Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene–environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic–pituitary–adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.
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Kazdin, A. E. in Evidence-Based Psychotherapies for Children and Adolescents (eds Kazdin, A. E. & Weisz, J. R.) 241–262 (Guilford, New York, 2003).
Coghill, D. Editorial: do clinical services need to take conduct disorder more seriously? J. Child Psychol. Psychiatry 54, 921–923 (2013).
Erskine, H. E. et al. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J. Child Psychol. Psychiatry 55, 328–336 (2014). This study is one of the first attempts to document the worldwide impact of CD in terms of disability and impairment (years lived with disability), demonstrating that CD is associated with a substantial global burden. Strikingly, CD is responsible for almost 12 times more years lived with disability than ADHD.
Kim-Cohen, J. et al. Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Arch. Gen. Psychiatry 60, 709–717 (2003).
Simonoff, E. et al. Predictors of antisocial personality. Continuities from childhood to adult life. Br. J. Psychiatry 184, 118–127 (2004).
Blair, R. J. R., Mitchell, D. G. V. & Blair, K. S. The Psychopath: Emotion and the Brain (Blackwell, 2005).
Nock, M. K., Kazdin, A. E., Hiripi, E. & Kessler, R. C. Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychol. Med. 36, 699–710 (2006).
Barker, E. D. et al. Developmental trajectories of male physical violence and theft: relations to neurocognitive performance. Arch. Gen. Psychiatry 64, 592–599 (2007).
Burt, S. A. Are there meaningful etiological differences within antisocial behavior? Results of a meta-analysis. Clin. Psychol. Rev. 29, 163–178 (2009).
Hare, R. D. & Neumann, C. S. Psychopathy as a clinical and empirical construct. Annu. Rev. Clin. Psychol. 4, 217–246 (2008).
Frick, P. J. & Ray, J. V. Evaluating callous-unemotional traits as a personality construct. J. Pers. 83, 710–722 (2015).
Krueger, R. F. et al. Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. J. Abnorm. Psychol. 111, 411–424 (2002).
Krueger, R. F., Markon, K. E., Patrick, C. J. & Iacono, W. G. Externalizing psychopathology in adulthood: a dimensional-spectrum conceptualization and its implications for DSM-V. J. Abnorm. Psychol. 114, 537–550 (2005).
Kendler, K. S., Prescott, C. A., Myers, J. & Neale, M. C. The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch. Gen. Psychiatry 60, 929–937 (2003).
Hicks, B. M., Krueger, R. F., Iacono, W. G., McGue, M. & Patrick, C. J. Family transmission and heritability of externalizing disorders: a twin-family study. Arch. Gen. Psychiatry 61, 922–928 (2004).
Beauchaine, T. P., Zisner, A. R. & Sauder, C. L. Trait impulsivity and the externalizing spectrum. Annu. Rev. Clin. Psychol. 13, 343–368 (2017).
Bornovalova, M. A., Hicks, B. M., Iacono, W. G. & McGue, M. Familial transmission and heritability of childhood disruptive disorders. Am. J. Psychiatry 167, 1066–1074 (2010).
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A. & Rohde, L. A. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J. Child Psychol. Psychiatry 56, 345–365 (2015).
Copeland, W., Shanahan, L., Costello, E. J. & Angold, A. Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. J. Am. Acad. Child Adolesc. Psychiatry 50, 252–261 (2011).
Collishaw, S., Maughan, B., Goodman, R. & Pickles, A. Time trends in adolescent mental health. J. Child Psychol. Psychiatry 45, 1350–1362 (2004).
Fombonne, E. Increased rates of psychosocial disorders in youth. Eur. Arch. Psychiatry Clin. Neurosci. 248, 14–21 (1998).
Erskine, H. E. et al. Research review: epidemiological modelling of attention-deficit/hyperactivity disorder and conduct disorder for the Global Burden of Disease Study 2010. J. Child Psychol. Psychiatry 54, 1263–1274 (2013).
Anderson, J. C., Williams, S., McGee, R. & Silva, P. A. DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population. Arch. Gen. Psychiatry 44, 69–76 (1987).
Cohen, P. et al. An epidemiological study of disorders in late childhood and adolescence: 1. Age- and gender-specific prevalence. J. Child Psychol. Psychiatry 34, 851–867 (1993).
Merikangas, K. R. et al. Lifetime prevalence of mental disorders in U. S. adolescents: results from the National Comorbidity Survey Replication — Adolescent Supplement (NCS-A). J. Am. Acad. Child Adolesc. Psychiatry 49, 980–989 (2010).
Costello, E. J., Keeler, G. P. & Angold, A. Poverty, race/ethnicity, and psychiatric disorder: a study of rural children. Am. J. Publ. Health 91, 1494–1498 (2001).
Lahey, B. et al. Validity of DSM-IV subtypes of conduct disorder based on age of onset. J. Am. Acad. Child Adolesc. Psychiatry 37, 435–442 (1998).
Erskine, H. et al. The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiol. Psychiatr. Sci. 26, 395–402 (2017).
Keenan, K. et al. Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers. J. Child Psychol. Psychiatry 52, 47–55 (2011).
Moffitt, T. et al. Research Review: DSM-V conduct disorder: research needs for an evidence base. J. Child Psychol. Psychiatry 49, 3–33 (2008).
Broidy, L. et al. Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Dev. Psychol. 39, 222–245 (2003).
Wichstrøm, L. et al. Prevalence of psychiatric disorders in preschoolers. J. Child Psychol. Psychiatry 53, 695–705 (2012).
Maughan, B., Rowe, R., Messer, J., Goodman, R. & Metzler, H. Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J. Child Psychol. Psychiatry 45, 609–621 (2004).
Loeber, R., Burke, J. D., Lahey, B. B., Winters, A. & Zera, M. Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J. Am. Acad. Child Adolesc. Psychiatry 39, 1468–1484 (2000).
Moffitt, T. et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol. Med. 40, 899 (2010).
Compton, W. M. & Lopez, M. F. Accuracy in reporting past psychiatric symptoms: the role of cross-sectional studies in psychiatric research. JAMA Psychiatry 71, 233–234 (2014).
Judy, S., Moore, A. A. & Michael, R. Age of onset and the subclassification of conduct/dissocial disorder. J. Child Psychol. Psychiatry 56, 826–833 (2015).
Regier, D. A. et al. DSM-5 field trials in the United States and Canada, part II: test-retest reliability of selected categorical diagnoses. Am. J. Psychiatry 170, 59–70 (2013).
Angold, A., Costello, E. J. & Erkanli, A. Comorbidity. J. Child Psychol. Psychiatry 40, 57–87 (1999).
Copeland, W., Shanahan, L., Erkanli, A., Costello, E. J. & Angold, A. Indirect comorbidity in childhood and adolescence. Front. Psychiatry 4, 144 (2013).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) (American Psychiatric Press, Inc., 1994).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) (American Psychiatric Press, Inc., 2013).
Rowe, R., Costello, E. J., Angold, A., Copeland, W. E. & Maughan, B. Developmental pathways in oppositional defiant disorder and conduct disorder. J. Abnorm. Psychol. 119, 726–738 (2010).
Hinshaw, S. P. in Progress in Experimental Personality and Psychopathology Research 1994. Special Focus on Psychopathy and Antisocial Behavior: A Developmental Perspective (eds Fowles, D. C., Sutker, P. & Goodman, S. H.) 3–44 (Springer, NY, 1994).
Abikoff, H. & Klein, R. G. Attention-deficit hyperactivity and conduct disorder: comorbidity and implications for treatment. J. Consult. Clin. Psychol. 60, 881–892 (1992).
Thapar, A., Harrington, R. & McGuffin, P. Examining the comorbidity of ADHD-related behaviours and conduct problems using a twin study design. Br. J. Psychiatry 179, 224–229 (2001).
Copeland, W. E. et al. Diagnostic transitions from childhood to adolescence to early adulthood. J. Child Psychol. Psychiatry 54, 791–799 (2013).
Latimer, K. et al. Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors. Child Care Health Dev. 38, 611–628 (2012).
