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Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

Published online by Cambridge University Press:  24 April 2007

MICHAEL C. MONUTEAUX
Affiliation:
The Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
STEPHEN V. FARAONE
Affiliation:
Departments of Psychiatry and Neuroscience & Physiology, SUNY Upstate Medical University, USA
LARA MICHELLE GROSS
Affiliation:
The Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
JOSEPH BIEDERMAN
Affiliation:
The Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Corresponding
E-mail address:

Abstract

Background

Research on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD.

Method

We conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6–18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16·7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews.

Results

Baseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5·8, 95% confidence interval (CI) 2·9–11·5, p<0·001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (⩾12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up.

Conclusions

ADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

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References

Aguilar, B., Sroufe, L. A., Egeland, B. & Carlson, E. (2000). Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: from birth to 16 years. Development and Psychopathology 12, 109132.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). American Psychiatric Association: Washington, DC.Google ScholarPubMed
Biederman, J., Faraone, S. V., Mick, E., Williamson, S., Wilens, T. E., Spencer, T. J., Weber, W., Jetton, J., Kraus, I., Pert, J. & Zallen, B. (1999). Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources. Journal of the American Academy of Child and Adolescent Psychiatry 38, 966975.CrossRefGoogle ScholarPubMed
Biederman, J., Faraone, S. V. & Monuteaux, M. C. (2002). Differential effect of environmental adversity by gender: Rutter's index of adversity in a sample of boys and girls with and without ADHD. American Journal of Psychiatry 159, 15561562.CrossRefGoogle Scholar
Biederman, J., Faraone, S. V., Monuteaux, M. C., Spencer, T., Wilens, T., Bober, M. & Cadogan, E. (2004). Gender effects of attention deficit hyperactivity disorder in adults, revisited. Biological Psychiatry 55, 692700.CrossRefGoogle ScholarPubMed
Biederman, J., Milberger, S., Faraone, S. V., Kiely, K., Guite, J., Mick, E., Ablon, S., Warburton, R. & Reed, E. (1995). Family-environment risk factors for attention deficit hyperactivity disorder: a test of Rutter's indicators of adversity. Archives of General Psychiatry 52, 464470.CrossRefGoogle ScholarPubMed
Biederman, J., Monuteaux, M., Mick, E., Spencer, T., Wilens, T., Klein, K., Price, J. E. & Faraone, S. V. (2006 a). Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biological Psychiatry 60, 10981105.CrossRefGoogle ScholarPubMed
Biederman, J., Monuteaux, M., Mick, E., Spencer, T., Wilens, T., Silva, J., Snyder, L. & Faraone, S. V. (2006 b). Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year prospective follow-up study. Psychological Medicine 36, 167179.CrossRefGoogle Scholar
Busch, B., Biederman, J., Cohen, L., Faraone, S., Sayer, J., Monuteaux, M., Mick, E. & Zallen, B. (2002). Similar correlates of ADHD in children from pediatric and psychiatric clinics. Psychiatric Services 53, 11031111.CrossRefGoogle ScholarPubMed
Calhoun, G., Jurgens, J. & Chen, F. (1993). The neophyte female delinquent: a review of the literature. Adolescence 28, 461471.Google ScholarPubMed
Cote, S., Tremblay, R. E., Nagin, D. S., Zoccolillo, M. & Vitaro, F. (2002). Childhood behavioral profiles leading to adolescent conduct disorder: risk trajectories for boys and girls. Journal of the American Academy of Child and Adolescent Psychiatry 41, 10861094.CrossRefGoogle ScholarPubMed
Faraone, S., Biederman, J., Garcia Jetton, J. & Tsuang, M. (1997). Attention deficit disorder and conduct disorder: longitudinal evidence for a familial subtype. Psychological Medicine 27, 291300.CrossRefGoogle ScholarPubMed
Faraone, S. V., Biederman, J., Keenan, K. & Tsuang, M. T. (1991). A family-genetic study of girls with DSM-III attention deficit disorder. American Journal of Psychiatry 148, 112117.Google ScholarPubMed
