ABSTRACT
Disruptive behavior disorders (DBDs; e.g., conduct disorder [CD], oppositional defiant disorder [ODD], and attention deficit hyperactivity disorder [ADHD]) are among the most common behavioral and emotional problems for children and adolescents to present to clinical settings. Prevalence data from population-based studies show rates of DBDs ranging from 2.1% to 14.2% in children and 4.5% to 15.8% in adolescents (Loeber, Burke, Lahey, Winters, & Zera, 2000). Consensus among delinquency studies show an increase from childhood through adolescence in the prevalence of nonaggressive CD behaviors such as serious theft and fraud (Loeber & Farrington, 1998; Loeber, Farrington, & Waschbusch, 1998) and covert behaviors (Loeber & Stouthamer-Loeber, 1998). Although many forms of aggression decrease into adolescence, the prevalence of more serious forms of aggression such as rape, robbery, and attempted or completed homicide tend to increase during adolescence (Loeber & Farrington, 1998). DBDs have a high level of comorbidity not only with other DBDs but with other psychiatric disorders such as anxiety and depressive disorders and substance use disorders (Jensen et al., 1999; Loeber et al., 2000). Overall, 30% to 80% of diagnosed hyperactive children continue to have features of ADHD persisting into adolescence and up to 65% into adulthood (Barkley, Murphy, & Kwasnik, 1996; Weiss & Hechtman, 1993). In one recent study (Barkley, Murphy, & Kwasnik, 1996), over 70% of hyperactive children continued to meet criteria for ADHD as adolescents. A family history of ADHD, psychosocial adversity, and comorbidity with conduct, mood, and anxiety disorders increase the risk of
Oscar G. Bukstein University of Pittsburgh School of Medicine
persistence of ADHD symptoms (Biederman et al., 1996). As suggested by these potential adverse outcomes, DBDs in children and adolescents carry an increased risk for a heavy burden of suffering in terms of its relatively high prevalence and high societal costs (Offord, Boyle, & Racine, 1989).