Jaffee, S. R., Strait, L. B. & Odgers, C. L. From correlates to causes: can quasi-experimental studies and statistical innovations bring us closer to identifying the causes of antisocial behavior? Psychol. Bull. 138, 272–295 (2012).
Gaysina, D. et al. Maternal smoking during pregnancy and offspring conduct problems: evidence from 3 independent genetically sensitive research designs. JAMA Psychiatry 70, 956–963 (2013).
Popova, S. et al. Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. Lancet 387, 978–987 (2016).
Ruisch, I. H., Dietrich, A., Glennon, J. C., Buitelaar, J. K. & Hoekstra, P. J. Maternal substance use during pregnancy and offspring conduct problems: a meta-analysis. Neurosci. Biobehav. Rev. 84, 325–336 (2018).
MacKinnon, N., Kingsbury, M., Mahedy, L., Evans, J. & Colman, I. The association between prenatal stress and externalizing symptoms in childhood: evidence from the Avon Longitudinal Study of Parents and Children. Biol. Psychiatry 83, 100–108 (2018).
Sandman, C. A. et al. Cortical thinning and neuropsychiatric outcomes in children exposed to prenatal adversity: a role for placental CRH? Am. J. Psychiatry 175, 471–479 (2018).
Barker, E. D. & Maughan, B. Differentiating early-onset persistent versus childhood-limited conduct problem youth. Am. J. Psychiatry 166, 900–908 (2009).
Rice, F. et al. The links between prenatal stress and offspring development and psychopathology: disentangling environmental and inherited influences. Psychol. Med. 40, 335–345 (2009).
O’Connor, T. G., Heron, J. & Glover, V. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J. Am. Acad. Child Adolesc. Psychiatry 41, 1470–1477 (2002).
Murray, J. et al. Moderate alcohol drinking in pregnancy increases risk for children’s persistent conduct problems: causal effects in a Mendelian randomisation study. J. Child Psychol. Psychiatry 57, 575–584 (2016).
Lukkari, S. et al. Exposure to obstetric complications in relation to subsequent psychiatric disorders of adolescent inpatients: specific focus on gender differences. Psychopathology 45, 317–326 (2012).
Raine, A., Brennan, P. & Mednick, S. A. Interaction between birth complications and early maternal rejection in predisposing individuals to adult violence: specificity to serious, early-onset violence. Am. J. Psychiatry 154, 1265–1271 (1997).
Barker, E. D., Copeland, W., Maughan, B., Jaffee, S. R. & Uher, R. Relative impact of maternal depression and associated risk factors on offspring psychopathology. Br. J. Psychiatry 200, 124–129 (2012).
Liu, J. Early health risk factors for violence: conceptualization, review of the evidence, and implications. Aggress. Violent Behav. 16, 63–73 (2011).
Hodgins, S., Kratzer, L. & McNeil, T. F. Obstetric complications, parenting, and risk of criminal behavior. Arch. Gen. Psychiatry 58, 746–752 (2001).
Kim, J. et al. Chronic fetal hypoxia affects axonal maturation in guinea pigs during development: a longitudinal Diffusion Tensor Imaging and T2 mapping study. J. Magn. Reson. Imaging 42, 658–665 (2015).
Liu, J., Raine, A., Wuerker, A., Venables, P. H. & Mednick, S. The association of birth complications and externalizing behavior in early adolescents: direct and mediating effects. J. Res. Adolesc. 19, 93–111 (2009).
Liu, J. & Raine, A. The effect of childhood malnutrition on externalizing behavior. Curr. Opin. Pediatr. 18, 565–570 (2006).
Vaughn, M. G., Salas-Wright, C. P., Naeger, S., Huang, J. & Piquero, A. R. Childhood reports of food neglect and impulse control problems and violence in adulthood. Int. J. Environ. Res. Public Health 13, 389 (2016).
Marcus, D. K., Fulton, J. J. & Clarke, E. J. Lead and conduct problems: a meta-analysis. J. Clin. Child Adolesc. Psychol. 39, 234–241 (2010).
Beckley, A. L. et al. Association of childhood blood lead levels with criminal offending. JAMA Pediatr. 172, 166–173 (2018).
Kendler, K. S., Aggen, S. H. & Patrick, C. J. Familial influences on conduct disorder reflect 2 genetic factors and 1 shared environmental factor. JAMA Psychiatry 70, 78–86 (2013).
Johnson, A. M., Hawes, D. J., Eisenberg, N., Kohlhoff, J. & Dudeney, J. Emotion socialization and child conduct problems: a comprehensive review and meta-analysis. Clin. Psychol. Rev. 54, 65–80 (2017).
Moore, A. A., Silberg, J. L., Roberson-Nay, R. & Mezuk, B. Life course persistent and adolescence limited conduct disorder in a nationally representative US sample: prevalence, predictors, and outcomes. Soc. Psychiatry Psychiatr. Epidemiol. 52, 435–443 (2017).
Waller, R. & Hyde, L. Callous-unemotional behaviors in early childhood: measurement, meaning, and the influence of parenting. Child Dev. Perspect. 11, 120–126 (2017).
Kim-Cohen, J. et al. MAOA, maltreatment, and gene-environment interaction predicting children’s mental health: new evidence and a meta-analysis. Mol. Psychiatry 11, 903–913 (2006).
Norman, R. E. et al. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLOS Med. 9, e1001349 (2012).
Jaffee, S. R. et al. Nature X nurture: genetic vulnerabilities interact with physical maltreatment to promote conduct problems. Dev. Psychopathol. 17, 67–84 (2005).
Afifi, T. O., McMillan, K. A., Asmundson, G. J., Pietrzak, R. H. & Sareen, J. An examination of the relation between conduct disorder, childhood and adulthood traumatic events, and posttraumatic stress disorder in a nationally representative sample. J. Psychiatr. Res. 45, 1564–1572 (2011).
Boden, J. M., Fergusson, D. M. & Horwood, L. J. Risk factors for conduct disorder and oppositional/defiant disorder: evidence from a New Zealand birth cohort. J. Am. Acad. Child Adolesc. Psychiatry 49, 1125–1133 (2010).
Price, J., Drabick, D. A. G. & Ridenour, T. A. Association with deviant peers across adolescence: subtypes, developmental patterns, and long-term outcomes. J. Clin. Child Adolesc. Psychol. 48, 238–249 (2018).
Trudeau, L., Mason, W. A., Randall, G. K., Spoth, R. & Ralston, E. Effects of parenting and deviant peers on early to mid-adolescent conduct problems. J. Abnorm. Child Psychol. 40, 1249–1264 (2012).
Piotrowska, P. J., Stride, C. B., Croft, S. E. & Rowe, R. Socioeconomic status and antisocial behaviour among children and adolescents: a systematic review and meta-analysis. Clin. Psychol. Rev. 35, 47–55 (2015).
Kersten, L. et al. Community violence exposure and conduct problems in children and adolescents with conduct disorder and healthy controls. Front. Behav. Neurosci. 11, 219 (2017).
Jennings, W. G., Perez, N. M. & Reingle Gonzalez, J. M. Conduct disorder and neighborhood effects. Annu. Rev. Clin. Psychol. 14, 317–341 (2018).
Pingault, J. B. et al. Using genetic data to strengthen causal inference in observational research. Nat. Rev. Genet. 19, 566–580 (2018).
Salvatore, J. E. & Dick, D. M. Genetic influences on conduct disorder. Neurosci. Biobehav. Rev. 91, 91–101 (2018).
Wesseldijk, L. W. et al. Genetic and environmental influences on conduct and antisocial personality problems in childhood, adolescence, and adulthood. Eur. Child Adolesc. Psychiatry 27, 1123–1132 (2017).
Gelhorn, H. et al. Common and specific genetic influences on aggressive and nonaggressive conduct disorder domains. J. Am. Acad. Child Adolesc. Psychiatry 45, 570–577 (2006).
