Natural History

Other psychiatric disorders frequently occur in conjunction with conduct disorder. The most prevalent comorbid (coexisting) psychiatric disorder is attention deficit disorder. By adolescence, the comorbid conditions of psychoactive substance use disorder with depressive disorders often emerge; however, virtually any type of psychiatric disorder can be present concurrently with CD (Rutter, 1984). By adulthood, an ANTISOCIAL PERSONALITY disorder is the most common outcome of CD; this disorder may also be accompanied by any other psychiatric disorder.

Among those who have CD with attention deficit disorder, the onset age of behavior problems tends to be earlier and more severe than in cases with either disorder alone. In the situation where both are present, children are also at greater risk for developing criminal behavior and substance abuse by adolescence or young adulthood.

The coexistence of CD and substance abuse has been frequently observed. It is estimated that as many as 50 percent of serious offenders are substance abusers. In these cases, CD usually preceded the onset of substance abuse. Some evidence has been marshaled to suggest that, for many individuals, substance abuse and CD are the overt expressions of a common underlying predisposition. Only in some cases, does the onset of CD follow the onset of substance abuse. Drug use during adolescence, by virtue of its pattern of illegal behavior plus association with nonnormative peers, increases the risk for violent assault as well as getting arrested and convicted for drug possession or distribution. In effect, the use of drugs in this circumstance socializes a person to a deviant lifestyle by early to mid-adolescence.

Approximately 30 percent of boys with CD also qualify for a diagnosis of DEPRESSION. In this comorbid condition, there appears to be a lower risk of depression in adulthood compared to cases of depression in childhood without CD. Since the outcome of depressed children with comorbid CD is similar to nondepressed CD children, this suggests that the affective disturbance is a secondary condition.

CD in childhood is associated with an increased risk for antisocial personality disorder in adulthood. Compared to other psychiatric disorders of childhood, CD is the most likely to remain stable. Persistence of conduct problems into adulthood is most likely if the behavior problems are serious, are generalized across multiple environments or situations, have an early age onset, and lead the person into the criminal-justice system (Loeber, 1991).

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