The validity of conduct disorder symptom profiles in high-risk male youth
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Conduct disorder (CD) is a heterogeneous pattern of rule-breaking and aggressive symptoms. Until now it has been unclear whether valid, clinically useful symptom profiles can be defined for populations in youth at high-risk of CD. Interview-based psychiatric disorders, CD symptoms and officially recorded offences were assessed in boys from a detention facility and a forensic psychiatric hospital (N = 281; age 11.2–21.3 years). We used latent class analyses (LCA) to examine CD subtypes and their relationships with comorbid psychiatric disorders, suicidality, and criminal recidivism. LCA revealed five CD subtypes: no CD, mild aggressive CD, mild covert CD, moderate CD, and severe CD. The severe and, to a lesser degree, the moderate CD subtype were related to comorbid attention deficit hyperactivity disorder, substance use disorder, affective disorder, and suicidality. Time to violent criminal re-offending was predicted by severe CD (OR 5.98, CI 2.5–13.80) and moderate CD (OR 4.18, CI 1.89–9.21), but not by any other CD subtype in multivariate Cox regressions (controlling for age, low socioeconomic status and foreign nationality). These results confirm the existence of different CD symptom profiles in a high-risk group. Additional variable-oriented analyses with CD symptom count and aggressive/rule-breaking CD-dimensions further supported a dimensional view and a dose–response relationship of CD and criminal recidivism. Classifying high-risk young people according to the number of aggressive and rule-breaking CD symptoms is of major clinical importance and may provide information about risk of violent recidivism.
KeywordsForensic youth Juvenile offender Aggression Rule-breaking Criminal recidivism Suicidality
We thank Metin Aysel, MD, Silke Nessbach, MSc, Hellvig Spinka, MD, and Madleina Manetsch, MD, who helped with data collection.
Compliance with ethical standards
Conflict of interest
M. Aebi and C. Bessler received in the last 5 years royalties from Hogrefe. Their work was supported in the last 5 years by the Swiss Federal Institute of Justice and the Juvenile Justice Authorities of the Canton Zurich. S. Walitza has received in the last 5 years royalties from Thieme Hogrefe, Kohlhammer, Springer, Beltz. S. Walitza has received lecture honoraria from Opopharma in the last 5 years. Her work was supported in the last 5 years by the Swiss National Science Foundation (SNF), diff. EU FP7s, HSM Hochspezialisierte Medizin of the Kanton Zurich, Switzerland, Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, Gertrud Thalmann Fonds. Outside professional activities and interests are declared under the link of the University of Zurich http://www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web/.
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