The following researchers and articles have described a variety of factors that seem to increase the risk of CD development in children and adolescents (Encyclopedia of Children’s Health, no date). Cognitive problems leading to school failures increase the probability that a child will develop CD. Children with a normal IQ may have trouble with verbal and abstract reasoning and thus lag behind their classmates aca- demically. Their academic difficulties in turn can result in low self-esteem, social rejection, and increasing frustration, all of which can lead to the onset of CD.
Moffitt (1993) found that having a learning disorder (LD) is associated with developing CD. Her research demonstrates that learning impairments and minimal brain dysfunction (MBD) are highly related to the initiation of aggressive behavior, deviant behavior, and hyperactivity. A number of studies have found a link between attention-deficit/hyperactivity disorder (ADHD) and CD.
Byun et al. (2006) discovered that 53 or 50.5% of 105 patients in Korea diagnosed with ADHD had ODD.
In a study of 131 children in British Columbia, Canada, with ADHD, Klassen et al. (2004) found that 45 or 34.4% were diagnosed with CD or ODD.
Kilic and Sener (2005) evaluated family functioning and psychosocial attributes of 92 children, aged 6–11 years, diagnosed with ADHD and ADHD with co-existing ODD/CD. Based on the parents’ completion of the Child Behavior Checklist, the authors reported that children with ADHD and comorbid ODD/CD scored high in dysfunctional behavior. However, these children had low scores related to social withdrawal and sexual problems. The researchers discovered a high degree of maternal depression and paternal alcohol difficulties among the children with ADHD and co-existing ODD/CD. In addition, the families of children with ADHD and ODD/CD demonstrated a high degree of dysfunctional family functioning based on the Roles and Behavior Control subscales of the Family Assessment Device.
Causes of CD 133 Cunningham and Boyle (2002) evaluated mothers and their 4-year-old children at risk for ADHD, both ADHD and ODD, and a comparison group of mothers with symptom-free children. They found that mothers of children at risk for ODD had more family problems, perceived themselves as less capable as parents, and had fewer strategies for resolving their children’s behavior difficulties than the control group. Moreover, mothers of children at risk for ODD were not as assertive in man- aging their children, showed higher levels of individual depression, and indicated that their children were more likely to internalize their problems than the mothers of children in the control group.
Relative to the control group, the children at risk for ADHD were more likely to have behavioral difficulties in school such as classroom management and social interaction problems.
When dealing with discipline problems, mothers in all groups used twice as many negative or controlling approaches as preventive or positive management approaches. Interestingly, the mothers of daughters at risk for the different disor- ders rewarded their daughters more often for each example of positive conduct than did the boys’ mothers.
Youth diagnosed with CDs often have co-existing mental disorders, including anxiety and depressive disorders and substance abuse problems (Boylan et al.,2007;
Turgay,2005). Boylan et al. (2007) suggest that young children with ODD have an increased likelihood of developing internalizing conditions, such as anxiety and depression. In addition, mania is present in 40% of children and adolescents with CD (Biederman et al.,1999; Wrowley and Riggs,1995; Young et al.,1995).
Conner (1998–2000) suggests that some of the following interactions can lead to CD:
1. Inadequate parent–child relationships and inappropriate or inconsistent parenting.
2. Negative reinforcement, such as harsh and/or inconsistent discipline toward the child and/or other family members.
3. Parents or significant others who model aggressive and coercive behaviors increase the risk that the child will imitate these antisocial behaviors.
4. Family environments characterized by emotional, physical, or sexual abuse.
5. Parental alcoholism and a family history of antisocial personality.
6. Adverse characteristics of the school environment.
7. Negative influences from peers and friends.
Based on a sample of 1,162 female and male twin pairs, aged 12–19 years, and 429 siblings, Ehringer et al. (2006) found that both genetic and non-shared environmen- tal influences may contribute to the development of common adolescent disorders, including CD, ODD, and ADHD.
However, other researchers have emphasized the impact of environmental influ- ences on these behavioral problems. For example, a meta-analysis of twin and adoption studies by Burt (2009) demonstrated that environmental influences, which produced similarities between siblings, accounted for 10–30% of the variability
within CD, ODD, anxiety, depression, and other internalizing and externalizing conditions. In contrast, ADHD seemed to be caused largely by genetic factors.
Diagnosis
If a CD is suspected, the child should be evaluated promptly by her or his health practitioner and possibly a mental health professional (Encyclopedia of Children’s Health, no date). Admission to an inpatient mental health facility may be necessary if a child diagnosed with CD has thoughts of self-injury or suicide or is a danger to other people.
A diagnosis of CD is made if the person repeatedly engages in aggressive and antisocial behaviors that disrupt social, family, and educational functioning as well as job-related performance. Individuals with CD may bully and threaten other peo- ple; start fights; be cruel to animals and people; coerce individuals into having sex;
deliberately destroy other people’s property; be frequently truant; have run away from home overnight at least twice or once for a long time period (Encyclopedia of Children’s Health, no date). Three of these types of behaviors must have occurred over the prior 12 months, and one of the three behaviors must have taken place in the previous 6 months.
A diagnosis of ODD is made if the child or adolescent commits negative, defi- ant, and hostile behaviors more frequently than normal for the individual’s age and developmental stage and that these actions substantially impair the individual’s functioning (Office of Child and Family Policy,2008).
A person is not diagnosed with both CD and ODD. Those who fulfill the criteria for both disorders are diagnosed with CD (Office of Child and Family Policy,2008).
Clinicians need to consider the age of onset when diagnosing CD or ODD.
Individuals with ODD have a younger age of onset than persons with CD (Office of Child and Family Policy,2008).
Youth with CD often have a history of ODD, but not all children with ODD will develop CD (Loeber et al.,1991). Children with ODD who develop CD initially exhibit problems, such as being a bully, fighting, being dishonest, and destruction of property. These individuals later engage in CD-related behaviors including truancy, school vandalism, breaking and entering, aggravated assault, rape, and homicide.
Persons with child-onset CD must have one criterion of the condition before the age of 10 (Office of Child and Family Policy,2008). Persons with adolescent-onset CD do not meet any criteria for the condition before 10 years of age.
Some researchers believe that youth with child-onset CD initially acquire their disruptive behaviors in their family environment (Office of Child and Family Policy, 2008). They then expand their deviant behaviors as they interact with antisocial peer groups, e.g., gangs, and isolate themselves from conventional peer groups. It is important to distinguish between child- and adult-onset CD, since studies show that persons with adolescent-onset CD are less likely to continue their antisocial behaviors as adults than those with child-onset CD (Grizenko,1997; Robins,1981).
Another investigation found that children in preschool and elementary school who
Treatment 135 display antisocial conduct have a higher probability of engaging in antisocial behav- iors in adulthood than preschool and elementary school children who do not exhibit antisocial behaviors (Kazdin,1987).