Conduct disorder (CD) is usually diagnosed in childhood and requires that an individual exhibit at least three of 15 specific symptoms for a period of a year. CD manifests through social violations that can lead to further difficulties. Children with CD are much more likely to develop problems with substance misuse, employment, relationship stability, and psychological issues than children without CD. The symptoms that exist in CD do not always co-occur, and very often, children and young adults exhibit symptoms independently of each other but still suffer with significant emotional, social, and academic difficulties as a result.
Because the current diagnostic criteria affect the course of treatment designed for individuals with CD, it is imperative that accurate criteria be used when identifying those at risk for this psychiatric challenge. Some mental health experts believe that some children who do not meet the clinical threshold for CD could still benefit from treatment, thus necessitating the creation of CD subtypes. To determine if there is enough evidence to warrant a change to the current diagnostic threshold as outlined in the DSM-IV, Joshua Breslau, PhD, of the RAND Corporation in Pennsylvania collaborated with his colleagues from the University of California, Davis, in Sacramento on a recent study.
The team examined data from a larger longitudinal study and analyzed the frequency, severity, and onset age of symptoms in adults ranging between 18 and 44 years old. They also evaluated the level of parental mental health, life stressors, and psychiatric condition of the participants. Breslau found three clear classifications of symptoms, including low level, intermediate, and severe. The largest percentage of the participants fell into the intermediate class, which put them at risk for antisocial tendencies and anxiety and mood issues. The majority of the cases that fit into one of these classes also met current clinical diagnostic criteria for CD. Breslau said, “Consistent identification of subtypes among people with relatively low levels of symptoms suggests the potential value of further delineating subtypes of CD.” However, he does not feel that these findings warrant changes to the existing diagnostic model at this time.
Breslau, J., Saito, N., Tancredi, D. J., Nock, M., Gilman, S. E. (2012). Classes of conduct disorder symptoms and their life course correlates in a US national sample. Psychological Medicine, 42.5, 1081-1089.
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