Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 25
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Erskine, Holly E. Norman, Rosana E. Ferrari, Alize J. Chan, Gary C.K. Copeland, William E. Whiteford, Harvey A. and Scott, James G. 2016. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry,

    Maire, Jenna Galéra, Cédric Meyer, Eric Salla, Julie and Michel, Grégory 2016. Is emotional lability a marker for attention deficit hyperactivity disorder, anxiety and aggression symptoms in preschoolers?. Child and Adolescent Mental Health,

    Shubina, Ivanna 2016. Counseling and Therapy of Patients with Behavioural Disorders Using the Cognitive-behavioural Approach. Procedia - Social and Behavioral Sciences, Vol. 217, p. 1008.

    Bunford, Nora Evans, Steven W. and Wymbs, Frances 2015. ADHD and Emotion Dysregulation Among Children and Adolescents. Clinical Child and Family Psychology Review, Vol. 18, Issue. 3, p. 185.

    Giannotta, Fabrizia and Rydell, Ann-Margret 2015. The Prospective Links Between Hyperactive/Impulsive, Inattentive, and Oppositional-Defiant Behaviors in Childhood and Antisocial Behavior in Adolescence: The Moderating Influence of Gender and the Parent–Child Relationship Quality. Child Psychiatry & Human Development,

    Newcorn, Jeffrey H. Lalonde, Mary M. and Leikauf, John 2015. Psychiatry.

    Steinberg, Elizabeth A. and Drabick, Deborah A. G. 2015. A Developmental Psychopathology Perspective on ADHD and Comorbid Conditions: The Role of Emotion Regulation. Child Psychiatry & Human Development, Vol. 46, Issue. 6, p. 951.

    Seymour, Karen E. Chronis-Tuscano, Andrea Iwamoto, Derek K. Kurdziel, Gretchen and MacPherson, Laura 2014. Emotion Regulation Mediates the Association Between ADHD and Depressive Symptoms in a Community Sample of Youth. Journal of Abnormal Child Psychology, Vol. 42, Issue. 4, p. 611.

    Kotte, Amelia Faraone, Stephen V. and Biederman, Joseph 2013. Association of genetic risk severity with ADHD clinical characteristics. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, Vol. 162, Issue. 7, p. 718.

    Meinzer, Michael C. Lewinsohn, Peter M. Pettit, Jeremy W. Seeley, John R. Gau, Jeff M. Chronis-Tuscano, Andrea and Waxmonsky, James G. 2013. ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN ADOLESCENCE PREDICTS ONSET OF MAJOR DEPRESSIVE DISORDER THROUGH EARLY ADULTHOOD. Depression and Anxiety, Vol. 30, Issue. 6, p. 546.

    Wymbs, Brian T. McCarty, Carolyn A. Baer, John S. King, Kevin M. Stoep, Ann Vander and McCauley, Elizabeth 2013. Callous-Unemotional Traits and Conduct Disorder Symptoms as Prospective Risk Factors for Adolescent Sexual Activity. Journal of Clinical Child & Adolescent Psychology, Vol. 42, Issue. 5, p. 693.

    Hosain, G.M. Monawar Berenson, Abbey B. Tennen, Howard Bauer, Lance O. and Wu, Z. Helen 2012. Attention Deficit Hyperactivity Symptoms and Risky Sexual Behavior in Young Adult Women. Journal of Women's Health, Vol. 21, Issue. 4, p. 463.

    Seymour, Karen E. Chronis-Tuscano, Andrea Halldorsdottir, Thorhildur Stupica, Brandi Owens, Kristian and Sacks, Talia 2012. Emotion Regulation Mediates the Relationship between ADHD and Depressive Symptoms in Youth. Journal of Abnormal Child Psychology, Vol. 40, Issue. 4, p. 595.

    Smith, Cary Stacy and Hung, Li-Ching 2012. The relative influence of conduct problems and attention-deficit hyperactivity disorder in the development of adolescent psychopathy. Aggression and Violent Behavior, Vol. 17, Issue. 6, p. 575.

