Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-18T22:54:33.282Z Has data issue: false hasContentIssue false

Conduct and affective disorders in developmental perspective: A systematic study of adolescent psychopathology

Published online by Cambridge University Press:  31 October 2008

Gil G. Noam*
Affiliation:
Laboratory of Developmental Psychology and Developmental Psychopathology, Harvard Medical School and McLean Hospital
Katherine Paget
Affiliation:
Laboratory of Developmental Psychology and Developmental Psychopathology, Harvard Medical School and McLean Hospital
Gayle Valianta
Affiliation:
Laboratory of Developmental Psychology and Developmental Psychopathology, Harvard Medical School and McLean Hospital
Sophie Borst
Affiliation:
Laboratory of Developmental Psychology and Developmental Psychopathology, Harvard Medical School and McLean Hospital
John Bartok
Affiliation:
Laboratory of Developmental Psychology and Developmental Psychopathology, Harvard Medical School and McLean Hospital
*
Address correspondence and reprint requests to: Dr. Gil Noam, Laboratory of Developmental Psychology and Developmental Psychopathology, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02178.

Abstract

This study examined the relationship of psychiatric diagnoses to gender, IQ, and ego development level in an inpatient sample of 269 adolescents. It was found that adolescents with an affective disorder diagnosis, in contrast to those with a diagnosis of conduct or mixed affective-conduct disorder, were more likely to (a) be female, (b) have higher IQ scores, and (c) have higher ego development levels. No significant age differences were found between groups. Comparisons between the single diagnosis and mixed disorder groups indicated that the mixed disorder group is characterized by the most severe symptoms found in each of the pure affective and conduct disordered groups. A relationship between type of DSM-III diagnosis and ego development level in adolescence was demonstrated after controlling for the effects of age, gender, and IQ. These results are offered as an explication of the developmental dimensions inherent in DSM-III psychiatric diagnoses.

Type
Articles
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achenbach, T. M., & Edelbrock, C. (1987). Manual for the youth self report and profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
Alessi, N. E., McManus, M., Grapentine, W. L., & Brickman, A. (1983). The characterization of depressive disorders in serious juvenile offenders. Journal of Affective Disorders, 6, 917.Google Scholar
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.).Washington, DC: Author.Google Scholar
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
Angold, A., & Costello, E. G. (1991). Developing a developmental epidemiology. In Cicchetti, D. & Toth, S. L. (Eds.), Rochester Symposium on Developmental Psychopathology: Vol. 3. Models and integrations (pp. 7596). Rochester, NY: Rochester University Press.Google Scholar
Angold, A., & Rutter, M. (1992). Effects of age and pubertal status on depression in a large clinical sample. Development and Psychopathology, 4(1), 528.Google Scholar
Borst, S., & Noam, G. G. (1989). Suicidality and psychopathology in hospitalized children and adolescents. Acta Psychologica, 52, 165175.Google Scholar
Borst, S. R., & Noam, C. G. (1993). Developmental psychopathology in suicidal and nonsuicidal adolescent girls. Journal of the American Academy of Child and Adolescent Psychiatry. 32(3), 501508.Google Scholar
Borst, S. R., Noam, G. G., & Bartok, J. (1991). Adolescent suicidality: A clinical-developmental approach. Journal of the American Academy of Child and Adolescent Psychiatry, 30(5), 796803.Google ScholarPubMed
Bowlby, J. (1952). Maternal care and mental health. Geneva: World Health Organization.Google Scholar
Bowlby, J. (1980). Attachment and loss: Loss, sadness, and depression. New York: Basic Books.Google Scholar
Brent, D. A. (1987). Correlates of medical lethality of suicide attempts in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 8789.Google Scholar
