Aggressive externalizing behaviors

Most children’s behavior progresses to a certain level of dysfunction and then plateaus or decreases (Loeber, 1990). In a large longitudinal study of children initially aged 4 to 12 years, (Verhulst, Koot et al. 1990) found that rates of aggressive and externalizing behaviors decreased over a four-year period for children of all ages (White, notes).

Progression of conduct problems into adulthood is more likely for children with a greater diversity of behavioral symptoms which manifest across a greater variety of settings, and with an earlier onset (Loeber, 1982; Robins, 1991). For example, Robins (1991) reported that only 0.9% of children who displayed relatively few conduct problems at age 12 years, developed Antisocial Personality Disorder (ASPD), while 71% of those who displayed severe wide-ranging problems at age six years, met later diagnostic criteria for ASPD. Of those whose problems persist, not all have serious forms of conduct problems in adulthood (Dumas, 1989; Patterson et al., 1989).

Persistent conduct problems represent a risk for the development of a variety of problems in adolescence such as peer rejection, poor school performance, engagement in risk behaviors, increased substance abuse and delinquency. These problems effect adulthood with restricted employment opportunities, relationship difficulties, criminal activity and increase the risk of general psycho pathology (Fergusson et al, 1993, 1994; Hinshaw, 1992; McMahon ; Wells, 1998; Robins ; Price, 1991; Rutter, 1989). Childhood conduct problems are associated with substantial long term costs for the individual, affecting multiple areas of functioning throughout a major portion of the life span. Conduct problems are also associated with high use of clinical, educational, welfare and justice services. An estimated one-third to one-half of referrals to child and adolescent mental health services are for identified conduct problems. These problems clearly present a substantial cost to the young person, family, friends and society in general (White, notes).

Disturbances of conduct and oppositional behavior problems are common in childhood and adolescence. This type of disorder includes conduct disorder, oppositional defiant disorder and disruptive disorders. These disorders range from a pattern of negativistic, defiant, disobedient, and hostile behavior to a more severe pattern of behavior involving the violation of social rules and the rights of others (American Psychiatric Association [APA], 1994).

Between 33% and 75% of all young children who are referred to mental health agencies are eventually diagnosed with disruptive behavior disorder (Robins, 1981), making conduct problems one of the most frequent diagnoses in mental health facilities for children. The prevalence of conduct disorder has increased over recent years. Rates are higher in urban than rural settings, and higher for males than females. Estimates range from 6% to 16% for males and 2% and 9% for females. Similar rates have been reported for oppositional defiant disorder, with estimates ranging from 2% to 16% of the population (Kazdin, 1987).

Childhood disruptive behavior disorders can lead to serious short and long term problems. Children with disruptive behavior disorders often experience associated difficulties such as learning problems, particularly with reading; low self-esteem and low frustration tolerance; poor social skills and interpersonal relationships, and depressive symptoms. These children are at an increased risk not only of being abused by their parents, but also for developing later problems such as poor marital, social, and occupational adjustment (U. S. Public Health Service, 2000) (White, notes, 2005).

Childhood behavior problems are also a risk factor for the development of adult personality disorder, alcohol abuse, and other psychiatric disorders. In addition to personal costs, long term disruptive behavior disorders constitute a major social problem, being costly to society through early intervention in conduct problems in children demands they place on mental health services, the criminal justice system, special education programs, and other social services (White, notes, 2005).

Conduct problems represent a complex, multi-determined phenomenon and a myriad of child, family and community influences have been associated with its development. The development of clinical practice guidelines is a key strategy to bring about the implementation of effective early intervention strategies as the means of achieving these better health outcomes. Scientific research has produced a large pool of data from which many professionals referred while examining individuals with childhood conduct problems. All of this has yielded an accumulation of work which examines the role of relevant risk factors in the development of early onset conduct problems. Interventions that have proven most effective address variables that are known to increase the risk of the development of conduct problems (Offord, 1989) (White, notes, 2005).

Conduct problems in childhood are complex, multi-determined problems affecting the functioning of the child, family and community. Conduct problems in children are common in the community and in primary care and mental health settings. This can cause long term morbidity and reduced quality of life and often precedes alcohol and other serious substance abuse. Conduct problems also place demands on mental health services so that these resources are insufficient to effectively manage the problems on an ever increasing scale and are associated with varied clinical practice, often with the provision of secondary and tertiary level health care in response to more severe manifestations of a disorder. This has been the subject of scientific research over the past two decades and has required an integrated treatment approach, with an emphasis on early intervention, where specific treatment components are included in the management plan based on the known risk factors of each case.