    White, Jacquelyn W. and Buehler, Cheryl 2012. Adolescent Sexual Victimization, ADHD Symptoms, and Risky Sexual Behavior. Journal of Family Violence, Vol. 27, Issue. 2, p. 123.

    Elkins, Irene J. Malone, Steve Keyes, Margaret Iacono, William G. and McGue, Matt 2011. The Impact of Attention-Deficit/Hyperactivity Disorder on Preadolescent Adjustment May Be Greater for Girls Than for Boys. Journal of Clinical Child & Adolescent Psychology, Vol. 40, Issue. 4, p. 532.

    Diamantopoulou, Sofia Verhulst, Frank C. and van der Ende, Jan 2010. Testing Developmental Pathways to Antisocial Personality Problems. Journal of Abnormal Child Psychology, Vol. 38, Issue. 1, p. 91.

    Galéra, Cédric Messiah, Antoine Melchior, Maria Chastang, Jean-François Encrenaz, Gaelle Lagarde, Emmanuel Michel, Gregory Bouvard, Manuel-Pierre and Fombonne, Eric 2010. Disruptive behaviors and early sexual intercourse: The GAZEL Youth Study. Psychiatry Research, Vol. 177, Issue. 3, p. 361.

    Galéra, C. Bouvard, M.-P. Melchior, M. Chastang, J.-F. Lagarde, E. Michel, G. Encrenaz, G. Messiah, A. and Fombonne, E. 2010. Disruptive symptoms in childhood and adolescence and early initiation of tobacco and cannabis use: The Gazel Youth study. European Psychiatry, Vol. 25, Issue. 7, p. 402.

    Gau, Susan Shur-Fen Ni, Hsing-Chang Shang, Chi-Yung Soong, Wei-Tsuen Wu, Yu-Yu Lin, Liang-Ying and Chiu, Yen-Nan 2010. Psychiatric comorbidity among children and adolescents with and without persistent attention-deficit hyperactivity disorder. Australian and New Zealand Journal of Psychiatry, Vol. 44, Issue. 2, p. 135.


Predictors, clinical characteristics, and outcome of conduct disorder in girls with attention-deficit/hyperactivity disorder: a longitudinal study

  • DOI:
  • Published online: 01 April 2007

Research on the overlap between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in males has provided useful information on the etiology, correlates, course, and nosology of this co-morbid condition. However, it is unclear how these results extend to females. Our aim was to examine the predictors, clinical characteristics, and functional outcome of CD in a sample of female youth with and without ADHD.


We conducted a blind, 5-year prospective longitudinal study of girls with (n=140) and without (n=122) ADHD, aged 6–18 years at baseline. At the 5-year follow-up, 123 (88%) and 112 (92%) of the ADHD and control children respectively were reassessed at a mean age of 16·7 years. Psychiatric disorders were assessed using blind structured diagnostic interviews.


Baseline ADHD was a significant risk factor for lifetime CD throughout childhood and adolescence [hazard ratio (HR) 5·8, 95% confidence interval (CI) 2·9–11·5, p<0·001]. Among ADHD girls, childhood-onset (<12 years) CD was predicted by paternal antisocial personality disorder (ASPD), while adolescent-onset CD (⩾12 years) was predicted by family conflict. In addition, lifetime CD significantly predicted academic, psychiatric and sexual behavior problems in girls with ADHD at follow-up.


ADHD is a significant risk factor for CD in girls. CD is associated with increased risk for academic, psychiatric and sexual behavior problems compared to ADHD girls without CD. Given that the therapeutic approaches indicated by ADHD and CD differ, these findings highlight the importance of improved efforts aimed at early identification and treatment of CD in girls with ADHD.

