The Reporting of Race and Ethnicity in the Conduct Disorder Literature: A Time-Sensitive Review

Background: Among presenting conditions in pediatric acute care settings, conduct disorder (CD) is a potentially stigmatizing yet common diagnosis in the setting of behavioral dysregulation requiring psychiatric admission. Concerns exist about over-diagnosis of CD in non-Hispanic Black children relative to White peers and the potential for the CD diagnosis to obfuscate manifestations of co-occurring psychiatric conditions.

Methods: We evaluated the number of manuscripts on CD diagnoses that report race and ethnicity and co-occurring mental health characteristics (i.e., history of trauma, attention-deficit hyperactivity disorder [ADHD], or substance use disorders [SUDs]) that are often undertreated in racially minoritized children. Using the keywords "conduct disorder" or "externalizing disorder," we screened peer-reviewed articles in PubMed published from January 2013 to November 2023.

Results: We screened 2791 manuscripts for potential inclusion, of which 136 were original research articles with data on children with CD diagnoses. Thirteen articles contained racial and ethnic data for people with CD diagnoses, with the majority illustrating that Black children were overrepresented among those with CD diagnoses. No studies provided details on how race and ethnicity were ascertained and few mentioned racism as a potential explanation for racial disparities in CD diagnoses. No studies contained data collected after 2016, with three studies using data collected as early as 2001-2002. Across all articles, data on co-occurring trauma, ADHD, and SUDs were scarce.

Conclusions: The overwhelming majority of studies on CD diagnoses did not provide comprehensive data on race and ethnicity and co-occurring psychiatric disorders in children receiving diagnoses of CD.