Waxing and waning in concert: Dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 17 years among clinic-referred boys.

Abstract

Six waves of structured diagnostic assessments were conducted of 168 clinic-referred 7-to 12-year-olds, over 7 years. Wave-to-wave changes in the number of conduct disorder (CD) behaviors were paralleled by correlated changes in the numbers of symptoms of oppositional defiant disorder (ODD), attentiondeficit/hyperactivity disorder (ADHD), depression, and anxiety. In addition, CD in Wave 1 predicted levels of ODD, ADHD, depression, and anxiety in later waves when initial levels of those symptoms were controlled, but only ODD in Wave 1 predicted CD in later waves when initial CD levels were controlled. These findings indicate a striking degree of dynamic comorbidity between CD and other types of psychopathology and provide an initial empirical framework for needed developmental models of comorbidity.Conduct disorder (CD) co-occurs at greater than chance levels with oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and depressive disorders in both clinical and population-based samples (Angold, Costello, & Erkanli, 1999;Caron & Rutter, 1991;Lahey, Miller, Gordon, & Riley, 1999;Loeber & Keenan, 1994;Moffitt, Caspi, Rutter, & Silva, 2001). Comorbid psychopathology almost certainly contributes to the distress and functional impairment experienced by youths with CD and complicates their treatment. Moreover, theories of the origins and course of CD that do not explain its high degree of comorbidity with other types of psychopathology would be incomplete. Therefore, understanding these patterns of comorbidity is essential to understanding the fundamental nature of both CD and its comorbid conditions. Caron and Rutter (1991) and Loeber and Keenan (1994) noted the particular need for longitudinal studies of comorbidity to understand the developmental relationships among disorders. Among other things, such studies would help to determine if (a) one type of psychopathology tends to precede another in developmental time and increase the likelihood of the latter type of psychopathology, (b) whether CD and other disorders are more likely to be comorbid at particular times in development than other times, and (c) whether CD and other disorders tend to wax and wane in concert over time. Such information would provide much of the necessary empirical framework for theories of both the development of CD and its dynamic comorbidity with other disorders.

Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication

“…The prevalence of individual CD symptoms varies widely and the median age-of-onset for CD is 11.6 (0.2). Consistent with prior reports, CD is significantly more prevalent among boys (12.0%) than girls (7.1%), and is associated with low education, marital disruption, and urban residence (Lahey et al, 2002;Lambert et al, 2001;Loeber & Keenen, 1994). In addition, CD is estimated to be significantly more prevalent in the West than in other regions of the country.…”

“…There also are questions regarding the widely documented comorbidity of CD with other mental disorders (Kim-Cohen et al, 2003;Lahey, Loeber, Burke, Rathouz, & McBurnett, 2002;Lahey, Miller, Gordon, & Riley, 1999;Loeber, Burke et al, 2000;Maughan et al, 2004). Although it is clear that CD is associated with other disorders, little is known about whether comorbid disorders precede or follow the onset of CD, whether comorbidities differ by CD subtype, or whether CD is associated with the adult persistence of comorbid disorders.…”

Patterns of Psychopathology in the Families of Children with Conduct Problems, Depression, and both Psychiatric Conditions

“…According to this theory, factors such as peer rejection, school failure, and social isolation develop as secondary consequences of aggressive and antisocial behavior (Keiley, Lofthouse, Bates, Dodge, & Pettit, 2003). In a longitudinal study of clinic referred boys, initially high levels of CD predicted increases in depression at later assessments, even when controlling for initial levels of depression (Lahey, Loeber, Burke, Rathouz, & McBurnett, 2002). In contrast, initially high levels of depression did not predict later increases in CD symptoms.…”

“…Longitudinal research has also indicated that comorbid symptoms both within and across the externalizing and internalizing spectra tend to covary over time. That is, increases in depression tend to occur with increases in CD, and not necessarily before or after such increases (Lahey et al, 2002). Whether these covarying changes derive from common biological mechanisms or environmental influences remains to be determined.…”

Affective Decision-Making and Externalizing Behaviors: The Role of Autonomic Activity

“…These correlates include deficient social problem-solving skills and impaired social functioning (Frankel and Feinberg 2002;Matthys et al 1999), poor academic achievement Rapport et al 1999), and co-occurring internalizing disorders Jensen et al 2001). In addition, ADHD and ODD are related prospectively to substance use, poor academic achievement, conduct disorder (CD), and antisocial behavior (Masten et al 2005;van Bokhoven et al 2005), though the association between ADHD and CD may be accounted for by co-occurring ODD (Lahey et al 2002;van Lier et al 2007). …”