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Conduct Disorder and Hyperactivity: II

A Cluster Analytic Approach to the Identification of a Behavioural Syndrome

Published online by Cambridge University Press:  29 January 2018

E. Taylor*
Affiliation:
Behavioural Science
B. S. Everitt
Affiliation:
Behavioural Science
M. L. Rutter
Affiliation:
Institute of Psychiatry, London
G. Thorley
Affiliation:
Institute of Child Health, London
R. Schachar
Affiliation:
Hospital for Sick Children, Toronto
H. M. Wieselberg
Affiliation:
Middlesex Hospital, London
*
Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Abstract

The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with Impairment of family relationships and adverse social factors. It was concluded that a dimension of Inattentive, restless activity should be separated from one of antisocial, defiant conduct In children with psychiatric disorder.

Sixty boys, aged from 6 to 10 years, were studied after their referral to psychiatric clinics for antisocial or disruptive behaviour. Their scores on reliable measures of hyperactivity, defiant behaviour, emotional disorder and attention deficit were taken for the home, school and clinic settings; and subjected to two techniques of cluster analysis. Both gave a similar set of clusters, one of which had high scores on all measures of hyperactivity and attention deficit. Membership of this cluster was associated with a lower IQ, a younger age of problem onset and referral, an abnormal neurological examination, a history of developmental delay, smaller family size, poor peer relationships and a high rate of accidental injuries; and It predicted a good response to stimulant medication In a controlled trial. Other research on the classification of hyperactivity is discussed, and proposals are made for the criteria of a rather narrow definition of ‘hyperkinetic conduct disorder’.

