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.