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LETTERS TO EDITOR  
Year : 2018  |  Volume : 60  |  Issue : 2  |  Page : 253-254
Nosology and subtypes of conduct disorder


Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

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Date of Web Publication17-Aug-2018
 

How to cite this article:
Patra S. Nosology and subtypes of conduct disorder. Indian J Psychiatry 2018;60:253-4

How to cite this URL:
Patra S. Nosology and subtypes of conduct disorder. Indian J Psychiatry [serial online] 2018 [cited 2018 Oct 16];60:253-4. Available from: http://www.indianjpsychiatry.org/text.asp?2018/60/2/253/239148




Sir,

Attention-deficit hyperactivity disorders (ADHDs) remain the most debated psychiatric diagnosis, while conduct disorders (CDs) still remain enigmatic![1] While ADHDs result in functional impairment of the individual, CDs are regarded as public health problems. There are differences in classification of these disorders in the two major diagnostic systems of International Classification of Diseases-10 (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition. While the diagnostic criteria are being still worked on, recently, the American Psychological Association has included a subtype of CD, the callous unemotional type in DSM-5 “with limited prosocial emotions” as specifier.[2] Other subtypes of CD which include aggressive/nonaggressive CD, reactive/proactive aggression, and physical/relational aggressions remain under investigation.[1]

Little is known about Indian children with these disorders. The article by Jayaprakash et al. is a commendable effort in this direction.[3] While the authors have documented that 45% of children had comorbid hyperactivity, whether this subgroup fulfilled criteria for hyperkinetic CD or had comorbid hyperkinetic disorder as per the ICD-10 Diagnostic Criteria for Research is not clear. As per the ICD system, a diagnosis of hyperkinetic disorder is given priority over CD. The higher prevalence of hyperactivity in younger age group as compared to the adolescent age group might have been due to the fact that this belonged to the different category of hyperkinetic CD which is marked by younger age of onset and more severe symptomatology, which is in line with the findings of an earlier study.[4]

The validity of findings in the present scenario could have been increased using a standardized and validated scale: Child Behaviour Checklist which remains the gold standard for measuring child and adolescent emotional/behavioral problems and social competencies.[5] The instrument has three versions for parents, youths, and teachers with two sections: one section for social/adaptive functioning and the second section for problem behaviors. The behavioral profile section comprises of 118 items scored as 0 (not true), 1 (somewhat or sometimes true), or 2 (very true or often true). These items provide score on eight narrow scales: withdrawn/depressed, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, rule-breaking behavior, and aggressive behavior. The CD symptoms could have been rated on aggression and nonaggression dimensions using this scale.

There is an inherent problem of misreading the features of disinhibition, inattention, and distractibility of hyperkinetic disorders as lying, serious aggression, and illegal behavior. The overlap in symptoms of hyperactivity and conduct is so pronounced that a clear distinction between the two is often difficult.

In spite of the aforementioned limitations of the study, much of which can be due to the nature of the two major externalizing disorders of childhood, this is the first prospective study which throws light on the symptom profile, contributory family stressors, and the resulting functional limitations. The most common subtype reported in the study was CD in family context followed by oppositional defiant type which is quite a heartening finding.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lahey BB, Waldman ID. Annual research review: Phenotypic and causal structure of conduct disorder in the broader context of prevalent forms of psychopathology. J Child Psychol Psychiatry 2012;53:536-57.  Back to cited text no. 1
    
2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.  Back to cited text no. 2
    
3.
Jayaprakash R, Rajamohanan K, Anil P. Determinants of symptom profile and severity of conduct disorder in a tertiary level pediatric care set up: A pilot study. Indian J Psychiatry 2014;56:330-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Malhotra S, Aga VM, Balraj, Gupta N. Comparison of conduct disorder and hyperkinetic conduct disorder: A retrospective clinical study from North India. Indian J Psychiatry 1999;41:111-21.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Achenbach TM, Ruffle TM. The child behavior checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev 2000;21:265-71.  Back to cited text no. 5
    

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Correspondence Address:
Suravi Patra
Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_361_14

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