Type
Papers
Copyright
Copyright © 1986 The Royal College of Psychiatrists 

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References

Achenbach, T. M. & Edelbrock, C. A.(1978) The classification of child psychopathology: a review and analysis of empirical efforts. Psychological Bulletin, 85, 12751301.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders 3rd ed. Washington, DC: APA.Google Scholar
August, G. J. & Stewart, M. A.(1982) Is there a syndrome of pure hyperactivity? British Journal of Psychiatry, 140, 305311.CrossRefGoogle Scholar
Barkley, R.(1976) Predicting the response of hyperkinetic children to stimulant drugs: a review. Journal of Abnormal Child Psychology, 4, 327348.CrossRefGoogle ScholarPubMed
Barkley, R.(1981) Hyperactive Children: A Handbook for Diagnosis and Treatment. Chichester, UK: Wiley.Google Scholar
Broadbent, D. E.(1971) Decision and Stress. London: Academic Press.Google Scholar
Brown, G. W. and Rutter, M.(1966) The measurement of family activities and relationships: a methodological study. Human Relations, 19, 241263.CrossRefGoogle Scholar
Campbell, S. B., Endman, M. W. & Bernfeld, G.(1977) A 3-year follow-up of hyperactive preschoolers into elementary school. Journal of Child Psychology and Psychiatry, 18, 239249.CrossRefGoogle Scholar
Conners, C. K.(1969) A teacher rating scale for use in drug studies with children. American Journal of Psychiatry, 126, 884888.CrossRefGoogle ScholarPubMed
Conners, C. K.(1973) Rating scales for use in drug studies with children. Psychopharmacology Bulletin (Special issue Pharmacotherapy of Children), 2484.Google Scholar
Edelbrock, C. S. & Achenbach, C. S.(1980) A typology of child behavior profile patterns: distribution and correlates for disturbed children aged 6–16, Journal of Abnormal Child Psychology, 8, 441470.CrossRefGoogle ScholarPubMed
Erlenmeyer-Kimling, L. & Cornblatt, B.(1978) Attentional measures in a study of children at high-risk for schizophrenia. Journal of Psychiatric Research, 14, 9398.CrossRefGoogle Scholar
Everitt, B. S.(1980) Cluster Analysis 2nd ed. London: Heinemann Educational.Google Scholar
Ferguson, H. B. & Rapoport, J. L.(1983) Nosological issues and biological validation. In Developmental Neuropsychiatry (ed. Rutter, M.). New York: Guilford.Google Scholar
Firestone, P. & Martin, J. E.(1979) An analysis of the hyperactive syndrome: a comparison of hyperactive, behavior problem, asthmatic and normal children. Journal of Abnormal Child Psychology, 7, 261273.CrossRefGoogle ScholarPubMed
Langner, T. S., Gersten, J. C. & Eisenberg, J. G.(1974) Approaches to measurement and definition in the epidemiology of behavior disorders: ethnic background and child behavior. International Journal of Health Services, 4, 483501.CrossRefGoogle ScholarPubMed
Lessing, E. R., Williams, V. & Revelle, W.(1981) Parallel forms of the UR Behavior Checklist for parents, teachers and clinicians. Journal of Consulting and Clinical Psychology, 49, 3450.CrossRefGoogle Scholar
Lessing, E. R., Williams, V. & Revelle, W. & Gill, E.(1982) A cluster-analytically derived typology; feasible alternative to clinical diagnostic classifícation of children? Journal of Abnormal Child Psychology, 10, 451482.CrossRefGoogle ScholarPubMed
Loney, J., Langhorne, J. & Paternité, C.(1978) An empirical basis for subgrouping the hyperkinetic/minimal brain dysfunction syndrome. Journal of Abnormal Psychology, 87, 431441.CrossRefGoogle ScholarPubMed
Lorion, R. P., Cowen, E. L. & Caldwell, R. A.(1974) Problem types of children referred to a school-based mental health program: identification and outcome. Journal of Consulting and Clinical Psychology, 42, 491496.CrossRefGoogle ScholarPubMed
McGee, R., Williams, S. & Silva, P. A.(1984) Behavioral and developmental characteristics of aggressive, hyperactive and aggressive-hyperactive boys. Journal of the American Academy of Child Psychiatry, 23, 270279.CrossRefGoogle ScholarPubMed
Office Of Population Censuses And Surveys (1970) Registrar General's Classification of Occupations. London: HMSO.Google Scholar
O'Malley, J. & Eisenberg, L.(1973) The hyperkinetic syndrome Seminars in Psychiatry, 5, 95103.Google ScholarPubMed
Pastore, R. A. & Scheirer, C. J.(1974) Signal detection theory: Considerations for general application. Psychological Bulletin, 81, 945958.CrossRefGoogle Scholar
Patterson, G. R.(1964) An empirical approach to the classification of disturbed children. Journal of Clinical Psychology, 20, 326337.3.0.CO;2-Z>CrossRefGoogle Scholar
