Because comorbid conduct disorders are associated with the poorest outcomes in children with ADHD, it is important to identify significant predictors of persistent conduct disorders. Biederman et al. (2001) tested predictors of persistent conduct disorders in a 4-year follow-up of boys diagnosed with ADHD at ages 6-17. Three groups were defined according to their intake and outcome status: 24 CD “persisters,” 18 CD “desisters,” and 73 non-CD.

Persisters and desisters were similar in SES, parents’ marital status, family ADHD/CD history, age of onset of CD, and mean number of total, overt, and covert CD symptoms at intake. However, persisters had significantly higher CBCL Aggressive Behavior and Delinquent Behavior scores at both intake and follow-up. Using intake CBCL Aggressive Behavior and Delinquent Behavior syndrome T-scores > 65 as a cutoff, the researchers found that persisting vs. remitting CD was predicted with 77% accuracy. Persisters also had higher rates of special class placement, higher scores on the “Problems at School” and “Problems with Parents” scales of the Social Adjustment Inventory for Children and Adolescents (John et al., 1987), and worse scores on the “Family Cohesion” and “Family Conflict Scales” of the Family Environment Scale (Moos 1985).

In discussing the clinical implications of the study, Biederman et al. state, “Because the CBCL is an empirically derived, easy-to-administer paper-and-pencil questionnaire with excellent psychometric properties, it could serve as a useful tool to identify those at highest risk for a persistent course of CD in samples of youth with ADHD.” 

Reference: Biederman, J., Mick, E., Faraone, S.V., & Burback, M. (2001). Patterns of remission and symptom decline in conduct disorder: A four-year prospective study of an ADHD sample. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 290-298.