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Professor of Child and Adolescent Psychiatry, School of Psychiatry and Behavioural Sciences, University of Manchester, Royal Manchester Children's Hospital, Hospital Road, Pendlebury Manchester M27 4HA, UK - Conduct Disorders in Childhood and Adolescence Edited by Jonathan Hill & Barbara Maughan. Cambridge: Cambridge University Press. 2000. 581pp. $ 39.95 (pb). ISBN 0 521 78639 8

Published online by Cambridge University Press:  02 January 2018

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Copyright © 2002 The Royal College of Psychiatrists 

Is it possible to study bad behaviour in children from a scientific standpoint? The answer to the question is by no means obvious. Society has puzzled for thousands of years over what to do with children who do not do what adults want them to. Most of its solutions have little to do with science and much more to do with criminal justice and the moral standards of society. Of course, no one can seriously dispute the fact that some children show a syndrome of antisocial behaviours that has substantial effects on others. This syndrome can be assessed with high reliability and passes many of the conventional tests that psychiatry sets for its diagnostic categories. Indeed, conduct disorder passes more of these tests than many other child psychiatric problems. For example, more than 30 years of research has consistently shown that a diagnosis of conduct disorder in childhood is a robust predictor of important outcomes in adulthood, particularly personality and social dysfunction. Conduct disorder also shows a reliable association with a cluster of family problems such as poor supervision and family discord.

But the question remains: can a disorder in which the chief characteristic is behaviour that gives rise to social disapproval ever be studied using conventional scientific methods? This excellent book shows that it can, but only if the approach taken is multi-disciplinary and tackles the problem from several different viewpoints. The book is based on three key themes and each is approached from a variety of perspectives.

The first is the nature and phenomenology of conduct disorder. It might be thought that, since conduct disorder is now operationalised in both DSM and ICD, any questions about its nosology have been resolved. This is very far from being the case. Current controversies centre around three main issues: (a) ‘normal’ behaviour v. conduct disorder; (b) the extent to which antisocial behaviour at one age is isomorphic with antisocial behaviour at another; and (c) the best way of dividing up what is undoubtedly a heterogeneous group of problems. This last issue provides a good illustration of the scope of this book, in which aggression is studied from a cognitive, neurobiological, phenomenological, philosophical and epidemiological perspective.

The second key issue is the interface between these perspectives. It is clear that the field is now moving beyond the question of how much is biology and how much is social to the much more interesting and potentially rewarding question of how the two interact. Of course, it is almost a cliché these days to talk of the interaction between nature and nurture. One of the many strengths of this book is that we are given examples of how the two work together. This comes over particularly well in the chapters on neurobiology and genetics, but is touched on by many other contributors.

The third theme is the prevention and treatment of conduct disorder. Conduct disorder is notoriously difficult to treat and often presages poor social adjustment in adulthood. One of the heartening themes from the research reviewed here is that treatment is possible. Intensive interventions that are delivered at several different levels, including the child and the family, do seem to work. Nevertheless, they are very labour intensive and not surprisingly there has also been a lot of research on prevention. Again, there are some encouraging findings. Early interventions can help to prevent important outcomes several years later, although the effects are typically small.

This publication provides a comprehensive and up-to-date account of conduct disorder and it will be of interest to a wide range of mental health professionals. The editors are to be congratulated not only because they have assembled some of the best known researchers and academics in this field but also because they have encouraged them to produce some truly first-class work. Much original material is presented, something that cannot always be said about multi-author books on problems like conduct disorder. This is one of the best current books on the topic and it deserves to be widely read.

References

EDITED BY SIDNEY CROWN and ALAN LEE

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