Comparison between Conduct Disorder and Hyperkinetic Conduct Disorder

Sir, I read with great interest the study by Malhotra et al.(1999, 41, 111-121). This study was designed to evaluate the symptomatology and clinical variables of hyperkinetic conduct disorder (HCD) and compare it with conduct disorder (CD) and also to determine the clinical variables that can discriminate these two disorders as a validation of HCD as a category. However, this study merits certain comments. Firstly, the authors could have excluded, on basis of their study aims, rather than including a case of depressive conduct disorder (mixed conduct and emotional disorders), a category different from CD, in the CD group. Secondly, authors stated, initially, that 3% relatives of CD children were having psychiatric morbidity. However, while elaborating it, they mentioned that 4% of sibs had mental retardation, 8% of sibs had epilepsy and related syndromes and 8% of parents had affective disorder. This raises a query whether the subsequently presented data is an excess of initial data (20% vs 3%) or incomplete one (20% out of 3% of relative's morbidity). Thirdly, although the authors reported, in the results, that both HCD and CD had poor outcome at one year, in the discussion they stated that they could not reach a meaningful conclusion regarding course and outcome. As both HCD (10%) and CD (4.2%) groups had poor one year follow-up rates, in spite of commenting on outcome, description of the characteristics of subjects on regular follow-up would have been more interesting. Fourthly, authors, in the results', mentioned that 15% of HCD and 32% of CD children had perinatal complications, conversely, in the abstract they stated that HCD children had more perinatal complications. Finally, the authors concluded that, in overall, this study highlights the need to study the etiology of CD children in India. Making concluding remark over HCD, the main study category, rather than on CD, would be more meaningful.