European Child & Adolescent Psychiatry

, Volume 28, Issue 11, pp 1537–1546 | Cite as

The validity of conduct disorder symptom profiles in high-risk male youth

  • Marcel AebiEmail author
  • Steffen Barra
  • Cornelia Bessler
  • Susanne Walitza
  • Belinda Plattner
Original Contribution


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.


Forensic 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

Supplementary material

787_2019_1339_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 24 kb)


  1. 1.
    Frick PJ (2016) Current research on conduct disorders in children and adolescents. S Afr J Psychol 46(2):160–174. CrossRefGoogle Scholar
  2. 2.
    Erskine HE, Norman RE, Ferrari AJ, Chan GC, Copeland WE, Whiteford HA, Scott JG (2016) Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 55(10):841–850. CrossRefPubMedGoogle Scholar
  3. 3.
    Blair RJ, Leibenluft E, Pine DS (2015) Conduct disorder and callous-unemotional traits in youth. N Engl J Med 372(8):784. CrossRefPubMedGoogle Scholar
  4. 4.
    Lindhiem O, Bennett CB, Hipwell AE, Pardini DA (2015) Beyond symptom counts for diagnosing oppositional defiant disorder and conduct disorder? J Abnorm Child Psychol 43(7):1379–1387. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Burt SA, Donnellan MB, Iacono WG, McGue M (2011) Age-of-onset or behavioral sub-types? A prospective comparison of two approaches to characterizing the heterogeneity within antisocial behavior. J Abnorm Child Psychol 39(5):633–644. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Frick PJ, Lahey BB, Loeber R, Tannenbaum L, Van Horn Y, Christ MAG, Hart EA, Hanson K (1993) Oppositional defiant disorder and conduct disorder: a meta-analytic review of factor analyses and cross-validation in a clinic sample. Clin Psychol Rev 13(4):319–340. CrossRefGoogle Scholar
  7. 7.
    Tackett JL, Krueger RF, Iacono WG, McGue M (2005) Symptom-based subfactors of DSM-defined conduct disorder: evidence for etiologic distinctions. J Abnorm Psychol 114(3):483. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Burt SA (2012) How do we optimally conceptualize the heterogeneity within antisocial behavior? An argument for aggressive versus non-aggressive behavioral dimensions. Clin Psychol Rev 32(4):263–279. CrossRefPubMedGoogle Scholar
  9. 9.
    Breslau J, Saito N, Tancredi DJ, Nock M, Gilman SE (2012) Classes of conduct disorder symptoms and their life course correlates in a US national sample. Psychol Med 42(5):1081–1089. CrossRefPubMedGoogle Scholar
  10. 10.
    Lacourse E, Baillargeon R, Dupere V, Vitaro F, Romano E, Tremblay R (2010) Two-year predictive validity of conduct disorder subtypes in early adolescence: a latent class analysis of a Canadian longitudinal sample. J Child Psychol Psychiatry 51(12):1386–1394. CrossRefPubMedGoogle Scholar
  11. 11.
    Nock MK, Kazdin AE, Hiripi E, Kessler RC (2006) Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychol Med 36(5):699–710. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Colins OF (2016) The clinical usefulness of the DSM-5 specifier for conduct disorder outside of a research context. Law Hum Behav 40(3):310–318. CrossRefPubMedGoogle Scholar
  13. 13.
    Colins OF, Vermeiren RR (2013) The usefulness of DSM-IV and DSM-5 conduct disorder subtyping in detained adolescents. J Nerv Ment Dis 201(9):736–743. CrossRefPubMedGoogle Scholar
  14. 14.
    Pechorro P, Jiménez L, Hidalgo V, Nunes C (2015) The DSM-5 Limited Prosocial Emotions subtype of Conduct Disorder in incarcerated male and female juvenile delinquents. Int J Law Psychiatry 39:77–82. CrossRefPubMedGoogle Scholar
  15. 15.
    Aebi M, Giger J, Plattner B, Metzke CW, Steinhausen H-C (2014) Problem coping skills, psychosocial adversities and mental health problems in children and adolescents as predictors of criminal outcomes in young adulthood. Eur Child Adolesc Psychiatry 23(5):283–293. CrossRefPubMedGoogle Scholar
  16. 16.
    Lahey BB, Loeber R, Burke JD, Applegate B (2005) Predicting future antisocial personality disorder in males from a clinical assessment in childhood. J Consult Clin Psychol 73(3):389–399. CrossRefPubMedGoogle Scholar
  17. 17.
    Aebi M, Barra S, Bessler C, Steinhausen HC, Walitza S, Plattner B (2016) Oppositional defiant disorder dimensions and subtypes among detained male adolescent offenders. J Child Psychol Psychiatry 57(6):729–736. CrossRefPubMedGoogle Scholar
  18. 18.
    Sheehan DV, Sheehan KH, Shytle D, Janavs J, Bannon Y, Rogers JE, Milo KM, Stock SL, Wilkinson B (2010) Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). J Clin Psychiatry 71(3):313–326. CrossRefPubMedGoogle Scholar
  19. 19.
    Plattner B, Kraemer HC, Williams RP, Bauer SM, Kindler J, Feucht M, Friedrich MH, Steiner H (2007) Suicidality, psychopathology, and gender in incarcerated adolescents in Austria. J Clin Psychiatry 68(10):1593–1600. CrossRefPubMedGoogle Scholar
  20. 20.
    Le Corff Y, Toupin J (2014) Overt versus covert conduct disorder symptoms and the prospective prediction of antisocial personality disorder. J Pers Disord 28(6):864–872. CrossRefPubMedGoogle Scholar
  21. 21.
    International Labour Organisation (2008) International Standard Classification Of Occupations (ISCO). Accessed 10 Aug 2017
  22. 22.
    Muthen B, Muthen L (2012) Mplus user’s guide, 7th edn. Muthén & Muthén, Los AngelesGoogle Scholar
  23. 23.
    Nylund KL, Asparouhov T, Muthén B (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model 14(4):535–569. CrossRefGoogle Scholar
  24. 24.
    Imbach D, Aebi M, Metzke CW, Bessler C, Steinhausen HC (2013) Internalizing and externalizing problems, depression, and self-esteem in non-detained male juvenile offenders. Child Adolesc Psychiatry Ment Health 7(1):7CrossRefGoogle Scholar
  25. 25.
    Fairchild G, van Goozen SH, Calder AJ, Goodyer IM (2013) Research review: evaluating and reformulating the developmental taxonomic theory of antisocial behaviour. J Child Psychol Psychiatry 54(9):924–940. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Jambroes T, Jansen LM, Vermeiren RR, Doreleijers TA, Colins OF, Popma A (2016) The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5. Eur Child Adolesc Psychiatry 25(8):891–902. CrossRefPubMedGoogle Scholar
  27. 27.
    Kahn RE, Frick PJ, Youngstrom E, Findling RL, Youngstrom JK (2012) The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder. J Child Psychol Psychiatry 53(3):271–282. CrossRefPubMedGoogle Scholar
  28. 28.
    Moffitt TE (1993) Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychol Rev 100(4):674–701CrossRefGoogle Scholar
  29. 29.
    Vermeiren R, Jespers I, Moffitt T (2006) Mental health problems in juvenile justice populations. Child Adolesc Psychiatr Clin N Am 15(2):333–351. CrossRefPubMedGoogle Scholar
  30. 30.
    Burt SA (2009) Are there meaningful etiological differences within antisocial behavior? Results of a meta-analysis. Clin Psychol Rev 29(2):163–178. CrossRefPubMedGoogle Scholar
  31. 31.
    Loeber R, Wung P, Keenan K, Giroux B, Stouthamer Loeber M, Van Kammen WB (1993) Developmental pathways in disruptive child behavior. Dev Psychopathol 5:103–133. CrossRefGoogle Scholar
  32. 32.
    Sawyer AM, Borduin CM, Dopp AR (2015) Long-term effects of prevention and treatment on youth antisocial behavior: a meta-analysis. Clin Psychol Rev 42:130–144. CrossRefPubMedGoogle Scholar
  33. 33.
    Odgers CL, Caspi A, Broadbent JM, Dickson N, Hancox RJ, Harrington H, Poulton R, Sears MR, Thomson WM, Moffitt TE (2007) Prediction of differential adult health burden by conduct problem subtypes in males. Arch Gen Psychiatry 64(4):476–484. CrossRefPubMedGoogle Scholar
  34. 34.
    Washburn JJ, Romero EG, Welty LJ, Abram KM, Teplin LA, McClelland GM, Paskar LD (2007) Development of antisocial personality disorder in detained youths: the predictive value of mental disorders. J Consult Clin Psychol 75(2):221–231. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Nagin D, Tremblay RE (1999) Trajectories of boys’ physical aggression, opposition, and hyperactivity on the path to physically violent and nonviolent juvenile delinquency. Child Dev 70(5):1181–1196CrossRefGoogle Scholar
  36. 36.
    Fonagy P, Luyten P (2018) Conduct problems in youth and the RDoC approach: a developmental, evolutionary-based view. Clin Psychol Rev 64:57–76. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Forensic Psychiatry, Child and Youth Forensic ServiceUniversity Hospital of PsychiatryZurichSwitzerland
  2. 2.Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Hospital of PsychiatryZurichSwitzerland
  3. 3.Department of Child and Adolescent PsychiatryParacelsus Medical UniversitySalzburgAustria

Personalised recommendations