disruptive/impulse control/conduct

ODD criteria

for 6+ months angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness with 4+ symptoms with at least 1 being with someone who isn’t a sibling: loses temper, is angry/resentful, deliberately annoys others, blames others for their mistakes or misbehavior

gender ratio ODD

in young children, more common boys. in order children and adolescents, its about equal.

what percent of children with ODD will be diagnosed with conduct disorder

30%

what makes a child with ODD higher risk for conduct disorder?

earlier age of onset

treatment for ODD

no single treatment, most effective is multimodal and tailored to age, symptoms, and comorbidities. evidence-based psychosocial interventions are first-line (e.g., PCIT, PMT, functional family therapy, etc)

conduct disorder

persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules. 3+ symptoms during the past 12 months, at least 1 symptom in the past 6 months. aggression to people/animals, destruction of property, deceitfulness or theft, serious violation of rules.

for 6+ months angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness with 4+ symptoms with at least 1 being with someone who isn’t a sibling: loses temper, is angry/resentful, deliberately annoys others, blames others for their mistakes or misbehavior

ODD

persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules. 3+ symptoms during the past 12 months, at least 1 symptom in the past 6 months. aggression to people/animals, destruction of property, deceitfulness or theft, serious violation of rules.

conduct disorder

this diagnosis cannot be assigned to someone 18+ who meets criteria for antisocial personality disorder

conduct disorder

conduct disorder cannot be diagnosed in who?

people 18+ who meet criteria for antisocial personality disorder

conduct disorder gender ratio

more common in males

conduct disorder age onset

may occur in early childhood but more often emerge between middle childhood and middle adolescence

conduct disorder specifiers

mild, moderate, severe (depending on number of problems and severity of their consequences)

childhood-onset type: at least 1 symptom before age 10

adolescent-onset type: no symptoms before age 10

unspecified onset: onset is unknown

there are also specifiers for remorse or guilt and lack of empathy, but these don’t determine severity specifier

childhood-onset type in conduct disorder is associated with

higher degree of aggression and greater risk for future diagnosis of antisocial personality disorder and/or substance use disorder

the etiology of conduct disorder has been linked to

heredity, family experiences, lower physiological reaction to stress

heritability estimates of conduct disorder for men and woman

65% ; 43%

concordance rates of conduct disorder for male monozygotic and male dyzygotic twins

53% ; 37%

concordance rates of conduct disorder for female monozygotic and male dyzygotic twins

30% ; 18%

risk factors for conduct disorder

physical abuse, sexual abuse, neglect, harsh and inconsistent discipline, frequent changes in caregivers, parental criminology and substance abuse, low resting heart rate

what do children with CD alone and children with CD + ADHD have in common

lower physiological reactions to aversive stimuli (based on self-report, skin conduction, heart rate)

cortisol and HR responses to a stressful procedure in adolescents with and without CD

both report similar increase in negative affect but adolescents with CD don’t experience the same cortisol and HR response

according to Fairchild et al, the discrepancy between subjective report and actual physiological changes to stress for youth with CD suggests

poor coordination between emotional and physiological arousal

Moffitt distinguishes between 2 types of antisocial behavior that correspond to the CD childhood-onset and adolescent-onset types, ____ and ____

life-course-persistent type and adolescence-limited type

life-course-persistent type

a type of CD characterized by a pattern of increasingly serious antisocial behaviors that begin in early childhood, continue into adulthood, and is consistent across situations

a type of CD characterized by a pattern of increasingly serious antisocial behaviors that begin in early childhood, continue into adulthood, and is consistent across situations

life-course-persistent type

adolescence-limited type

a type of CD characterized by a temporary and situational type of antisocial behavior that’s due to a “maturity gap” between an adolescent’s biological and sexual maturity and their social maturity. antisocial behaviors are a way to attain mature status.

a type of CD characterized by a temporary and situational type of antisocial behavior that’s due to a “maturity gap” between an adolescent’s biological and sexual maturity and their social maturity. antisocial behaviors are a way to attain mature status.

