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=Conduct Disorder (description, assessment and diagnosis)=

Overview
Overview of Multistage Strategy for Evidence-Based Assessment of Conduct Disorder (adapted from McMahon and Frick, 2005; 2007) Stage 1:

Stage 2:
 * Achenbach System of Empirically Based Assessments (ASEBA): Child Behavior Checklist (CBCL), Teacher Report Form (TRF), Youth Self-Report (YSR)
 * 1) Used to broadly identify behaviors relevant to conduct disorder
 * Antisocial Process Screening Device (APSD)
 * 1) Used to determine whether child or adolescent is displaying callous and unemotional (CU) traits
 * 2) See Appendix 3 for proposed revisions to diagnosis of Conduct Disorder for DSM-IV: additional specifier for CU
 * Structured Diagnostic Interview
 * 1) (Available online: KSADS: http://www.wpic.pitt.edu/ksads/KSADS-PL_2009_working_draft_full.PDF)
 * 2) Helps to assess potential comorbidity.
 * Standardized intelligence test and academic achievement screener
 * Developmental and medical history obtained through clinical interview
 * Observational analogues, including parent-child interactions – examples:
 * 1) Child’s Game
 * 2) Parent’s Game
 * 3) Clean Up
 * Parent observation measures
 * 1) E.g., Parent Daily Report
 * Level of functional impairment or adaptive disability determined through interviews or ratings
 * 1) E.g., Child and Adolescent Functional Assessment Scale
 * Age of onset of conduct problems established through clinical or structured interviews with parent or youth
 * 1) Helps determine developmental pathway (see Moffitt’s (1993) seminal article “Adolescent-limited and life-course persistent antisocial behavior: A developmental taxonomy”), which has implications for the “three P’s”
 * 2) Helps determine temporal ordering of potential comorbid disorders (e.g., did anxiety problems precede conduct problems, or vice-versa?), which also has implications for “three P’s”

Stage 3:
 * Broader social and environmental context should be assessed.
 * 1) E.g., Neighborhood Questionnaire, Community Interaction Checklist, Things I Have Seen and Heard
 * Assessment of social informational processing could yield important information relevant to the “three P’s”
 * 1) E.g., Intention-Cue Detection Task
 * Parental/personal adjustment assessment to assess for familial risk factors
 * 1) E.g., Antisocial Behavior Checklist
 * Further assessments specific to the symptomatology of the child or adolescent should be conducted
 * 1) E.g., assessments specific to fire-setting behaviors

Additional notes:
 * Covert conduct problem behaviors are difficult to assess, and the clinical utility of some innovative observational paradigms needs to be demonstrated.
 * McMahon & Frick (2005) point to the “recent proliferation of research concerning girls and CP (p. 496) and suggest that this emerging research “should facilitate the development of evidence-based guidelines that are applicable to girls in the near future.” For the time being, they recommend following the same guidelines for girls as for boys, with the addition of a measure of relational aggression in girls.

Sources:
 * McMahon, R. J. & Frick, P. J. (2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 477-505.
 * McMahon, R. J. & Frick, P. J. (2007). Conduct and oppositional disorders. In E.J. Mash & R.A. Barkley (Eds.), Assessment of childhood disorders (4th ed., p. 132-183). New York: The Guilford Press.

Diagnostic Changes
The same 4 domains of symptoms are used in DSM-IV as in DSM-5, and of these, 3 of the 4 must have been present in the last twelve months for diagnosis:
 * aggression to people or animals;
 * destruction of property;
 * deceitfulness or theft;
 * serious violations of rules.

The changes in DSM-5 to conduct disorder are as follows:
 * 1) A descriptive specifier has been added for individuals who meet full criteria for the disorder;
 * 2) This specifier applies to those with conduct disorder who show a callous and unemotional interpersonal style across multiple settings and relationships.

Base Rates of Conduct Disorder in different clinical settings
p Parent interviewed as part of diagnostic assessment; y youth interviewed as part of diagnostic assessment; r adult interviewed for retrospective report as part of diagnostic assessment.

Notes: CIDI = World Health Organization (WHO) Composite International Diagnostic Interview; CAPA = Child and Adolescent Psychiatric Interview; SCID-IV = Structured Clinical Interview for DSM-IV.

Despite a plethora of studies assessing prevalence of comorbidity of conduct disorder with other disorders (e.g., substance abuse, bipolar, ADHD), searches outlined below did not yield a single study providing a prevalence of conduct disorder alone in an outpatient or community clinic setting.

Treatments
See Effective Child Therapy, a website sponsored by The Society for Child and Adolescent Psychology (APA, Division 53) and the Association for Behavioral and Cognitive Therapies (ABCT), for current summary of evidence-based treatments.

Community Resources
1. Deborah Jones, Ph.D., Private Practice Clinician specializing in cognitive-behavioral therapies and behavioral family-systems therapies for children, adolescents and their families (and Associate Professor of Clinical Psychology at UNC)

2. AHB Center for Behavioral Health and Wellness – Information and articles from April Harris Britt, Ph.D..

3. Center for Child and Family Health – Restoring Stability and Hope for Children & Families.

4. Chapel Hill-Carrboro YMCA: Boomerang – Program housed in the YMCA, recommended by Deborah Jones, Ph.D. The program is designed as an alternative program for youth who are suspended; 919-442-9622.

5. Effective Child Therapy –a website sponsored by The Society for Child and Adolescent Psychology (APA, Division 53) and the Association for Behavioral and Cognitive Therapies (ABCT), was launched in April of 2010 to offer information to parents, clinicians, and the general public about evidence-based treatments for disorders including conduct disorder. The website is coordinated by Mitch Prinstein of UNC (mitch.prinstein@unc.edu) and John Guerry of UNC (jguerry@unc.edu). This website provides helpful information for parents, and it also provides a search function to look for therapists in specific geographic areas who are trained in cognitive-behavioral therapies.