Conduct Disorder

FRIDAY, July 26, 2024 -- There are widespread brain structural alterations apparent in conduct disorders, mostly in surface area, according to a study published in the August issue of The Lancet Psychiatry . Yidian Gao, Ph.D., from the University of Birmingham in the United Kingdom, and colleagues examined brain structural correlates of conduct disorders among those aged 18 years or younger. Individual participant data were collected from 1,185 young people with conduct disorder and 1,253 typically developing young people (mean age, 13.5 years). The researchers found that the conduct disorder group had lower surface area in 26 cortical regions and lower total surface area relative to typically developing young people. Differences were seen in cortical thickness in the caudal anterior cingulate cortex and the banks of the superior temporal sulcus. Smaller amygdala, nucleus accumbens, thalamus, and hippocampus volumes were also seen in the conduct disorder group. After adjustment for attention-deficit/hyperactivity disorder comorbidity or intelligence quotient, most differences remained significant. There were no group-by-sex or group-by-age interactions seen. Between Diagnostic and Statistical Manual of Mental Disorders -defined conduct disorder subtypes, few differences were found. However, more widespread differences were seen for individuals with high callous-unemotional traits versus controls than for those with low callous-unemotional traits. "These findings provide further evidence that brain alterations could contribute to conduct disorder," the authors write. "This underrecognized disorder warrants greater consideration in research, including longitudinal studies exploring neurodevelopmental trajectories and additional subtyping approaches." Several authors disclosed ties to the biopharmaceutical industry. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

WEDNESDAY, July 17, 2024 -- Defiance, tantrums, aggression: All signs of a condition called conduct disorder, which Mental Health America says affects up to 16% of boys and 9% of girls. Now, research is revealing real differences in the brain structure of children and youths with conduct disorder, compared to those without the condition. Specifically, the study of the brains of people ages 7 through 21 found that the brain's outer layer, the cerebral cortex, was smaller than is typical for people with conduct disorder. “Conduct disorder has among the highest burden of any mental disorder in youth," noted study co-author Dr. Daniel Pine . "However, it remains understudied and under-treated." "Understanding brain differences associated with the disorder takes us one step closer to developing more effective approaches to diagnosis and treatment, with the ultimate aim of improving long-term outcomes for children and their families," said Pine. He's chief of the Section on Development and Affective Neuroscience at the National Institute of Mental Health (NIMH). The new study was published July 16 in the journal Lancet Psychiatry . In their research, Pine and his colleagues used MRI scans to examine the brains of about 2,400 children and youth who'd enrolled in 15 different studies from around the world. About half of the participants had been diagnosed with conduct disorder while the other half had not. The scans looked specifically at the thickness of each person's cerebral cortex, as well as the volume of deeper "subcortical" brain regions. Compared to kids and young adults unaffected by conduct disorder, those with the condition differed in terms of the thickness of their cerebral cortices. They also "had lower volume in several subcortical brain regions, including the amygdala, hippocampus and thalamus," according to a news release from the NIMH. These regions are known to be key to behavioral regulation. In prior studies, the prefrontal cortex and amygdala had already been implicated as playing possible roles in conduct disorder, but the new study has pinpointed other brain regions. No differences in terms of brain changes were noted between girls and boys with conduct disorder. However, young people with more severe forms of conduct disorder -- for example, they had low levels of empathy, remorse or guilt -- tended to display the largest brain differences on MRI, the research team said. According to the authors, the new study is the largest to date and supports the notion that physical changes in the brain might drive conduct disorder. "The study also provides novel evidence that brain changes are more widespread than previously shown, spanning all four lobes and both cortical and subcortical regions," according to the NIMH news release. The good news: The findings could give researchers a new foothold in pursuing the cause and treatment of conduct disorder, the team said. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

