AMultifaceted Treatment Approach for Young Children with Conduct Disorders

The incidence of oppositional defiant disorder (ODD) and conduct disorder (CD) in children is alarmingly high, with reported rates ofearly-onset conduct problems in young preschool children ranging from 4-6% (Egger & Angold, 2006) and as high as 35% for low-income families (Webster-Stratton & Hammond, 1998), Developmental theorists have suggested that, compared with typical children, early-starter delinquents-that is, those who first exhibit ODD symptoms in the preschool years-have a two~ to threefold risk of becoming tomorrow's serious violent and chronic juvenile offenders (Loeber et aI., 1993; Patterson, Capaldi, & Bank, 1991; Snyder, 2001; Tremblay et aI., 2000). These children with early-onset CD also account for a disproportionate share ofdelinquent acts in adulthood, including interpersonal violence, substance abuse, and property crimes. Indeed, the primary developmental pathway for serious CDs in adolescence and adult­ hood appears to be established during the preschool period. Risk factors from a number of different areas contribute to child conduct problems, including ineffective parenting (Jaffee, Caspi, Moffitt, & Taylor, 2004), family mental health and criminal risk factors (Knutson, DeGarmo, Koeppl, & Reid, 2005), child bio­ logical and developmental risk factors (e.g., attention-deficit disorders, learning disabili­ ties, language delays), school risk factors (Hawkins, Catalano, Kosterman, Abbott, & Hill, 1999), and peer and community risk factors (e.g., poverty and gangs) (Collins, Mac­ coby, Steinberg, Hetherington, & Bornstein, 2000; Hawkins et al., 2008). Treatment­ outcome studies suggest that interventions for CD are of limited effect when offered in !