Subtypes of DSM Conduct Disorder in a National Sample of Australian Boys

Conduct problems are of great concern to mental health workers, educators, parents, and society as a whole. Major investments have been made in efforts to understand, prevent, and treat conduct problems. The DSM-IV lists 15 criterial symptoms for Conduct Disorder (CD). Any 3 of the 15 symptoms can qualify a youth for the diagnosis.

Consequently, some youths may be diagnosed as having CD on the basis of 3 kinds of overtly aggressive behavior (e.g., forced sex; use of a dangerous weapon; physical cruelty to animals or people). Others may be diagnosed on the basis of 3 kinds of nonaggressive behaviors (e.g., lying, stealing, staying out late, running away from home, truancy).

Still others may be diagnosed on the basis of a mixture of both kinds of behaviors. Multivariate analyses of the CBCL, TRF, YSR, and other rating forms have yielded separate, though correlated, syndromes of aggressive versus nonaggressive conduct problems. To determine whether the DSM-IV CD symptoms form such patterns, a team of American and Australian researchers factor analyzed DSM-IV CD symptoms reported by parents of a national sample of 1,669 Australian boys aged 6 to 17 (Tackett, Krueger, Sawyer, & Graetz, 2003).

The parents’ reports were obtained by home interviewers who administered the Diagnostic Interview Schedule for Children Version IV (DISC-IV). After being interviewed with the DISC-IV, the parents completed the CBCL. (Girls were not included in the analyses because parents reported 11 of the 15 DSM-IV CD symptoms for <1% of girls.) Factor analysis of the CD symptoms yielded one factor with highest loadings for overtly aggressive symptoms and a second factor with highest loadings for nonaggressive symptoms. These two factors thus reflected groupings of symptoms like the syndromes of conduct problems found in multivariate analyses of rating forms.

To test associations between the two groups of DSM-IV symptoms and empirically based syndromes, the researchers performed separate multiple regressions of each group of DSM-IV symptoms on the boys’ scores for the CBCL Aggressive Behavior and Delinquent (now called Rule-Breaking) Behavior syndromes.

The results revealed that the overtly aggressive CD symptoms were predicted primarily by the CBCL Aggressive Behavior syndrome. Conversely, the nonaggressive CD symptoms were predicted primarily by the CBCL Delinquent Behavior syndrome. The researchers concluded that “the distinction between aggressive and delinquent antisocial behavior in this age group, as captured by the CBCL, appears to provide a more accurate account of childhood antisocial behaviors than the unitary conduct disorder defined in the DSM-IV” (p. 652).

Reference: Tackett, J.L., Krueger, R.F., Sawyer, M.G., & Graetz, B.W. (2003). Subfactors of DSM-IV Conduct Disorder: Evidence and connections with syndromes from the Child Behavior Checklist. Journal of Abnormal Child Psychology, 31, 647-654.