RESEARCH UPDATE REVIEW
Oppositional Defiant Disorder and Conduct Disorder: A Review of the Past 10 Years, Part II

https://doi.org/10.1097/00004583-200211000-00009Get rights and content

ABSTRACT

Objective:

To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD).

Method:

Selected summaries of the literature over the past decade are presented.

Results:

Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models. Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains.

Conclusions:

Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD.

Section snippets

Scope of the Selected Research

Our intention was to consider research on the diagnoses of ODD and CD. However, many worthwhile studies have examined overlapping constructs. Therefore, where relevant, we include studies of risk factors for delinquency and violence, realizing that such constructs are not identical with DBD. The similarities they share with DBD suggest that risk factors for delinquency and violence may also increase the risk for DBD. In addition, most theories of DBD are based on data from males and probably

DEVELOPMENTAL MODELS

The basic developmental model expressed in the DSM-IV (American Psychiatric Association, 1994) is that DBD are not transient but are stable disorders and that ODD can be a precursor to CD, which in turn can be a precursor to antisocial personality disorder (APD).

CHILD BIOLOGICAL FACTORS

The subcategories into which we have grouped this review of literature on risk factors intrinsic to the child in no way suggest independence among these factors. Clearly, such domains as genetics, neuroanatomy, and neurochemistry are interrelated. As research progresses within circumscribed domains, however, a clearer picture of the interaction among these factors should emerge. One area of particular interest is the relationship of biological processes with DBD. CD is identified by behaviors,

Temperament

Temperament is regarded as a constitutional facet of child development that may be observed very early in childhood, appears biologically based, and, when dysregulated, may evoke maladaptive parenting (Lytton, 1990, Lytton, 1991) and may facilitate the progression from early disruptive problems to CD (Cole and Zahn-Waxler, 1992;Kingston and Prior, 1995). However, the investigation of temperament has been hampered by a lack of consensus regarding definitions of the construct and a difficulty

Parenting

Numerous studies show that poor parenting is related to disruptive behavior (e.g., Frick et al., 1992;Haapasalo and Tremblay, 1994), while favorable parenting behaviors may be protective (McCord, 1991). Little evidence disentangling parenting behaviors from parental psychopathology is available, but Kaplan and Liu (1999) suggest that while both contribute, parental psychopathology may be a stronger determinant of DBD in offspring than parenting behavior. Nonetheless, parenting behaviors may

CONCLUSIONS ABOUT RISK FACTORS

Both ODD and CD have similar risk factors and may evince a common genetic underpinning (Eaves et al., 2000), although we cannot exclude a common exogenous origin. Risk factors have generally proven to be stronger predictors of CD than ODD (Loeber et al., 1993;Pfiffner et al., 1999), but more studies have focused on the predictors of CD or composite indices than ODD alone.

Furthermore, many studies have concentrated on aggregated measures of antisocial behavior, which often include symptoms of

TREATMENT STRATEGIES

CD has long been regarded as relatively intractable and resistant to treatment interventions. Findings from the past 10 years suggest no giant leaps in treatment of CD but, instead, a number of small steps, such as new strategies in service delivery (e.g., Kazdin, 1997). As the preceding review has demonstrated, a diverse range of risk factors has been implicated in the development of CD. Successful interventions commonly use some intervention focused on parenting factors. However, rather than

CONCLUSION

The literature on risk factors for DBD is as varied as the symptoms of the disorders. While the role of some risk factors continues to be refined, it is clear that many questions remain to be answered. Some of these questions result from a lack of sound research, such as the thorough exploration of possible prevention strategies and difficulty in identifying specific mechanisms related to intervention success. Many well-meaning intervention studies have been conducted, yet only a few provide

REFERENCES (224)

  • CJ Golden et al.

    Neuropsychological correlates of violence and aggression: a review of the clinical literature

    Aggressive Viol Behav

    (1996)
  • JA Graber et al.

    Is psychopathology associated with the timing of pubertal development?

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • JM Halperin et al.

    Serotonin, aggression, and parental psychopathology in children with attention-deficit hyperactivity disorder

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • TI Herrenkohl et al.

    Developmental risk factors for youth violence

    J Adolesc Health

    (2000)
  • KA Howard et al.

    Violence-prevention programs in schools: state of the science and implications for future research

    Appl Prev Psychol

    (1999)
  • AE Kazdin

    Child, parent and family dysfunction as predictors of outcome in cognitive-behavioral treatment of antisocial children

    Behav Res Ther

    (1995)
  • AE Kazdin

    Parent management training: evidence, outcomes, and issues

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • AE Kazdin et al.