Van Hulle, C. A., Waldman, I. & Lahey, B. B. Sex differences in the genetic and environmental influences on self-reported non-aggressive and aggressive conduct disorder symptoms in early and middle adolescence. Behav. Genet. 48, 271–282 (2018).
Jacobson, K. C., Prescott, C. A. & Kendler, K. S. Sex differences in the genetic and environmental influences on the development of antisocial behavior. Dev. Psychopathol. 14, 395–416 (2002).
Niv, S., Tuvblad, C., Raine, A. & Baker, L. A. Aggression and rule-breaking: heritability and stability of antisocial behavior problems in childhood and adolescence. J. Crim. Justice 41, 285–291 (2013).
Harden, K. P. et al. Developmental changes in genetic and environmental influences on rule-breaking and aggression: age and pubertal development. J. Child Psychol. Psychiatry 56, 1370–1379 (2015).
Moore, A. A. et al. The Inventory of Callous-Unemotional Traits (ICU) in children: reliability and heritability. Behav. Genet. 47, 141–151 (2017).
Viding, E., Blair, R. J., Moffitt, T. E. & Plomin, R. Evidence for substantial genetic risk for psychopathy in 7-year-olds. J. Child Psychol. Psychiatry 46, 592–597 (2005).
Viding, E. et al. Genetics of callous-unemotional behavior in children. PLOS ONE 8, e65789 (2013).
Anttila, V. et al. Analysis of shared heritability in common disorders of the brain. Science 360, eaap8757 (2018).
Ioannidis, J. P. Why most published research findings are false. PLOS Med. 2, e124 (2005).
Veroude, K. et al. Genetics of aggressive behavior: an overview. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171B, 3–43 (2016).
Fernandez-Castillo, N. et al. RBFOX1, encoding a splicing regulator, is a candidate gene for aggressive behavior. Eur. Neuropsychopharmacol. https://doi.org/10.1016/j.euroneuro.2017.11.012 (2017).
Anney, R. J. et al. Conduct disorder and ADHD: evaluation of conduct problems as a categorical and quantitative trait in the international multicentre ADHD genetics study. Am. J. Med. Genet. B Neuropsychiatr. Genet. 147B, 1369–1378 (2008).
Dick, D. M. et al. Genome-wide association study of conduct disorder symptomatology. Mol. Psychiatry 16, 800–808 (2011). This is the first GWAS of CD in n = 872 cases and n = 3,091 controls using CD symptoms as a phenotype. Although underpowered, the first genetic variants associated with CD severity were identified (including C1QTNF7 ).
Derringer, J. et al. Genome-wide association study of behavioral disinhibition in a selected adolescent sample. Behav. Genet. 45, 375–381 (2015).
McGue, M. et al. A genome-wide association study of behavioral disinhibition. Behav. Genet. 43, 363–373 (2013).
Viding, E. et al. In search of genes associated with risk for psychopathic tendencies in children: a two-stage genome-wide association study of pooled DNA. J. Child Psychol. Psychiatry 51, 780–788 (2010).
Mick, E. et al. Genome-wide association study of the child behavior checklist dysregulation profile. J. Am. Acad. Child Adolesc. Psychiatry 50, 807–817 (2011).
Aebi, M. et al. Gene-set and multivariate genome-wide association analysis of oppositional defiant behavior subtypes in attention-deficit/hyperactivity disorder. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171, 573–588 (2016).
Brevik, E. J. et al. Genome-wide analyses of aggressiveness in attention-deficit hyperactivity disorder. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171, 733–747 (2016).
Rautiainen, M. R. et al. Genome-wide association study of antisocial personality disorder. Transl Psychiatry 6, e883 (2016).
Tiihonen, J. et al. Genetic background of extreme violent behavior. Mol. Psychiatry 20, 786–792 (2015).
Merjonen, P. et al. Hostility in adolescents and adults: a genome-wide association study of the Young Finns. Transl Psychiatry 1, e11 (2011).
Mick, E. et al. Genome-wide association study of proneness to anger. PLOS ONE 9, e87257 (2014).
Tielbeek, J. J. et al. Unraveling the genetic etiology of adult antisocial behavior: a genome-wide association study. PLOS ONE 7, e45086 (2012).
Pappa, I. et al. A genome-wide approach to children’s aggressive behavior: the EAGLE consortium. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171, 562–572 (2016).
Tielbeek, J. J. et al. Genome-wide association studies of a broad spectrum of antisocial behavior. JAMA Psychiatry 74, 1242–1250 (2017).
van Donkelaar, M. M. J. et al. Monoamine and neuroendocrine gene-sets associate with frustration-based aggression in a gender-specific manner. Eur. Neuropsychopharmacol. https://doi.org/10.1016/j.euroneuro.2017.11.016 (2017).
Tielbeek, J. J. et al. Genetic correlation of antisocial behaviour with alcohol, nicotine, and cannabis use. Drug Alcohol Depend. 187, 296–299 (2018).
Faraone, S. V. & Larsson, H. Genetics of attention deficit hyperactivity disorder. Mol. Psychiatry 24, 562–575 (2018).
Waltes, R., Chiocchetti, A. G. & Freitag, C. M. The neurobiological basis of human aggression: a review on genetic and epigenetic mechanisms. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171, 650–675 (2016).
Zhang-James, Y. et al. An integrated analysis of genes and functional pathways for aggression in human and rodent models. Mol. Psychiatry. https://doi.org/10.1038/s41380-018-0068-7 (2018).
Fernandez-Castillo, N. & Cormand, B. Aggressive behavior in humans: genes and pathways identified through association studies. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171, 676–696 (2016).
Brunner, H. G., Nelen, M., Breakefield, X. O., Ropers, H. H. & van Oost, B. A. Abnormal behavior associated with a point mutation in the structural gene for monoamine oxidase A. Science 262, 578–580 (1993).
Bevilacqua, L. et al. A population-specific HTR2B stop codon predisposes to severe impulsivity. Nature 468, 1061–1066 (2010).
Zhang-James, Y. & Faraone, S. V. Genetic architecture for human aggression: a study of gene-phenotype relationship in OMIM. Am. J. Med. Genet. B Neuropsychiatr. Genet. 171, 641–649 (2016).
Holz, N. E. et al. Gene x environment interactions in conduct disorder: implications for future treatments. Neurosci. Biobehav. Rev. 91, 239–258 (2018).
Kendler, K. S., Jacobson, K., Myers, J. M. & Eaves, L. J. A genetically informative developmental study of the relationship between conduct disorder and peer deviance in males. Psychol. Med. 38, 1001–1011 (2008).
Henry, J. et al. Early warm-rewarding parenting moderates the genetic contributions to callous-unemotional traits in childhood. J. Child Psychol. Psychiatry 59, 1282–1288 (2018).
Cloninger, C. R., Sigvardsson, S., Bohman, M. & von Knorring, A. L. Predisposition to petty criminality in Swedish adoptees. II. Cross-fostering analysis of gene-environment interaction. Arch. Gen. Psychiatry 39, 1242–1247 (1982).
Hyde, L. W. et al. Heritable and nonheritable pathways to early callous-unemotional behaviors. Am. J. Psychiatry 173, 903–910 (2016). This large adoption study of 561 families elucidates heritable and nonheritable pathways to early CU behaviours. Despite limited or no contact with offspring, antisocial behaviour in the biological mothers predicts early CU behaviours in their offspring, whereas positive parenting by adoptive mothers protects against early CU behaviour.
Caspi, A. et al. Role of genotype in the cycle of violence in maltreated children. Science 297, 851–854 (2002).
Nilsson, K. W., Aslund, C., Comasco, E. & Oreland, L. Gene-environment interaction of monoamine oxidase A in relation to antisocial behaviour: current and future directions. J. Neural Transm. (Vienna) 125, 1601–1626 (2018).
Franke, B. & Buitelaar, J. K. in Oxford Textbook of Attention Deficit Hyperactivity Disorder Ch. 5 (eds Banaschewski, T., Coghill, D. & Zudas, A.) (Oxford Univ. Press, 2018).
Thurman, R. E. et al. The accessible chromatin landscape of the human genome. Nature 489, 75–82 (2012).