Brent, D. A., Perper, J. A., Goldstein, C. E., Kolko, D. J., Allan, M. J., Allman, C. J., & Zelenak, J. P. (1988). Risk factors for adolescent suicide. A comparison of adolescent suicide with suicidal in-patients. Archives of General Psychiatry, 45(6), 581588.Google Scholar
Bretherton, I. (1990). Open communication and internal working models: Their role in the development of attachment relationships. In Thompson, R. (Ed.), Nebraska Symposium on Motivation: Vol. 36. Socioemotlonal development (pp. 57114). Lincoln: University of Nebraska Press.Google Scholar
Brooks-Gunn, J., & Peterson, A. C. (1984). Problems in studying and defining pubertal events. Journal of Youth and Adolescence, 13(3), 181196.Google Scholar
Browning, D. L. (1986). Psychiatric ward behavior and length of stay in adolescent and young adult in-patients: A developmental approach to prediction. Journal of Consulting and Clinical Psychology, 54, 227230.Google Scholar
Browning, D. L., & Quinlan, D. (1985). Ego development and intelligence in a psychiatric population: Wechsler subtest scores. Journal of Personality Assessment, 49(3), 260263.CrossRefGoogle Scholar
Carlson, G. A., & Cantwell, D. P. (1980). Unmasking masked depression in children and adolescents. American Journal of Psychiatry, 137, 445449.Google ScholarPubMed
Chandler, M. J. (1976). Social cognition: A selective review of current research. In Overton, W. & Gallagher, J. (Eds.), Knowledge and development (Vol. 1). New York: Plenum Press.Google Scholar
Chandler, M. J. (in press). Self continuity in suicidal and non-suicidal adolescents. In Noam, G. & Borst, S. (Eds.), Children, Youth and Suicide: Developmental Perspectives. New directions in child development. San Francisco: Jossey-Bass.Google Scholar
Chiles, J. A., Miller, M. L., & Cox, G. B. (1980). Depression in an adolescent delinquent population. Archives of General Psychiatry, 37, 11791184.Google Scholar
Cicchetti, D. (1984). The emergence of developmental psychopathology. Child Development, 55(1), 17.Google Scholar
Cicchetti, D., & Toth, S. L. (Eds.). (1991). Rochester Symposium on Developmental Psychopathology: Vol. 2. Internalizing and externalizing expressions of dysfunction. Hillsdale, NJ: Erlbaum.Google Scholar
Costello, A. J., Edelbrock, C. S., Dulcan, M. K., Kalas, R., & Klaric, S. H. (1984). Development and testing of the NIMH diagnostic interview schedule for children on a clinical population: Final report (Contract No. RFP-DB-81–0027). Rockville, MD: Center for Epidemiologic Studies, National Institute for Mental Health.Google Scholar
Costello, E. J., Costello, A. J., Edelbrock, C., Burns, B. J., Dulcan, M. K., Kalas, R., Brent, D., & Janiszewski, S. (1988). Psychiatric disorders in pediatric primary care. Archives of General Psychiatry, 45, 11041116.Google Scholar
Cowan, P. (1982). The relationship between emotional and cognitive development. New Directions for Child Development, 16, 4982.Google Scholar
Crittenden, P. M., & Craig, S. E. (1990). Developmental trends in the nature of child homicide. Journal of Interpersonal Violence, 5(2), 202216.Google Scholar
Damon, W., & Hart, W. (1982). The development of self-understanding from infancy through adolescence. Child Development, 53, 841864.Google Scholar
Digdon, N., & Gotlieb, I. H. (1985). Developmental considerations in the study of childhood depression. Developmental Review, 5, 162199.Google Scholar
Dill, D. L., & Noam, G. G. (1990). Ego development and treatment requests. Psychiatry, 53, 8591.Google Scholar
Edelbrock, C. S., & Achenbach, T. M. (1980). A typology of child behavior profile patterns: Distribution and correlates for disturbed children aged 6–16. Journal of Abnormal Child Psychology, 8, 441470.Google Scholar
Elkind, D. (1967). Egocentrism in adolescence. Child Development, 38, 10251034.Google Scholar
Erikson, E. (1950). Childhood and society. New York: Norton.Google Scholar
Fischer, K. (1980). A theory of cognitive development: The control and construction of hierarchies of skills. Psychological Review, 87, 477531.Google Scholar
