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Conduct Problems: Prevalence and Comorbidities

Conduct Problems: Prevalence and Comorbidities

Overview of Conduct Problems

  • Conduct problems, primarily Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), are prevalent diagnoses in both clinical and community settings.

Prevalence of Conduct Problems

  • General Prevalence:

    • Commonly diagnosed in mental health clinics.
    • Prevalence rates in the community: 3-5% for ODD and CD combined.
    • Noted for their stability and resilience to treatment.

  • Sex Differences in ODD and CD:

    • ODD:
    • In early childhood, boys are diagnosed at a rate of 2:1 compared to girls.
    • In adolescence, diagnosis rates equalize between boys and girls.
    • CD:
    • Boys are more likely to be diagnosed.
    • Ratio is 3:1 in childhood and 2:1 in adolescence.
    • Possible reasons for these disparities include socialization, genetic factors, and environmental influences.

Co-morbidities Associated with Conduct Problems

  • ADHD:

    • Most common comorbidity at approximately 40%.
    • More prevalent in individuals with CD (75%) compared to ODD (27%).
    • Suggested link between differences in brain development:
    • Symptoms: Hyperactivity and impulsivity leading to aggressive behaviors.

  • Substance Use Problems:

    • Individuals with conduct problems may begin using substances at an earlier age.
    • Possible contributing factors include:
    • Genetic predisposition.
    • Environmental influences.

Associated Features of Conduct Problems

  • Academic Underachievement:

    • Approximately 25% of affected children show academic difficulties:
    • Low academic scores, repetition of grades, and referrals for special education.
    • Often exhibit a negative attitude towards teachers and the academic environment.
    • IQ Implications:
    • Average IQ found to be roughly 8 points lower than peers.
    • Verbal IQ (VIQ) is often less than Performance IQ (PIQ), leading to frustration and negative interactions that can hinder self-control development.

  • Internalizing Disorders:

    • Co-occurrence with conduct problems in the community is around 33%. In clinical settings, this can increase to 75%.
    • Notable gender differences, with girls being twice as likely to develop internalizing disorders as boys.
    • Patterson’s Dual Failure Model:
    • Proposes a cycle where conduct problems lead to social and academic challenges, ultimately resulting in depressive symptoms.