PBS6: Conduct Disorder

Conduct Disorder (APA, 2013)

• Aggression to people and animals 

• Destruction of properly  

• Deceitfulness or theft  

• Serious violations of rules

Moore et al. (2019)

Literature review of genetic studies. Found that CU traits have 36% heritability. win studies found that the heritability of CU traits differs along a broad range. Molecular genetic studies found that the candidate genes associated with CU traits are also associated with serotonin and oxytocin systems.

Widom et al. (2020)

Prospective cohort design, compared children with experiences of maltreatment compared to to matched controls.

Interviewed to assessed CU traits and extracted DNA through blood saliva. Found that childhood maltreatment predicted higher CU scores, but there were no significant scores for 5-HTTLPR (a serotonin transporter gene associated with aggressive traits).

Levy et al. (2015)

Oxytocin has been linked with prosocial behaviours. Investigated 67 male adolescents using a questionnaire for CU traits and history of antisocial behaviour. Took saliva samples to measure oxytocin levels. Found that children with conduct problems and low levels of oxytocin are at high risk for CU traits - potential biomarker.

Hyde et al. (2016)

It is possible to resolve CU traits through positive parenting, even if biological mothers show antisocial behaviours themselves.

Sonuga-Barke et al. (2016)

Literature review of decision making across neurotypes. Conduct disorders are marked by reckless decisions and an insensitive attitude to consequences. Argues that these is caused by disturbances to reinforcement mechanisms, impacting the evaluation and appraisal stages of decision making.

E.g. may have reduced signals for understanding future punishment and risk, and reduced sensitivity to aversive outcomes - reduces the ability to learn from negative feedback

Wang and Liu (2021)

Longitudinal study that collected data in waves over 6 years, using multiple informants. EF was measured using tasks and standardised tests, social competence measured using classroom observations and mother'/teacher reports.

Found that poor EF in 1st grade predicted higher externalising problems, and a low rate of decline on externalising problems over time. Deficits in EF could mean that children struggle to inhibit inappropriate behaviours.

Miura and Fuchigami (2017)

Prospective cohort study with 221 male adolescents with conduct disorder, in juvenile detention centres for the same time. Compared the scores of participants that reoffended and the participants that didn’t. Found that 34% of participants re-offended

There was no direct differences between the groups in EF, but there were age differences in EF and recidivism. Argue that impaired EF in CD young people should be considered a risk factor for recidivism.

Schoorl et al. (2018)

Compared aspects of EF (e.g. inhibition, working memory, cognitive flexibility), with boys with CD and non-clinical controls, both under typical and stressful conditions. Stressful condition was aroused using a frustrating computer task.

Found that in stressful conditions the CD boys showed impaired WM and sustained attention. Argues that CD may be impacted by an inability to adapt to the environment.

Hughes et al. (2023)

Conducted a longitudinal twin study. Looked at 197 families, that involved video-based ratings of emotional regulation with mothers and fathers during dyadic play. Measured at 14 and 24 months. Measures of EF were gathered at each home visit. Found that executive function predicted emotional regulation, but this was limited to observations with mothers.

Early individual differences in EF could predict later conduct problems in children. Could be because mothers were more likely to take parental leave and have a stronger influence on the child.

Hughes and Devine (2019)

Assessed executive functioning for both the adult and the child in a 13 month longitudinal study. Found that negative parenting and scaffolding were specific predictors of the children’s executive functioning, rather than general child development.

Colonnesi et al. (2019)

Parent mind-mindedness - refers to the parent’s ability to treat their child as an intentional agent. Measured the combined effect of mothers’ and father’s MM in a longitudinal study. Measured the child’s externalising problems at age 4. Observed parent-child free play interactions and used parent reports of child’s externalizing behaviours.

Found that at 30 months, infrequent use of MM comments predicted children’s externalizing problems. Non attuned comments predicted children’s low social competence.

Kellij et al. (2022)

Literature review looking at the encoding and interpretation of social information. Looked at articles from 1998 to 2021. Found support for the preventing hypothesis.

Prevention Hypothesis - Victims pf bullying focus more on negative social cues to prevent further escalation.

Victims seem to have a more negative perception of peers in general and more negative situational attribution. A negative social information processing style could prevent the development of positive social interactions

Newbury-Helps et al. (2017)

Looked at participants with anti-social personality disorder, that had a history of violent behaviour. Took part in a battery of computer mentalizing tests - had to recognise mental states in the context of social interaction. Results were compared to non-offending controls.

Found that the offender groups showed impaired mentalising on all tasks.

Hauschild et al. (2023)

Feasibility study considering whether treatment for conduct disorder is effective. Mentalisation based treatment for adolescents with conduct disorder - therapists rated their experience. RCT - one weekly individual session and a monthly group session, over 6 to 12 months. Initial recruitment quite slow. Found that there was improvements in empathy in participants that took part - and it is feasible to change therapists in this approach even if they have no previous experience.

