Oppositional Defiant Disorder and Conduct Disorder

Oppositional Defiant Disorder

• Pattern of negativistic, hostile, and defiant behavior toward authority

• 4 or more sxs for 6 or more months

  • angry/irritable mood

    • often loses temper

    • often touchy/easily annoyed by others

    • often angry/resentful

  • argumentative/defiant behavior

    • often argues w/adults

    • often actively defies/refuses to comply w/adults’ requests/rules

    • often deliberately annoys ppl

    • often blames others for own mistakes/behavior

  • Vindictiveness

    • often spiteful/vindictive

Conduct Disorder

• Repetitive and persistent pattern of behavior in which basic rights of others/major age appropriate societal norms/rules are violated

• 3 or more sxs in the past 12 mos, 1 sx in the past 6 mos

  • Aggressiveness to people and animals

  • destruction of property

  • deceitfulness/theft

  • serious rule violation

*limited prosocial emotion as a specifier (aka callous/unemotional (CU), a subtype of antisocial behavior)

Aggression to ppl and animals (Conduct)

• bullies/threatens/intimidates

• intimates physical fights

• has used a weapon that can cause serious physical harm to others

• been physically cruel to others/animals

• has stolen while confronting a victim

• has forced someone into sexual activity

Destruction of Property (Conduct)

• Has deliberately engaged in fire setting w/ intention of causing serious damage

• deliberately destroyed others property

Deceitfulness/theft (Conduct)

• broken into house, building, car

• lies to obtain goods, favors, avoid obligations

• stolen items of nontrivial value w/o confronting a victim

Serious violation of rules (Conduct)

• stays out at night despite parental prohibitions, beginning before 13 years old

• run away from home overnight at least 2x while living with a parent/surrogate (or 1x if lengthy period)

• often truant, beginning before 13 years old

Epidemiology

• ODD: typically diagnosed 3-7 yrs, can be diagnosed later if conduct disorder criteria not met

• CD: typically diagnosed in adolescent, but can be dx in adults of antisocial prsty. disorder (ASPD) criteria not met

• ODD and CD prevalence is about 8-12% (combined)

  • ODD may be slightly more common in boys, but fairily =

  • CD more common in boys (~3:1)

Developmental Pathways

• 1 in 4 boys w/ ODD will go on to have CD; most CD begins with ODD

• ~40% of CD kids go onto have ASPD, typically begins with CD

• ADHD often precursor to CD (ADHD → school problems and peer rejection → association w/ deviant peers → CD)

• behavior tends to transition from overt to covert w/ age

development of conduct problems

• mofitt (1993)

  • life course persistent (M : 10.5%; F: 7.5%)

    • childhood onset (prior to age 10), clear indication by age 3

    • individual risks (neurcognitive deficits, undercontrolled temperament, hyperactivity) combined w/ adverse parenting/environment

• Adolescent Limited (M: 19.6%, F: 17.4)

  • onset after age 10

  • individual risks less salient, but SOCIAL factors are MORE salient (influence of deviant peers)

  • maturity gap: when puberty hits before the child is cognitively mature, so immature kids are hanging out with older kids who are more physically similar => conduct problems

*problems often continue to adulthood, so perhaps it should be called adolescent onset

Biological Etiology

Structural

• deficits in executive functioning regarding planning and control due to frontal lobe abnormalities

• hypoactive (and reduced volume in) amygdala, especially in CU => lower fear/not paying attention to others fears?

Biochemical

• impulsivity and aggression due to serotonin imbalance

• decreased dopaminergic functioning

• higher rates in males due to testosterone?

• lower HPA activity => lower cortisol => low physiiological arousal to punishment in ASPD too

Genetics

• offspring of criminal parents, even when raised by adoptive parents, show higher rates of ODD and CD

• heritability ranges 40-50% (aggression is more heritable than delinquency)

• CU is more highly heritable than conduct problems alone

Psychosocial etiology

• Poverty/urbanicity

  • all disorders of attention and conduct are more common in low SES (socioeconomic status), high stress environments

  • downward social drift (social selection hypothesis) or environmental causation (sociogenic hypothesis?)

• Family conflict/violence

• peer relationships

• cogntive bias

Coercive parenting (Patterson, 1997)

• Parenting is a transactional process

  • child influence by parent, parent is influenced by child

  • 2 system interaction and both are changed as a function of that environment

• Poor behavioral management => parents engaging in coercive cycles w/their child

  • escalating parent and child demands

  • escalating ( - ) consequences

  • person who dispenses most ( - ) consequences “wins”

  • “winning the battle but losing the war”

• These exchanges are self perpetuating and fuel oppositional and manipulative child behaviors

• coercive transactions happen between siblings systems too

Gene x Environment Adoption Study (et al., 1996)

children born to parents who are antisocial/substance abuse who were adopted early in life → children are more likely to be antisocial and hostile → adoptive parents harsh and critical toward children → MORE antisocial and hostile behavior in children

Dodges Cognitive Theory

Assume others will be aggressive → ambiguous incident w/ another child → attribute incident to hostile, intentional act → respond aggressively → other child retaliates/seeks help from adults → conduct disorder, child’s beliefs that others are against them are reinforced (and this loops back up to assuming others will be aggressive)