Monique G. McCoy’s research while affiliated with University of Alabama and other places

This chapter explores the characteristics and causes of conduct disorder (CD). CD is one of two disruptive behavior disorders defined by the Diagnostic and Statistical Manual of Mental Disorders. CD refers to a persistent pattern of behavior in which the basic rights of others and major societal norms or rules are violated. The symptoms used to operationally define this pattern of behavior fall into four categories: aggression to people or animals, destruction of property, deceitfulness or theft, and serious violation of rules. The breakdown of CD into childhood-onset and adolescent-onset subtypes illustrates a very important concept for understanding and treating children with CD. Specifically, it illustrates the fact that children with CD constitute a very heterogeneous group with major differences among those with the disorder in their clinical presentation, clinical course, and underlying causes of behavior. The prevalence of CD depends on a number of factors including the type of symptoms leading to the diagnosis, the age group studied, and the gender of the child. Case conceptualization is critical for designing effective treatments for children with CD. It should be the cornerstone of clinical endeavor and a bridge between the research literature on CD in children and adolescents, and the design of treatment plans for them as individuals.

This study focused on the use of callous-unemotional (CU) traits to identify a subgroup of children with both attention deficit/hyperactivity disorder (ADHD) and a conduct problem diagnosis (oppositional defiant disorder [ODD] or conduct disorder [CD] who show characteristics similar to adults with psychopathy. In a clinic-referred sample of children aged 6 to 13 years (N = 154), those with diagnoses of both ADHD and ODD/CD were divided on the basis of teacher ratings of CU traits. Children high on these traits showed features typically associated with psychopathy, such as a lack of fearfulness and a reward-dominant response style. Furthermore, children with CU traits seemed less distressed by their behavior problems. These findings are consistent with research on adults showing that impulsivity and antisocial behavior alone are insufficient to document persons who fit the construct of psychopathy.

Research has consistently found associations among parenting practices, socioeconomic disadvantage, ethnicity and conduct problems in children. We investigated whether parenting practices might mediate the relation between ethnicity and conduct problems and the relation between socioeconomic status (SES) and conduct problems. The subjects were 141 clinic-referred children between the ages of 6 and 17 and their primary custodial parents. Using multiple indicators for each construct, except ethnicity, the mediational role of parenting was tested using structural equation modeling. The results indicated that the effects of SES on conduct problems was largely mediated by the influence of ineffective parenting practices. In contrast, ethnicity was not associated with conduct problems in this clinic-referred sample, even prior to controlling for SES and parenting practices, suggesting that the link between minority status and conduct problems may be dependent on the demographic characteristics of the sample. Exploratory analyses also revealed that there were ethnic differences in the types of parenting practices that were most strongly associated with conduct problems.

Research has consistently shown that children with severe conduct problems often exhibit intellectual deficits, especially in their verbal abilities. We investigated whether or not this finding only applies to certain subgroups of children with severe conduct problems. In a sample of 117 clinic-referred children between the ages of 6 and 13, we assessed for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) symptoms using a structured diagnostic interview with each child's parent and teacher, callous and unemotional traits using parent and teacher ratings, and intellectual functioning using a standard individually administered intelligence test. Children with an ODD or CD diagnosis who did not show callous and unemotional traits showed a deficit on subtests measuring verbal reasoning ability relative to a clinic control group. Children with an ODD or CD diagnosis who also showed callous and unemotional traits did not show a verbal deficit and, in fact, showed a trend toward having weaker nonverbal abilities. These results highlight the importance of recognizing distinct subgroups of children with severe conduct problems when studying potential intellectual deficits in these children.