Smoking and mental health - NCSCT

Mental disorders 1
not diagnosed until adulthood. ADHD symptoms decline with age, but can
persist into adult life in up to 60% of cases. 50 It is estimated that worldwide
around 2% of adults may be affected. 51 People with this disorder have a high
level of psychiatric co-morbidity, and are more likely to underachieve
educationally and occupationally, and to be unemployed. 52,53 Proposed risk
factors include a genetic influence, very low birthweight, 54 maternal smoking,
exposure to lead, and consumption of additives and preservatives in the diet. 55
A small proportion of children improve after alterations in their diet. 49
1.7.2 Conduct disorders
Conduct disorders are characterised by repetitive patterns of antisocial,
disruptive and aggressive behaviour in children and young people. This
behaviour is persistent (lasting over 6 months), significantly violates ageappropriate
expectations and is therefore in excess of normal childhood
behaviour. 1 The WHO recognises subgroups of conduct disorder (more
common in children aged 11–12 or older) and oppositional defiant disorder
(ODD), which is predominantly a disorder of younger children.
Children with ODD display repeated defiant, disobedient and disruptive
behaviours that go beyond mere ‘naughtiness’. 1 However, the category of ODD
does not include the more aggressive forms of behaviour, or delinquency.
Behaviours exhibited in conduct disorder are more extreme than in ODD.
Examples given by the WHO 1 include: excessive levels of fighting or bullying,
cruelty to other people or animals, severe destructiveness to property, fire setting,
stealing, repeated lying, truancy from school and running away from home,
unusually frequent and severe temper tantrums, and disobedience. For diagnosis
of a conduct disorder, any of these behaviours should not be isolated antisocial
acts but part of a persistent pattern. Conduct disorder can also be divided into
socialised and unsocialised forms, depending on how well the child is integrated
into his or her peer group.
Conduct disorders are the most common mental health disorder in children
and young people 56 and are more common in boys than in girls. The 2004 Child
Mental Health Survey of 5–16 year olds in Great Britain 57 reported a prevalence
of 5.8% (7.5% in boys and 3.9% in girls). Prevalence increases with age, with
4.9% of children in the 5–10 age group meeting diagnostic criteria compared
with 6.6% in the 11–16 age band. These disorders are more common in the lower
socioeconomic groups, and among children looked after by local authorities – in
the 2003 survey of the mental health of looked-after children, 36% were found to
have a conduct disorder. 58
Conduct disorders are associated with considerable co-morbidity. In the 2004
survey, 35% of children with conduct disorder had at least one other mental
disorder, most commonly an emotional disorder or ADHD. The diagnosis has
wide-ranging implications for the child’s educational, social and health
© Royal College of Physicians 2013 9