Adolescents with conduct disorder can be mindful of their aggressive behavior.

Adolescents with conduct disorder frequently engage in aggressive and disruptive behaviors. Often these behaviors are controlled or managed through behavioral or other psychosocial interventions. However, such interventions do not always ensure lasting changes in an adolescent's response repertoire so that he or she does not engage in aggression when exposed to the same situations that gave rise to the behavior previously. Mindfulness training provides a treatment option that helps an individual focus and attend to conditions that give rise to maladaptive behavior. Using a multiple baseline design, we assessed the effectiveness of a mindfulness training procedure in modulating the aggressive behavior of three adolescents who were at risk of expulsion from school because of this behavior. The adolescents were able to learn the mindfulness procedure successfully and use it in situations that previously occasioned aggressive behavior. This led to large decreases in the aggression of all three individuals. Follow-up data showed that the adolescents were able to keep their aggressive behavior at socially acceptable levels in school through to graduation. Maladaptive behaviors, other than aggression, that the adolescents chose not to modify, showed no consistent change during mindfulness training, practice, and follow-up.

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Adolescents with conduct disorder engage in "a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated" (American Psychiatric Association, 2000, p. 93). To be diagnosed with conduct disorder, children or adolescents must have displayed at least 3 of 15 criterion behaviors within the previous 12 months and at least 1 within the previous 6 months. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision, the 15 criterion behaviors are divided into four groups: (a) aggressive conduct that causes or threatens physical harm to other people or animals (bullying, fighting, using a weapon, being physically cruel to others, being physically cruel to animals, stealing while confronting the victim, initiating forced sexual activity); (b) nonaggressive conduct that causes property loss or damage (fire setting, engaging in other destruction of property); (c) deceitfulness or theft (breaking and entering, lying for personal gain, stealing without confronting the victim); and (d) serious violations of rules (before age 13: running away from home and being truant). The diagnostic criteria clearly indicate that conduct disorder includes both overt and covert aggression.

Community-based studies indicate a high prevalence of conduct disorder, ranging from about 2% to more than 10% in the general population of children and adolescents (Lahey, Miller, Gordon, & Riley, 1999). Adjacent literature from systems of care suggests that there is a high rate of clinical referrals to community-based care (Landrum, Singh, Nemil, Ellis, & Best, 1995; Quinn & Epstein, 1998) and inpatient care (Singh, Landrum, Donatelli, Hampton, & Ellis, 1994) for children and adolescents with conduct disorder. Also, it is known that these children and adolescents tend to have negative long-term outcomes as adults, with about 80% of them likely to meet criteria for a psychiatric disorder (Kazdin, 2003). The problems for children and adolescents with conduct disorder are compounded by the co-occurrence of other childhood psychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, substance abuse and dependence disorders, depressive disorder, and anxiety disorders (Hinshaw & Lee, 2003).

There are no psychopharmacological treatments for conduct disorder approved by the Federal Drug Administration, although psychotropic drugs have proven beneficial in controlling some symptoms of the disorder. For example, biologically mediated aggression in children and adolescents in residential facilities is often treated with psychotropic drugs (Connor, Ozbayrak, Harrison, & Melloni, 1998; Connor, Ozbayrak, Kusiak, Caponi, & Melloni, 1997). Whether arising from conduct disorder or other childhood psychiatric disorders, aggression that is impulsive, explosive, hostile, or rageful appears to be medication responsive (Campbell, Gonzalez, & Silva, 1992). However, other forms of aggression in children and adolescents with conduct disorder are not responsive to psychiatric medication. For example, predatory or instrumental aggression that is associated with low levels of autonomic nervous system arousal typically does not respond to medication (Eichelman, 1988). Given the multifactorial nature of conduct disorder, psychopharmacological interventions are best used adjunctively with psychosocial interventions.

Several empirically tested psychosocial interventions exist for children and adolescent with conduct disorders (Kazdin, 1997). Most of these interventions focus primarily on overt, rather than covert, maladaptive behaviors. Given the central role of the family in the development and maintenance of overt conduct problems (Patterson, Reid, & Dishion, 1992), these interventions are delivered within the family context (McMahon & Kotler, 2006). Although effective to some extent, all family-based interventions have limitations, particularly in terms of the extensive parental effort requirement and the socioeconomic status of the parents (Kazdin, 1997).

Cognitive-behavioral skills training programs have also been shown to be effective with aggressive adolescents (McMahon & Kotler, 2006). For example, research shows that Problem-Solving Skills Training (Kazdin, 2003) is effective with children with serious aggressive conduct problems, in both inpatient and outpatient settings, and that the effects can be maintained over time. Cognitive-behavioral therapies enable children and adolescents to engage in and take control of their own behavior--two key concepts in mental health recovery (Davidson, O'Connell, Tondora, Lawless, & Evans, 2005). The most successful procedures have been multicomponent treatments. Many cognitive-behavioral approaches, however, are single-component programs (e.g., social skills training), which appear to be less robust and not long lasting, even if effective in the short term (McMahon & Wells, …