children with CD. These results tentatively suggest that sensation seeking can be validly measured in prepubertal children, but argue for further refinements in the SSSC.

Attention Deficits, Impulsivity, and Hyperactivity with or Without Conduct Problems: Relationships to Delinquency and Unique Contextual Factors

Although advances have been made in the past three decades with regard to the identification of precursors to delinquency (see the review by Loeber & Stouthamer-Loeber, 1987), a critical question remains whether or not such precursors apply to all later delinquents. One school of thought assumes that common precursors are the rule, reflecting one developmental path toward delinquency (e.g., Robins, 1966). Another perspective questions whether or not certain precursors are more common among particular youngsters and absent among others; i.e., whether there are several developmental paths leading to various forms of antisocial behavior (Loeber, 1988a). Answers to these questions may elucidate the nature of different etiological processes, and thus help to disentangle the Gordian nature of potential causal factors that has frustrated further advances in knowledge about antisocial and delinquent behavior.

Association of parental psychopathology to the comorbid disorders of boys with attention deficit-hyperactivity disorder.

This study examined whether particular forms of parental psychopathology are related to similar forms of comorbid psychopathology in offspring with attention deficit-hyperactivity disorder (ADHD). Parental disorders were assessed using maternal interviews, and child disorders were assessed using multiple-informant interviews for 111 clinic-referred boys (aged 7-12) with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) ADHD. Associations between parental and child internalizing disorders and between parental and child externalizing disorders were found, but associations across categories of disorder (i.e., internalizing and externalizing) were not. Similar relationships were observed in 66 clinic-referred boys without ADHD. These findings support specific modes of familial transmission, in contrast to theories that comorbidity simply reflects more severe psychopathology in children with ADHD.

Semiquantitative assessment of focal cartilage damage at 3 T MRI: A comparative study of dual echo at steady state (DESS) and intermediate-weighted (IW) fat suppressed fast spin echo sequences

PURPOSE The aim of the study was to compare semiquantitative assessment of focal cartilage damage using the dual echo at steady state (DESS)- and intermediate-weighted (IW) fat suppressed (fs) sequences at 3T MRI. METHODS Included were 201 subjects aged 35-65 with frequent knee pain. MRI was performed with the same sequence protocol as in the Osteoarthritis Initiative (OAI): sagittal IW fs, triplanar DESS and coronal IW sequences. Cartilage status was scored according to the WORMS system using all five sequences. A total of 243 focal defects were detected. In an additional consensus reading, the lesions were evaluated side-by-side using only the sagittal DESS and IW fs sequences. Lesion conspicuity was graded from 0 to 3, intrachondral signal changes adjacent to the defect were recorded and the sequence that depicted the lesion with larger diameter was noted. Wilcoxon signed-rank tests, controlled for clustering by person, were used to examine differences between the sequences. RESULTS 37 (17.5%) of the scorable lesions were located in the medial tibio-femoral (TF), 48 (22.7%) in the lateral TF and 126 (59.7%) in the patello-femoral compartment. 82.5% were superficial and 17.5% full-thickness defects. Conspicuity was superior for the IW sequence (p<0.001). The DESS sequence showed more associated intrachondral signal changes (p<0.001). In 103 (48.8%) cases, the IW fs sequence depicted the lesions as being larger (p<0.001). CONCLUSIONS The IW fs sequence detected more and larger focal cartilage defects than the DESS. More intrachondral signal changes were observed with the DESS.