Disruptive Behaviour 77school and offer, for example, parent training and social skills to those
at risk. To date, there have been few follow-up studies of long-term
effectiveness.Continuity and outcome
1 Forwards continuity: 40% of children and adolescents with disruptive
behavioural disorders become delinquent young adults with ongoing
behaviour problems and disrupted relationships.
2 Backwards continuity: 90% of young adult delinquents had disruptive
behavioural disorders as children.
Factors predicting outcome
1 In the child or adolescent: A poor outcome is predicted by early onset, a
wide range and high total number of symptoms, greater severity and fre-
quency of individual symptoms, pervasiveness across situations (home,
school and other), associated hyperactivity, and callous-unemotional
traits. Conversely, having only one area of problem behaviour, such
as aggressiveness alone, has a good prognosis provided there are no
problems in other areas, including peer relationships and educational
achievements. The presence or absence of a constellation of problems is
what is important.
2 In family: A poor outcome is predicted by parental psychiatric disorder,
parental criminality, high hostility and high discord focused on the child.
Type of adult outcome
1 Homotypiccontinuity – with the symptoms remaining much the same –
occurs more often in males, with continuing aggressiveness and vio-
lence, antisocial personality, alcohol and drug misuse, crime.
2 Heterotypiccontinuity – with different types of symptoms coming to
predominate – occurs more often in females, with a switch to a wide
range of emotional and personality disorders, with less aggressiveness
and criminality.
In addition to being at greater psychiatric and forensic risk, individuals
with a history of CD are also more likely to be socially impaired in adult-
hood, being more likely to have few, if any, educational qualifications, a
poor job history and impaired social relations, for example, more marital
breakdown.
Subject review
Bloomquist ML, Schnell SV. (2005)Helping Children with Aggression and
Conduct Problems. Guilford Press, New York.