Corresponding author
*Address for correspondence: Michael C. Monuteaux, Sc.D., Pediatric Psychopharmacology Program, 55 Fruit Street, Warren 705, Boston MA 02114, USA. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

B. Aguilar , L. A. Sroufe , B. Egeland & E. Carlson (2000). Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: from birth to 16 years. Development and Psychopathology 12, 109132.

J. Biederman , S. V. Faraone & M. C. Monuteaux (2002). Differential effect of environmental adversity by gender: Rutter's index of adversity in a sample of boys and girls with and without ADHD. American Journal of Psychiatry 159, 15561562.

J. Biederman , S. V. Faraone , M. C. Monuteaux , T. Spencer , T. Wilens , M. Bober & E. Cadogan (2004). Gender effects of attention deficit hyperactivity disorder in adults, revisited. Biological Psychiatry 55, 692700.

J. Biederman , S. Milberger , S. V. Faraone , K. Kiely , J. Guite , E. Mick , S. Ablon , R. Warburton & E. Reed (1995). Family-environment risk factors for attention deficit hyperactivity disorder: a test of Rutter's indicators of adversity. Archives of General Psychiatry 52, 464470.

J. Biederman , M. Monuteaux , E. Mick , T. Spencer , T. Wilens , K. Klein , J. E. Price & S. V. Faraone (2006 a). Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biological Psychiatry 60, 10981105.

B. Busch , J. Biederman , L. Cohen , S. Faraone , J. Sayer , M. Monuteaux , E. Mick & B. Zallen (2002). Similar correlates of ADHD in children from pediatric and psychiatric clinics. Psychiatric Services 53, 11031111.

S. Cote , R. E. Tremblay , D. S. Nagin , M. Zoccolillo & F. Vitaro (2002). Childhood behavioral profiles leading to adolescent conduct disorder: risk trajectories for boys and girls. Journal of the American Academy of Child and Adolescent Psychiatry 41, 10861094.

S. Faraone , J. Biederman , J. Garcia Jetton & M. Tsuang (1997). Attention deficit disorder and conduct disorder: longitudinal evidence for a familial subtype. Psychological Medicine 27, 291300.

S. V. Faraone , J. Biederman & M. C. Monuteaux (2000). Attention-deficit disorder and conduct disorder in girls: evidence for a familial subtype. Biological Psychiatry 48, 2129.

P. Frick , B. Lahey , R. Loeber , L. Tannenbaum , Y. Horn , M. Christ , E. Hart & K. Hanson (1993). Oppositional defiant disorder and conduct disorder: a meta-analytic review of factor analyses and cross-validation in a clinical sample. Clinical Psychology Review 13, 319340.

E. S. Gershon , J. Hamovit , J. J. Guroff , E. Dibble , J. F. Leckman , W. Sceery , S. D. Targum , J. I. Nurnberger Jr., L. R. Goldin & W. E. Bunney Jr. (1982). A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Archives of General Psychiatry 39, 11571167.

S. P. Hinshaw (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive, and social functioning, and parenting practices. Journal of Consulting and Clinical Psychology 70, 10861098.

E. Ilomaki , K. Viilo , H. Hakko , M. Marttunen , T. Makikyro & P. Rasanen (2006). Familial risks, conduct disorder and violence: a Finnish study of 278 adolescent boys and girls. European Child and Adolescent Psychiatry 15, 4651.

K. Keenan , R. Loeber & S. Green (1999). Conduct disorder in girls: a review of the literature. Clinical Child and Family Psychology Review 2, 319.

M. Kovacs , R. Krol & L. Voti (1994). Early onset psychopathology and the risk for teenage pregnancy among clinically referred girls. Journal of the American Academy of Child and Adolescent Psychiatry 33, 106113.

B. Lahey , R. Loeber , H. Quay , B. Applegate , D. Shaffer , I. Waldman , E. Hart , K. McBurnett , P. Frick , P. Jensen , M. Dulcan , G. Canino & H. Bird (1998). Validity of DSM-IV subtypes of conduct disorder based on age of onset. Journal of the American Academy of Child and Adolescent Psychiatry 37, 435442.