Faraone, S. V., Biederman, J. & Monuteaux, M. C. (2000). Attention-deficit disorder and conduct disorder in girls: evidence for a familial subtype. Biological Psychiatry 48, 2129.CrossRefGoogle ScholarPubMed
Faraone, S. V. & Tsuang, M. T. (1995). Methods in psychiatric genetics. In Textbook in Psychiatric Epidemiology (ed. Tohen, M., Tsuang, M. T. and Zahner, G. E. P.), pp. 81134. John Wiley: New York.Google Scholar
Frick, P., Lahey, B., Loeber, R., Tannenbaum, L., Horn, Y., Christ, M., Hart, E. & Hanson, K. (1993). Oppositional defiant disorder and conduct disorder: a meta-analytic review of factor analyses and cross-validation in a clinical sample. Clinical Psychology Review 13, 319340.CrossRefGoogle Scholar
Gershon, E. S., Hamovit, J., Guroff, J. J., Dibble, E., Leckman, J. F., Sceery, W., Targum, S. D., Nurnberger, J. I. Jr., Goldin, L. R. & Bunney, W. E. Jr. (1982). A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Archives of General Psychiatry 39, 11571167.CrossRefGoogle ScholarPubMed
Hinshaw, S., Lahey, B. & Hart, E. (1993). Issues of taxonomy and comorbidity in the development of conduct disorder. Development and Psychopathology 5, 3149.CrossRefGoogle Scholar
Hinshaw, S. P. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive, and social functioning, and parenting practices. Journal of Consulting and Clinical Psychology 70, 10861098.CrossRefGoogle ScholarPubMed
Hollingshead, A. B. (1975). Four Factor Index of Social Status. Yale Press: New Haven.Google Scholar
Ilomaki, E., Viilo, K., Hakko, H., Marttunen, M., Makikyro, T. & Rasanen, P. (2006). Familial risks, conduct disorder and violence: a Finnish study of 278 adolescent boys and girls. European Child and Adolescent Psychiatry 15, 4651.CrossRefGoogle ScholarPubMed
Keenan, K., Loeber, R. & Green, S. (1999). Conduct disorder in girls: a review of the literature. Clinical Child and Family Psychology Review 2, 319.CrossRefGoogle ScholarPubMed
Kovacs, M., Krol, R. & Voti, L. (1994). Early onset psychopathology and the risk for teenage pregnancy among clinically referred girls. Journal of the American Academy of Child and Adolescent Psychiatry 33, 106113.CrossRefGoogle ScholarPubMed
Lahey, B., Loeber, R., Quay, H., Applegate, B., Shaffer, D., Waldman, I., Hart, E., McBurnett, K., Frick, P., Jensen, P., Dulcan, M., Canino, G. & Bird, H. (1998). Validity of DSM-IV subtypes of conduct disorder based on age of onset. Journal of the American Academy of Child and Adolescent Psychiatry 37, 435442.CrossRefGoogle ScholarPubMed
Loeber, R., Burke, J. D., Lahey, B. B., Winters, A. & Zera, M. (2000). Oppositional defiant and conduct disorder: a review of the past 10 years, Part I. Journal of the American Academy of Child and Adolescent Psychiatry 39, 14681484.CrossRefGoogle ScholarPubMed
Loeber, R., Green, S., Keenan, K. & Lahey, B. (1995). Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 34, 499509.CrossRefGoogle Scholar
Loeber, R., Keenan, K., Lahey, B., Green, S. & Thomas, C. (1993). Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder. Journal of Abnormal Child Psychology 21, 377410.CrossRefGoogle ScholarPubMed
Loeber, R. & Schmaling, K. B. (1985). Empirical evidence for overt and covert patterns of antisocial conduct problems: a metaanalysis. Journal of Abnormal Child Psychology 13, 337352.CrossRefGoogle ScholarPubMed
Loeber, R. & Stouthamer-Loeber, M. (1998). Development of juvenile aggression and violence. Some common misconceptions and controversies. American Psychology 53, 242259.CrossRefGoogle ScholarPubMed
Luthar, S. (1993). Annotation: methodological and conceptual issues in research on childhood resilience. Journal of Child Psychology and Psychiatry 34, 441453.CrossRefGoogle ScholarPubMed
Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P. & LaPadula, M. (1993). Adult outcome of hyperactive boys: educational achievement, occupational rank and psychiatric status. Archives of General Psychiatry 50, 565576.CrossRefGoogle ScholarPubMed
Marmorstein, N. R. & Iacono, W. G. (2005). Longitudinal follow-up of adolescents with late-onset antisocial behavior: a pathological yet overlooked group. Journal of the American Academy of Child and Adolescent Psychiatry 44, 12841291.CrossRefGoogle ScholarPubMed
Mennin, D., Biederman, J., Mick, E. & Faraone, S. V. (2000). Towards defining a meaningful anxiety phenotpye for research in ADHD children. Journal of Attention Disorders 3, 192199.CrossRefGoogle Scholar