PsychENCODE Consortium. et al. The PsychENCODE project. Nat. Neurosci. 18, 1707–1712 (2015).
Hannon, E., Lunnon, K., Schalkwyk, L. & Mill, J. Interindividual methylomic variation across blood, cortex, and cerebellum: implications for epigenetic studies of neurological and neuropsychiatric phenotypes. Epigenetics 10, 1024–1032 (2015).
Freytag, V. et al. A peripheral epigenetic signature of immune system genes is linked to neocortical thickness and memory. Nat. Commun. 8, 15193 (2017).
Hannon, E. et al. An integrated genetic-epigenetic analysis of schizophrenia: evidence for co-localization of genetic associations and differential DNA methylation. Genome Biol. 17, 176 (2016).
Provencal, N. et al. Association of childhood chronic physical aggression with a DNA methylation signature in adult human T cells. PLOS ONE 9, e89839 (2014).
Provencal, N. et al. The signature of maternal rearing in the methylome in rhesus macaque prefrontal cortex and T cells. J. Neurosci. 32, 15626–15642 (2012).
Hovey, D. et al. Antisocial behavior and polymorphisms in the oxytocin receptor gene: findings in two independent samples. Mol. Psychiatry 21, 983–988 (2016).
Cecil, C. A. et al. Environmental risk, oxytocin receptor gene (OXTR) methylation and youth callous-unemotional traits: a 13-year longitudinal study. Mol. Psychiatry 19, 1071–1077 (2014). This epigenetic study is one of the first in this area, showing that epigenetic changes in the oxytocin system, which is implicated in affiliative behaviour, at birth are linked to CU traits in late childhood in youths without internalizing symptoms. By contrast, there is no association between epigenetic changes and CU traits in those with internalizing symptoms; instead, this group has greater environmental risk exposure.
Cecil, C. A. M. et al. Neonatal DNA methylation and early-onset conduct problems: a genome-wide, prospective study. Dev. Psychopathol. 30, 383–397 (2018).
Fairchild, G., Van Goozen, S. H. M., Calder, A. J., Stollery, S. J. & Goodyer, I. M. Deficits in facial expression recognition in male adolescents with early-onset or adolescence-onset conduct disorder. J. Child Psychol. Psychiatry 50, 627–636 (2009).
Stevens, D., Charman, T. & Blair, R. Recognition of emotion in facial expressions and vocal tones in children with psychopathic tendencies. J. Genet. Psychol. 162, 201–211 (2001).
Martin-Key, N., Brown, T. & Fairchild, G. Empathic accuracy in male adolescents with conduct disorder and higher versus lower levels of callous-unemotional traits. J. Abnorm. Child Psychol. 45, 1385–1397 (2017).
Fanti, K. A., Kimonis, E. R., Hadjicharalambous, M. Z. & Steinberg, L. Do neurocognitive deficits in decision making differentiate conduct disorder subtypes? Eur. Child Adolesc. Psychiatry 25, 989–996 (2016).
Fairchild, G. et al. Decision making and executive function in male adolescents with early-onset or adolescence-onset conduct disorder and control subjects. Biol. Psychiatry 66, 162–168 (2009).
Sonuga-Barke, E. J., Cortese, S., Fairchild, G. & Stringaris, A. Annual research review: transdiagnostic neuroscience of child and adolescent mental disorders — differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety. J. Child Psychol. Psychiatry 57, 321–349 (2016).
Sidlauskaite, J. et al. Sex differences in risk-based decision making in adolescents with conduct disorder. Eur. Child Adolesc. Psychiatry 27, 1133–1142 (2018).
Dawel, A., O’Kearney, R., McKone, E. & Palermo, R. Not just fear and sadness: meta-analytic evidence of pervasive emotion recognition deficits for facial and vocal expressions in psychopathy. Neurosci. Biobehav. Rev. 36, 2288–2304 (2012).
Schwenck, C. et al. Empathy in children with autism and conduct disorder: group-specific profiles and developmental aspects. J. Child Psychol. Psychiatry 53, 651–659 (2012).
Hobson, C. W., Scott, S. & Rubia, K. Investigation of cool and hot executive function in ODD/CD independently of ADHD. J. Child Psychol. Psychiatry 52, 1035–1043 (2011).
Dolan, M. & Lennox, C. Cool and hot executive function in conduct-disordered adolescents with and without co-morbid attention deficit hyperactivity disorder: relationships with externalizing behaviours. Psychol. Med. 43, 2427–2436 (2013).
Alegria, A. A., Radua, J. & Rubia, K. Meta-analysis of fMRI studies of disruptive behavior disorders. Am. J. Psychiatry 173, 1119–1130 (2016). This meta-analysis of fMRI studies of CD is the first, and it not only compares youths with CD (or conduct problems) with typically developing youths but also conducts a subgroup analysis focusing specifically on those with CD and psychopathic traits.
Noordermeer, S. D., Luman, M. & Oosterlaan, J. A. Systematic review and meta-analysis of neuroimaging in Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) taking Attention-Deficit Hyperactivity Disorder (ADHD) into account. Neuropsychol. Rev. 26, 44–72 (2016).
Viding, E. & McCrory, E. J. Understanding the development of psychopathy: progress and challenges. Psychol. Med. 48, 566–577 (2018).
Passamonti, L. et al. Neural abnormalities in early-onset and adolescence-onset conduct disorder. Arch. Gen. Psychiatry 67, 729–738 (2010).
White, S. F. et al. Neural correlates of the propensity for retaliatory behavior in youths with disruptive behavior disorders. Am. J. Psychiatry 173, 282–290 (2016).
Fairchild, G. et al. Atypical neural responses during face processing in female adolescents with conduct disorder. J. Am. Acad. Child Adolesc. Psychiatry 53, 677–687 (2014).
Finger, E. C. et al. Impaired functional but preserved structural connectivity in limbic white matter tracts in youth with conduct disorder or oppositional defiant disorder plus psychopathic traits. Psychiatry Res. 202, 239–244 (2012).
Marsh, A. A. et al. Reduced amygdala response to fearful expressions in children and adolescents with callous-unemotional traits and disruptive behavior disorders. Am. J. Psychiatry 165, 712–720 (2008).
Ewbank, M. P. et al. Psychopathic traits influence amygdala-anterior cingulate cortex connectivity during facial emotion processing. Soc. Cogn. Affect. Neurosci. 13, 525–534 (2018).
Blair, R. J. R., Veroude, K. & Buitelaar, J. K. Neuro-cognitive system dysfunction and symptom sets: a review of fMRI studies in youth with conduct problems. Neurosci. Biobehav. Rev. 91, 69–90 (2018).
White, S. F. et al. Disrupted expected value and prediction error signaling in youths with disruptive behavior disorders during a passive avoidance task. Am. J. Psychiatry 170, 315–323 (2013).
Finger, E. C. et al. Abnormal ventromedial prefrontal cortex function in children with psychopathic traits during reversal learning. Arch. Gen. Psychiatry 65, 586–594 (2008).
Sterzer, P., Stadler, C., Krebs, A., Kleinschmidt, A. & Poustka, F. Abnormal neural responses to emotional visual stimuli in adolescents with conduct disorder. Biol. Psychiatry 57, 7–15 (2005).
Hwang, S. et al. Dual neurocircuitry dysfunctions in disruptive behavior disorders: emotional responding and response inhibition. Psychol. Med. 46, 1485–1496 (2016).
Herpertz, S. C. et al. Emotional processing in male adolescents with childhood-onset conduct disorder. J. Child Psychol. Psychiatry 49, 781–791 (2008).
Cohn, M. D. et al. Fear conditioning, persistence of disruptive behavior and psychopathic traits: an fMRI study. Transl Psychiatry 3, e319 (2013).
Zhou, J., Yao, N., Fairchild, G., Zhang, Y. & Wang, X. Altered hemodynamic activity in conduct disorder: a resting-state FMRI investigation. PLOS ONE 10, e0122750 (2015).