Flavell, J. H. (1963). The developmental psychology of Jean Piaget. New York: Van Nostrand.Google Scholar
Flavell, J. H., Botken, P., Fry, C., Wright, J., & Jarvis, P. (1968). The development of role taking and communication skills in children. New York: Wiley.Google Scholar
Frank, S., & Quinlan, D. (1976). Ego development and adjustment patterns in adolescence. Journal of Ab-normal Psychology, 85, 505510.Google Scholar
Garber, J. (1984). The developmental progression of depression in female children. New Directions for Child Development, 26, 2958.Google Scholar
Gfellner, B. (1986). Ego changes in moral development in adolescents: A longitudinal study. Journal of Adolescence, 9, 281302.Google Scholar
Gold, S. N. (1980). Relations between level of ego development and adjustment patterns in adolescents. Journal of Personality Assessment, 44(6), 630638.CrossRefGoogle ScholarPubMed
Goodnow, J. J. (1962). A test of milieu effects with some of Piaget's tasks. Psychological Monographs, 76, 121.Google Scholar
Graham, P., & Rutter, M. (1973). Psychiatric disorder in the young adolescent: A follow-up study. Proceedings of the Royal Society of Medicine, 66, 12261229.Google Scholar
Harrington, R., Fudge, H., Rutter, M., Pickler, A., & Hill, J. (1991). Adult outcome of childhood and adolescent depression: H. Links with antisocial disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 30(3), 434439.Google Scholar
Hauser, S. T. (1976). Loevlnger's model and measure of ego development: A critical review. Psychological Bulletin, 83, 928955.Google Scholar
Hollingshead, A. B. (1957). Two factor index of social position. Unpublished report, New Haven, CT.Google Scholar
Institute of Medicine. (1989). Research on children and adolescents with mental, behavioral and developmental disorders. Washington, DC: National Academic Press.Google Scholar
Kashani, J. H., Carlson, G. A., Beck, N. C., Hoeper, E. W., Corcoran, C. M., McAllister, J. A., Fallahi, C., Rosenberg, T. K., & Reid, J. C. (1987). Depression, depressive symptoms, and depressed mood among a community sample of adolescents. American Journal of Psychiatry, 144, 931934.Google Scholar
Kashani, J. H., Manning, G. W., McKnew, D. H., Cytryn, L., Simonds, J. F., & Wooderson, P. C. (1980). Depression among incarcerated delinquents. Psychiatry Research, 3, 185191.CrossRefGoogle ScholarPubMed
Kastrup, M. (1977). Urban-rural differences in 6 year olds. In Graham, P. J. (Ed.), Epidemiological approaches in child psychiatry (pp. 181194). London: Academic Press.Google Scholar
Kazdin, A. E. (1989). Developmental psychopathology. American Psychologist, 44, 180187.Google Scholar
Kazdin, A. E. (1990). Childhood depression. Journal of Child Psychology and Psychiatry, 31(1), 121160.CrossRefGoogle ScholarPubMed
Kohlberg, L. (1969). Stage and sequence: The cognitive developmental approach to socialization. In Goslin, D. (Ed.), Handbook of socialization, theory and research (pp. 347480). New York: Rand Me-Nally.Google Scholar
Kovacs, M., Feinberg, T. L., Crouse-Novak, M. A., Paulauskas, S. L., & Finkelstein, R. (1984). Depressive disorders in children. Archives of General Psychiatry, 41, 229237.Google Scholar
Kovacs, M., & Goldstone, D. (1991). Cognitive development of depressed children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 30(3), 388392.Google Scholar
Kovacs, M., & Paulauskas, S. L. (1984). Developmental stage and the expression of depressive disorders in children: An empirical analysis. New Directions for Child Development, 26, 5980.Google Scholar
Kreitman, N. (1986). The clinical assessment and management of the suicidal patient. In Roy, A. (Ed.), Suicide (pp. 181195). Baltimore, MD: Williams & Wilkins.Google Scholar
Lavik, N. J. (1977). Urban-rural differences in rates of disorders. A comparative psychiatric population study of Norwegian adolescents. In Graham, P. J. (Ed.), Epidemiological approaches in child psychiatry (pp. 223251). London: Academic Press.Google Scholar
Lerner, R., & Foch, T. T. (Eds.). (1987). Biological-psychosocial interactions in early adolescence. Hillsdale, NJ: Erlbaum.Google Scholar
