Should Conduct Disorder Be Subtyped for Less Severe Cases?

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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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Vanessa


    May 7th, 2012 at 4:27 PM

    I have such a problem with some of this because htis is my thought: if you have had enough training to be a therapist you should be able to look and talk with a child to know if he or she has a conduct disorder. It should not take all kinds of specific criteria and subtypes and all that to make a fair and accurate diagnosis. I know that there are certain things that you will look for, but for the most part, if you have had the training and the time with the child, I don’t think that it is going to take all of this sort of specificity for you to know that there is something going on that needs treatment. I understand that for insurance and billing and stuff like that it could be important to have things coded in a way where the patient can get the most benefit from his coverage, but other than that I think that working beyond this is something that any well trained therapist will have the ability to do.

  • monique


    May 8th, 2012 at 4:10 AM

    There are always going to be little subtypes of this and small groups of that. We know that. If it doesn’t warrant any changes, then why even bother with it? Move on.

  • JannaPeterson


    May 8th, 2012 at 3:59 PM

    If this is a way for counselors to more effectively treat their patients, then I can’t see why anyone would be against these new sub categories of bahvior disorders. But if it is just going to be about jumping through more hoops and fighting more red tape, then I am not sure that there will be to many providers or patients either who will be overjoyed by that prospect. The last thing that any family trying to get treatment needs is having to do more and more work to get to the same end goal. But if there are specific traits of this one disorder that would be better classified and better treated as a result of new diagnosis tools, then that is only going to work to the patient’s benefit.

  • Ed


    May 9th, 2012 at 7:51 PM

    While making subtypes can help in better and more targeted treatment it could also label non-aafected individuals as affected if I’m reading this right. And such an act can only add numbers and demoralize a lot o people in my opinion.

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Title   Content   Author is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on