Developmental transitions among affective and behavioral disorders in adolescent boys

Background: This paper expands upon recent efforts to advance beyond the examination of concurrent comorbidity between affective and behavioral disorders by testing developmental sequences among disorders. Doing so allows for improved tests of theories, such as Capaldi and Patterson's failure model of Conduct Disorder (CD) and depression. Furthermore, Oppositional Defiant Disorder (ODD) is rarely considered distinctly from CD, minimizing the ability to identify distinct effects among behavioral disorders. Methods: This paper used data from the Developmental Trends Study, a clinic-referred cohort of 177 boys, along with their parents, who were assessed regularly using a structured clinical interview and a comprehensive set of other measures. Boys were recruited when they were between the ages of 7 and 12, and were reassessed annually until age 18. Predictive regression models tested the continuities among disorders, with depression, overanxious disorder, Attention Deficit Hyperactivity Disorder (ADHD), ODD and CD examined separately as outcomes. Results: Each disorder showed homotypic continuity, but a clear developmental sequence of heterotypic continuity also emerged. ADHD was predicted by no other disorders, and exclusively predicted ODD. CD was predicted only by ODD. However, ODD was also directly predictive of future anxiety and depression, and anxiety predicted future depression as well. A specific test of the failure model of CD and depression supported that model. Conclusion: ODD appears as a pivotal developmental disorder in young males, in that ODD is notably influential in both subsequent behavioral and affective disorders. CD influences later depression only indirectly, through psychosocial impairment. Anxiety precedes depression, and ADHD is not predicted by other disorders.