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Taxonomy and comorbidity of conduct problems: Evidence from empirically based approaches

Published online by Cambridge University Press:  31 October 2008

Thomas M. Achenbach
Thomas M. Achenbach*
Affiliation:
University of Vermont
*
Address reprint requests to: Thomas M. Achenbach, Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401.
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Abstract

Many children meet criteria for multiple Diagnostic and Statistical Manual (DSM) categories, such as oppositional defiant disorder (ODD) and conduct disorder (CD). If each disorder has been well validated as a separate entity, statistically significant co-occurrence of different disorders may be highly informative. However, ODD and CD have not been well validated as separate entities. The very high rate of overlap between diagnoses of ODD and CD may therefore arise artifactually from the lack of a valid distinction between them, rather than from potentially informative comorbidity between two different disorders. Empirical research strongly supports a distinction between two syndromes that correspond to subsets of the DSM-III-R criteria for CD. Designated as delinquent behavior and aggressive behavior, these syndromes have been found to differ in biological correlates, heritability, developmental stability, course, response to interventions, and long-term outcomes. At this stage of our knowledge, empirically based assessment and taxonomic methods can be especially useful for distinguishing between syndromes, deriving norms, doing longitudinal studies, and detecting patterns of comorbidity. These methods do not preclude categorical taxa, which can be formed by imposing cutpoints on the distributions of syndrome scores. Categorical taxa can also be formed by cluster analyzing profiles of syndrome scores. Accelerated longitudinal designs can bring multiple analyses to bear on empirically derived syndromes to test complex developmental relations more quickly and powerfully than can traditional longitudinal designs. Follow-ups of high-risk groups can identify variables that predict good versus poor outcomes if standardized baseline and outcome measures are used. Interventions for conduct problems should be designed to counteract the risk factors found to predict poor long-term outcomes.

Type
Articles
Information
Development and Psychopathology , Volume 5 , Issue 1-2 , Winter-Spring 1993 , pp. 51 - 64
Copyright
Copyright © Cambridge University Press 1993

