Profiles of current disruptive behavior: Association with recent drug consumption among adolescents
Introduction
During adolescence, the prodromes for many disturbances in health, behaviors, and social adaptation start to emerge, including those associated with drug use (Brook et al., 1998, Costello and Angold, 2000, Federman et al., 1997, Weinberg and Glantz, 1999). The expression of susceptibility in the form of disturbances in the mental life, behavior and social adaptation of adolescents is consistent with the psychobiological framework proposed by Adolph Meyer in the early 20th century (Neill, 1980) and also consistent with developmental models of psychopathology that have been advanced in more recent years (Costello and Angold, 2000, Institute of Medicine, 1994, Kellam and Ensminger, 1980, Patterson et al., 1992).
Data suggest that the onset of the first symptoms of American Psychiatric Association Diagnostic and Statistical Manual (DSM) behavior disorders in most cases precedes drug use (Costello, Erkanli, Federman, & Angold, 1999). However, treatment-based samples have shown that many of the delinquent behaviors associated with specific conditions, such as DSM-defined conduct disorder, may be attributed to drug use (Brown, Gleghorn, Schuckit, Myers, & Mott, 1996). The shared liabilities of dependence symptoms with conduct disorder may be due to genetic as well as environmental influences (Rose et al., 2004, True et al., 1999). Substance use disorders, as well as subdiagnostic levels of drug-related problems, have both been shown to relate to disruptive diagnoses (Shrier, Harris, Kurland, & Knight, 2003).
Although standard psychiatric classifications describe Attention-Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) as three distinct syndromes, these conditions often exhibit very similar or related symptoms (Loeber and Keenan, 1994, Maughan et al., 2004). Diagnostic assessments often fail to capture the behavioral heterogeneity and multiplicity of overlapping symptoms that emerge in youth. There is, therefore, a need for different approaches in research to examine the co-occurrence of adolescent disturbances in behavior and mental health. One alternative approach is: 1) to use assessments of psychological difficulties, such as the widely used instruments developed by Achenbach: the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR; Achenbach, 1991a, Achenbach, 1991b, Achenbach, 1991c), and 2) to use a statistical technique to identify patterns in the observed symptom response profiles, instead of classifying youth in terms of the presence or absence of clinically significant symptomatology based on predetermined cut off scores of separate syndromes. The response profiles or ‘classes’ are derived empirically using latent class analysis and the classes may indicate underlying subsyndromes or biopsychological similarities. Latent class analysis (LCA) has been useful in identifying several disruptive behavior symptom profiles from instruments developed by Achenbach based on teacher reports of young elementary children and among general population samples of preadolescents based on both parent- and self-report symptoms (Sondeijker et al., 2005; van Lier, Verhulst, & Crijnen, 2003). In addition, other research groups have been exploring the class structure of behavioral symptoms derived from other instruments assessing DSM-IV diagnoses (e.g., Volk, Neuman, & Todd, 2005). Findings from these studies advocate that LCA may provide more precise characterization of comorbidity among the externalizing disorders.
Using nationally representative samples of adolescents collected as part of the 1994–1996 United States National Household Survey on Drug Abuse (NHSDA), we first sought to classify adolescents into groups with distinct disruptive behavior profiles using latent class analyses of self-reported responses to items consistent with behavioral features of conduct disorder (CD), oppositional defiant disorder (ODD), and attention-deficit/hyperactivity disorder (ADHD). In this group of adolescents, we explored whether latent class analysis might reveal meaningful summary patterns that reflected a qualitative difference (e.g., overt antisocial behaviors versus covert behaviors) in additional to or instead of only a severity gradation. A qualitative difference might be of significance since specific behavioral features (e.g., aggressive behavior and covert conduct problems) have been found to relate more strongly to substance use than other behavioral features (Moss and Kirisci, 1995, Rey et al., 2002, Pedersen et al., 2001). In addition, different types of subclinical conduct problems have been found to relate to the initiation of specific substances. Serious delinquent acts have been found to have a moderate effect for cannabis initiation among boys, while aggressive and covert dimensions have had stronger effects among girls (Pedersen et al., 2001). Externalizing and delinquent behaviors have also been associated with the progression of drug use, whether progression in stage of use within a particular drug (van den Bree & Pickworth, 2005) or becoming involved with other drugs, in particular illicit drugs, such as marijuana and inhalants (Mackesy-Amiti and Fendrich, 1999, King et al., 2004). While it is established that disruptive behaviors are found in a majority of adolescents with substance use disorders, little is known about the recent drug consumption of youth classified empirically into distinct disruptive behavior subgroups.
In this report we investigate the extent to which being classified into different classes of disruptive behavior is associated with drug consumption in the month prior to the survey assessment. Under problem behavior theory, disruptive behavior that deviates from societal norms would be part of the same pattern of behavior where the use of drugs (e.g., alcohol, tobacco cigarettes, inhalants, or marijuana) is also more common (Jessor & Jessor, 1977). We hypothesized that classes characterized by a greater number or reflective of more serious behavioral problems would be associated with greater risk for drug use overall and that the strength of the association would be stronger for inhalant and marijuana use than alcohol or tobacco cigarette use. A differential risk by age, as well as gender, for drug use, disruptive behavior, and their potential co-occurrence has been suggested by others (Clark and Cornelius, 2004, Cote et al., 2002, Maughan et al., 2004, Miles et al., 2002, Moss and Lynch, 2001, Pineda et al., 2003, Sung et al., 2004). So, in order to present a more complete picture of these relationships, we also 1) explored the use of each drug type individually as they might be associated with disruptive behavior classes and 2) explored possible age and gender variations. The association between disruptive behavior and drug use was hypothesized to be stronger for males and older youth.
Section snippets
Sample
Data for this study came from the public use files of the 1994b–1996 National Household Surveys on Drug Abuse (NHSDA) (http://www.oas.samhsa.gov). During each of those years, independent nationally representative samples of non-institutionalized civilians aged 12 or older were identified, via stratified, multi-stage area probability sampling. Details of the research protocols and sampling procedures can be found in NHSDA publications (Substance Abuse and Mental Health Service Administration,
Classes of disruptive behavior
An overview of the occurrence of each clinical feature within the study sample is presented in Table 1. Features often characteristic of adolescence – being argumentative, talking too much, “swearing” – were the most commonly reported behavioral features. Being stubborn and having trouble concentrating were expressed by half of the sample. Behaviors reflecting features of ADHD and ODD were more commonly reported than those of CD. More severely deviant behaviors such as stealing, destroying, and
Discussion
Using LCA, we found evidence to support a three class latent structure of disruptive behavior. None of the classes identified youth displaying problems of only one type of disruptive behavior; instead, the behavior syndromes tended to co-occur. Nearly half of the youth in this sample expressed intermediate levels of disruptive behavior (Class 2) common with features of ADHD and ODD, while just under one in five were more likely to experience high levels of disruptive behavior with CD symptoms
Acknowledgments
This work was supported by NIDA R01DA016323 (CLS) and K01DA16720 (VHA). The data reported herein come from the National Household Survey of Drug Abuse 1994–1996 collected under the auspices of the Office of Applied Studies, Substance Abuse and Mental Health Services Administration.
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