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Practice Parameters for the Assessment and Treatment of Children and Adolescents With Conduct Disorder

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These practice parameters address the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. Voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned but not fully addressed from a clinical perspective. Clinical features of youth with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

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  • Cited by (0)

    These parameters were developed by Hans Steiner, M.D., principal author, and the Work Group on Quality Issues: John E. Dunne, M.D., Chair, William Ayres, M.D., former Chair, Valerie Arnold, M.D., Elissa Benedek, M.D., R. Scott Benson, M.D., Gail A. Bernstein, M.D., William Bernet, M.D., Oscar Bukstein, M.D., Joan Kinlan, M.D., Henrietta Leonard, M.D., Jon McClellan, M.D. AACAP Staff: L. Elizabeth Sloan, L.P.C., Christine M. Miles. Research Assistant: Ross W. McQuivey, B.A. Consultants and other individuals who commented on a draft of these parameters include the California Wellness Foundation Violence Prevention Initiative at Stanford University (Zakee Matthews, M.D., Traci Pitts, Ph.D., Lisa Benton-Hardy, M.D., Sharon Williams, Ph.D.) and the AACAP Committee on Conduct Disorders (Hans Steiner, M.D., Chair, Bruce Perry, M.D., Ph.D., Graham Rogeness, M.D., Jon Shaw, M.D., Marcus Kruesi, M.D., Richard Angell, M.D., Ronel Lewis, M.D., Zakee Matthews, M.D., Paula D. Riggs, M.D.). The authors wish to thank the Preventive Committee of the Group for the Advancement of Psychiatry (Naomi Rae-Grant, M.D., Chair, Morton Silverman, M.D., George Makini, M.D., Lynelle Thomas, M.D., Warren T. Vaughan, M.D., Brian McConville, M.D., David Offord, M.D., Stephen Fleck, M.D.), Dennis Cantwell, M.D., James Comer, M.D., Felton Earls, M.D., Shirley Feldman, M.D., Scott Henggeler, Ph.D., Carl Jesness, Ph.D., Alan Kazdin, Ph.D., Dorothy Otnow Lewis M.D., James Lock, M.D., Rolf Loeber, Ph.D., Mark Lipsey, Ph.D., Daniel Offer, M.D., David Offord, M.D., Gerald Patterson, Ph.D., Helmuth Remschmidt, M.D., Karl Richters, Ph.D., Sir Michael Rutter, M.D., and Pirooz Sholevar, M.D., for their thoughtful review. These parameters were made available to the entire Academy membership for review at the 1996 Annual Meeting and were approved by the AACAP Council on March 31, 1997. These parameters are available to AACAP members on the World Wide Web (www.aacap.org). These parameters replace the parameters developed by the AACAP Work Group on Quality Issues chaired by Steven Jaffe, M.D., and published in the Journal of the American Academy of Child and Adolescent Psychiatry 31:iv-vii, 1992.

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