Society pays heavy price for failure to diagnose and treat conduct disorder

Much greater awareness, improved diagnosis and enhanced treatment are all required in order to reduce the burden on society of the severe behavioural condition conduct disorder, according to a new expert review led by the University of Bath (UK).

Conduct Disorder (CD), which is a common and highly impairing psychiatric disorder, usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour, including physical aggression, theft, property damage and violation of others’ rights.

Its prevalence is estimated at around 3% in school-aged children and it is a leading cause of referral to child and adolescent mental health services. Yet paradoxically it is one of the least widely recognised or studied psychiatric disorders, and funding for research into CD lags far behind many other childhood disorders.

What the evidence shows is that CD is associated with an exceptionally high individual, societal and economic burden. The health and personal burden of CD is seven times greater than that of attention-deficit/hyperactivity disorder (ADHD), a much more widely known disorder. Whilst it is likely that children diagnosed with ADHD may also show signs of CD, very few will be diagnosed or receive treatment for the CD. CD is also associated with a greater health burden than autism.

This failure to tackle and treat CD in children and adolescents led the researchers to write the new Nature Reviews paper which calls for a greater awareness of the condition, and more funding to improve our understanding and ability to treat the disorder.

The review – a comprehensive overview of all aspects of CD, its diagnosis, clinical management and long-term impact – highlights the negative consequences and adult outcomes that can occur if it is not correctly diagnosed or treated.

In particular it reveals the high physical and mental health burden on patients and their families. In children, CD is associated with a higher risk of developing ADHD, oppositional defiant disorder and developmental language disorders; while for teenagers, comorbidities can include depression, anxiety, alcohol and substance abuse. Up to 50% of individuals with CD develop antisocial or borderline personality disorder in adulthood, along with more serious criminal behaviour and gang involvement.

It also finds that young people with CD are more likely to have children earlier, with more unplanned pregnancies, to become dependent on benefits, homeless or even to attempt suicide. Such behaviours have a huge detrimental effect on an individual and their families. In addition, those with CD display parenting problems which often mean that their own children are at higher risk for developing CD.

However, the researchers suggest that with the correct diagnosis, management for the condition is possible with the support of Child and Adolescent Mental Health Services (CAMHS). Their study highlights the value of both training parents in better supporting children with CD, and skills training for children and adolescents with the condition to help them improve their social and problem-solving skills and their ability to regulate emotions. Combined, the authors suggest, these approaches can have profound impacts on a patient’s well-being and longer-term life chances.

Lead author Dr Graeme Fairchild from Bath’s Department of Psychology hopes the study can act as a catalyst to improve the diagnosis and treatment of children with CD, and to highlight the societal impact of the condition which he suggests requires more government funding and charity involvement.

He explains: “Despite the fact that it is associated with a very high personal, familial, and societal burden, Conduct Disorder is under-recognised and frequently goes undiagnosed and untreated. The government have committed to increasing the funding for the treatment of child and adolescent mental health problems. They should take this opportunity to improve the diagnosis and treatment of children and teenagers with Conduct Disorder by investing in training in evidence-based treatments for this condition and ensuring that the families in question can access Child and Adolescent Mental Health Services. Research in other European countries and the United States has shown that this kind of investment will pay for itself over time.”

Recent other publications from Dr Fairchild have identified brain wiring differences in children with conduct disorder as well as altered brain activity in antisocial girls.

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