# Evidence-based assessment/Conduct disorder (assessment portfolio)

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## What is a "portfolio"?

* For background information on what assessment portfolios are, click the link in the heading above.
* Want more information? There's a extended version of this page here.

## Preparation phase
### Diagnostic criteria for Conduct disorder

   ICD-11 Diagnostic Criteria
   Conduct-dissocial disorder is characterized by a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms, rules, or laws are violated such as aggression towards people or animals; destruction of property; deceitfulness or theft; and serious violations of rules. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. To be diagnosed, the behaviour pattern must be enduring over a significant period of time (e.g., 12 months or more). Isolated dissocial or criminal acts are thus not in themselves grounds for the diagnosis.
   Note: The ICD-11 lists 8 additional subcategories of conduct-dissocial disorder. They can be found here with more information.
   Changes in DSM-5
   * The diagnostic criteria for Conduct disorder changed slightly from DSM-IV to DSM-5. Summaries are available here.

### Base rates of conduct disorder in different clinical settings and populations

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of conduct disorder that they are likely to see in their clinical practice.
* To see prevalence rates across multiple disorders, click here.
| Demography | Setting | Base Rate | Diagnostic Method |
| All of U.S.A. | Nationally representative large-scale study (N=9282) - adult retrospective report | 9.5% overall: 12% males, 7% females | CIDI: WHO Composite International Diagnostic Interview (Parent Interview) |
| Western North Carolina | The Great Smoky Mountains Study – longitudinal, population-based study of community sample | 9.0% overall: 14% males, 4% females | CAPA: Child and Adolescent Psychiatric Interview (Parent and Youth Interview) |
| California, Division of Juvenile Justice (DJJ) | Incarcerated adolescents | 93% males, 92% females | SCID-IV: Structured Clinical Interview for DSM-IV (Youth Interview) |
| All of USA | National Comorbidity Survey Replication Adolescent Supplement –population-based study of adolescents | 5.4% Overall | CIDI (Parent Interview) |
| Various locations across USA | Community samples – summary of past findings | 6-16% males, 2-9% females | Varied |
| Urban Midwestern USA | Clinic-referred sample | 12.5% overall; 50% of those with CD met criteria for CU traits based on combined-informant report on APSD | KSADS-PL |
| Small metropolitan area in SE USA | Community based sample | 16.2% overall; 32% of those with CD met criteria for CU traits based on combined-informant report on APSD | CSI-4, based on combined-informant report |
Note: Despite a plethora of studies assessing prevalence of comorbidity of conduct disorder with other disorders (e.g., substance abuse, bipolar, ADHD), searches outlined below did not yield a single study providing a prevalence of conduct disorder alone in an outpatient or community clinic setting.

## Prediction phase
### Recommended screening instruments for conduct disorder

| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Where to Access |
| ASEBA (Achenbach System of Empirically Based Assessment) not free | Parent report (CBCL) Youth self-report (YSR) | 6-18 (CBCL) 11-18 (YSR) | 10-15 minutes | For Purchase |
| BASC-2 (Behavior Assessment System for Children, 2nd Edition) not free | teacher/ parent/ self-report | 2:0-21:11 for parent/ teacher; 6:0-college age for self-report | 10-20 minutes for parent/ teacher; 30 minutes self-report | For Purchase |
| ECBI/ SESBI-R (Eyberg Child Behavior Inventory/Sutter-Eyberg Child Behavior Inventory-Revised) not free | parent/ teacher | 2-16 | 5 minutes | For Purchase |
Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

## Prescription phase
### Gold standard diagnostic interviews

* For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

### Semi-structured and Structured Diagnostic Interviews

| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Where to Access |
| Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (KSADS-PL) | Structured interview | 6-28 | 45-75 minutes | PDF Version |
| Diagnostic Interview Schedule for Children IV (DISC-IV) | Structured Interview (Self report and parent) | 4-12 | 70/ 90-120 | Interviewer manual |
| Diagnostic Interview for Children and Adolescents (DICA) | Structured interview | 6-18 | | |
Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

## Process phase

The following section contains a brief overview of treatment options for Conduct disorder and list of process and outcome measures for Conduct disorder. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

### Outcome and severity measures

This table includes clinically significant benchmarks for Conduct disorder specific outcome measures
* Information on how to interpret this table can be found here.
* Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
* For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
   Statistically significant change benchmarks with common instruments
   | Measure | Subscale | Cut-off scores* | Cut-off scores* | Cut-off scores* | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) |
   | | | A | B | C | 95% | 90% | SE$_{difference}$ |
   | Benchmarks Based on Published Norms ||||||||
   | CBCL T-scores (2001 Norms) | Externalizing | 49 | 70 | 58 | 7 | 6 | 3.4 |
   | Conduct Disorder Samples Were Not Found in Searches* ||||||||
Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean
Search terms: (1)“antisocial process screening device,” (2) antisocial process screening device AND benchmarks, searches previously mentioned.

## External Resources

See Effective Child Therapy, a website sponsored by The Society for Child and Adolescent Psychology (APA, Division 53) and the Association for Behavioral and Cognitive Therapies (ABCT), for current summary of evidence-based treatments.
* w:Antisocial personality disorder
* Bullying
* Oppositional defiant disorder
* Parental alienation
* Society of Clinical Child and Adolescent Psychology
* EffectiveChildTherapy.Org information on rule-breaking, defiance, and acting out