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Conduct Disorder What do we know about risk factors / cause of conduct disorder?

What do we know about risk factors / cause of conduct disorder?

Conduct disorder is currently considered a multidetermined condition involving both biological and environmental factors, and most certainly resulting from different developmental trajectories. Although diverse, trajectories leading to conduct disorder are likely to share accumulation of risk factors and lack of protective factors.

Behavioral genetic studies show moderate influence of genetic factors in the etiology of conduct disorder; influence of genetic factors appear to be highest in early-onset, pervasive conduct disorder and in children / adolescents with conduct disorder and callous-unemotional traits. Molecular genetic studies have shown associations between genetic variants of genes of the dopaminergic and serotoninergic systems and conduct disorder. Some genetic factors moderate the impact of environmental adversity; for example, gene-environment interactions influence developmental risk for conduct problems, aggression and violence in children exposed to maltreatment (Caspi et al. 2002).

Dysfunctional family relations as well as parental abuse/neglect, poor parenting and family adversity have been associated with development ad reinforcement of conduct problems. Parental psychopathology (especially a family history of conduct disorder/antisocial personality and substance use) are also related to elevated risk for disruptive symptoms in offspring, including conduct disorder. During adolescence, influence of peers becomes increasingly important; some conduct problems may arise or be maintained by affiliation with deviant peers. On the contrary, familial and peer relationships can also be protective and attenuate the effect of other risk factors.

The impact of environmental factors may be modified by individual characteristics like temperament, social skills, and IQ. Difficult temperament, poor social skills and hostile attributions in interpersonal relationships as well as low verbal IQ and school failure have been associated with conduct disorder.

Both attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder are risk factors for conduct disorder and frequent comorbidities. Comorbid ADHD/CD is particularly impairing and associated with poor functional outcome. Chronic illness and perinatal factors have also been associated with a heightened risk for conduct disorder in subsequent development.

Several other conditions are common comorbidities of conduct disorder and should be systematically assessed. These include substance use/abuse, internalized disorders (depressive, anxiety disorders) and learning disorders.