Conduct Problems

Overview of Conduct Disorders

• Those who engage in conduct problems engage in above average, antisocial and risk-taking behavior compared to their peers

• The most common disorders in children and adolescents — accounting for approximately 50% of the referrals to mental health clinics

What are the types of conduct problems in children and adolescents?

• Oppositional Defiant Disorder

• Conduct Disorder

• Intermittent Explosive Disorder

What are the social and economic costs of youth with conduct problems?

Are classified as the costliest mental helath problem in North America. There are mental health costs and lifetime costs to society for them to leave high school for a life of crime and substance abuse

What are the four categories for conduct problems?

Property violations, aggression, oppositional behavior, and status violations

What is oppositional defiant disorder?

A disorder that describes active refusal to follow the directing and demands of authority figures. Physically or verbally

How is defiance different from non-compliance?

Non-compliance is a typical behavior (it may take one or two reminders) whereas for defiant behavior it is chronic

What are some diagnostic criteria as per dsm-5 for ODD?

At least 4 symptoms from below should be present on most days for at least 6 months:

• Often loses temper

• Often touchy or easily annoyed

• Often angry and resentful

• Often argue with authority figures

• Often refuse to comply with requests

• Often blames others for his or her mistakes

What is vindictiveness?

Being mean just to be mean (willingness to inflict harm bc of perceived injustice)

How are symptoms classified?

• Mild → symptoms are confined to only 1 setting

• Moderate → at least 2 settings

• Severe → 3 or more settings

What is the common interactional pattern?

Caregiver requests a behavior/response

• child ignores

• parent threatens negative consequence

• child protests/talks back

• punishment or gives up

Parent and child are angry and/or withdrawn from one another

(pattern occurs 3-5 times)

What are the associated consequences of the dynamic between a parent and defiant child?

• Destabilized family unit

• Reduced family activities

• Academic difficulties

• Child rejected by peers

• Attenuated social growth

• Parental mental health problems

• Halt in supervision — gives up

• Negative interactional patterns in a broader context

Conduct Problems

From a psychological perspective, these problems fall along a continuous dimension of externalizing behaviors:

• Overt acts: Visible acts such as fighting

• Covert acts: Lying or stealing without confronting victim

• Destructive acts: Cruelty to animals, physical assault

• Nondestructive acts: Arguing or irritability

What are the types of aggression?

• Proactive

• Reactive

• Overt

• Covert

What are the gender differences in conduct problems?

• Rates are about 2-4 times higher for boys than for girls, with boys showing an earlier age at onset and greater persistence

• Boys also display more of these problems and report using more physical aggression. Girls display relational/covert

• Boys are more likely to express their aggression through acts like theft, truancy, substance abuse, etc

What are the dsm-5 criteria for conduct disorder?

A repetitive and persistent pattern of behavior in which the basic rights of others or rules are violated, as manifested by the presence of at least three of the following criteria in the past 12 months:

• Aggression to people and animals

• Destruction of property

• Deceitfulness or theft

• Serious violations or rules

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning

Onset Types of Conduct Disorder

• Childhood-onset type: Individuals show at least one symptom characteristic of conduct disorder prior to 10 years of age

• Adolescent-onset type: Individuals show no symptom characteristic of conduct disorder prior to 10 years of age

• Unspecified onset: Criteria for a diagnosis of conduct disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after 10 years

What are some specifiers of behavior for people with conduct disorder?

• Limited prosocial emotions

• Lack of remorse or guilt

• Callous-lack of empathy

• Unconcerned about performance

• Shallow or deficient affect (outward expression of emotion)

What are the specifiers in symptom type for conduct disorder?

• Mild → Few if any conduct problems

• Moderate → the # of conduct problems and the effect on others are intermediate between those specified in mild and those in severe

• Severe → Many conduct problems, causing considerable damage

Relation of Conduct Disorder and Personality Disorders?

An individual with a conduct disoder is most likely to develop a personality disorder (i.e., antisocial personaltiy disorder) in their adult years

What are the pathways and outcomes of conduct disorder?

• childhood-onset increased risk

• adolescent-onset delinquents at 26 years were less extreme but still had issues

• Those who were aggressive as children but not delinquent as adolescents became low-level offenders with anxiety and depression

What are some dispositional risk factors for conduct disorder?

• neurobiological differences

• personality traits

• information processing difficulties

• low verbal intelligence

• impulsivity

• temperament

What are contextual factors for conduct disorder?

• Green space access

• Exposure to violence

• Deviant peers

• Parenting style

• Family problems

• Prenatal exposure to teratogens

• Parent mental illness