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

"There needs to be a concerted effort 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 families can access child and adolescent mental health services. At LSU, we provide diagnostic services to the community for children and adolescents with serious behavior problems ages 6 to 17 through our Psychological Services Center, run by the LSU Department of Psychology," said co-author Paul Frick, LSU Department of Psychology professor.

The study reviewed evidence from research conducted around the world and estimated the prevalence of conduct disorder to be around 3 percent 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 recognized or studied psychiatric disorders, and funding for research into it lags far behind many other childhood disorders.

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

"Despite the fact that it is associated with a very high personal, familial, and societal burden, conduct disorder is under-recognized and frequently goes undiagnosed and untreated. Unfortunately, the longer this goes on, the more difficult it is to treat. It truly exemplifies the old saying that 'an ounce of prevention is worth a pound of cure.' Also, many treatments that are being used in the community have not proven effective," Frick said.

This failure to tackle and treat conduct disorder 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 paper -- a comprehensive overview of all aspects of conduct disorder, 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, conduct disorder is associated with a higher risk of developing depression, anxiety, alcohol and substance abuse. Up to 50 percent of individuals with conduct disorder develop antisocial or borderline personality disorder in adulthood, along with more serious criminal behavior and gang involvement. The study also finds that young people with conduct disorder are more likely to have children earlier, with more unplanned pregnancies, to become dependent on benefits, homeless or even to attempt suicide. Such behaviors have a huge detrimental effect on an individual, their families and society. In addition, those with conduct disorder display parenting problems which often mean that their children are at higher risk for developing conduct disorder, starting an inter-generational cycle.

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. The study highlights the value of both training parents in better supporting children with conduct disorder and skills training for children and adolescents with the condition to help them improve their social and problem-solving skills and ability to regulate their emotions. Frick and his co-authors suggest these approaches can have profound impacts on the patient's well-being and life chances.

Frick hopes the study can bring much needed attention to the diagnosis and treatment of children with conduct disorder. Most people view children with conduct disorder as just "bad kids" and often don't recognize the need for mental health treatment. He hopes the paper highlights the societal impact of the condition which requires more funding for research on treatment from both governmental and private sources.