ABSTRACT
Conduct problems constitute a third to a half of all clinic referrals (Burke, Loeber & Birmaher, 2002; Farrington, 1995; Kazdin, 1995; Loeber, Burke, Lahey, Winters & Zera, 2000). One of the most common referrals in child and family psychology is a boy in middle childhood who presents with conduct problems, specific learning difficulties and related family and school problems. Conduct problems are the single most costly disorder of childhood and adolescence for three reasons. First, they are remarkably unresponsive to treatment. Positive outcome rates for routine treatments range from 20 to 40%. Second, about 60% of children with conduct problems have a poor prognosis. A summary of some of the adult outcomes for children with conduct disorder is presented in Table 10.1. From this figure it is apparent that
Table 10.1 Outcome for adults identified as conduct disordered during childhood or adolescence compared with control groups
Criminality More criminal behaviour, arrests, convictions, imprisonment and rates of driving while intoxicated
Mental health Higher rates of psychiatric hospitalization and higher rates of all psychological symptoms, anti-social personality disorder, drug abuse and alcohol abuse
Physical health Higher rates of hospitalization and mortality
Educational attainment
Higher rates of school drop-out and lower attainment levels
Occupational adjustment
Higher unemployment, lower occupational status if employed, more frequent job changes
Marital adjustment Higher rates of separation, divorce and remarriage
Social adjustment Less contact with relatives, friends, neighbours and church Intergenerational transmission
More children with conduct problems
children with conduct disorder turn to adult criminality and develop antisocial personality disorders, alcohol-related problems and a variety of psychological difficulties. They also have more problems with health, educational attainment, occupational adjustment, marital stability and social integration. The third reason for the high cost of conduct problems is the fact that they are intergenerationally transmitted. Adults with a history of conduct disorder rear children with a particularly high prevalence of conduct difficulties.