Loevinger, J. (1968). The relation of adjustment to ego development. In Sells, S. S. (Ed.), The definition and measurement of mental health (pp. 161180). Washington, DC: Government Printing Office.Google Scholar
Loevinger, J. (1976). Ego development. San Francisco: Jossey-Bass.Google Scholar
Loevinger, J. (1979). Construct validity of the Sentence Completion Test of ego development. Applied Psychological Measurement, 3, 281311.Google Scholar
Loevinger, J., Wessler, R., & Redmore, C.(1970). Measuring ego development: Vol. 2. Scoring manual for women and girls. San Francisco: Jossey-Bass.Google Scholar
Masten, A., Best, K., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 2, 425444.Google Scholar
McManus, M., Alessi, N. E., Grapentine, W. L., & Brickman, A. (1984). Psychiatric disturbances in serious delinquents. Journal of the American Academy of Child Psychiatry, 23, 602615.Google Scholar
Noam, G. G. (1984). Self, morality and biography: Studies in clinical-developmental psychology. Unpublished doctoral dissertation. Harvard University, Cambridge.Google Scholar
Noam, G. G. (1986). The theory of biography and transformation and the borderline personality disorders (Part II): A developmental typology. McLean Hospital Journal, XI, 2.Google Scholar
Noam, G. G. (1988). A constructivist approach to developmental psychopathology. Developmental psychopathology and its treatment. New Directions for Child Development, 39, 91121.Google Scholar
Noam, G. G. (1993a). Ego development, true or false? Psychological Inquiry, 4(1), 4348.Google Scholar
Noam, G. G. (1993b). “Normative Vulnerabilities” of the self. In Noam, G. G. and Wren, T. (Eds.), The moral self (pp. 209238). Cambridge, MA: MIT Press.Google Scholar
Noam, G. G., & Dill, D. L. (1991). Adult development and symptomatology. Psychiatry, 54, 208217.Google Scholar
Noam, G. G., Hauser, S., Santostefano, S., Garrison, W., Jacobson, A., Powers, S., & Mead, M. (1984). Ego development and psychopathology: A study of hospitalized adolescents. Child Development, 55, 184194.Google Scholar
Noam, G. G., & Houlihan, J. (1990). Developmental dimensions of DSM-III diagnoses in adolescent psychiatric patients. American Journal of Orthopsychiatry, 60(3), 371378.CrossRefGoogle ScholarPubMed
Noam, G. G., Kilburn, D., & Ammen-Elkins, G. (1989). Adolescent development and psychiatric symptomatology. Unpublished McLean Hospital Report, Belmont, MA.Google Scholar
Noam, G. G., Recklitis, C., & Paget, K. (1991). Pathways of ego development: Contributions to malad-aptation and adjustment. Development and Psychopathology, 3(3), 311328.Google Scholar
Noam, G. G., & Valiant, G. (1994). Clinical-developmental psychology in developmental psychopathology: Theory and research of an emerging perspective. In Cicchetti, D. & Toth, S. (Eds.) Rochester Symposium on Developmental Psychopathology: Vol. 5. Disorders and dysfunctions of the self. Rochester, NY: Rochester University Press.Google Scholar
Noam, G. G., & Borst, S. (in press). Developing meaning – Losing meaning: Understanding suicidal behavior in the young. In Noam, G. G. and Borst, S. (Eds.) Children, Youth and Suicide: Developmental Perspectives. New Directions in Child Development. San Francisco: Jossey Bass.Google Scholar
Pfeffer, C. R., Plutchik, R., & Mizruchi, M. S. (1983). Suicidal and assaultive behavior in children: Classification, measurement and interrelations. American Journal of Psychiatry, 140, 154157.Google Scholar
Phillips, L., & Zigler, E. (1964). Role orientation, the action-thought dimension, and outcome in psychiatric disorder. Journal of Abnormal and Social Psychology, 68, 381389.Google Scholar
Piaget, J. (1981). Intelligence and affectivity: Their relationship during child development. Palo Alto, CA: Annual Reviews.Google Scholar
Puig-Antich, J. (1982). Major depression and conduct disorder in prepuberty. Journal of the American Academy of Child Psychiatry, 21, 118128.Google Scholar
Recklitis, C. J., & Noam, G. G. (08, 1990). Aggression in adolescent psychopathology: Development of personality dimensions. Paper presented at the annual meeting of the American Psychological Association, Boston, MA.Google Scholar
