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Conduct Problems Underdiagnosed in Prepubertal Children

Diagnostic criteria for conduct disorder in DSM-III-R and DSM-IV downplay the importance of less serious conduct problems in children, such as lying and nonconfrontive stealing, by not considering them conduct-disordered problems. Instead, conduct disorder can only be diagnosed for confrontive behavior, such as robbing a bank or mugging, which is unlikely among prepubertal children. These two studies suggest that there are clinically significant consequences of this practice.

In the first study, researchers followed 89 boys (aged 6 to 12) diagnosed as hyperactive and 87 normal controls for 13 to 23 years, obtaining all official arrest records, juvenile records, and adult incarceration records. Hyperactive children who had no conduct problems were unlikely to have later legal problems. However, hyperactive children who told lies or stole in nonaggressive ways were significantly more likely to be adolescent and adult offenders. Adolescents arrested before age 15 or arrested multiple times were at the highest risk for serious criminal behavior later in life.

In the second study, researchers randomized 83 children aged 6 to 15 who met DSM-III criteria for conduct disorder to receive either methylphenidate (MPH) (up to 60 mg/day; mean dose, 41.3 mg/day) or placebo for five weeks. Two thirds of the children also met criteria for attention deficit hyperactivity disorder. When compared with placebo, MPH significantly reduced antisocial behaviors specific to conduct disorder. The effect of MPH was independent of the severity of ADHD symptoms.

Comment: The first study suggests that conduct problems, such as lying and stealing, in hyperactive boys are risk factors for adolescent and adult criminal behavior. The second study suggests that MPH, a stimulant known to effectively treat hyperactivity and aggression in children with ADHD, has short-term positive effects on the symptoms of conduct disorder. Both studies highlight the importance of paying serious attention to early conduct problems that are not included in DSM-III and DSM-IV criteria and emphasize the need for finding treatment interventions for young children with conduct problems to reduce later criminal behavior. Therefore, the true value of MPH for children with conduct disorder will depend on its long-term efficacy.

— B Geller

Published in Journal Watch Psychiatry February 1, 1998

Citation(s):

Satterfield JH and Schell A. A prospective study of hyperactive boys with conduct problems and normal boys: Adolescent and adult criminality. J Am Acad Child Adolesc Psychiatry 1997 Dec 36 1726-1735.

• Medline abstract (Free)

Klein RG et al. Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Arch Gen Psychiatry 1997 Dec 54 1073-1080.

• Medline abstract (Free)