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References

Achenbach, T. M. (1991a). “Comorbidity” in child and adolescent psychiatry: Categorical and quantitative perspectives. Journal of Child and Adolescent Psychopharmacology, 1, 271–278.CrossRefGoogle Scholar
Achenbach, T. M. (1991b). Integrative guide for the 1991 CBCL/4–18, YSR, and TRF profiles. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M. (1991c). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M. (1991d). Manual for the Teacher's Report Form and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M. (1991e). Manual for the Youth Self-Report and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M. (1992). Manual for the Child Behavior Checklist/2–3 and 1992 Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M. (1993). Empirically based taxonomy: How to use syndromes and profile types derived from the CBC44–18, TRF, and YSR. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Achenbach, T. M., Conners, C. K., Quay, H. C., Verhulst, F. C., & Howell, C. T. (1989). Replication of empirically derived syndromes as a basis for taxonomy of child/adolescent psychopathology. Journal of Abnormal Child Psychology, 17, 299–323.CrossRefGoogle ScholarPubMed
Achenbach, T. M., & Edelbrock, C. (1978). The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin, 85, 1275–1301.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1968, 1980, 1987, 1993). Diagnostic and statistical manual of mental disorders (2nd ed.; 3rd ed.; 3rd ed., rev.; 4th ed.). Washington, DC: Author.Google Scholar
August, G. J., & Garfinkel, B. D. (1990). Comorbidity of ADHD and reading disability among clinic-referred children. Journal of Abnormal Child Psychology, 18, 29–45.CrossRefGoogle ScholarPubMed
Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148, 564–577.Google ScholarPubMed
Birmaher, B., Stanley, M., Greenhill, L., Twomey, I., Gavrilescu, A., & Rabinovich, H. (1990). Platelet imipramine binding in children and adolescents with impulsive behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 914–918.CrossRefGoogle ScholarPubMed
Brown, S.-L., & van Praag, H. M. (Eds.). (1991). The role of serotonin in psychiatric disorders. New York: Brunner/Mazel.Google Scholar
Butterfield, F. (1992, 07 19). Are American jails becoming shelter from the storm? New York Times, Section 4, p. 4.Google Scholar
Cantor, N., & Genero, N. (1986). Psychiatric diagnosis and natural categorization: A close analogy. In Millon, T. & Klerman, G. L. (Eds.), Contemporary directions in psychopathology: Toward the DSM IV (pp. 233–256). New York: Guilford Press.Google Scholar
Cantor, N., Smith, E. E., French, R. deS., & Mezzich, J. (1980). Psychiatric diagnosis as prototype categorization. Journal of Abnormal Psychology, 89, 181–193.CrossRefGoogle ScholarPubMed
Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues, and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063–1080.CrossRefGoogle ScholarPubMed
Costello, A. J., Edelbrock, C., Dulcan, M. K., Kalas, R., & Klaric, S. H. (1984). Report on the Diagnostic Interview Schedule for Children (DISC). Pittsburgh, PA: University of Pittsburgh, Department of Psychiatry.Google Scholar
DiLalla, L. F., & Gottesman, I. I. (1989). Heterogeneity of causes for delinquency and criminality: Life-span perspectives. Development and Psychopathology, 1, 339–349.CrossRefGoogle Scholar
Edelbrock, C., Rende, R., Plomin, R., & Thompson, L. A. (1993). Genetic and environmental effects on competence and problem behavior in childhood and early adolescence. Journal of Child Psychology and Psychiatry, (in press).Google Scholar
Education of the Handicapped Act. (1977, 1981). Federal Register, 42, 42478. Amended in Federal Register (1981), 46, 3866.Google Scholar
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, 112–117.Google ScholarPubMed
Furth, H. G. (1969). Piaget and knowledge. Theoretical foundations. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Ghodsian-Carpey, J., & Baker, L. A. (1987). Genetic and environmental influences on aggression in 4- to 7-year-old twins. Aggressive Behavior, 13, 173–186.3.0.CO;2-Y>CrossRefGoogle Scholar
Gray, J. A. (1982). The neuropsychology of anxiety: An inquiry into the function of the septo-hippocampal system. New York: Oxford University Press.Google Scholar
Gray, J. A. (1987a). Perspectives on anxiety and impulsivity: A commentary. Journal of Research in Personality, 21, 493–509.CrossRefGoogle Scholar
Gray, J. A. (1987b). The psychology of fear and stress. New York: Cambridge University Press.Google Scholar
Group for the Advancement of Psychiatry. (1966). Psychopathological disorders in childhood: Theoretical considerations and a proposed classification. GAP Report No. 62.Google Scholar
Guzé, S. (1978). Validating criteria for psychiatric diagnosis: The Washington University approach. In Akiskal, M. S. & Webb, W. L. (Eds.), Psychiatric diagnosis: Exploration of biological predictors. New York: Spectrum.Google Scholar
Henn, F. A., Bardwell, R., & Jenkins, R. L. (1980). Juvenile delinquents revisited. Adult criminal activity. Archives of General Psychiatry, 37, 1160–1163.CrossRefGoogle ScholarPubMed
Hewitt, L. E., & Jenkins, R. L. (1946). Fundamental patterns of maladjustment: The dynamics of their origin. Springfield: State of Illinois.Google Scholar