Fairchild et al. (2014)

Used fMRI data from 20 females with CD, compared to non-clinical controls. Viewed angry, sad and neutral faces. Found that CD participants had reduced activation in the medial orbitofrontal cortex - atypical neural activation, in an rea that places an important role in social cognitive processes.

Unlike males, there were no emotion specific responses, and there was reduced recognition to all classes of facial stimuli.

Crick and Dodge (1996) - Hostile Attribution Bias

Also called theory of nasty minds (Happe and Frith, 1996)

Refers to the tendency to naturally interpret information with a negative lens, which makes a person more likely to react with hostile or angry behaviour.

Supported by Dodge (2015) - found that HAB predicted chronic aggression across 9 countries

Gillespie et al. (2018)

Adolescent boys that had been incarcerated for antisocial behaviour. Found a positive link between affective Theory of Mind and proactive aggression.

Conduct problems may not be associated with a lack of theory of mind. As children acquire ToM they may apply it in different ways - distinguish between knowing and caring about what people think

Healey et al. (2015)

Longitudinal study - measured at 18 months and age 5.

Looked at HAB in mothers and whether this predicted CP in the child.

Maternal hostile attributions were associated with negative parenting behaviour, which influenced child adjustment.

However, even when taking account of parenting influences, there was a direct link between HAB and child aggression

Valcan et al. (2018)

Conducted a meta-analysis to understand the relationship between parental behaviours and EF in children.

Found that cognitive parental behaviours (scaffolding, stimulation, autonomy support)was positively associated with development of EF. Negative parenting (controlling, intrusive, detached) was negatively associated with child EF.

Hughes et al. (2016)

Observed parents and children in the home and took 5 minute long maternal speech samples. Analysed the extent to which they showed MM when talking about their child.

Found that family adversity was moderated by whether the mother was mind-minded. MM predicted variance in children’s disruptive behaviour at age 12/

Papieska et al. (2019)

Determined the effect of teacher led intervention, that promotes children’s social emotional competence. 339 Polish pupils and their teachers. Teachers were trained in the intervention, collected data in pre and post rest. . Peer ratings measured the child’s cooperative behaviour, teacher reported on child’s prosocial behaviour and conduct problems.

Found that children who took part in the intervention improved significantly in social understanding and ha reduced conducting problems.

Pinquart and Kauser (2018)

Meta-analysis looking at parenting styles across cultures. Looked at differences in ethnic groups in western countries, compared with the level of collectivism and individualism in that country.

In all regions, authoritative parenting was associated with positive outcomes, and authoritarian parenting was associated with negative outcomes. Authoritative parenting associated with fewer internalizing and externalizing problems and better academic performance.

Associations on authoritarianism were weaker in individualist cultures - moderator.

Piotrowska et al. (2015)

Meta-analysis. Found that lower SES was associated with more antisocial behaviour. Association stronger when looking at association between SES and CU traits.

Association was stronger when antisocial behaviour was reported by parents or teachers rather than the child - robustness of studies can vary.

Marcoone et al. (2020)

Participants - parents and teachers of children aged 6-15.

Assessed parenting style via parent reports, and child behaviour disregulation via teacher reports.

Authoritarian parenting was associated with greater aggressive behaviour towards peers - and can act as a pathway to externalizing problems in the child

Patterson (1982) - Coercive Cycles of Violence

If children misbehave and act aggressively, parents may respond aggressively. Rather than diffusing the situation, this causes the child to be frightened and their aggression increases.

Siblings can also be agents in these cycles

Smith (2014) - Prevention Trial

• Ethnically diverse sample recruited to observed coercive child-caregiver interactions, and the child’s aggressive behaviour – compared with longitudinal conduct problems 

• Found that coercive interactions didn't cause child non-compliance, they did amplify it  

• Initial levels and slope of child oppositional behaviors predicted later conduct problems  

Rhee et al. (2016) - Developmental Propensity Model

Looks at the etiology of conduct problems in the Colorado Longitudinal Twin Study. Assessed negative emotionality, disregard for others and cognitive ability as predictors of conduct problems across childhood. Conduct problems were amplified by early environmental influences that promote disregard for others.

Found that early predictors were influenced by shared environments rather than by genes. Environmental factors may not directly influence, but can prevent the ability to build up the skills needs to maintain harmonious relationships  

Mills-Koonce et al. (2016)

Family life project longitudinal study. Examined conduct problems and CU traits in relation to early contextual influences. Found that maternal sensitivity mediated the impact of low SES or a highly chaotic environment on the development of CU traits.

Findings did not hold for influence on conduct problems

Leijten et al. (2018)

Review of randomised control trials looking at the Incredible Years Parenting program in Europe. Intervention attempts to strengthen parent-child relationships and bonding, and promote effective limit setting and routines.