Mikami, A. Y. & Hinshaw, S. P. (2003). Buffers of peer rejection among girls with and without ADHD: the role of popularity with adults and goal-directed solitary play. Journal of Abnormal Child Psychology 31, 381397.CrossRefGoogle ScholarPubMed
Moffitt, T. (1993). Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychological Review 100, 674701.CrossRefGoogle ScholarPubMed
Moffitt, T. E. (1990). Juvenile delinquency and attention deficit disorder: boys' developmental trajectories from age 3 to age 15. Child Development 61, 893910.CrossRefGoogle ScholarPubMed
Monuteaux, M., Fitzmaurice, G., Blacker, D., Buka, S. & Biederman, J. (2004). Specificity in the familial aggregation of overt and covert conduct disorder symptoms in a referred ADHD sample. Psychological Medicine 34, 115.CrossRefGoogle Scholar
Moos, R. (1985). Family Environment Scale. In The Ninth Mental Health Measurements Yearbook, Vol. 1 (ed. Mitchell, J. V.), pp. 573575. Buros Institute of Mental Measurements, University of Nebraska: Lincoln, NE.Google Scholar
Moos, R. H. & Moos, B. S. (1974). Manual for the Family Environment Scale. Consulting Psychologists Press: Palo Alto, CA.Google Scholar
Neuman, R. J., Heath, A., Reich, W., Bucholz, K. K., Madden, P. A. F., Sun, L., Todd, R. D. & Hudziak, J. J. (2001). Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins. Journal of Child Psychology and Psychiatry 42, 933942.CrossRefGoogle Scholar
Nock, M. K., Kazdin, A. E., Hiripi, E. & Kessler, R. C. (2006). Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychological Medicine 36, 699710.CrossRefGoogle ScholarPubMed
Orvaschel, H. (1994). Schedule for Affective Disorder and Schizophrenia for School-Age Children – Epidemiologic Version. Nova Southeastern University: Ft Lauderdale, FL.Google Scholar
Pajer, K. A., Kazmi, A., Gardner, W. P. & Wang, Y. (2007). Female conduct disorder: health status in young adulthood. Journal of Adolescent Health 40, 84e1–7.CrossRefGoogle ScholarPubMed
Robins, L. N. (1986). The consequences of conduct disorder in girls. In Development of Antisocial and Prosocial Behavior: Research, Theories, and Issues (ed. Olweus, D., Block, J. and Radke-Yarrow, M.), pp. 385414. Academic Press: Orlando, FL.Google Scholar
Silverthorn, P. & Frick, P. J. (1999). Developmental pathways to antisocial behavior: the delayed-onset pathway in girls. Development and Psychopathology 11, 101126.CrossRefGoogle ScholarPubMed
Smalley, S. L., McGough, J. J., Del'Homme, M., NewDelman, J., Gordon, E., Kim, T., Liu, A. & McCracken, J. T. (2000). Familial clustering of symptoms and disruptive behaviors in multiplex families with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 39, 11351143.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Williams, J. B., Gibbon, M. & First, M. B. (1990). Structured Clinical Interview for DSM-III-R: Non-Patient Edition (SCID-NP, Version 1.0). American Psychiatric Press: Washington, DC.Google Scholar
Weissman, M. M., Leckman, J. F., Merikangas, K. R., Gammon, G. D. & Prusoff, B. A. (1984). Depression and anxiety disorders in parents and children: results from the Yale Family Study. Archives of General Psychiatry 41, 845852.CrossRefGoogle ScholarPubMed
WHO (1986). ICD-10: Draft of Chapter V. Mental, Behavioural and Developmental Disorders. World Health Organization: Geneva.Google Scholar
Widom, C. S. (1989). Child abuse, neglect, and adult behavior: research design and findings on criminality, violence, and child abuse. American Journal of Orthopsychiatry 59, 355367.CrossRefGoogle ScholarPubMed
Zoccolillo, M. (1993). Gender and the development of conduct disorder. Development and Psychopathology 5, 6578.CrossRefGoogle Scholar
Zoccolillo, M., Pickles, A., Quinton, D. & Rutter, M. (1992). The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder. Psychological Medicine 22, 971986.CrossRefGoogle ScholarPubMed
Zoccolillo, M. & Rogers, K. (1991). Characteristics and outcome of hospitalized adolescent girls with conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry 30, 973981.CrossRefGoogle ScholarPubMed
Zoccolillo, M., Tremblay, R. & Vitaro, F. (1996). DSM-III-R and DSM-III criteria for conduct disorder in preadolescent girls: specific but insensitive. Journal of the American Academy of Child and Adolescent Psychiatry 35, 461470.CrossRefGoogle ScholarPubMed

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