adolescence-limited type

course/prognosis of conduct disorder

for most people the disorder remits by adulthood, especially for adolescent-onset type. for those who begin in childhood, they have a worse prognosis and increased risk of criminal behavior, conduct disorder, and substance-related disorders in adulthood

first-line treatment for CD and other disruptive behavior disorders

psychosocial interventions. 4 types: child-focused, parent-focused, family-focused, or multimodal

child-focused intervention for CD and other disruptive behavior disorders

problem-solving skills training. focuses on the cognitive processes that underlie children’s problematic behavioral and helps them accurately perceive the feelings of others, understand the consequences of their actions, and identify prosocial ways to resolve interpersonal problems and conflicts

problem-solving skills training (PSST) for CD/disruptive behavior disorders

child-focused intervention that focuses on the cognitive processes that underlie children’s problematic behavioral and helps them accurately perceive the feelings of others, understand the consequences of their actions, and identify prosocial ways to resolve interpersonal problems and conflicts

child-focused intervention for CD/disruptive behavior disorders that focuses on the cognitive processes that underlie children’s problematic behavioral and helps them accurately perceive the feelings of others, understand the consequences of their actions, and identify prosocial ways to resolve interpersonal problems and conflicts

problem-solving skills training (PSST)

parent-focused interventions for CD/disruptive behavior disorders

Kazdin’s PMT

parent management training - Oregon model (PMTO)

PCIT

parent management training - Oregon model (PMTO)

parent-focused interventions for CD/disruptive behavior disorders for parents of children 2-18. based on the assumption that their aggressive, antisocial, and other externalizing behaviors are the result of an escalating cycle of coercive interactions between children and their parents. helps parents replace coercive parenting with positive parenting (pos reinforcement, non-coercive discipline, setting limits, monitoring behavior)

parent-focused interventions for CD/disruptive behavior disorders for parents of children 2-18. based on the assumption that their aggressive, antisocial, and other externalizing behaviors are the result of an escalating cycle of coercive interactions between children and their parents. helps parents replace coercive parenting with positive parenting (pos reinforcement, non-coercive discipline, setting limits, monitoring behavior)

parent management training - Oregon model (PMTO)

Kazdin’s PMT

parent-focused interventions for CD/disruptive behavior disorders for parents of children 2-17 with oppositional, aggressive, and/or antisocial behavior. based on principals of operant conditioning and focuses on replacing antecedents and consequences with ones that foster more desirable behaviors.

parent-focused interventions for CD/disruptive behavior disorders for parents of children 2-17 with oppositional, aggressive, and/or antisocial behavior. based on principals of operant conditioning and focuses on replacing antecedents and consequences with ones that foster more desirable behaviors.

Kazdin’s PMT

research on efficacy of PMT and PSST

combining them is more effective than either alone

PCIT

parent-focused interventions for CD/disruptive behavior disorders for parents of children 2-7 with severe behavioral problems or who have experienced/at risk of experiencing maltreatment. focuses on altering negative parent-child interactions through child-directed interaction phase (enhances parent-child relationship) and parent-directed interaction phase (teaches effective discipline)

parent-focused interventions for CD/disruptive behavior disorders for parents of children 2-7 with severe behavioral problems or who have experienced/at risk of experiencing maltreatment. focuses on altering negative parent-child interactions through child-directed interaction phase (enhances parent-child relationship) and parent-directed interaction phase (teaches effective discipline)

PCIT

family-focused interventions for CD/disruptive behavior disorders

Functional family therapy (FTT)

multidimensional family therapy (MDFT)

Functional family therapy (FTT)

family-focused interventions for CD/disruptive behavior disorders for families with child 11-18 with an externalizing behavior disorder, substance use, or high risk for delinquency. based on assumption that problematic behaviors in a family regulate connections by fostering interdependence or independence and regulate relational hierarchies by creating power structures. goal is to replace w/non-problematic behaviors that serve the same function

family-focused interventions for CD/disruptive behavior disorders for families with child 11-18 with an externalizing behavior disorder, substance use, or high risk for delinquency. based on assumption that problematic behaviors in a family regulate connections by fostering interdependence or independence and regulate relational hierarchies by creating power structures. goal is to replace w/non-problematic behaviors that serve the same function