PoRTEus, S.(1947) The Porteus Maze Test Manual. London: Harrap.Google Scholar
Quay, H. C.(1979) Classification: patterns of aggression, anxiety- withdrawal and immaturity. In Psychopathological Disorders of Childhood (eds Quay, H. C. & Werry, J. S.), 2nd ed. New York: Wiley.Google Scholar
Quinton, D., Rutter, M. & Liddle, C.(1984) Institutional rearing, parenting difficulties and marital support. Psychological Medicine, 14, 107124.CrossRefGoogle ScholarPubMed
Rutter, M.(1978) Diagnostic validity in child psychiatry. Advances in Biological Psychiatry, 2, 222.CrossRefGoogle Scholar
Rutter, M. & Graham, P.(1968) The reliability and validity of the psychiatric assessment of the child: 1. Interview with the child. British Journal of Psychiatry, 114, 563579.CrossRefGoogle Scholar
Rutter, M. & Graham, P. & Yule, W.(1970a) A Neuropsychiatrie Study in Childhood. London: SIMP/Heinemann. (Clinics in Developmental Medicine 35/36).Google Scholar
Rutter, M. & Graham, P. & Yule, W., Tizard, J. & Whitmore, K.(1970b) Education, Health and Behaviour. London: Longman.Google Scholar
Rutter, M. & Graham, P. & Yule, W., Tizard, J. & Whitmore, K., Shaffer, D. & Sturge, C.(1976) A Guide to a Multiaxial Classification Scheme for Psychiatric Disorders in Childhood and Adolescence. London: Institute of Psychiatry.Google Scholar
Safer, D. J. & Allen, R. P.(1976) Hyperactive Children: Diagnosis and Management. Baltimore: University Park Press.Google Scholar
Sandberg, S. T.(1981) The overinclusiveness of the diagnosis of hyperkinetic syndrome. In Strategic Interventions for Hyperactive Children (ed. Gittelman, R.). New York: M. E. Sharpe.Google Scholar
Sandberg, S. T., Rutter, M. & Taylor, E.(1978) Hyperkinetic disorder in clinic attenders. Developmental Medicine and Child Neurology, 20, 279299.CrossRefGoogle ScholarPubMed
Sandberg, S. T., Wieselberg, M. & Shaffer, D.(1980) Hyperkinetic and conduct problem children in a primary school population: some epidemiological considerations. Journal of Child Psychology and Psychiatry, 21, 293311.CrossRefGoogle Scholar
Schachar, R., Rutter, M. & Smith, A.(1981) The characteristics of situationally and pervasively hyperactive children: implications for syndrome definition. Journal of Child Psychology and Psychiatry, 22. 375392.CrossRefGoogle ScholarPubMed
Schleifer, M., Neiss, G., Cohen, N., Cvejic, H. & Druger, E.(1975) Hyperactivity in preschoolers and the effect of methylphenidate. American Journal of Orthopsychiatry, 45, 3850.CrossRefGoogle ScholarPubMed
Stewart, M. A., Cummings, C., Singer, S. & de Blois, C. S. (1981) The overlap between hyperactive and unsocialized aggressive children. Journal of Child Psychology and Psychiatry, 22, 3546.CrossRefGoogle ScholarPubMed
Swanson, J. & Kinsbourne, M.(1976) Stimulant related state- dependent learning in hyperactive children. Science, 192, 13541356.CrossRefGoogle ScholarPubMed
Taylor, E.(1979) The use of drugs in hyperkinetic states: clinical issues. Neuropharmacology, 18, 951958.CrossRefGoogle ScholarPubMed
Taylor, E.(1980) Development of attention. In Scientific Foundations of Developmental Psychiatry (ed. Rutter, M.). London: Heinemann.Google Scholar
Taylor, E.(1983) Drug response and diagnostic validation. In Developmental Neuropsychiatry (ed. Rutter, M.). New York: Guilford Press.Google Scholar
Taylor, E.(1985) Syndromes of overactivity and attention deficit. In Child Psychiatry: Modem Approaches (eds Rutter, M. and Hersov, L.). Oxford: Blackwell.Google Scholar
Taylor, E. & Sandberg, S.(1984) Hyperactive behaviour in English schoolchildren: A questionnaire survey. Journal of Abnormal Child Psychology, 12, 143156.CrossRefGoogle ScholarPubMed
Taylor, E., Schachar, R., Wieselberg, M. & Thorley, G.(1986) Which boys respond to stimulant medication. Psychological Medicine (in press).Google Scholar
Thorley, G.(1984) Clinical characteristics and outcome of hyperactive children. Ph.D. Thesis, University of London.Google Scholar
Tizard, B. & Hodges, J.(1978) The effect of early institutional rearing on the development of eight year old children. Journal of Child Psychology and Psychiatry, 19, 99118.CrossRefGoogle ScholarPubMed
Waldrop, M., Pedersen, F. & Bell, R. Q.(1968) Minor physical anomalies and behavior in preschool children. Child Development, 39, 391400.CrossRefGoogle ScholarPubMed
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