Patterns of remission and symptom decline in conduct disorder: A four-yearprospective study of an ADHD sample

Objective: To evaluate systematically the longitudinal course of conduct di sorder (CD) in a sample of youths with attention-deficit hyperactivity diso rder (ADHD) to determine the effects of a persistent course on outcome. Met hod: One hundred forty children with ADHD and their nuclear families were a ssessed at baseline and again at 1 and 4 years. Subjects were examined by m eans of DSM-III-R-based structured interviews. They were also evaluated for cognitive and social functioning. Persistent (exhibiting symptoms of CD at either follow-up) and desistent (symptoms of CD at neither follow-up) case s were identified. Results: Forty-two percent of CD cases followed a persis tent course. Although both persistent and desistent subjects had high rates of antisocial disorders in relatives, increased family conflict and decrea sed family cohesion were selectively associated with a persistent course. I n addition, subjects with persistent symptoms of CD exhibited more impaired ratings on the Aggression and Delinquency subscales of the Child Behavior Checklist, as well as higher rates of bipolar, oppositional defiant, and su bstance use disorders. Conclusions: These findings suggest that the poor pr ognosis associated with CD is limited to an identifiable subgroup with a pe rsistent course.