'Conduct disorder is one of the most intractable of children's mental health problems (Conduct Problems Prevention Research Group [CPPRG], 1992). Conduct disorder includes a cluster of oppositional and problem behaviors which may vary by context and by developmental period. The essential feature of conduct disorder, as defined by the DSM-IV (1994), is a repetitive and persistent pattern of behavior that violates the rights of others or acts against age-appropriate norms or rules of society for a period of at least 6 months. Conduct disorder is the most frequently reported childhood behavior disorder, occurring in approximately 5 to 10% of the total population of school-age children and more frequently among children from disadvantaged backgrounds (Institute of Medicine,1989; Pepler & Rubin, 1991). Conduct disorder and related problem behaviors (e.g., noncompliance, oppositional behavior, aggression) may take different forms, but the broad class of behavior is self-perpetuating across development. That is, patterns of behavior associated with the disorder influence the child's environment in ways that further exacerbate the individual's behavior difficulties (Patterson, 1982). Once established, conduct disorder tends to be persistent over time, resulting in significant problems in social relationships with peers (Asher & Coie, 1990) and family members (Patterson, Capaldi, & Bank, 1989). This disorder, detected in early childhood, frequently continues into adolescence (Loeber, 1991) and influences adult life outcomes (Farrington, 1991; Loeber & Dishion, 1983). Disrupted development of social relationships; difficulties in everyday interactions in school, home and community; and poor academic performance are associated with the presence of childhood conduct disorder.
The purposes of this article are to review the variables associated with conduct disorder and propose an early intervention prevention model based on existing research. Initial sections detail risk factors associated with development of conduct disorder, including environmental factors, parent characteristics, and child characteristics with particular attention to the co-occurrence of communication deficits and conduct disorder. Next, the need for early intervention and methodological challenges to intervention research are discussed. A model of the early development of conduct disorder is then presented, ending with implications of this model for research and practice.
Risk Factors Associated with Conduct Disorder
Conduct disorder typically develops in a context of multiple determinants (CPPRG, 1992). Three classes of factors have been consistently associated with this problem in young children: (1) living in disadvantaged economic and social circumstances, (2) dysfunctional parenting, and (3) specific child characteristics.
Living in poverty is associated with adverse mental health outcomes for all children and adults (Tarnowski & Rohrbeck, 1993). For example, rates of behavior problems among children who receive Medicaid benefits are significantly higher than those for children from more advantaged backgrounds. The specific pathways through which poverty affects the development of childhood behavior problems are difficult to document, but correlational data suggest that environmental stress (Belle, 1990) and depression (Hall, Williams, & Greenberg, 1985) coupled with limited access to prenatal, perinatal, and childhood health care are critical variables (Tarnowksi & Rohrbeck, 1993).
Dysfunctional parenting is a major contributing factor in childhood behavioral disorders (Pettit, Bates, & Dodge, 1993). Both correlational and experimental studies suggest that specific patterns of parent-child interaction lead to poor child behavioral outcomes (Kendziora & O'Leary, 1993). The linkage between dysfunctional parenting and conduct disorder is illustrated most clearly in the longitudinal work of Patterson and his colleagues (cf. …