Hinshaw, S. P., Lahey, B. B., & Hart, E. L. (1993). Issues of taxonomy and comorbidity in the development of conduct disorder. Development and Psychopathology, 5, 31–49.CrossRefGoogle Scholar
Horowitz, L. M., Post, D. L., French, R. deS., Wallis, K. D., & Siegelman, E. Y. (1981). The prototype as a construct in abnormal psychology: 2. Clarifying disagreement in psychiatric judgments. Journal of Abnormal Psychology, 90, 575–585.CrossRefGoogle ScholarPubMed
Horowitz, L. M., Wright, J. C., Lowenstein, E., & Parad, H. W. (1981). The prototype as a construct in abnormal psychology: 1. A method for deriving prototypes. Journal of Abnormal Psychology, 90, 568–574.CrossRefGoogle Scholar
Individuals with Disabilities Education Act. (1990). Public Law 101–476. 104 Statutes, 1103–1151.Google Scholar
Jenkins, R. L., & Boyer, A. (1968). Types of delinquent behavior and background factors. International Journal of Social Psychiatry, 14, 65–76.CrossRefGoogle Scholar
Kagan, J. (1969). The three faces of continuity in human development. In Goslin, D. A. (Ed.), Handbook of socialization theory and research (pp. 983–1002). Chicago, IL: Rand McNally.Google Scholar
Kraepelin, E. (1883, 1915). Compendium der Psychiatrie. Leipzig: Abel.Google Scholar
Lahey, B. B., Loeber, R., Stouthamer-Loeber, M., Christ, M. A. G., Green, S., Russo, M. F., Frick, P. J., & Dulcan, M. (1990). Comparison of DSM-III and DSM-III-R diagnoses for prepubertal children: Changes in prevalence and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 620–626.CrossRefGoogle ScholarPubMed
Loeber, R., & Schmaling, K. B. (1985). Empirical evidence for overt and covert patterns of antisocial conduct problems: A meta-analysis. Journal of Abnormal Child Psychology, 13, 337–352.CrossRefGoogle Scholar
McClellan, J. M., Rubert, M. P., Reichler, R. J., & Sylvester, C. E. (1990). Attention deficit disorder in children at risk for anxiety and depression. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 534–539.CrossRefGoogle ScholarPubMed
McConaughy, S. H., Stanger, C., & Achenbach, T. M. (1992). Three-year course of behavioral/emotional problems in a national sample of 4- to 16-year-olds: I. Agreement among informants. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 932–940.CrossRefGoogle Scholar
Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Manuscript submitted for publication.CrossRefGoogle Scholar
Quay, H. C. (1986). Classification. In Quay, H. C. & Werry, J. S. (Eds.), Psychopathological disorders of childhood (3rd ed., pp. 1–42). New York: Wiley.Google Scholar
Quay, H. C. (1993). The psychobiology of undersocialized aggressive conduct disorder: A theoretical perspective. Development and Psychopathology, 5, 165–180.CrossRefGoogle Scholar
Rosch, E. (1978). Principles of categorization. In Rosch, E. & Lloyd, B. B. (Eds.), Cognition and categorization (pp. 27–48). Hillsdale, NJ: Erlbaum.Google Scholar
Spitzer, R. L., Davies, M., & Barkley, R. A. (1990). The DSM-III-R field trial of disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 690–697.CrossRefGoogle ScholarPubMed
Stanger, C., McConaughy, S. H., & Achenbach, T. M. (1992). Three-year course of behavioral/emotional problems in a national sample of 4- to 16-year-olds: I. Predictors of syndromes. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 941–950.CrossRefGoogle Scholar
Stanger, C., Achenbach, T. M., & Verhulst, F. C. (1993). Accelerated longitudinal research on aggressive and delinquent behavior. Presented at the Society for Research in Child and Adolescent Psychopathology, Santa Fe, New Mexico.Google Scholar
Steingard, R., Biederman, J., Doyle, A., & Sprich-Buckminster, S. (1992). Psychiatric comorbidity in attention deficit disorder: Impact on the interpretation of Child Behavior Checklist results. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 449–454.CrossRefGoogle ScholarPubMed
Stoff, D. M., Pollack, L., Vitiello, B., Behar, D., & Bridger, W. H. (1987). Reduction of 3-Himipramine binding sites on platelets of conduct disordered children. Neuropsychopharmacology, 155, 62.Google Scholar
Van Den Oord, E. J. C. G., Boomsma, D. I., & Verhulst, F. C. (1993). Genetic and environmental influences on problem behaviors in international adoptees: Evidence for sibling cooperation. Manuscript submitted for publication.Google Scholar
Verhulst, F. C., Koot, H. M., & Berden, G. F. M. G. (1990). Four-year follow-up of an epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 440–448.CrossRefGoogle ScholarPubMed
Walker, J. L., Lahey, B. B., Russo, M. F., Christ, M. A. G., McBurnett, K., Loeber, R., Stouthamer-Loeber, M., & Green, S. M. (1991). Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 187–191.CrossRefGoogle ScholarPubMed
Weinstein, S. R., Noam, G. G., Grimes, K., Stone, K., & Schwab-Stone, M. (1990). Convergence of DSM-III diagnoses and self-reported symptoms in child and adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 627–634.CrossRefGoogle ScholarPubMed
World Health Organization. (1978, 1992). Mental disorders: Glossary and guide to their classification in accordance with the Ninth Revision of the International Classification of Diseases (9th and 10th eds.). Geneva: Author.Google Scholar
Zoccolillo, M. (1993). Gender and the development of conduct disorder. Development and Psychopathology, 5, 65–78.CrossRefGoogle Scholar