Chapter 9 - Conduct disorders

Define conduct disorder.

age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and the personal or property rights of others. These children and adolescents display problems in the self-control of emotions and behaviors.

Identify at least two possible contributing factors leading to conduct disorder.

Numerous socioeconomic factors contribute to a higher incidence of conduct disorder in children and adolescents, such as neglect and abuse, substance abuse disorders, and criminal problems in parents of these children.

Describe the cost of conduct disorder to society.

Costs to the educational, health, social service, criminal justice, and mental health systems that deal with youth make conduct problems one of the most costly mental health problems in North America.

Identify the four perspectives of conduct problems.

1. From a legal perspective, conduct problems are defined as criminal acts that result in apprehension and court contact and are referred to as “delinquency.”

2. From a psychological perspective, conduct problems fall along a continuous dimension of externalizing behavior, which includes a mix of impulsive, aggressive, and rule-breaking acts.

3. From a psychiatric perspective, conduct problems are viewed as a distinct category of mental disorder based on DSM symptoms. The overall category is called Disruptive, Impulse-Control, and Conduct Disorders, and includes ODD and CD.

4. A public health perspective cuts across disciplines and blends the legal, psychological, and psychiatric perspectives with public health concepts of prevention and intervention.

Describe the three dimensions that ODD symptoms can be grouped into.

symptoms can be grouped into three dimensions: negative affect, defiance, and vindictiveness

Describe the prognosis for early-onset CD vs adolescent-onset CD.

Children who display childhood-onset CD (before age 10) are more likely to be boys, show more aggressive symptoms, account for a disproportionate amount of illegal activity, and persist in their antisocial behavior over time.Children with adolescent-onset CD are as likely to be girls as boys and do not display the severity or psychopathology that characterizes the childhood-onset group

List at least three callous-unemotional (CU) traits.

traits such as lacking in guilt, not showing empathy, and not displaying feelings or emotions.

Identify three types of deficits in children and adolescents with conduct problems.

Many children with conduct problems show cognitive, verbal, and language deficits, despite their normal intelligence.

Describe the strongest and most consistent correlate of conduct problems.

General family disturbances, and disturbances in parenting practices and family functioning.

Identify at least two risk factors for youths with conduct problems.

Youths with conduct problems engage in many behaviors that place them at high risk for health-related problems, including personal injuries, illnesses, sexually transmitted diseases, and substance abuse.

Identify the prevalence rate of CD and ODD

8% for CD (9% for males, 6% for females)

12% for ODD (13% for males, 11% for females

Describe the association between CD and depression.

About 50% of children with conduct problems are diagnosed with depression or a co-occurring anxiety disorder. Symptoms of negative mood associated with ODD best account for the relationship between conduct problems and depression

Identify the role of anxiety in conduct problems.

Anxiety related to shyness, inhibition, and fear may protect against conduct problems, whereas anxiety associated with negative emotionality and social avoidance/withdrawal based on a lack of caring about others may increase the child’s risk for conduct problems.

List at least three evidence-based treatments.

PMT, PSST and MST

Describe the focus of Parent Management Training (PMT)

is on teaching parents to change their child’s behavior in the home.

adolescent-limited (AL) path

A developmental pathway to antisocial behavior whereby the child’s antisocial behavior begins around puberty, continues into adolescence, and later desists in young adulthood.

adolescent-onset conduct disorder

A specific type of conduct disorder for which individuals show no symptom characteristic of conduct disorder prior to age 10 years.

amplifier hypothesis

The premise that stress may serve to amplify the maladaptive predispositions of parents, thereby disrupting family management practices and compromising the parents’ ability to be supportive of their children.

antisocial personality disorder (APD)

An adult disorder characterized by a pervasive pattern of disregard for, and violation of, the rights of others, as well as engagement in multiple illegal behaviors.

behavioral activation system (BAS)

A subsystem of the brain that activates behavior in response to cues of reward or nonpunishment.

behavioral inhibition system (BIS)

A subsystem of the brain that produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of nonreward or punishment.

callous and unemotional (CU) interpersonal style

A mode of social interaction that is characterized by an absence of guilt, lack of empathy, uncaring attitudes, shallow or deficient emotional responses, and related traits of narcissism and impulsivity.

childhood-onset conduct disorder

A specific type of conduct disorder whereby the child displays at least one symptom of the disorder prior to age 10 years.

coercion theory

A developmental theory proposing that coercive parent-child interactions serve as the training ground for the development of antisocial behavior. Specifically, it is proposed that through a four-step escape-conditioning sequence, the child learns how to use increasingly intense forms of noxious behavior to escape and avoid unwanted parental demands.

conduct problem(s)

Age-inappropriate actions and attitudes that violate family expectations, societal norms, and the personal or property rights of others.

destructive–nondestructive dimension

An independent dimension of antisocial behavior consisting of a continuum ranging from acts such as cruelty to animals or destruction of property at one end to nondestructive behaviors such as arguing or irritability at the other.