Broulidakis, M. J. et al. Reduced default mode connectivity in adolescents with conduct disorder. J. Am. Acad. Child Adolesc. Psychiatry 55, 800–808 (2016).
Zhou, J. et al. Disrupted default mode network connectivity in male adolescents with conduct disorder. Brain Imaging Behav. 10, 995–1003 (2016).
Lu, F.-M. et al. Functional connectivity estimated from resting-state fMRI reveals selective alterations in male adolescents with pure conduct disorder. PLOS ONE 10, e0145668 (2015).
Aghajani, M. et al. Disorganized amygdala networks in conduct-disordered juvenile offenders with callous-unemotional traits. Biol. Psychiatry 82, 283–293 (2017).
Rogers, J. C. & De Brito, S. A. Cortical and subcortical gray matter volume in youths with conduct problems: a meta-analysis. JAMA Psychiatry 73, 64–72 (2016). This is the first meta-analysis of voxel-based morphometry (structural MRI) studies of CD. This study found that youths with CD (or conduct problems) show reliable reductions in amygdala, anterior insula, ACC and fusiform gyrus volume relative to typically-developing youths. A supplementary analysis comparing youths with childhood-onset conduct problems with typically-developing youths showed amygdala and anterior insula volume reductions in the former subgroup.
Raschle, N. M., Menks, W. M., Fehlbaum, L. V., Tshomba, E. & Stadler, C. Structural and functional alterations in right dorsomedial prefrontal and left insular cortex co-localize in adolescents with aggressive behaviour: an ALE meta-analysis. PLOS ONE 10, e0136553 (2015).
Fairchild, G. et al. Brain structure abnormalities in adolescent girls with conduct disorder. J. Child Psychol. Psychiatry 54, 86–95 (2013).
Sebastian, C. L. et al. Grey matter volumes in children with conduct problems and carying levels of callous-unemotional traits. J. Abnorm. Child Psychol. 44, 639–649 (2015).
Raznahan, A. et al. How does your cortex grow? J. Neurosci. 31, 7174–7177 (2011).
Hyatt, C. J., Haney-Caron, E. & Stevens, M. C. Cortical thickness and folding deficits in conduct-disordered adolescents. Biol. Psychiatry 72, 207–214 (2012).
Wallace, G. L. et al. Cortical and subcortical abnormalities in youths with conduct disorder and elevated callous-unemotional traits. J. Am. Acad. Child Adolesc. Psychiatry 53, 456–465 (2014).
Jiang, Y. et al. Abnormalities of cortical structures in adolescent-onset conduct disorder. Psychol. Med. 45, 3467–3479 (2015).
Fairchild, G. et al. Cortical thickness, surface area, and folding alterations in male youths with conduct disorder and varying levels of callous-unemotional traits. Neuroimage Clin. 8, 253–260 (2015).
Smaragdi, A. et al. Sex differences in the relationship between conduct disorder and cortical structure in adolescents. J. Am. Acad. Child Adolesc. Psychiatry 56, 703–712 (2017).
Waller, R., Dotterer, H. L., Murray, L., Maxwell, A. M. & Hyde, L. W. White-matter tract abnormalities and antisocial behavior: A systematic review of diffusion tensor imaging studies across development. Neuroimage Clin. 14, 201–215 (2017).
Puzzo, I. et al. Altered white-matter microstructure in conduct disorder is specifically associated with elevated callous-unemotional traits. J. Abnorm. Child Psychol. 46, 1451–1466 (2018).
Sethi, A. et al. Anatomy of the dorsal default-mode network in conduct disorder: association with callous-unemotional traits. Dev. Cogn. Neurosci. 30, 87–92 (2018).
Passamonti, L. et al. Abnormal anatomical connectivity between the amygdala and orbitofrontal cortex in conduct disorder. PLOS ONE 7, e48789 (2012).
Menks, W. M. et al. Microstructural white matter alterations in the corpus callosum of girls with conduct disorder. J. Am. Acad. Child Adolesc. Psychiatry 56, 258–265 (2017).
Decety, J., Yoder, K. J. & Lahey, B. B. Sex differences in abnormal white matter development associated with conduct disorder in children. Psychiatry Res. 233, 269–277 (2015).
Insel, T. et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am. J. Psychiatry 167, 748–751 (2010).
Button, K. S. et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat. Rev. Neurosci. 14, 365–376 (2013).
De Brito, S. A. et al. Structural neuroimaging and the antisocial brain: main findings and methodological challenges. Crim. Justice Behav. 36, 1173–1186 (2009).
Viding, E. et al. Amygdala response to preattentive masked fear in children with conduct problems: The role of callous-unemotional traits. Am. J. Psychiatry 169, 1109–1116 (2012).
Rubia, K. et al. Disorder-specific dissociation of orbitofrontal dysfunction in boys with pure conduct disorder during reward and ventrolateral prefrontal dysfunction in boys with pure ADHD during sustained attention. Am. J. Psychiatry 166, 83–94 (2008).
Bayard, F. et al. Distinct brain structure and behavior related to ADHD and conduct disorder traits. Mol. Psychiatry https://doi.org/10.1038/s41380-018-0202-6 (2018).
Fairchild, G. et al. Brain structure abnormalities in early-onset and adolescent-onset conduct disorder. Am. J. Psychiatry 168, 624–633 (2011).
Teicher, M. H., Samson, J. A., Anderson, C. M. & Ohashi, K. The effects of childhood maltreatment on brain structure, function and connectivity. Nat. Rev. Neurosci. 17, 652–666 (2016).
Farah, M. J. The neuroscience of socioeconomic status: correlates, causes, and consequences. Neuron 96, 56–71 (2017).
McBurnett, K., Lahey, B. B., Rathouz, P. J. & Loeber, R. Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Arch. Gen. Psychiatry 57, 38–43 (2000).
Pajer, K., Gardner, W., Rubin, R. T., Perel, J. & Neal, S. Decreased cortisol levels in adolescent girls with conduct disorder. Arch. Gen. Psychiatry 58, 297–302 (2001).
Fairchild, G. et al. Cortisol diurnal rhythm and stress reactivity in male adolescents with early-onset or adolescence-onset conduct disorder. Biol. Psychiatry 64, 599–606 (2008).
Popma, A. et al. The diurnal cortisol cycle in delinquent male adolescents and normal controls. Neuropsychopharmacology 32, 1622–1628 (2007).
von Polier, G. G. et al. Reduced cortisol in boys with early-onset conduct disorder and callous-unemotional traits. Biomed. Res. Int. 2013, 349530 (2013).
Popma, A. et al. Hypothalamus pituitary adrenal axis and autonomic activity during stress in delinquent male adolescents and controls. Psychoneuroendocrinology 31, 948–957 (2006).
Northover, C., Thapar, A., Langley, K., Fairchild, G. & van Goozen, S. H. M. Cortisol levels at baseline and under stress in adolescent males with attention-deficit hyperactivity disorder, with or without comorbid conduct disorder. Psychiatry Res. 242, 130–136 (2016).
Snoek, H., Van Goozen, S. H., Matthys, W., Buitelaar, J. K. & van Engeland, H. Stress responsivity in children with externalizing behavior disorders. Dev. Psychopathol. 16, 389–406 (2004).
Stadler, C. et al. Cortisol reactivity in boys with attention-deficit/hyperactivity disorder and disruptive behavior problems: the impact of callous unemotional traits. Psychiatry Res. 187, 204–209 (2011).
Fairchild, G., Baker, E. & Eaton, S. Hypothalamic-pituitary-adrenal axis function in children and adults with severe antisocial behavior and the impact of early adversity. Curr. Psychiatry Rep. 20, 84 (2018).
Koss, K. J. & Gunnar, M. R. Annual research review: early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. J. Child Psychol. Psychiatry 59, 327–346 (2018).
Portnoy, J. & Farrington, D. P. Resting heart rate and antisocial behavior: an updated systematic review and meta-analysis. Aggress. Violent Behav. 22, 33–45 (2015).
Latvala, A. et al. Association of resting heart rate and blood pressure in late adolescence with subsequent mental disorders: a longitudinal population study of more than 1 million men in Sweden. JAMA Psychiatry 73, 1268–1275 (2016).