MONDAY, May 1, 2023 -- Growing numbers of American kids and teens are cutting or burning themselves, banging their heads against walls, pulling out their hair and even trying to die by suicide. But figuring out who is at highest risk for harming themselves has been a daunting challenge. Until now. Researchers report they have developed risk profiles that can help doctors pinpoint which kids or teens are in the most danger. "The U.S. is in the midst of a mental health crisis, with mental health diagnoses and hospitalizations surging over the past few years, and many of these hospitalizations are for self-harm events or concern for future self-harm," said study author Dr. James Antoon , an assistant professor of pediatrics and hospital medicine at Monroe Carell Jr. Children's Hospital at Vanderbilt University in Nashville, Tenn. “Self-harm is a big bucket of events from mild things like cutting on the arms or thighs to taking so much Tylenol that you die on purpose or jumping out of a window, and we wanted to find out which kids require hospitalization and more intensive treatment and monitoring," he said. There’s a pronounced shortage of in-patient hospital beds for kids with mental health issue in the United States, which makes the situation even more dire. Knowing which kids are at the highest risk can help make better use of these limited resources, Antoon noted. So, his team developed four risk profiles for serious self-harm based on age, gender and psychiatric and medical conditions. Of nearly 1,100 children hospitalized for psychiatric reasons at two children’s hospitals from April 2016 to March 2020, 37% were there for self-harm. The researchers found that boys aged 10 to 13 with ADHD, bipolar disorder, autism spectrum disorder or another developmental disorder were 80% more likely to engage in serious self-harm behavior that requires hospitalization. Meanwhile, teen girls aged 14 to 17 with depression and anxiety, substance- and trauma-related disorders, and personality and eating disorders were also at high risk for serious self-harm, the study showed. Suicide attempts comprised the majority of serious self-harm behaviors in the study. In a counterintuitive finding, kids who were at moderate risk for serious self-harm didn’t necessarily have depression, Antoon said. “It is assumed that if you are suicidal, you must be depressed, but there are other things that can drive self-harm and suicide, including anxiety disorders,” he noted. The study was published online May 1 in the journal Pediatrics . There are many reasons kids and teens will try to harm themselves, said Elizabeth Bailey , director of clinical services at the 3East Boys Intensive Program at McLean Hospital in Boston. “It can serve to help individuals self-regulate or control overwhelming emotions, escape from feelings of being numb or empty or punish themselves, and [it] also serves as a form of unspoken communication to others about one’s suffering," said Bailey, who was not involved with the study. But it's not always easy to spot the signs of self-harm in kids, as they hide evidence by wearing long sleeves to cover scars on their arms or other methods, she said. Still, there are some things to look out for. "A typically outgoing and social child who suddenly withdraws, or an academically driven and achieving child who stops completing assignments for a sustained period of time may be cause for concern,” Bailey said. Self-harming behaviors are often portrayed as problems for girls and women in the media, added Anna Precht , program director at 3East Boys Intensive Program. “The finding that the highest risk profile is characterized by boys aged 10-13 with anxiety and depression, as well as other psychiatric disorders including externalizing behaviors like ADHD and conduct disorder, highlights the importance of assessing for self-harm behaviors across diagnostic and gender presentations," said Precht, who was not part of the new research. If you are concerned that your child is engaging in self-harm, contact a psychologist, social worker or pediatrician, she advised. Help is available. “Dialectical Behavior Therapy [a type of talk therapy based on cognitive behavioral therapy] helps people to understand what factors contribute to self-injurious behaviors [as well as other problematic behaviors] and teaches skills for managing emotions more effectively,” Precht said. “This a treatment that has been shown to be effective in treating these behaviors and has been adapted for teens and their families.” Sources James Antoon, MD, PhD, MPH, assistant professor, pediatrics, hospital medicine, Monroe Carell Jr. Children’s Hospital, Vanderbilt University, Nashville, Tenn. Elizabeth Bailey, PsyD, director, clinical services, 3East Boys Intensive Program, McLean Hospital, Boston Anna Precht, PsyD, program director, 3East Boys Intensive Program, McLean Hospital Pediatrics , May 1, 2023 Posted May 2023