Redmore, C., & Loevinger, J. (1979). Ego development in adolescence: Longitudinal studies. Journal of Youth and Adolescence, 8, 120.Google Scholar
Remschmidt, H., Hohner, G., & Merschmann, W. (1977). Epidemiology of delinquent behavior in children. In Graham, P. J. (Ed.), Epidemiological approaches in child psychiatry. London: Academic Press.Google Scholar
Rosznafsky, J. (1981). The relationship of level of ego development to Q-sort personality ratings. Journal of Personality and Social Psychology, 41, 99120.Google Scholar
Rutter, M., Cox, A., Tupling, C., Berger, M., & Yule, W. (1975). Attainment and adjustment in two geographical areas: I, The prevalence of psychiatric disorder. British Journal of Psychiatry, 126, 493509.Google Scholar
Rutter, M., & Garmezy, N. (1983). Development psychopathology. In Hetherington, E. M. (Ed.), Mussen's handbook of child psychology. Socialization, personality, and social development (Vol. 4, pp. 775911). New York: Wiley.Google Scholar
Rutter, M., Tizard, J., & Whitmore, K. (1970/1981). Education, health and behavior, Huntington, NY: Krieger. (Original work published 1970. London: Longmans)Google Scholar
Ryan, N. D. (1989). Major depression. In Last, C. & Hershon, M. (Eds.), Handbook of child psychiatric diagnosis (pp. 317329). New York: Wiley.Google Scholar
Ryan, N. D., Puig-Antich, J., Ambrosini, P., Rabin-ovich, H., Robinson, D., Nelson, B., Iyengar, S., & Twomney, J. (1987). The clinical picture of major depression in children and adolescents. Archives of General Psychiatry, 44, 854861.Google Scholar
Selman, R. L., Jaquette, D., & Bruss-Saunders, E. (1979). Assessing interpersonal understanding: An interview and scoring manual in five parts. Unpublished manuscript, Cambridge, MA.Google Scholar
Shaffer, D. (1974). Suicide in childhood and early adolescence. Journal of Child Psychology and Psychiatry, 15, 275291.Google Scholar
Shafii, M., Steltz-Lenarsky, J., Derrick, A. M., Beckner, C., & Whittinghill, J. R. (1988). Comorbidity of mental disorders in the post-mortem diagnosis of completed suicide in children and adolescents. Journal of Affective Disorders, 15(3), 227233.Google Scholar
Shepard, M., Oppenheim, B., & Mitchell, S. (Eds.). (1971). Childhood behavior and mental health. London: University of London Press.Google Scholar
Sroufe, A. (1989). Pathways to adaptation and malad-aptation: Psychopathology as developmental deviation. In Cicchetti, D. (Ed.), Rochester Symposium on Developmental Psychopathology: Vol. 1. The emergence of a discipline (pp. 1340). Hillsdale, NJ: Erlbaum.Google Scholar
Sullivan, E. V., McCullough, G., & Stager, H. A. (1970). A developmental study of the relationship between conceptual, ego and moral development. Child Development, 41, 399411.Google Scholar
Tabachnik, B. G., & Fidell, L. S. (1983). Using multivariate statistics. New York: Harper & Row.Google Scholar
Valiant, G. L., & Noam, G. G. (manuscript in preparation). Age/stage dysynchrony in adolescent development and psychiatric diagnoses. Unpublished manuscript.Google Scholar
Vaillant, G. E., & Drake, R. E. (1985). Maturity of ego defenses in relation to DSM-III axis II personality disorder. Archives of General Psychiatry, 42, 597601.Google Scholar
Vaillant, G. (1993). The wisdom of the ego. Cambridge, MA: Harvard University Press.Google Scholar
Werner, H. (1948). Comparative psychology of mental development. New York: International University Press.Google Scholar
Werry, J. S., & Quay, H. C. (1971). The prevalence of behavior symptoms in younger elementary school children. American Journal of Orthopsychiatry, 41, 136143.Google Scholar
Wilber, C. H., Rounsaville, B., Sugarman, A., Casey, J., & Kleber, H. (1982). Ego development in opiate addicts. An application of Loevinger's stage model. Journal of Nervous and Mental Disease, 170, 202208.Google Scholar
Wohlwill, J. F. (1973). The concept of experience: S or R? Human Development, 16(1–2), 90107.Google Scholar
Zoccolillo, M. (1993). Gender and the development of conduct disorder. Development and Psychopathology, 5(1–2), 6578.Google Scholar