Sack et al., (1993) has suggested that cultural disparity, minority status and poverty may be important factors in the genesis of CD in First Nations people, and further speculated that CD rates may be a “barometer of socio-cultural stress” akin to the way neonatal mortality rate is seen as a measure of the quality of overall healthcare. In this regard, Costello et al., (2003) reported on a natural experiment in an American Indian community in the Smoky Mountains where the opening of a casino provided an income supplement that moved 14% of their study families out of poverty. Children in the study were evaluated 4 years before and 4 years after the casino opened. The effect of moving out of poverty was found to be specific to reducing symptoms of conduct and oppositional defiant disorders, whereas anxiety and depression symptoms were unaffected. Taken together these studies provide some support for a social causation explanation of the high prevalence of CD seen in some American Indian communities.