Oldenhof, H. et al. Baseline autonomic nervous system activity in female children and adolescents with conduct disorder: psychophysiological findings from the FemNAT-CD study. J. Crim. Justice. https://doi.org/10.1016/j.jcrimjus.2018.05.011 (2018).
Herpertz, S. C. et al. Response to emotional stimuli in boys with conduct disorder. Am. J. Psychiatry 162, 1100–1107 (2005).
Fairchild, G., Van Goozen, S. H., Stollery, S. J. & Goodyer, I. M. Fear conditioning and affective modulation of the startle reflex in male adolescents with early-onset or adolescence-onset conduct disorder and healthy control subjects. Biol. Psychiatry 63, 279–285 (2008).
Gao, Y., Raine, A., Venables, P. H., Dawson, M. E. & Mednick, S. A. Association of poor childhood fear conditioning and adult crime. Am. J. Psychiatry 167, 56–60 (2010).
Syngelaki, E. M., Fairchild, G., Moore, S. C., Savage, J. C. & van Goozen, S. H. Fearlessness in juvenile offenders is associated with offending rate. Dev. Sci. 16, 84–90 (2013).
World Health Organization. International Classification of Diseases and Related Health Problems 11th edn (WHO, 2018).
Fairchild, G., Van Goozen, S. H. M., Calder, A. J. & Goodyer, I. M. Research review: evaluating and reformulating the developmental taxonomic theory of antisocial behaviour. J. Child Psychol. Psychiatry 54, 924–940 (2013).
Frick, P. J. & Viding, E. Antisocial behavior from a developmental psychopathology perspective. Dev. Psychopathol. 21, 1111–1131 (2009).
Frick, P. J., Ray, J. V., Thornton, L. C. & Kahn, R. E. Can callous-unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? A comprehensive review. Psychol. Bull. 140, 1–57 (2014).
Cecil, C. A. M., McCrory, E. J., Barker, E. D., Guiney, J. & Viding, E. Characterising youth with callous-unemotional traits and concurrent anxiety: evidence for a high-risk clinical group. Eur. Child Adolesc. Psychiatry 27, 885–898 (2018).
Frick, P. J. Developmental pathways to conduct disorder: implications for future directions in research, assessment, and treatment. J. Clin. Child Adolesc. Psychol. 41, 378–389 (2012).
Werthamer-Larsson, L., Kellam, S. & Wheeler, L. Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems. Am. J. Commun. Psychol. 19, 585–602 (1991).
Achenbach, T. M. & Rescorla, L. A. Manual for the ASEBA School-age Forms & Profiles (Univ. of Vermont, Research Center for Children, Youth & Families, 2001).
Frick, P. J. & Nigg, J. T. Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Annu. Rev. Clin. Psychol. 8, 77–107 (2012).
Kuhn, C. et al. Effective mental health screening in adolescents: should we collect data from youth, parents or both? Child Psychiatry Hum. Dev. 48, 385–392 (2017).
Goodman, A., Lamping, D. L. & Ploubidis, G. B. When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): data from British parents, teachers and children. J. Abnorm. Child Psychol. 38, 1179–1191 (2010).
Goodman, R., Ford, T., Simmons, H., Gatward, R. & Meltzer, H. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Int. Rev. Psychiatry 15, 166–172 (2003).
Eyberg, S. & Pincus, D. Eyberg Child Behavior Inventory & Sutter–Eyberg Student Behavior Inventory-Revised: Professional Manual (Psychological Assessment Resources, 1999).
Hendriks, A. M., Bartels, M., Colins, O. F. & Finkenauer, C. Childhood aggression: a synthesis of reviews and meta-analyses to reveal patterns and opportunities for prevention and intervention strategies. Neurosci. Biobehav. Rev. 91, 278–291 (2018). This paper presents a synthesis of meta-analyses and systematic reviews on non-pharmacological treatments for childhood aggression, spanning universal prevention, selective prevention, indicated prevention and intervention. Effect sizes across types of treatments are examined, along with the effects of various moderators of treatment outcomes.
de Vries, S. L., Hoeve, M., Assink, M., Stams, G. J. & Asscher, J. J. Practitioner review: effective ingredients of prevention programs for youth at risk of persistent juvenile delinquency — recommendations for clinical practice. J. Child Psychol. Psychiatry 56, 108–121 (2015).
National Collaborating Centre for Mental Health and Social Care Institute for Excellence. Antisocial Behaviour and Conduct Disorders in Children and Young People: Recognition, Intervention and Management (The British Psychological Society and The Royal College of Psychiatrists, 2013).
Comer, J. S., Chow, C., Chan, P. T., Cooper-Vince, C. & Wilson, L. A. Psychosocial treatment efficacy for disruptive behavior problems in very young children: a meta-analytic examination. J. Am. Acad. Child Adolesc. Psychiatry 52, 26–36 (2013).
Olds, D. et al. Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. JAMA 280, 1238–1244 (1998).
Piquero, A. R. et al. A meta-analysis update on the effects of early family/parent training programs on antisocial behavior and delinquency. J. Exp. Criminol. 12, 229–248 (2016).
Erskine, H. E. et al. Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J. Am. Acad. Child Adolesc. Psychiatry 55, 841–850 (2016). This meta-analysis provides a clear picture of the long-term effects of CD in childhood or adolescence on adult functioning by pooling results from 98 studies. CD is associated with lower educational attainment, higher levels of mental and substance use problems (including antisocial personality disorder), early pregnancy and violent criminality.
Sampaio, F. et al. Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study. Eur. Child Adolesc. Psychiatry 27, 933–944 (2017).
Dodge, K. A. et al. Impact of early intervention on psychopathology, crime, and well-being at age 25. Am. J. Psychiatry 172, 59–70 (2015).
National Institute for Health and Care Excellence. Antisocial behaviour and conduct disorders in children and young people: recognition and managemen. NICE http://guidance.nice.org.uk/CG158 (2017).
Michelson, D. et al. Do evidence-based interventions work when tested in the “real world?” A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clin. Child Fam. Psychol. Rev. 16, 18–34 (2013).
Forgatch, M. S. & Gewirtz, A. H. in Evidence-Based Psychotherapies for Children and Adolescents (eds Weisz, J. R. & Kadzin, A. E.) 3rd edn 85–102 (Guilford Press, NY, 2017).
Sanders, M. R. Development, evaluation, and multinational dissemination of the triple P-Positive parenting program. Annu. Rev. Clin. Psychol. 8, 345–379 (2012).
Webster-Stratton, C. & Reid, M. J. Treating conduct problems and strengthening social and emotional competence in young children: the Dina Dinosaur treatment program. J. Emot. Behav. Disord. 11, 130–143 (2003).
Leijten, P. et al. Research review: harnessing the power of individual participant data in a meta-analysis of the benefits and harms of the Incredible Years parenting program. J. Child Psychol. Psychiatry 59, 99–109 (2018).
Garland, A. F., Hawley, K. M., Brookman-Frazee, L. & Hurlburt, M. S. Identifying common elements of evidence-based psychosocial treatments for children’s disruptive behavior problems. J. Am. Acad. Child Adolesc. Psychiatry 47, 505–514 (2008).
Kaminski, J. W. & Claussen, A. H. Evidence base update for psychosocial treatments for disruptive behaviors in children. J. Clin. Child Adolesc. Psychol. 46, 477–499 (2017). This systematic literature review identifies evidence that is available to support various forms of treatment for CD in children up to 12 years of age. On the basis of explicit criteria concerning number and quality of published clinical trials, these treatments are classified as ‘well established’, ‘probably efficacious’, ‘possibly efficacious’, ‘experimental treatments’ or ‘treatments of questionable efficacy’.
Dadds, M. R., Cauchi, A. J., Wimalaweera, S., Hawes, D. J. & Brennan, J. Outcomes, moderators, and mediators of empathic-emotion recognition training for complex conduct problems in childhood. Psychiatry Res. 199, 201–207 (2012).
McCart, M. R., Priester, P. E., Davies, W. H. & Azen, R. Differential effectiveness of behavioral parent-training and cognitive-behavioral therapy for antisocial youth: a meta-analysis. J. Abnorm. Child Psychol. 34, 527–543 (2006).
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D. & Cunningham, P. B. Multisystemic Therapy for Antisocial Behavior in Children and Adolescents 2nd edn (Guilford Press, 2009).
van der Stouwe, T., Asscher, J. J., Stams, G. J., Dekovic, M. & van der Laan, P. H. The effectiveness of Multisystemic Therapy (MST): a meta-analysis. Clin. Psychol. Rev. 34, 468–481 (2014).
Sinclair, I. et al. Multi-dimensional treatment foster care in England: differential effects by level of initial antisocial behaviour. Eur. Child Adolesc. Psychiatry 25, 843–852 (2016).
Fonagy, P. et al. Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial. Lancet Psychiatry 5, 119–133 (2018).
Chamberlain, P. The Oregon multidimensional treatment foster care model: features, outcomes, and progress in dissemination. Cogn. Behav. Pract. 10, 303–312 (2003).
Social Programs That Work. Treatment foster care oregon. Social Programs That Work https://evidencebasedprograms.org/programs/treatment-foster-care-oregon (updated 22 Feb 2018).
McCart, M. R. & Sheidow, A. J. Evidence-based psychosocial treatments for adolescents with disruptive behavior. J. Clin. Child Adolesc. Psychol. 45, 529–563 (2016).
Sexton, T. & Turner, C. W. The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting. J. Fam. Psychol. 24, 339–348 (2010).
Gibbs, J. C., Potter, G. B. & Goldstein, A. P. The EQUIP Program: Teaching Youth to Think and Act Responsibly Through a Peer-Helping Approach (Research Press, 1995).
Shin, S. K. Effects of a solution-focused program on the reduction of aggressiveness and the improvement of social readjustment for Korean youth probationers. J. Soc. Serv. Res. 35, 274–284 (2009).
Bronsard, G. et al. The prevalence of mental disorders among children and adolescents in the child welfare system: a systematic review and meta-analysis. Medicine (Baltimore) 95, e2622 (2016).
Powers, C. J., Bierman, K. L. & Coffman, D. L. Restrictive educational placements increase adolescent risks for students with early-starting conduct problems. J. Child Psychol. Psychiatry 57, 899–908 (2016).
Welty, L. J. et al. Trajectories of substance use disorder in youth after detention: a 12-year longitudinal study. J. Am. Acad. Child Adolesc. Psychiatry 56, 140–148 (2017).
Abram, K. M. et al. Comorbidity and continuity of psychiatric disorders in youth after detention: a prospective longitudinal study. JAMA Psychiatry 72, 84–93 (2015).
Gatti, U., Tremblay, R. E. & Vitaro, F. Iatrogenic effect of juvenile justice. J. Child Psychol. Psychiatry 50, 991–998 (2009).
Moore, E. et al. International youth justice systems: promoting youth development and alternative approaches: a position paper of the society for adolescent health and medicine. J. Adolesc. Health 59, 482–486 (2016).
Pilling, S. et al. Recognition, intervention, and management of antisocial behaviour and conduct disorders in children and young people: summary of NICE-SCIE guidance. BMJ 346, f1298 (2013).
Gorman, D. A. et al. Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder. Can. J. Psychiatry 60, 62–76 (2015).
Loy, J. H., Merry, S. N., Hetrick, S. E. & Stasiak, K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst. Rev. 9, CD008559 (2017).
Pringsheim, T., Hirsch, L., Gardner, D. & Gorman, D. A. Pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: a systematic review and meta-analysis. Part 2: antipsychotics and traditional mood stabilizers. Can. J. Psychiatry 60, 52–61 (2015).
Gadow, K. D. et al. Risperidone added to parent training and stimulant medication: effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression. J. Am. Acad. Child Adolesc. Psychiatry 53, 948–959 (2014).
Gadow, K. D. et al. Severely aggressive children receiving stimulant medication versus stimulant and risperidone: 12-month follow-up of the TOSCA trial. J. Am. Acad. Child Adolesc. Psychiatry 55, 469–478 (2016).
Turgay, A., Binder, C., Snyder, R. & Fisman, S. Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs. Pediatrics 110, e34 (2002).
Reyes, M., Croonenberghs, J., Augustyns, I. & Eerdekens, M. Long-term use of risperidone in children with disruptive behavior disorders and subaverage intelligence: efficacy, safety, and tolerability. J. Child Adolesc. Psychopharmacol. 16, 260–272 (2006).
Groenman, A. P., Janssen, T. W. P. & Oosterlaan, J. Childhood psychiatric disorders as risk factor for subsequent substance abuse: a meta-analysis. J. Am. Acad. Child Adolesc. Psychiatry 56, 556–569 (2017).
Bernhard, A., Martinelli, A., Ackermann, K., Saure, D. & Freitag, C. M. Association of trauma, posttraumatic stress disorder and conduct disorder: a systematic review and meta-analysis. Neurosci. Biobehav. Rev. 91, 153–169 (2018).
Weisz, J. R. et al. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch. Gen. Psychiatry 69, 274–282 (2012).
Chorpita, B. F. et al. Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. J. Consult. Clin. Psychol. 81, 999–1009 (2013).
Petrosino, A., Turpin-Petrosino, C., Hollis-Peel, M. E. & Lavenberg, J. G. ‘Scared Straight’ and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database Syst. Rev. 4, CD002796 (2013).
Jolliffe, D., Farrington, D. P. & Howard, P. How long did it last? A 10-year reconviction follow-up study of high intensity training for young offenders. J. Exp. Criminol. 9, 515–531 (2013).
Bardone, A. et al. Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety. J. Am. Acad. Child Adolesc. Psychiatry 37, 594–601 (1998).
Fergusson, D. M., John Horwood, L. & Ridder, E. M. Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J. Child Psychol. Psychiatry 46, 837–849 (2005).
Odgers, C. L. et al. Female and male antisocial trajectories: from childhood origins to adult outcomes. Dev. Psychopathol. 20, 673–716 (2008).
Maughan, B., Stafford, M., Shah, I. & Kuh, D. Adolescent conduct problems and premature mortality: follow-up to age 65 years in a national birth cohort. Psychol. Med. 44, 1077–1086 (2014).
Colman, I. et al. Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. BMJ 338, a2981 (2009).
Moffitt, T. E. Male antisocial behaviour in adolescence and beyond. Nat. Hum. Behav. 2, 177–186 (2018).
Bevilacqua, L., Hale, D., Barker, E. D. & Viner, R. Conduct problems trajectories and psychosocial outcomes: a systematic review and meta-analysis. Eur. Child Adolesc. Psychiatry 27, 1239–1260 (2018).
Rivenbark, J. G. et al. The high societal costs of childhood conduct problems: evidence from administrative records up to age 38 in a longitudinal birth cohort. J. Child Psychol. Psychiatry 59, 703–710 (2018).
Odgers, C. L. et al. Prediction of differential adult health burden by conduct problem subtypes in males. Arch. Gen. Psychiatry 64, 476–484 (2007). This important study investigated the adult outcomes of different developmental trajectories of conduct problems (life-course persistent, adolescence-onset and childhood-limited) in males. It showed that adolescence-onset conduct problems frequently persist into adult life and that both life-course persistent and adolescence-onset conduct problems are associated with a broad range of negative outcomes.
Burt, S. A. et al. Commentary: childhood conduct problems are a public health crisis and require resources: a commentary on Rivenbark et al. J. Child Psychol. Psychiatry 59, 711–713 (2018).
Woelbert, E., Kirtley, A., Balmer, N. & Dix, S. How much is spent on mental health research: developing a system for categorising grant funding in the UK. Lancet Psychiatry 6, 445–452 (2019).
Scott, S., Knapp, M., Henderson, J. & Maughan, B. Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 323, 191 (2001).