disruptive behavior disorders

A general term used to describe repetitive and persistent patterns of antisocial behavior such as oppositional defiant disorder and conduct disorder.

externalizing behavior

A continuous dimension of behavior that includes a mixture of impulsive, overactive, aggressive, and delinquent acts.

hostile attributional bias

The tendency of aggressive children to attribute negative intent to others, especially when the intentions of another child are unclear (e.g., when a child accidentally bumps into them, they are likely to think the other child did it on purpose).

life-course–persistent (LCP) path

A developmental pathway to antisocial behavior in which the child engages in antisocial behavior at an early age and continues to do so into adulthood.

multisystemic therapy (MST)

An approach to treatment that attempts to address the multiple determinants of problematic behavior by involving family members, school personnel, peers, juvenile justice staff, and others in the child’s life, and by drawing on multiple techniques such as parent management training, cognitive problem-solving skills training, and marital therapy, as well as specialized interventions such as special education placements, referral to substance abuse treatment programs, or referral to legal services

oppositional defiant disorder (ODD)

A pattern of angry/irritable mood, argumentative/defiant behavior, or vin-dictiveness lasting at least 6 months and exhibited during interaction with a least one individual who is not a sibling.

overt–covert dimension

An independent dimension consisting of a continuum of antisocial behavior ranging from overt forms such as physical aggression at one end, to covert forms (i.e., hidden or sneaky acts) at the other. The overt forms of antisocial behavior correspond roughly to those on the aggressive subdimension of the externalizing dimension, whereas the covert behaviors correspond roughly to those on the delinquent subdimension of the externalizing dimension.

parent management training (PMT)

A program aimed at teaching parents to cope effectively with their child’s difficult behavior and their own reactions to it.

problem-solving skills training (PSST)

Instruction aimed at targeting the cognitive deficiencies and distortions displayed by children and adolescents who experience conduct problems in interpersonal situations, particularly those children who are aggressive

psychopathic features

A pattern of deceitful, callous, manipulative, and remorseless behavior.

reciprocal influence

The theory that the child’s behavior is both influenced by and itself influences the behavior of other family members.

relational aggression

A form of indirect aggression in which harm is caused through damage to one’s relationships or social status rather than direct physical harm. It may involve the use of verbal insults, gossip, tattling, ostracism, threatening to withdraw one’s friendship, getting even, or third-party retaliation.

social–cognitive abilities

The skills involved in attending to, interpreting, and responding to social cues.

social selection hypothesis

The premise that people tend to select environments in which there are other people similar to themselves.

with limited prosocial emotions

A term used in DSM-5 to describe youths with conduct disorder (CD) who display a persistent and typical pattern of interpersonal and emotional functioning involving at least two of the following three characteristics: lack of remorse or guilt; callous–lack of empathy; and unconcerned about performance.

Diversification

new forms of antisocial behavior develop over time

Negative adult outcomes for those on LCP path

− Males: criminal behavior, work problems, and substance abuse

− Females: depression, suicide, and health problem

List the two pathways for youth with conduct problems

The two pathways are the life-course-persistent (LCP) pathway and the adolescent-limited (AL) pathway.

50% or more of variance in antisocial behaviour is

hereditary

Social–Cognitive Factors of CD

• Immature forms of thinking

• Cognitive deficiencies

• Cognitive distortions

• Deficits in facial expression recognition and eye contact

• Dodge and Pettit comprehensive social-cognitive framework model

− Cognitive and emotional processes are mediator

Steps in thinking and behaviour

1. Encoding

2. Interpretation

3. Response Search

4. Response Decision

5. Enactment

Step 1: Encoding.

Socially aggressive children use fewer cues before making a decision. When defining and resolving an interpersonal situation, they seek less information about the event before acting

Step 2: Interpretation.

Socially aggressive children attribute hostile intentions to ambiguous social events

Step 3: Response Search.

Socially aggressive children generate fewer and more aggressive responses and have less knowledge about social problem solving

Step 4: Response Decision.

Socially aggressive children are more likely to choose aggressive solutions

Step 5: Enactment.

Socially aggressive children use poor verbal communication and strike out physically.

Coercion theory:

parent–child interactions provide a training ground for the development of antisocial behavior

Attachment theory:

quality of children’s attachment to parents will determine their eventual identification with parental values, beliefs, and standards

Amplifier hypothesis:

stress amplifies the maladaptive predispositions of parents and compromises parents’ ability to be supportive of their children

Social disorganization theories

−Adverse contextual factors are associated with

Poor parenting

Coercive and inconsistent discipline

Poor parental monitoring

The main assumptions of preventive interventions

− Conduct problems can be treated more easily and more effectively in younger children

− It is possible to control or limit a developmental trajectory of increased aggression

−Preventive interventions will reduce the substantial costs

Comprehensive multi-pronged approach include

−Webster-Stratton—early intervention/prevention program

−incredible Years Child Training

−Fast Track