R. Loeber , J. D. Burke , B. B. Lahey , A. Winters & M. Zera (2000). Oppositional defiant and conduct disorder: a review of the past 10 years, Part I. Journal of the American Academy of Child and Adolescent Psychiatry 39, 14681484.

R. Loeber , S. Green , K. Keenan & B. Lahey (1995). Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 34, 499509.

R. Loeber , K. Keenan , B. Lahey , S. Green & C. Thomas (1993). Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder. Journal of Abnormal Child Psychology 21, 377410.

R. Loeber & K. B. Schmaling (1985). Empirical evidence for overt and covert patterns of antisocial conduct problems: a metaanalysis. Journal of Abnormal Child Psychology 13, 337352.

R. Loeber & M. Stouthamer-Loeber (1998). Development of juvenile aggression and violence. Some common misconceptions and controversies. American Psychology 53, 242259.

S. Luthar (1993). Annotation: methodological and conceptual issues in research on childhood resilience. Journal of Child Psychology and Psychiatry 34, 441453.

S. Mannuzza , R. G. Klein , A. Bessler , P. Malloy & M. LaPadula (1993). Adult outcome of hyperactive boys: educational achievement, occupational rank and psychiatric status. Archives of General Psychiatry 50, 565576.

N. R. Marmorstein & W. G. Iacono (2005). Longitudinal follow-up of adolescents with late-onset antisocial behavior: a pathological yet overlooked group. Journal of the American Academy of Child and Adolescent Psychiatry 44, 12841291.

D. Mennin , J. Biederman , E. Mick & S. V. Faraone (2000). Towards defining a meaningful anxiety phenotpye for research in ADHD children. Journal of Attention Disorders 3, 192199.

A. Y. Mikami & S. P. Hinshaw (2003). Buffers of peer rejection among girls with and without ADHD: the role of popularity with adults and goal-directed solitary play. Journal of Abnormal Child Psychology 31, 381397.

T. Moffitt (1993). Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychological Review 100, 674701.

T. E. Moffitt (1990). Juvenile delinquency and attention deficit disorder: boys' developmental trajectories from age 3 to age 15. Child Development 61, 893910.

R. J. Neuman , A. Heath , W. Reich , K. K. Bucholz , P. A. F. Madden , L. Sun , R. D. Todd & J. J. Hudziak (2001). Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins. Journal of Child Psychology and Psychiatry 42, 933942.

K. A. Pajer , A. Kazmi , W. P. Gardner & Y. Wang (2007). Female conduct disorder: health status in young adulthood. Journal of Adolescent Health 40, 84e1–7.

P. Silverthorn & P. J. Frick (1999). Developmental pathways to antisocial behavior: the delayed-onset pathway in girls. Development and Psychopathology 11, 101126.

S. L. Smalley , J. J. McGough , M. Del'Homme , J. NewDelman , E. Gordon , T. Kim , A. Liu & J. T. McCracken (2000). Familial clustering of symptoms and disruptive behaviors in multiplex families with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 39, 11351143.

M. M. Weissman , J. F. Leckman , K. R. Merikangas , G. D. Gammon & B. A. Prusoff (1984). Depression and anxiety disorders in parents and children: results from the Yale Family Study. Archives of General Psychiatry 41, 845852.

C. S. Widom (1989). Child abuse, neglect, and adult behavior: research design and findings on criminality, violence, and child abuse. American Journal of Orthopsychiatry 59, 355367.

M. Zoccolillo & K. Rogers (1991). Characteristics and outcome of hospitalized adolescent girls with conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry 30, 973981.

M. Zoccolillo , R. Tremblay & F. Vitaro (1996). DSM-III-R and DSM-III criteria for conduct disorder in preadolescent girls: specific but insensitive. Journal of the American Academy of Child and Adolescent Psychiatry 35, 461470.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *