Conduct Disorders in Adolescence as a Predictor of Antisocial Personality Disorder (ASPD): A Review Overview

By: Thea Soleil “Nine” Dona 

(ASPD): A Review Overview 

Adolescent Conduct Disorder (CD) has a significant association with the development of Antisocial Personality Disorder (ASPD) in adulthood. This paper reviews the diagnostic characteristics, risk factors, and neurobiological underpinnings of CD, pointing to its developmental precursor to ASPD. It also covers comorbidities, treatment protocols, and general societal impacts of early-onset behavioral disorders. Understanding the CD-ASPD association can facilitate early intervention programs, which may avoid the development of chronic antisocial behavior. 

Introduction 

Conduct Disorder (CD) is an acute behavior and emotional disorder identified in children. Characterized by long-standing patterns of aggression, rule-breaking, lying, and the absence of conformity to social standards, CD has been termed the principal risk factor for the subsequent development of Antisocial Personality Disorder (ASPD) (American Psychiatric Association [APA], 2013). Empirical evidence reports early-starting CD, particularly before the age of 10 years, to play a predominant role in contributing to the diagnosis of ASPD in adults (Fairchild et al., 2019). 

To understand the CD-to-ASPD course, one should take into account genetic susceptibility, environment, neurobiological impairment, and psychiatric comorbidity. Interventions early on and in the treatment itself are also key in not exacerbating antisocial behavior.

Diagnostic Criteria and Prevalence 

The DSM-5 defines CD as a repeating and persistent behavior that violates the rights of others and social norms. Symptoms include aggression toward individuals and animals, property damage, deceitfulness, stealing, and severe rule-breaking (APA, 2013). Prevalence rates for CD vary but are estimated to be approximately 2-10% of children and adolescents, with a higher prevalence in males (Erskine et al., 2016). 

ASPD, on the other hand, is a personality disorder among adults (18+ years) with a prehistory of CD before age 15 (APA, 2013). According to studies, up to 40% of individuals with CD in childhood may later develop ASPD (Loeber et al., 2018). 

Risk Factors for Developing Conduct Disorder and ASPD 

Genetic and Neurobiological Factors 

It has been found through studies that genetic heritability accounts for 40-50% variation in antisocial behavior (Rhee & Waldman, 2011). Impulse control and decision-making deficits in the prefrontal cortex, which are structurally and functionally impaired, have been found in CD patients (Rogers & De Brito, 2016). Reduced amygdala activity, which is linked to poor emotional regulation and empathy, has also been observed in teenage individuals with extreme conduct problems (Blair, 2017). 

Environmental Influences 

Adverse childhood experiences (ACEs) such as abuse, neglect, drug or alcohol abuse by parents, and family conflict significantly increase the likelihood of developing CD (Moffitt, 2018). Social learning theory suggests that exposure to violence and unpredictable parental

discipline result in antisocial behavior (Patterson et al., 2010). In addition, peer offending and neighborhood disadvantage are strong predictors of long-term conduct problems (Odgers et al., 2008). 

Comorbid Psychiatric Disorders 

The CD also frequently co-occurs with other psychiatric disorders, such as: ● Attention-Deficit/Hyperactivity Disorder (ADHD): 30-50% of youth with CD also qualify for ADHD, which adds impulsivity and aggression (Thapar et al., 2017). 

● Substance Use Disorders (SUDs): CD teens are more likely to engage in early drug use, further promoting delinquent behavior (White et al., 2019). 

● Depression and Anxiety Disorders: While less common, some individuals with CD do exhibit internalizing symptoms that complicate diagnosis and treatment (Beauchaine & McNulty, 2013). 

Interventions and Prevention Strategies 

Early Identification and Behavioral Therapy 

Evidence-based treatments, such as Parent Management Training (PMT) and Cognitive Behavioral Therapy (CBT), have been successful in reducing conduct problems (Kazdin, 2017). Early detection of aggressive behavior in preschool and early elementary school settings allows targeted intervention before symptoms worsen. 

Multisystemic Therapy (MST)

MST is a community-based intervention that targets multiple risk factors, including family, peer, and academic functioning. Evidence points to the effectiveness of MST in lowering offending among juveniles and long-term outcomes for adolescents with CD (Henggeler et al., 2009). 

Pharmacological Intervention 

There is no medication for CD, but certain psychotropic medications, including stimulants (to treat comorbid ADHD) and atypical antipsychotics (to treat excessive aggression), are prescribed to alleviate symptoms (Connor et al., 2019). 

Long-term Outcomes and Social Effects 

The evolution of CD to ASPD is connected to chronic offending, joblessness, and increased health expenditure (Fazel et al., 2015). Due to the public expense, a preventive program for youth can have significant social and economic ramifications. Preventive interventions in vulnerable youth, improving family environments, and access to mental health services are crucial to reducing the prevalence of ASPD (Moffitt, 2018). 

Conclusion 

Adolescent Conduct Disorder is a robust predictor of Antisocial Personality Disorder in adults. Genetic risk, neurobiological dysfunction, and environmental influences are the determinants of the expression and perpetuation of antisocial behavior. Early intervention, evidence-based therapies, and policy-informed prevention strategies are critical to improve long-term CD outcomes. In the future, research needs to continue to examine neurodevelopmental indicators and new treatment approaches for improving outcomes in high-risk children.

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. 

Beauchaine, T. P., & McNulty, T. (2013). Comorbidities and continuities as ontogenic processes: Toward a developmental spectrum model of externalizing psychopathology. Development and Psychopathology, 25(4pt2), 1505-1528. https://doi.org/10.1017/S0954579413000746 

Blair, R. J. R. (2017). The neurobiology of impulsive aggression. Journal of Child and Adolescent Psychopharmacology, 27(7), 557-563. https://doi.org/10.1089/cap.2016.0140 

Connor, D. F., Steingard, R. J., Anderson, J. J., & Melloni, R. H. (2019). Use of atypical antipsychotics in children with conduct disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 58(4), 370-381. https://doi.org/10.1016/j.jaac.2018.11.006 

Erskine, H. E., Ferrari, A. J., Polanczyk, G. V., Moffitt, T. E., Murray, C. J., Vos, T., & Scott, J. G. (2016). The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. Journal of Child Psychology and Psychiatry, 57(4), 463-480. 

https://doi.org/10.1111/jcpp.12430 

Fairchild, G., Hawes, D. J., Frick, P. J., Copeland, W. E., & Odgers, C. L. (2019). Conduct disorder. Nature Reviews Disease Primers, 5(1), 1-25. 

https://doi.org/10.1038/s41572-019-0095-y

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Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents. Guilford Press. 

Kazdin, A. E. (2017). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. Oxford University Press. 

Moffitt, T. E. (2018). Male antisocial behavior in adolescence and beyond. Nature Human Behaviour, 2(3), 177-186. https://doi.org/10.1038/s41562-018-0309-9 

Rogers, J. C., & De Brito, S. A. (2016). Cortical and subcortical gray matter volume in youths with conduct problems. JAMA Psychiatry, 73(1), 64-72. 

https://doi.org/10.1001/jamapsychiatry.2015.2423