Conduct disorder: a retrospective record review of patients diagnosed with conduct disorder at Tara Psychiatric Hospital Children’s Clinic

Abstract

Conduct Disorder (CD) is a common childhood mental disorder which has the potential for significant adverse individual and societal consequences. There is currently a lack of information on CD in specialised settings in South Africa. CD is a serious psychiatric disorder with onset in childhood and adolescence associated with antisocial behaviour which may continue into adulthood. The aims of this study were to determine the prevalence, demographic profiles, referral sources and clinical characteristics of children with CD presenting to Tara Hospital Child and Adolescent Psychiatric Clinic between January 2013 and January 2017 as well as to compare children with mild and severe CD in order to identify any potentially significant features in these severity categories. Methods: A descriptive analytic retrospective record review was undertaken. A total of 953 clinical files at the Tara Hospital Child and Adolescent Psychiatric Clinic were reviewed and those with CD were identified. Variables in the dataset included gender, referral source, age at symptom onset, age when diagnosis was made, schooling, co-morbid diagnoses, pregnancy and birth history, perinatal complications, attachment, primary caregiver, milestones, discipline style, exposure to violence, abuse or neglect, social circumstances, other conditions that may be a focus of clinical attention (V or Z codes), family psychiatric history and interventions. Descriptive and comparative statistical analyses of the data were performed. Results: From the total number of files reviewed, 107 paediatric mental health care users were diagnosed with having CD. The male to female ratio of the sample was 2:1. The average age of onset of behavioural problems was 7.3 years (SD 3.86), and average age at diagnosis was 11.6 years. The most common single referral source was schools (44.9%) with the majority of the sample (54.2%) attending mainstream education. The majority of patients were recorded as having an insecure attachment with 53.3% having a parent as a primary caregiver. Of the sample, 75.5% experienced punitive discipline, and 66.4% were exposed to violence, abuse or neglect. In 57% of cases a parent had a documented psychiatric diagnosis, with ASPD documented in 40.2% of these cases. Severe CD was diagnosed in 69.2%, and these were more likely to have been exposed to violence, abuse or neglect, have had a parent with ASPD, or have two or more V codes. Children with mild CD were more likely to have had parents as primary caregivers. Conclusions: Consideration of factors associated with an increased risk for severe conduct disorder, may help to develop strategies for prevention-based strategies, earlier detection and intervention in children and adolescents at risk.