Monday, January 18, 2016

The Predictive Utility of Conduct Disorder Symptoms in Preschool Children: A 3-Year Follow-Up Study

Conduct disorder (CD) symptoms often emerge during the preschool years, but it is not clear whether they predict later symptoms. 

The present study examined whether age 3 CD symptoms predict age 6 CD symptoms beyond oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder—hyperactive/impulsive (ADHD HI) symptoms. Participants were 216 preschool children (MAge = 44.19 months), including an externalizing sample (n = 161) and a comparison group (n = 55). Parents were administered a diagnostic interview when children were 3 years old and again three years later. 

The externalizing sample exhibited more CD symptoms than the comparison sample. In the externalizing sample, initial CD symptoms predicted later CD symptoms above and beyond ODD and ADHD HI symptoms; this relation was stronger for boys than girls. Stealing, property destruction, and fighting independently predicted later CD symptoms. CD symptoms also predicted subsequent ADHD HI symptoms and predicted ODD symptoms at level that approached significance. 

Results support the predictive validity of CD symptoms in preschool.

...First, CD symptoms significantly discriminated 3-year-old children with and without externalizing problems, and were quite rare among children without problems, suggesting these behaviors are not developmentally normative. Second, consistent with recent findings that early CD diagnosis predicts later diagnosis [,], CD symptoms at age 3 predicted CD symptoms three years later, even above baseline ODD and ADHD HI symptoms. This result further suggests that early CD symptoms may be of clinical concern and not merely a normative developmental phase. Third, results suggested that three symptoms were particularly useful in predicting later CD symptoms: breaking things, stealing, and fighting. These results are consistent with Loeber et al.’s finding that fighting is an important symptom in school-age children []. Fourth, CD symptoms appear to have utility not only in predicting future CD, but also in predicting subsequent ADHD HI and ODD symptoms. In contrast, children with more early symptoms of ADHD HI and ODD were not more likely to show later symptoms of CD. Finally, consistent with previous research [,], early CD symptoms more strongly predicted later problems for boys than for girls, though the relationship between early and later CD symptoms was also significant for girls.

The results of this study did not support existing theory and research on older children that suggest that either ODD or ADHD are developmental precursors to CD [,]. The findings in relation to ADHD HI are in line with a number of studies with younger [] and older children [] that suggest that hyperactivity may not predict future CD/aggression once early symptoms are controlled. In fact, for boys in this study, there was an unexpected negative relation between ADHD HI symptoms at age 3 and CD symptoms at age 6 once initial ODD and CD symptoms were controlled. We are not sure how to account for this surprising finding, but we propose two possibilities. First, this could be an instance of suppressor variables. That is, because initial ODD and CD symptoms were controlled for in this analysis, our finding estimates the relation between ADHD HI symptoms and later CD symptoms in boys with equivalent levels of ODD and CD. When early problem behaviors exist, perhaps it is better if these are due to impulsivity that might be somewhat outgrown, than to other, perhaps even more entrenched causes. Second, given the unexpected nature of this finding, it could simply be a Type I error. This study also does not support the notion that ODD may be a developmental precursor to CD, at least during the preschool years. Co-occurrences among these problem types may be the result of common influences, such as coercive parenting cycles or biological risk factors, rather than heterotypic continuity. If in fact ODD and CD develop in parallel, rather than sequentially, it is not clear that CD should preclude a diagnosis of ODD, as is currently specified in DSM-5 []. More research is needed to better understand the developmental progression of ADHD HI, ODD, and CD symptoms... 

Full article at:

University of Massachusetts Amherst
Rolon-Arroyo, B. Department of Psychology (, University of Massachusetts, 135 Hicks Way, Amherst, 01003, USA ude.ssamu.hcysp@ranolorb
Arnold, D. H. Department of Psychology, University of Massachusetts, 135 Hicks Way, Amherst, 01003, USA ude.ssamu.hcysp@dlonrad
Harvey, E. A. Department of Psychology, University of Massachusetts, 135 Hicks Way, Amherst, 01003, USA ude.ssamu.hcysp@yevrahe

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