Freitag, C. M. et al. Conduct disorder in adolescent females: current state of research and study design of the FemNAT-CD consortium. Eur. Child Adolesc. Psychiatry 27, 1077–1093 (2018).
Collins, P. Y. et al. Grand challenges in global mental health: a consortium of researchers, advocates and clinicians announces here research priorities for improving the lives of people with mental illness around the world, and calls for urgent action and investment. Nature 475, 27–30 (2011).
Blair, R. J. R. The neurobiology of psychopathic traits in youths. Nat. Rev. Neurosci. 14, 786–799 (2013).
Bearden, C. E. & Thompson, P. M. Emerging global initiatives in neurogenetics: the Enhancing Neuroimaging Genetics Through Meta-Analysis (ENIGMA) consortium. Neuron 94, 232–236 (2017).
Blair, R. J. R., Leibenluft, E. & Pine, D. S. Conduct disorder and callous-unemotional traits in youth. N. Engl. J. Med. 371, 2207–2216 (2014).
Bywater, T. et al. Incredible Years parent training support for foster carers in Wales: a multi-centre feasibility study. Child Care Health Dev. 37, 233–243 (2011).
Dadds, M. R. et al. Keeping parents involved: predicting attrition in a self-directed, online program for childhood conduct problems. J. Clin. Child Adolesc. Psychol. https://doi.org/10.1080/15374416.2018.1485109 (2018).
Choy, O. & Raine, A. Omega-3 supplementation as a dietary intervention to reduce aggressive and antisocial behavior. Curr. Psychiatry Rep. 20, 32 (2018).
Loeber, R., Burke, J. D. & Pardini, D. A. Development and etiology of disruptive and delinquent behavior. Annu. Rev. Clin. Psychol. 5, 291–310 (2009).
Copeland, W. E., Shanahan, L., Costello, E. J. & Angold, A. Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Arch. Gen. Psychiatry 66, 764–772 (2009).
Gardner, F. et al. Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention. J. Clin. Child Adolesc. Psychol. 39, 568–580 (2010).
Hanisch, C., Hautmann, C., Plück, J., Eichelberger, I. & Döpfner, M. The prevention program for externalizing problem behavior (PEP) improves child behavior by reducing negative parenting: analysis of mediating processes in a randomized controlled trial. J. Child Psychol. Psychiatry 55, 473–484 (2014).
Forehand, R., Lafko, N., Parent, J. & Burt, K. B. Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clin. Psychol. Rev. 34, 608–619 (2014).
Dekovic, M., Asscher, J. J., Manders, W. A., Prins, P. J. M. & van der Laan, P. Within-intervention change: mediators of intervention effects during multisystemic therapy. J. Consult. Clin. Psychol. 80, 574–587 (2012).
Gardner, F., Montgomery, P. & Knerr, W. Transporting evidence-based parenting programs for child problem behavior (age 3–10) between countries: systematic review and meta-analysis. J. Clin. Child Adolesc. Psychol. 45, 749–762 (2016).
Sawyer, A. M., Borduin, C. M. & Dopp, A. R. Long-term effects of prevention and treatment on youth antisocial behavior: a meta-analysis. Clin. Psychol. Rev. 42, 130–144 (2015).
Beauchaine, T. P., Webster-Stratton, C. & Reid, M. J. Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. J. Consult. Clin. Psychol. 73, 371–388 (2005).
Hawes, D. J., Price, M. J. & Dadds, M. R. Callous-unemotional traits and the treatment of conduct problems in childhood and adolescence: a comprehensive review. Clin. Child Fam. Psychol. Rev. 17, 248–267 (2014).
The National Institute of Mental Health. Research Domain Criteria (RDoC). NIMH https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/index.shtml (2019).
Peterson, B. S. Editorial: Research Domain Criteria (RDoC): a new psychiatric nosology whose time has not yet come. J. Child Psychol. Psychiatry 56, 719–722 (2015).
Raine, A. Antisocial personality as a neurodevelopmental disorder. Annu. Rev. Clin. Psychol. 14, 259–289 (2018).
Rowe, R. et al. The role of callous and unemotional traits in the diagnosis of conduct disorder. J. Child Psychol. Psychiatry 51, 688–695 (2010).
Wakschlag, L. S. et al. The neurodevelopmental basis of early childhood disruptive behavior: irritable and callous phenotypes as exemplars. Am. J. Psychiatry 175, 114–130 (2018).
White, S. F. et al. The relationship between large cavum septum pellucidum and antisocial behavior, callous-unemotional traits and psychopathy in adolescents. J. Child Psychol. Psychiatry 54, 575–581 (2012).
Raine, A., Lee, L., Yang, Y. & Colletti, P. Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy. Br. J. Psychiatry 197, 186–192 (2010).
Biederman, J., Petty, C. R., Evans, M., Small, J. & Faraone, S. V. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res. 177, 299–304 (2010).
Scarr, S. & McCartney, K. How people make their own environments: a theory of genotype greater than environment effects. Child Dev. 54, 424–435 (1983).
Fergusson, D. M., Boden, J. M., Horwood, L. J., Miller, A. L. & Kennedy, M. A. MAOA, abuse exposure and antisocial behaviour: 30-year longitudinal study. Br. J. Psychiatry 198, 457–463 (2011).
Meyer-Lindenberg, A. et al. Neural mechanisms of genetic risk for impulsivity and violence in humans. Proc. Natl Acad. Sci. USA 103, 6269–6274 (2006).
G.F., S.D.B. and C.M.F. were supported by the European Commission’s FP7 scheme under grant agreement no. 602047 (FemNAT-CD). W.E.C. was supported by R01HD093651 and R01MH117559 from the National Institutes of Health. C.L.O. is a Fellow of the Canadian Institute of Advanced Research. B.F. receives support from a personal grant from the Netherlands Organization for Scientific Research (NWO; Vici grant 016-130-669), from a grant for the Dutch National Science Agenda for the NWA NeurolabNL project (grant 400 17 602), from the European Commission’s FP7 under grant agreement no. 602805 (Aggressotype), and from the European Commission’s Horizon 2020 Program (H2020/2014–2020) under grant agreement no. 728018 (Eat2beNICE).
C.F. has served as a consultant on autism spectrum disorders for Desitin and Roche. She receives royalties for books on autism spectrum disorders, attention-deficit/hyperactivity disorder and depression. B.F. has received educational speaking fees from Medice. All other authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Achenbach System of Empirically Based Assessment: www.aseba.org
Alabama Parenting Questionnaire: https://sites01.lsu.edu/faculty/pfricklab/apq/
Behavioral Assessment System for Children, Third Edition: https://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildADDADHDBehaviour/basc3/behavior-assessment-system-for-children-third-edition.aspx
Child Problematic Traits Inventory: https://www.oru.se/english/research/research-environments/hs/caps/cpti/
Diagnostic Interview Schedule for Children: https://www.cdc.gov/nchs/data/nhanes/limited_access/interviewer_manual.pdf
Dyadic Parent–Child Coding System: http://www.pcit.org/measures.html
Eyberg Child Behavior Inventory: https://www.parinc.com/products/pkey/97
Inventory of Callous-Unemotional traits: https://sites01.lsu.edu/faculty/pfricklab/icu/
Kiddie-Schedule for Affective Disorders and Schizophrenia: http://pediatricbipolar.pitt.edu/resources/instruments
Psychiatric Genomics Consortium: http://www.med.unc.edu/pgc
Strengths and Difficulties Questionnaire: http://www.sdqinfo.com/
Sutter–Eyberg Student Behavior Inventory-Revised: https://www.parinc.com
Wechsler Abbreviated Scale of Intelligence: https://www.pearsonclinical.co.uk/Psychology/AdultCognitionNeuropsychologyandLanguage/AdultGeneralAbilities/WASI-II/
Wechsler Intelligence Scale for Children-5th Edition: https://www.pearsonclinical.co.uk/Psychology/ChildCognitionNeuropsychologyandLanguage/ChildGeneralAbilities/wisc-v/
Woodcock Johnson 4th Edition Tests of Achievement: https://www.hmhco.com/programs/woodcock-johnson-iv