Conduct Disorder and Antisocial Personality Disorder: Axis of Evil

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Conduct Disorder and Antisocial Personality
Disorder Axis of Evil?

• Frank M. Tims, Ph.D.
• Ojesh Upadhyay, M.P.H.

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Conduct Disorder Axis II Disorder in
children/adolescents Persistent pattern of
maladaptive behaviors and disregard for
age-appropriate rules and norms.
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Antisocial Personality Disorder (ASPD)

• Axis II Disorder Persistent maladaptive behavior
  pattern, characterized by disregard for and
  violation of rights of others, beginning in
  childhood or early adolescence and continuing
  into adulthood.
• DSM-IV requires pre-existing conduct disorder to
  make this diagnosis.

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ASPD Criteria

• Age at least 18
• Law breaking
• Enjoy taking risks
• Dont think about consequences
• Lying and deceit
• Trouble holding job/ staying in school
• Get in physical fights
• Dont care if others get hurt

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ASPD Criteria

• Age at least 18
• Law breaking
• Enjoy taking risks
• Dont think about consequences
• Lying and deceit
• Trouble holding job/ staying in school
• Get in physical fights
• Dont care if others get hurt

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ASPD

• Runs in families
• More common among males
• CDADHD increases risk
• Other co-morbidity increases risk
• Abuse in childhood increases risk
• Adolescent AOD use increases risk

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Aggressive anti-social behavior among youth is
clearly linked to frequency of marijuana
useSource NHSDA Household Survey Data,
1994-1996
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Correlates of ASPD (At 30 Months Post Intake)
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Correlates of ASPD (At 30 Months Post Intake)
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PETSA -Two Longitudinal Samples Baseline to 30
Months

• Cannabis Youth Treatment (CYT) Study
• Adolescent Treatment Models (ATM)
• Combined sample N1,208
• Clients age 18
• N801

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Measures - Hyler Scale PDQ-4 and GAIN

• PDQ-4 DSM-IV criteria of ASPD, plus
  specification of age and previous conduct
  disorder
• GAIN Measures for Conduct Disorder, and Mental
  Disorders
• Other measures in GAIN and supplemental scales

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Client Characteristics at Baseline
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CD Category and Violent Symptoms Cross Tabulation
0 violent symptoms
1 to 2 violent symptoms
3 to 7 violent symptoms
Total
Count
287
25
0
312
No CD (2 or less symptoms)
Col
92.0
8.0
0.0
100
Count
157
194
58
409
Moderate CD (3 to 8 symptoms)
Col
38.4
47.4
14.2
100
Count
0
13
66
79
Severe CD (9 or more symptoms)
Col
0.0
16.5
83.5
100
Count
444
232
124
800
Total
Col
55.5
29
15.5
100
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Conduct Disorder and ASPD
Severe ASPD
No ASPD
Moderate ASPD
Total
CD No
125
77
70
272
within CD
46
28
26
100
CD Yes
139
174
216
529
within CD
26
33
41
100
Total
264
251
286
801
within CD
33
31
36
100
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Univariate Predictors of ASPD
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Univariate Predictors of ASPD
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Univariate Predictors of ASPD
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Univariate Predictors of ASPD
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Univariate Predictors of ASPD
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Univariate Predictors of ASPD
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Multivariate Predictors (simplified model)
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Multivariate Predictors (simplified model)
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Implications for Practitioners

• Screen for multiple diagnoses/ risk factors
• Importance of family history
• Assess recovery environment risk
• Need to provide systems of care that address
  these considerations
• Linkages between systems is needed
• Need multiple outcome measures
• Interpret outcomes in the context of the disorder