This annual report - Taranaki District Health Board

A diagnosis of conduct disorder according to DSM-IV requires the presence of at least three of the following inthe previous year and at least one in the previous six months:often lies to obtain goods or favours or to avoid obligations (i.e. “cons” others)often bullies, threatens, or intimidates othersoften initiates physical fightshas broken into someone else’s house, building, or carhas stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking andentering; forgery)has used a weapon that can cause serious physical harm to others (e.g. a bat, broken bottle, knife, gun)has been physically cruel to peoplehas been physically cruel to animalshas stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)has forced someone into sexual activityhas deliberately engaged in fire setting with the intention of causing serious damagehas deliberately destroyed others’ property (other than by fire setting)often stays out at night despite parental prohibitions, beginning before age 13 yearshas run away from home overnight at least twice while living in a parental or parental surrogate home (oronce without returning for a lengthy period)is often truant from school, beginning before age of 13 yearsThe same provisos regarding frequency, severity and developmental age apply as they do to ODD and, if ayoung person is over 18, they must not meet the criteria for Anti-social personality disorder.Conduct disorders can be divided into two sub-types, based on age of onset: A childhoodonsettype (if at least one criterion characteristic of Conduct Disorder was present prior toage 10 years) and an adolescent-onset Type (absence of any criteria characteristic ofConduct Disorder prior to age 10 years) [402].The prognosis for early-onset conduct disorders is generally poor, with outcomes inadulthood including alcoholism, drug abuse, criminality, domestic abuse and psychiatricdisorders (including anti-social personality disorder) [423,424].EpidemiologyThere have now been a number of community surveys of mental disorders in children andyouth in the U.K. and the U.S. which may be considered methodologically rigorousbecause they applied DSM-IV criteria and included both direct structured interviews withchildren and reports about children’s symptoms and functioning from parents or primarycaregivers. A recent review of these studies found a median 12-month prevalence ofdisruptive behaviour disorders (i.e. ODD or CD) of 6% with a range from 5 to 14 % [315].Conduct disorder has consistently been found to be much more prevalent in boys withmany studies finding prevalence 3–4 times higher in boys than in girls. Some, but not all,studies have found a higher prevalence of ODD in boys.In New Zealand, the Christchurch longitudinal study (of children born in 1977) reported theprevalence of Conduct Disorder at 14–15 years as being 14.1% for Māori and 3.5% fornon-Māori while the Dunedin longitudinal study (of children born between April 1972 andMarch 1973) reported the prevalence of conduct disorder at 17–18 years as being 13.6%for Māori and 7.7% for non-Māori [425].Earlier onset of disruptive behaviour disorders is associated with more aggressivebehaviours and worse outcomes. Youths with CD commonly also have ADHD and boyswho have a diagnosis of ADHD are more likely to have early onset behaviour disorders.There is also a strong association between mood and anxiety disorders and disruptivebehaviour disorders [315].TreatmentPoor quality parenting is an important precursor of childhood-onset conduct problems. It ischaracterised by low levels of parental involvement and supervision, and inconsistent andpunitive discipline, and it interacts with parental risk factors such as mental illness,substance abuse, disrupted family life, unemployment and low socio-economic status andwith risk factors in children including difficult temperament, low verbal intelligence,impulsivity and deficits in processing social information. Despite the cumulative effects ofIn-Depth Topic: Mental Health Issues in Children - 380