Prevention of Conduct Problems in Integrated Pediatric Primary Care

Conduct problems, which include disruptive and oppositional behavior as well as delinquency, are common in childhood and adolescence. If left untreated, conduct problems can lead to significant short- and long-term consequences for both the individual and for society in general. Children and teens with conduct problems may present with oppositional defiant disorder or conduct disorder, both of which are characterized primarily by externalizing behavior problems. Both disorders are highly comorbid with and exacerbated by attention deficit hyperactivity disorder (ADHD). Genetic, individual, family, and environmental influences interact to produce cascading profiles of risk over time. Key risk factors for conduct problems include being male; having callous-unemotional personality traits and other temperamental vulnerabilities; experiencing dysfunctional and invalidating family, school, and peer environments; and living in poverty. Effective screening, prevention, and early intervention are critical for disrupting this pattern of cascading developmental risk, and the pediatrician is often the first person caregivers turn to for support around these behaviors. Therefore, pediatricians and integrated pediatric behavioral health providers are well poised within the stepped care prevention model to consult with families and, when indicated, directly provide or make referrals for the appropriate interventions.