Contemporary diagnosis and treatment of conduct disorder in youth

ABSTRACT

Introduction

Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories.

Areas covered

The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators.

Expert opinion

Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.

KEYWORDS:

• Conduct disorder
• callous-unemotional traits
• emotional dysregulation
• Attention-Deficit/Hyperactivity Disorder
• second generation antipsychotics
• mood stabilizers
• psychostimulants

Article highlights

• Conduct disorder is a highly heterogeneous condition characterized by antisocial behaviors and one of the most frequently reported reasons of referral in youth.

• Relevant subtypes of CD, based on the presence of callous-unemotional traits, emotional dysregulation and patterns of comorbidity should be carefully characterized.

• Several clinical measures are available for screening purposes and may be used to identify youth with behavioral problems at risk for developing CD and related issues.

• Psychosocial interventions are the first option, possibly improving callous-unemotional traits and emotional dysregulation, especially if implemented early during development.

• Limited information based on low-quality studies supports the use of pharmacological agents including antipsychotics, mood stabilizers and stimulants, according to different target symptoms.

Declaration of interest

G Masi has received research grants from Lundbeck and Humana, was on an advisory board for Angelini, and has been a speaker for Angelini, FB Health, Janssen, Lundbeck, and Otsuka. S Caruci has had collaborations within projects from the European Union (7th Framework Program) and as sub-investigator in sponsored clinical trials by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen Cilag, and Angelini. C Balia has had collaborations within projects from the European Union (7th Framework Program) and as a sub-investigator in sponsored clinical trials by Lundbeck, Otsuka, Janssen Cilag, and Angelini.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work has been partially supported by the Italian Ministry of Health (Ricerca Corrente 2021 and the “5 × 1000” voluntary contributions.)