Conduct Disorder and Oppositional Defiant Disorder in a national sample: developmental epidemiology

TLDR

Despite growing epidemiological evidence, key aspects of childhood and adolescent antisocial disorder epidemiology remain uncertain. The study aimed to examine age trends, gender ratios, and comorbidity patterns of DSM‑IV Conduct Disorder and Oppositional Defiant Disorder in a nationally representative sample of 5‑15‑year‑olds. Cross‑sectional data from 10,438 5‑15‑year‑olds in the 1999 British Child Mental Health Survey were analyzed to assess prevalence and comorbidity. Conduct Disorder was more prevalent in boys and rose with age, with non‑aggressive problems increasing and aggressive symptoms decreasing over time; Oppositional Defiant Disorder showed reporter‑dependent gender differences, age trends that varied with CD overlap, and persistent rates when CD constraints were removed, while both disorders overlapped substantially and comorbid with other disorders, confirming and extending prior epidemiological findings.

Abstract

Despite an expanding epidemiological evidence base, uncertainties remain over key aspects of the epidemiology of the 'antisocial' disorders in childhood and adolescence.We used cross-sectional data on a nationally representative sample of 10,438 5-15-year-olds drawn from the 1999 British Child Mental Health Survey to examine age trends, gender ratios and patterns of comorbidity in DSM-IV Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD).CD was significantly more common in boys than girls, and increased in prevalence with age. Among children who met diagnostic criteria for CD, status violations and other non-aggressive conduct problems increased with age, while aggressive symptoms became less common. Gender differences in ODD varied by reporter. Estimates of age trends in ODD depended heavily on treatment of overlaps with CD. Following DSM-IV guidelines (where ODD is not diagnosed in the presence of CD), rates of ODD fell with age; if that constraint was released, clinically significant rates of oppositionality persisted at similar levels from early childhood to middle adolescence. CD and ODD showed high levels of overlap, and both diagnoses showed substantial comorbidity with other non-antisocial disorders.Results from this large-scale study confirm and extend previous findings in the epidemiology of the disruptive behaviour disorders.