Similarities and differences between

aggressive and delinquent children and

adolescents in a national sample

Joseph M. Rey, Michael G. Sawyer, Margot R. Prior

Objective: To examine differences in the correlates, comorbidity and use of services

between aggressive and delinquent children and adolescents.
Method: An Australian representative sample (n = 4083) of parents of children and adoles-
cents were administered a psychiatric diagnostic interview, the Child Behaviour Checklist,
and other instruments to measure service use. The characteristics of children with high
scores (top 5%) in the aggressive and delinquent syndromes or both were then examined.
Results: The proportion of aggressive children decreased with increasing age while that of
delinquents increased. The aggressive group was specifically associated with the impulsive-
hyperactive subtype of attention deficit hyperactivity disorder (ADHD) (OR = 12.63; 95%
CI = 5.97–26.74). Comorbidity between ADHD, aggression and delinquency was less
frequent among adolescents than in children, with the exception of the inattentive subtype in
which comorbidity was higher. Both aggressive and delinquent groups had a considerable
overlap with conduct disorder. Aggressive and delinquent youths used services more often,
but parents perceived aggressive children as more in need of help than delinquent ones.
Living in a sole parent family was specifically associated with the delinquent group
(OR = 3.34; 95% CI = 2.25–4.96).
Conclusions: The results suggest that these empirically derived syndromes while sharing
many features also differ in important ways, highlighting the need for further convergence
between categorical and dimensional classifications. Their differential association with the
subtypes of ADHD requires further examination and may help to understand the relationship
between ADHD and conduct problems. The importance of aggressive behaviour in children
should not be underestimated since it is associated with significant psychopathology, parental
distress and use of services.
Key words: aggression, attention deficit hyperactivity disorder subtypes, conduct dis-
order, delinquency, epidemiology.

Australian and New Zealand Journal of Psychiatry 2005; 39:366–372

Joseph M. Rey, Professor (Correspondence) Aggressive behaviour, non-compliance and rule-

Northern Clinical School, University of Sydney, Coral Tree Family
Service, North Ryde, New South Wales 1670, Australia.
Email: jrey@mail.usyd.edu.au
Michael G. Sawyer, Professor
Department of Paediatrics, Adelaide University and Research &
Evaluation Unit, Women’s and Children’s Hospital, North Adelaide,
South Australia
Margot R. Prior, Professor
Department of Psychology, University of Melbourne, Melbourne,
Australia
Received 20 July 2004; revised 20 September 2004; accepted 14 October
2004.
breaking are common during childhood and cause
significant impairment [1]. More importantly, they are
strongly associated with mental disorders and use of
mental health services in adulthood [2]. There has been
much progress in the understanding of these problems
but experts agree that the classification of externalizing
disorders is still unsatisfactory and there is a need to
refine these constructs further [e.g. 1,3,4]. Moreover,
rates, associations with age and gender, correlates,
and comorbidity vary considerably among studies [5].
 J.M. REY, M.G. SAWYER, M.R. PRIOR
Categorical and dimensional approaches are used to
classify these problems and the advantages and short-
comings of each have been highlighted [6–8]. Some
studies have reported differences between aggressive
and delinquent syndromes [9–11]. The aggressive syn-
drome comprises behaviours like destroying objects,
bullying, fighting and vandalism, while stealing, lying
and truancy are characteristic of the delinquent syn-
drome. There is growing evidence of a strong relation-
ship between aggression in childhood and violent
behaviour in adolescence [e.g. 12]. However, given the
frequent co-occurrence of these behaviours, they have
rarely been considered in their pure and combined forms.
These syndromes were examined in an unselected
community sample of children and adolescents. The
survey employed the Child Behaviour Checklist (CBCL)
[13] to identify childhood mental health problems and
structured diagnostic interviews to identify DSM-IV
defined mental disorders [14]. In addition to global
problem scores, the CBCL offers more detailed assess-
ment in terms of eight empirically derived syndromes.
Two of the syndromes are called delinquent (or rule-
breaking) and aggressive. The former consists of items
such as stealing, truancy, running away and use of
alcohol or drugs. The latter includes behaviours like
arguing, destroying objects, fighting, screaming, and
temper tantrums. The empirically derived CBCL syn-
dromes have good reliability, high cross-cultural consist-
ency and can be obtained easily and at low cost [13,15].
The primary aim was to ascertain whether there were
differences in the correlates, comorbidity and use of
services between children rated by parents as showing
high levels of aggressive behaviour, high levels of delin-
quent behaviour, and those with high levels of both
problems. The existence of differences would support
the validity and usefulness of these syndromes. A second
aim was to ascertain their overlap with DSM-IV diag-
noses of conduct disorder, depression and the subtypes
of attention deficit hyperactivity disorder (ADHD).
Although the association between aggression and delin-
quency with ADHD is well established, little is known
about whether associations vary according to ADHD
subtypes.
Method
Design
Ethics approval was given by the Research Ethics Committee at the
Women’s and Children’s Hospital, Adelaide. The survey method has
been described elsewhere in detail [16]. In summary, multistage prob-
ability sampling of households with children younger than 18 years
was used to obtain a representative sample of 4509 residents aged
367
4–17 years. There were no differences in the demographic characteris-
tics of children, parents and families who participated and those of the
population from which they were selected based on the 1996 Austral-
ian census, with the exception of age. Children aged 4 and 5 years were
slightly over-sampled while those aged 16 and 17 years were slightly
under-sampled. Age and gender distribution of participants as well as
prevalence and correlates of disorder have been published elsewhere
[17]. Unless otherwise specified, the word ‘children’ is used to design
people younger than 18 years.
Instruments
Parents or main caregivers (henceforth described as ‘parent/s’) com-
pleted the CBCL [13] and a questionnaire asking about children’s
demographic characteristics and their use of services during the previ-
ous 6 months to obtain help for emotional and behavioural problems.
Parents were also interviewed using the parent version of the Diagnos-
tic Interview Schedule for Children Version IV (DISC-IV) [14]. All
these instruments have been shown to have acceptable psychometric
properties [13,14].
Measures
Measures of children’s aggressive and delinquent behaviour were
derived from ratings on the parent-completed CBCL. Children who had
scores in the top 5% in the aggressive scale (a score of 18 or above)
were assigned to the ‘aggressive group’. Similarly, children who had
scores in the top 5% in the delinquent scale (a score of 6 or higher) were
assigned to the ‘delinquent group’. Children who scored in the top 5%
on both scales were assigned to the ‘combined group’. The cut-off of
5% was selected because it broadly coincides with the cut-off score for
clinical caseness on normative US data [13].
The DISC-IV [14] administered to parents was used to diagnose
depression (including major depression and dysthymia – very few
cases qualified for dysthymia) (n = 131, 3.7%), ADHD (inattentive,
n = 165, 5.1%; impulsive-hyperactive, n = 53, 1.6%; combined,
n = 103, 3.2%) and conduct disorder (n = 97, 3%). ADHD was diag-
nosed if there were symptoms and impairment in past year. No other
diagnoses were considered in the survey. The DISC-IV was not admin-
istered to parents of 4 and 5 years old children; hence diagnoses were
not available for this age group.
For the purpose of analyses, the following categories were created
for the demographic variables (coded as yes = 1, no = 0):
Metropolitan residence (n = 2508, 61%).
Low income family (less than 480 Australian dollars per week,
n = 625, 20%).
Family type, categorized as original two-parent (n = 3097, 76%),
step-blended (n = 331, 8%) sole parent (n = 574, 14%) and other
(n = 72, 2%). The ‘other’ group represented foster-care and other
family arrangements. Due to the small number and the variety of
family circumstance lumped together; the ‘other’ group was not
included in analysis.
Parental education, whether father (n = 949, 29%) or mother
(n = 1100, 28%) had left school before age 16.
Parental unemployment, whether neither parent was working full
or part-time (n = 817, 22%).
368 AGGRESSIVE AND DELINQUENT CHILDREN

Use of services: school services (n = 171, 4%); GP or paediatrician
(n = 156, 4%); mental health services (n = 125, 3%); medication
(n = 83, 2%).
Parental perception that the child has significant emotional or
behavioural problems and is in need of professional help (n = 366,
9%).
Statistical analysis
Alpha was set at 0.05. Variables describing demographic character-
istics and service use were dichotomous or dichotomised for analysis
and were examined using χ2. An initial analysis was performed accord-
ing to whether participants were in the top 5% in the aggressive and
delinquent scales, none or both. To identify relationships between
group membership and demographic and other variables, three hier-
archical multiple logistic regression models were fitted to the data.
Whether children were in the aggressive or delinquent group or quali-
fied for DISC-IV conduct disorder were the dependent variables.
Predictor variables were those listed in Table 1, with the exception of
metropolitan residence, which did not differ between the groups.
Subsequently, variables not associated with any of the dependent vari-
ables were excluded and new logistic regressions performed; these
results are reported in Table 2.
There was substantial data missing in some analyses. This was
largely due to parents not answering all items in questionnaires. Lower
response rates were large in the questions about income (n = 1356,

Table 1. Participants in the aggressive and delinquent groups according to demographic variables,
comorbid diagnosis and service use (percentages)

Neither in the Aggressive Delinquent Combined

aggressive nor group n = 105† group n = 108† aggressive and
delinquent group delinquent group
n = 3766† n = 104†
Gender
Male 49.9 67.6 60.2 63.5
Age, years
4–5 20.5 26.7 6.5 21.2
6–12 47.5 57.1 27.8 48.1
13–17 32.0 16.2 65.7 30.8
Residence
Metropolitan 61.2 66.7 61.1 65.4
Low family income
< $481 18.5 24.4 35.3 45.2
Family type
Original two-parent 78.0 67.0 51.9 38.5
Step-Blended 7.5 14.6 9.3 22.1
Sole parent 12.9 14.6 34.3 34.6
Parental education
Father < 16 years 28.5 34.2 39.7 42.6
Mother < 16 years 27.6 28.7 45.3 41.2
Parental employment
Neither parent working 20.5 31.0 49.5 51.3
DISC-IV diagnosis
Depression/dysthymia 2.2 22.5 14.3 26.9
ADHD 7.0 50.0 22.0 63.4
Inattentive 4.4 11.7 11.0 15.9
Impulsive-hyperactive 1.0 18.4 5.0 6.1
Combined 1.6 19.5 3.1 41.4
Conduct disorder 0.9 22.2 16.1 53.3
Treatment received
Counselling at school or other 2.8 12.4 13.0 26.0
school support
GP or paediatrician 2.1 21.0 5.6 29.9
Mental health 1.6 11.4 9.3 24.0
Medication 0.9 14.3 1.9 23.1
Significant problems and in need 5.6 49.0 31.8 65.4
of professional help according
to parent
†
Numbers may be lower for some variables due to missing data.
 J.M. REY, M.G. SAWYER, M.R. PRIOR 369

Table 2. Variables associated with having scores in the top 5% in the delinquent scale, aggressive scale and with
DISC-IV conduct disorder (OR, Odds Ratio; C.I., confidence interval. Boldface represents a significant association)

Predictor variables Dependent variable

Delinquent† Aggressive‡ DISC-IV conduct disorder§
n = 3178 n = 3178 n = 3135
Adjusted 95% CI Adjusted 95% CI Adjusted 95% CI
OR¶ OR¶ OR¶
Aggressive 20.48 12.29 34.14 – – – 5.52 2.86 10.65
Delinquent – – – 21.10 12.70 35.08 9.72 5.05 18.68
Being male 1.05 0.72 1.53 1.87 1.18 2.95 1.68 0.95 3.00
Older than 12 years 3.82 2.54 5.73 0.42 0.26 0.70 0.52 0.29 0.96
Sole parent 3.34 2.25 4.96 0.82 0.48 1.41 0.98 0.52 1.85
DISC-IV Depression/ 1.84 1.02 3.32 3.80 2.02 7.14 2.60 1.26 5.35
dysthymia
DISC-IV ADHD:
Impulsive-hyperactive 1.76 0.68 4.53 12.63 5.97 26.74 2.27 0.77 6.66
Inattentive 2.71 1.44 5.08 2.30 1.19 4.46 3.21 1.53 6.74
Combined 4.00 2.11 7.61 12.10 6.42 22.77 2.91 1.28 6.60
Service use
School services 2.00 1.11 3.62 1.22 0.62 2.41 1.67 0.77 3.60
Mental health (any) 2.08 1.06 4.07 3.36 1.60 7.04 2.38 1.06 5.34
†
Model χ2 = 426.4, df = 10, p < 0.001. ‡Model χ2 = 490.4, df = 10, p < 0.001. §Model χ2 = 336.1, df = 11, p < 0.001. ¶After controlling
for the effects of all variables listed.

30%) and parental educational level (n = 1250, 28%). Analysis using

the aggressive and delinquent syndromes, age and gender had fewer
missing cases (n = 426, 9%). Because multivariate analysis included
DISC-IV diagnosis, which were not obtained for children aged 4 and
5 years (n = 912, 20%), multivariate analyses refer only to participants
aged 6–17 years.

Results

Of the 4083 participants who had data, 317 (7.8%) had high scores
on these CBCL scales (2.6% aggressive only, 2.6% delinquent only,
2.5% both). Approximately half of the children with high scores on
one scale also scored on the other, indicating considerable overlap/
comorbidity.
Table 1 summarizes the findings describing children in the aggres-
sive, delinquent, and combined groups, along with those who were not
assigned to any of these groups. There were statistically significant
differences between the groups for all the variables with the exception
of metropolitan residence. Differences usually followed a dose–
response pattern with children in the neither group showing the lowest
rate of negative characteristics, children in the combined group the
highest and those in the aggressive and delinquent groups somewhere
in between.
Figure 1 shows changes in the proportion of children in each group
according to age. These can be summarized as follows:
Overall the proportion of children who were assigned to any of the
three groups was quite constant from 4 to 17 years (average 7.8%).
Differences were not statistically significant overall and for boys and
girls separately.
Figure 1. Percent of participants in the aggressive,
delinquent and combined groups according to age.
There was a gradual decrease in the proportion of children in
the aggressive group with increasing age, the contrary occurred for the
delinquent group. The proportion with both (combined) remained
constant.
The rate in the aggressive and delinquent group was fairly constant
between the ages of 4 and 9 years but there was a gradual decrease in
the proportion of children in the aggressive group after the age of
9 years. The contrary occurred for the delinquent group (Table 1).
The results of the multivariate analysis (the dependent variable
represents membership of that group versus all others) are summarized
in Table 2. Only those predictors associated with at least one of the
dependent variables are reported. Examination of the odds ratios shows
370 AGGRESSIVE AND DELINQUENT CHILDREN
similarities and differences in the pattern of associations. The strongest
predictor of being in either the aggressive or delinquent group was
membership of the alternative of these two groups. For example,
children in the aggressive group were about 20 times more likely to
also be in the delinquent group and vice-versa. Children in both groups
were more likely to meet criteria for DISC-IV conduct disorder, those
in the delinquent group twice as often as those in the aggressive group.
Male sex was associated with being in the aggressive but not with
the delinquent group or DISC-IV conduct disorder group (Table 2).
Although participants in the delinquent group were 1.6 times as likely
to be males (95% CI = 1.2, 2.1), this association became non-
significant when the gender association with aggressive behaviour was
controlled statistically. For example, among aggressive females 53%
were also in the delinquent group compared with 48% of males. This
was similar for DISC-IV conduct disorder, but due to the association
of male gender with ADHD combined subtype. Being older than
12 years was positively associated with the delinquent and negatively
associated with the aggressive group and with DISC-IV conduct dis-
order. Living in a sole parent family was specifically associated with
the delinquent group.
Service use and perceived need for professional help
Children in the three groups used mental health services more often
but only those in the delinquent group used school services more often
(Table 2). Parents believed that children in the aggressive, delinquent
and conduct disorder groups needed professional help more often than
those without these behaviours, even after taking into account the effect
of confounding variables. This was particularly so for those in the
aggressive group (adjusted OR = 9.40; 95% CI 5.60, 15.90), compared
with the delinquent group (adjusted OR = 2.76; 95% CI 1.67, 4.58) and
the conduct disorder group (adjusted OR = 1.97; 95% CI 1.01, 3.82).
Association with other disorders
This is also shown in Table 2. DISC-IV conduct disorder varied
according to age; it was twice as common among 6–12 years olds as
among 13–17 years olds. The combined and inattentive subtypes of
ADHD were positively associated with the aggressive, delinquent and
conduct disorder groups. However, the impulsive/hyperactive subtype
was specifically associated with the aggressive group. Overall, comor-
bidity with ADHD was lower among aggressive and delinquent adoles-
cents, with the exception of the predominantly inattentive subtype, in
which comorbidity was higher. ADHD inattentive was about four times
more prevalent among 13–17 years olds than in 6–12 years olds (12.2%
versus 38.0%, χ2 = 14.5, df = 1, p < 0.001).
Comorbidity with depression was higher among adolescents in all
groups, ranging from 11% in 6 to 12 years olds in the delinquent group
to 36% among adolescents in the combined group. After controlling
for the effect of gender and age, comorbidity with depression was
similar across the groups.
Discussion
Both aggressive and delinquent youths used services
more often, but parents perceived aggressive children as
more in need of help than delinquent ones. Living in a
sole parent family was specifically associated with the
delinquent group, while the aggressive group was specif-
ically associated with the impulsive-hyperactive subtype
of ADHD. Also, comorbidity between ADHD and anti-
social behaviour decreased when children were older
with the exception of the inattentive subtype in which
comorbidity was higher among adolescents. This high-
lights the existence of differences in the pattern of
comorbidity between aggression, delinquency, and the
various subtypes of ADHD. This differential association
requires further examination and may help to understand
better the nature of conduct disorder and of the subtypes
of ADHD.
The importance of comorbid hyperactivity in the
maintenance of antisocial behaviour has been empha-
sized [18,19]. However, recent data suggest that aggres-
sive delinquency in adolescents is largely the outcome of
being aggressive in earlier years and not of ADHD as
postulated in many studies [12]. The delinquent group
did not show gender differences while the aggressive
group was predominantly male. Other studies [e.g. 20]
have reported no gender differences in nonaggressive
conduct disorders also. This suggests that the male pre-
dominance among conduct disordered children is largely
the result of aggressive children being mostly male.
Prevalence of aggressive and antisocial behaviour in
this community sample remained quite constant from
4 to 17 years (at around 8%). This was due to a decrease
in the proportion of children in the aggressive group with
increasing age, which was compensated by an increase
in the delinquent group (Fig. 1). These changes became
noticeable around the age of 10 years. These results are
broadly consistent with previous findings [11,21] and
with the DSM-IV criterion of using 10 years of age as
the threshold for diagnosis of conduct disorder of adoles-
cent onset [22]. By contrast, a recent report [12] using
data from six long-term prospective studies in three
countries found that a small group of children exhibited
notably more physically aggressive behaviour than their
peers throughout. In these children, high levels of phys-
ical aggression were quite stable from childhood to ado-
lescence. In particular, this and another study [23] did
not show changes in antisocial behaviour consistent with
an adolescent-onset group. However, they focused on
aggressive behaviour and did not examine property (e.g.
stealing) or status violations (e.g. truancy), which are
rare before the age of 10 years [21].
The proportion of children in the combined aggressive
and delinquent group was relatively constant throughout
(between 2% and 3%). These children may be similar to
the persistently physically aggressive participants identi-
fied in the long term prospective studies quoted [12].
In our survey this group was strongly associated with a
 J.M. REY, M.G. SAWYER, M.R. PRIOR
DISC-IV diagnosis of conduct disorder (53% met cri-
teria for conduct disorder, Table 1).
Prevalence of a DISC-IV diagnosis of conduct dis-
order in this study decreased with increasing age, con-
trary to most reports which show that conduct problems
increase with increasing age [e.g. 21,24]. This may have
several explanations. Firstly, diagnoses in this study are
based on parent reports and parents may be unaware of
their adolescent children’s conduct problems [21]. Sec-
ondly, it may be an instrument-specific difficulty. That
is, DISC-IV may give undue weight to aggressive, non-
compliant symptoms in younger children resulting in
over diagnosis of conduct disorder in the younger age
group. Thirdly, the operationalization of the conduct
disorder construct in DSM-IV (which includes aggres-
sive symptoms, property violations and status violations)
may have poor validity. In this regard, at least two
studies have found that apart from oppositionality,
DSM-IV conduct disorder symptoms have three distinct
clusters: aggression, property violations (e.g. stealing)
and status offences (e.g. truancy, running away) [25,26],
which have different age and gender associations [21].
Prospective studies [e.g. 12] suggest that children’s
tendencies to engage in early disruptive behaviours
influence later delinquency, with different patterns of
behaviour problems being associated with somewhat
different delinquent outcomes. However, early physical
aggression, in spite of decreasing as children grow older,
is the most consistent predictor of both violent and non-
violent offending in adolescence. From the public health
and clinical perspectives, these findings emphasize the
importance of reducing social disadvantage (e.g. by pro-
viding better support to sole parents) and of treating
early aggressive and non-compliant behaviour. Among
others, parenting programs have been shown to be cost-
effective interventions in this regard [27].
While sharing many features, the results suggest that
these empirically derived syndromes differ in important
ways that need to be understood better if more effective
prevention and treatment strategies are to be developed.
There is a need to enhance convergence between empir-
ically derived syndromes, which are reliable and easy to
obtain, and clinical diagnosis. This should be a priority
for DSM-V if we want to advance the understanding of
these important conditions.
This study has some limitations which must be kept in
mind when interpreting the results. The main one is that it
is cross-sectional and does not provide information about
behaviour changes over time. Other limitations are that
group selection was based on parent reports alone and that
other conditions, particularly anxiety and learning disorders
were not assessed. The presence of comorbid anxiety dis-
orders may have influenced the use of services.
371
Acknowledgement
We thank T.M. Achenbach for his comments to an
earlier version of this paper.
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