Diagnosing Conduct Problems of Children and Adolescents in Residential Treatment

Abstract

This naturalistic study of diagnostic practice in residential treatment agencies for children investigated the use of the DSM-IVconduct disorder diagnosis and its association with residents' externalizing behaviors. The conduct disorder (CD) diagnosis was a poor predictor of participants' externalizing behaviors during their first few months in residence. Additionally, the assignment of the diagnosis was associated with the gender and race of study participants. Decisions of admissions personnel and practitioners in residential treatment facilities regarding their externalizing clients may not be well-served by use of DSM diagnoses. Assessments of caregivers may prove a useful adjunct to DSM diagnoses.Diagnosing emotional and behavioral problems has long been identified as an inexact science. Studies conducted over the last half of the 20th century have shown that the practice of diagnosing is susceptible to the influences of irrelevant factors that may sway diagnostic decision-

Risk Profiles of Children Entering Residential Care: A Cluster Analysis

“…These finding suggest these children are the ''stereotypical'' residential care children. They present externalizing behavior and mental health problems (i.e., increased levels) as would be expected according to previous studies (see Cameron and Guterman 2007;Casey et al 2008;Trout et al 2008a, b).…”

“…Specifically, these children scored lowest on measures of reading, math, and general academic knowledge. This is as expected from children in residential care based on research that suggests high levels of school mobility, deficits in school functioning, and elevated behaviors in this population (see Courtney et al 2004;Burton and Marshall 2005;Cameron and Guterman 2007).As a result, these children may miss important content and fall behind in school. Moreover, it is possible that this subgroup represents a group of children who may qualify for special education services because of their high levels of academic risk, but due to high mobility may have never been referred for special education services.…”

“…For example, many children in care come from families with low socioeconomic status (SES) and have experienced family instability, abuse or neglect, multiple home and school placements, and poor social supports (Bates et al 1997;Curry 1991;Frensch and Cameron 2002;Hussey and Guo 2005;Kohl et al 2005;Little et al 2005). As a group, these children may also present elevated levels of externalizing behavior such as rule-breaking and aggression (Cameron and Guterman 2007;Connor et al 2004), perform below grade level on academics (Trout et al 2008a, b), and reveal deficits on indicators of overall school functioning (e.g., poor attendance, high suspension and drop out rates: Burton and Marshall 2005;Suh et al 2007). Although these risks are generally present in some form, research suggests that children may not all present them to the same degree.…”

Distress tolerance and early adolescent externalizing and internalizing symptoms: The moderating role of gender and ethnicity

“…In regard to violent and delinquent behavior, evidence suggests that this behavior is more common among African American youth than their Caucasian peers (Eaton et al, 2006; Sampson, Morenoff, & Raudenbush, 2005). For instance, compared to Caucasians, studies indicate that African American youth are more likely to be diagnosed with conduct disorder (Cameron & Guterman, 2007), self report engaging in a higher rate of index offenses (Elliot, Huizinga, & Ageton, 1985), and to be involved in more serious delinquent behavior such as weapons offenses, auto theft, burglary, and felony drug offenses (Farrington, Loeber, Stouthamer-Loeber, Van Kammenm, & Schmidt, 1996; Kurtz, Giddings, Sutphen, Gill, & Martin, 1991). …”

Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth

“…This can be particularly true for the provision of a diagnosis of oppositional defiant disorder (ODD), conduct disorder (CD), and attentiondeficit/hyperactivity disorder (ADHD), as diagnosing these complex conditions can be nuanced. There is a growing body of evidence indicating that when compared to non-Hispanic white youth, some ethnic and racial minority youth are more likely to receive a diagnosis of a disruptive behavior disorder and are less likely to receive a diagnosis of ADHD [1][2][3][4][5][6][7][8]. When controlling for confounding variables such as adverse childhood experiences, prior juvenile offenses, genetics, and sociodemographics, these diagnostic and treatment disparities remain [6][7][8].…”