Functional family therapy (FTT)

family-focused intervention for CD/disruptive behavior disorders for families with someone 11-21 with substance use disorder and comorbid internalizing symptoms, externalizing symptoms, and/or delinquency. uses elements of family systems theory, ecological theory, and developmental psychology. goals are reduce/eliminate substance use, aggression, etc and improve adolescent and family functioning by facilitating change in 4 domains: adolescent, parents, family interactions, and extrafamilial sources of influence

multidimensional family therapy (MDFT)

multidimensional family therapy (MDFT)

family-focused intervention for CD/disruptive behavior disorders for families with someone 11-21 with substance use disorder and comorbid internalizing symptoms, externalizing symptoms, and/or delinquency. uses elements of family systems theory, ecological theory, and developmental psychology. goals are reduce/eliminate substance use, aggression, etc and improve adolescent and family functioning by facilitating change in 4 domains: adolescent, parents, family interactions, and extrafamilial sources of influence

multimodal interventions for CD/disruptive behavior disorders

multisystemic therapy (MST) and MST-CAN (child of abuse or neglect)

multidimensional treatment foster care (MTFC)

multisystemic therapy (MST) and MST-CAN

multimodal intervention for CD/disruptive behavior disorders. intensive family and community-based intervention for adolescents 12-18 at imminent risk for out-of-home placement due to antisocial behaviors, substance use, and/or serious psychiatric problems. based on Bronfenbrenner’s ecological theory and assumes behaviors are the result of risk factors at individual, family, peer, school, and community levels so interventions must be provided at all levels. MST-CAN is for families of abused and neglected children 6-17

multimodal intervention for CD/disruptive behavior disorders. intensive family and community-based intervention for adolescents 12-18 at imminent risk for out-of-home placement due to antisocial behaviors, substance use, and/or serious psychiatric problems. based on Bronfenbrenner’s ecological theory and assumes behaviors are the result of risk factors at individual, family, peer, school, and community levels so interventions must be provided at all levels.

multisystemic therapy (MST)

multidimensional treatment foster care (MTFC)

multimodal intervention for CD/disruptive behavior disorders that is an alternative to residential care for children and adolescents who need intensive support due to maltreatment, severe emotional disturbance, and/or juvenile delinquency. involves developing a behavior management plan tailored to the child and administered by a treatment team in their home, school, and community. children reside with highly trained and supervised foster parents while their parents receive training for positive reunification

multimodal intervention for CD/disruptive behavior disorders that is an alternative to residential care for children and adolescents who need intensive support due to maltreatment, severe emotional disturbance, and/or juvenile delinquency. involves developing a behavior management plan tailored to the child and administered by a treatment team in their home, school, and community. children reside with highly trained and supervised foster parents while their parents receive training for positive reunification

multidimensional treatment foster care (MTFC)

effectiveness of Scared Straight programs as prevention or intervention for conduct disorder

tend to have harmful effects, increases likelihood that juvenile offenders/at-risk juveniles will engage in criminal behavior in the future. their confrontational “rap sessions” (incarcerated people scaring them about what its like) and nonconfrontational (educational) approaches have even worse outcomes for seriously delinquent juveniles.

intermittent explosive disorder

recurrent behavioral outbursts in children 6+ (or similar developmental level) due to failure to control aggressive impulses as manifested by 1 of the following

a. verbal or physical aggression 2x/week for 3 months, not resulting in damage to property or physical injury to people or animals

b. 3 outbursts in a 12-month period that resulted in damage or destruction of property and/or injury to other people or animals

level of aggression must not be proportional to provocation or precipitating social stressors, not premeditated or for a tangible outcome, must cause distress, impairment, OR negative financial/legal consequences.

children 6+ outbursts 2x/week for 3 months without destruction/injury or 3x in 12 months with destruction/injury. out of proportion, no precipitating stressor, not premeditated.

intermittent explosive disorder