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OBJECTIVE: To present data from the DSM-IV field trials that led to the distinction between subtypes of conduct disorder (CD) that emerge in childhood or adolescence. In addition, data from a household sample were used to attempt to cross-validate these findings. METHOD: Differences between youths who met criteria for the two subtypes of CD were examined in the field trials sample of 440 youths aged 4 through 17 years and in a household sample of 1,285 youths aged 9 through 17 years. RESULTS: In both samples, there was a steep decline in aggression occurring around an age of onset of 10 years, but the number of nonaggressive behaviors was unrelated to the age of onset of CD. In the field trials sample, youths who met criteria for the adolescent-onset type were more likely to be girls, less likely to meet criteria for oppositional defiant disorder, and less likely to have a family history of antisocial behavior than the childhood-onset type, but these latter findings were not confirmed in the household sample. CONCLUSIONS: The DSM-IV approach to subtyping CD distinguishes subgroups that differ markedly in level of physical aggression. The advantages of a developmental approach to subtyping are discussed.

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This paper updates the author's earlier hypothesis that Attention Deficit Hyperactivity Disorder (ADHD) reflects underactivity in Gray's Behavioral Inhibition System. Five areas of research are reviewed: (1) studies using the stop-signal task, (2) studies of errors of commission, (3) a study of inhibition indexed by eye movements, (4) a neuroimaging study of the corpus callosum, and (5) a study on the prediction of response to methylphenidate. Data from the many different dependent variables in these studies are interpreted as supporting disinhibition as a core deficit in ADHD.

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We screened students (N = 710) in grades four through six at two public elementary schools for behavior problems, using the Revised Behavior Problem Checklist. Five groups of children were identified: conduct disorder (n = 8), attention deficit disorder (n = 9), conduct disorder plus attention deficit disorder with hyperactivity (n = 11), anxiety-withdrawal (n = 12), and normal control (n = 15). A response perseveration task, inhibitory control task, and a noninvasive measure of dopaminergic activity were administered to selected students, and group differences were predicted based on Quay's hypotheses as derived from Gray's theory of brain function. Hypothesized group differences were not found, although analyses revealed dimensional relationships that were consistent with the hypotheses. Results are discussed in terms of Quay's hypotheses and potential modifications to tasks for future research.

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Oppositional defiant disorder (ODD) and conduct disorder (CD) are reasonably distinct both in terms of statistical covariation among symptoms and ages of onset. The two disorders are related in similar ways to impairment and family history of antisocial behavior, but the association is stronger for CD than ODD. Virtually all clinic-referred youths with prepubertal onset of CD have retained the symptoms of ODD that emerged at earlier ages. Furthermore, a set of serious antisocial behaviors characteristically emerges at later ages in some youths with CD, suggesting further developmental progression within CD. These findings are consistent with a conceptualization of ODD and CD as developmentally staged, hierarchically organized levels of severity of the same disorder, but two findings argue for distinguishing separate disorders in DSM-IV: (1) many youths with ODD never develop CD, and (2) CD that emerges for the first time in adolescence appears to be independent of ODD.

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Students (N = 814) in grades 3 through 6 at a public school were screened for behavior problems using the Revised Behavior Problem Checklist. Fifty-three selected students, representing Conduct Disorder, Attention Deficit Disorder with Hyperactivity, Conduct Disorder plus Attention Deficit Disorder with Hyperactivity, Anxiety-Withdrawal Disorder, and normal controls were administered a response perseveration task and delayed responding task (DRL). It was predicted that performance on the two tasks would vary as a function of group membership. While DRL performance did not vary between groups, findings on the response perseveration task provided support for the hypothesis of the perseverative responding for reward in Conduct Disorder.

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We compared parent-reported problems and competencies for national samples of 2,600 4-16-year-olds assessed at intake into mental health services and 2,600 demographically matched nonreferred children assessed in a home interview survey. Parents responded to the ACQ Behavior Checklist, which includes 23 competence items, three competence scales, 216 problem items, eight syndrome scales, Internalizing, Externalizing, and total competence and problem scores. Most items and scales discriminated significantly (p less than .01) between referred and nonreferred samples. There were important sex and age differences in problem patterns, but regional and ethnic differences were minimal. Somewhat more problems and fewer competencies were reported for lower- than upper-socioeconomic-status children. Referral rates were similar in the most urban and rural areas, but they were significantly higher in areas of intermediate urbanization. Correlations of problem scores with those obtained 10 years earlier in a regional survey and with surveys in other countries showed considerable consistency in the rank order of prevalence rates among specific problems. Apparently owing to its more differentiated response scales, the ACQ was susceptible to respondent characteristics that reduced its discriminative power below that of the Child Behavior Checklist. Comparisons of procedures for discriminating between the normal and the clinical range supported the value of a borderline category for children who are neither clearly normal nor clearly deviant. Interview data from the survey sample yielded significantly higher ACQ problem scores for children who had fewer related adults in their homes, those who had more unrelated adults in their homes, those whose biological parents were unmarried, separated, or divorced, those whose families received public assistance, and those whose household or family members had received mental health services. Children who scored higher on Externalizing than Internalizing problems tended to have unmarried, separated, or divorced parents and to come from families receiving public assistance. However, among children whose household or family members had received mental health services, there were greater proportions of both Externalizing and Internalizing patterns than among other children.

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To advance the empirical identification of child/adolescent syndromes, principal components analyses were performed on four sets of parents' ratings of 8,194 6- to 16-year-olds referred to American and Dutch mental health services. The following syndromes replicated well for both sexes at ages 6-16: Aggressive, Anxious/Depressed, Attention Problems, Delinquent, Somatic Complaints, and Withdrawn. For both age ranges, a syndrome designated as Socially Inept replicated well among boys, and one designated as Mean replicated well among girls. Evidence was also found for a Schizoid syndrome in all sex/age groups and a Sex Problems syndrome among girls at ages 6-11. Syndrome scores discriminated well between nationwide normative and clinical samples. The replicated syndromes contribute to the empirical basis for a taxonomy of the kinds of disorders commonly seen between the ages of 6 and 16.

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A factor analysis of teacher ratings of 55 items of deviant behavior in a sample of 252 institutionalized retardates resulted in the emergence of three interpretable factors. Two factors clearly represented the broad-band dimensions of conduct disorder and anxiety-withdrawal, while the third reflected psychotic behavior. Only conduct disorder was related to age, sex, race, or intellectual level.

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