    Therapeutic changes in children, parents, and families resulting from treatment of children with conduct problems

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • B Aguilar et al.

    Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: from birth to 16 years

    Dev Psychopathol

    (2000)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • S Aos et al.

    The Comparative Costs and Benefits of Programs to Reduce Crime

    (2001)
  • J Arbuthnot

    Sociomoral reasoning in behavior-disordered adolescents: cognitive and behavioral change

  • RA Barkley et al.

    The efficacy of problem-solving communication training alone, behavioral management training alone, and their combination for parent–adolescent conflict in teenagers with ADHD and ODD

    J Consult Clin Psychol

    (2001)
  • L Baving et al.

    Oppositional children differ from healthy children in frontal brain activation

    J Abnorm Child Psychol

    (2000)
  • K Bjorkqvist et al.

    Do girls manipulate and boys fight? Developmental trends in regard to direct and indirect aggression

    Aggressive Behav

    (1992)
  • KE Bolger et al.

    Developmental pathways from child maltreatment to peer rejection

    Child Dev

    (2001)
  • PA Brennan et al.

    Psychophysiological protective factors for male subjects at high risk for criminal behavior

    Am J Psychiatry

    (1997)
  • N Breslau et al.

    Psychiatric sequelae of low birth weight at 6 years of age

    J Abnorm Child Psychol

    (1996)
  • EV Brestan et al.

    Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5272 kids

    J Clin Child Psychol

    (1998)
  • MC Brower et al.

    Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review

    J Neurol Neurosurg Psychiatry

    (2001)
  • BJ Burns et al.

    Children's mental health use across service sectors

    Health Aff

    (1995)
  • BJ Burns et al.

    Mental health education, child welfare, and juvenile justice service use

  • M Campbell et al.

    Behavioral efficacy of haloperidol and lithium carbonate: a comparison in hospitalized aggressive children with conduct disorder

    Arch Gen Psychiatry

    (1984)
  • SB Campbell et al.

    Boys' externalizing problems at elementary school age: pathways from early behavior problems, maternal control, and family stress

    Dev Psychopathol

    (1996)
  • RF Catalano et al.

    Comprehensive community- and school-based interventions to prevent antisocial behavior

  • P Chamberlain et al.

    A clinical model for parenting juvenile offenders: a comparison of group care versus family care

    Clin Child Psychol Psychiatry

    (1998)
  • EF Coccaro et al.

    Central serotonin activity and aggression: inverse relationship with prolactin response to d-fenfluramine, but not CSF 5-HIAA concentration in human subjects

    Am J Psychiatry

    (1997)
  • D Cohen et al.

    Empathy in conduct disordered and comparison youth

    Dev Psychol

    (1996)
  • P Cohen et al.

    Issues in the disruptive behavior disorders: attention deficit disorder without hyperactivity and the differential validity of oppositional defiant and conduct disorders

  • JD Coie et al.

    The development of aggression and antisocial behavior

  • JD Coie et al.

    The role of social context in the prevention of conduct disorder

    Dev Psychopathol

    (1993)
  • JD Coie et al.

    The development of antisocial individuals

  • JD Coie et al.

    Peer factors and interventions

  • A Colby et al.

    The Measurement of Moral Judgment: Theoretical Foundations and Research Validation

    (1987)
  • PM Cole et al.

    Emotional dysregulation in disruptive behavior disorders

  • Committee on Preventive Psychiatry et al.

    Violent behavior in children and youth: preventive intervention from a psychiatric perspective

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • Conduct Problems Prevention Research Group

    Merging universal and indicated prevention programs: the fast track model

    Addictive Behav

    (2000)
  • Conduct Problems Prevention Research Group

    Evaluation of the first 3 years of the Fast Track prevention trial with children at high risk for adolescent conduct problems

    J Abnorm Child Psychol

    (2002)
  • DF Connor et al.

    A pilot study of methylphenidate, clonidine, or the combination in ADHD comorbid with aggressive oppositional defiant or conduct disorder

    Clin Pediatr (Phila)

    (2000)
  • NR Crick et al.

    Relational aggression, gender, and socialpsychological adjustment

    Child Dev

    (1995)
  • Cited by (0)

    This study was supported in part by NIMH grant MH 42529 to Dr. Loeber.

    Reprint requests to Dr. Burke, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: [email protected].

    DOI: 10.1097/01.CHI.0000024839.60748.E8

    View full text