Found that parental use of praise improved, and that symptoms of conduct disorder improved. No evidence of harmful effects, but parental mental health did not improve.

Waid et al. (2020)

Conducted a scoping review of research looking at siblings an externalizing behaviours. Found that sibling coercive sibling interactions were consistently associated with conduct problems, but could be moderated by parental involvement and peer influence.

Children with low quality sibling relationships had decreased aggressive behaviours if had positive peer friendships. Child ren that engaged in sibling antisocial behaviour were more likely to engage in peer antisocial behaviour.

Hughes et al. (2023)

Questionnaire conducted in the first 2020 lockdown, involving 2000 families across 6 countries. Found that children with older siblings showed better adjustment.

• Perhaps because children see more mature behaviour modelled than in their peer group  

• Could also be that parents are better at being parents, may be more relaxed and not walking into battles they don't need to walk in – less conflict situations  

• In the pandemic context – older siblings were likely taking in the role of secondary caregiver  

Burt et al. (2016)

Conducted a study of twins that were oversampled to live in impoverished neighbourhoods. Found that sibling level share environmental influences were near zero in the wealthiest neighbourhoods, were most significant in poor neighourhoods. Founds that genetic risk was higher in upper class areas. #

In disadvantaged households, there is likely to be less space, and children are more likely to share bedrooms – spend more time together so more influential  

Tung and Lee (2018)

Looked at conduct problems that were specific to the home, school and were more general. Parents and teachers rated children’s conduct problems  

• General CP associated with harsh parenting and peer rejection 

• School conduct problems associated by peer rejection 

Allen et al. (2019)

Followed adolescents from 13 to 27, found that deviant friendships may prevent individuals from developing positive relationships with peers, as it disrupts the skills needed to be accepted in a normative group – an effect that peaks in adolescence  

Zych et al. (2019)

Conducted a systematic review of meta-analyses, considering protective factors against bullying. Found that the strongest predictor was self-oriented personal competencies. However, positive peer interactions, positive family environment and parental monitoring were also protective.

Suggests multiple levels should be taken into account when designing interventions – school, family, peers etc. 

Miura and Fuchigami (2022)

290 Adolescents with Conduct Disorder who had been to a juvenile justice assessment centre. Participants completed tests of neurocognition and self-report questionnaires. Participants were then followed for 3 years after being discharged.

Found that being a perpetrator of bullying significantly increased recidivism, whereas bully/victims showed less recidivism.

Armitage (2021)

Paper reviews two large WGO studies looking at bullying

• Need to recognize that bullying is a global public health problem, that exists in many different forms  

• These impact both the victim and the perpetrator, with children being perceived as different being at greater risk of victimization 

• 1/3 children globally are victims of bullying – extremely prevalent  

• Existing bullying prevention interventions are rarely evidence based

Dantchev et al (2019)

Part of the ALSPAC prospective longitudinal study. Assessed sibling and peer bullying usual self report measures, when children were aged 12. Internalizing problems were measured using self administered computerised interviews at age 24.

• sibling bullying is very common but often overlooked, more common amongst brothers and when there are more children in the household 

• Could be due to competition for limited resources and achieving social dominance  

• The perpetrators were more likely to have risk factors, but the victims were, like if they were being bullied outside of the home  

Huang et al. (2023) - Healthy Context Paradox

When you bring down the overall bullying, the severity of the bullying occurring to the minority increases. Suggests that interventions need to be iterative to have an overall positive effect.

Lanskey et al. (2016)

Mixed methods prospective longitudinal study. In all participants, fathers played an active roll in their lives prior to sentencing. Found that face to face contact and phone calls correlated with the quality of father-child relationships after released. Conducted interviews with fathers, mothers and children and self reports from children.

Contact with fathers released the anxiety that was felt upon arrest. Helped to maintain levels of normality despite the loss of a caregiver.

Turney et al. (2015)

Used data from an existing longitudinal cohort study looking at the effects of maternal incarceration on 9 year old children. Effects vary depending on the mother’s propensities for experiencing incarceration.

Incarceration has worse effects if it was unexpected. However, there were heterogeneous effects - some suffer substantial harm, others benefit. Perhaps if caregivers are likely to be arrested they are poor caregivers, so their removal can benefit the child.

Luk et al. (2023)

Systematic review of 57 articles. Most children and adolescents exposed to parental incarceration are vulnerable to mental health – anxiety, behavioural issues and school performance. Earlier the exposure – greater risk of marijuana use, STI’s, and multiple partners in adolescence. Buffering of adverse effects – parental wellbeing, positive family relationships and successful co-parenting.

Farmer (2017) - Review

Identifies that there is no formal process for recording the number of children effected by imprisonment. Argues that relationships are fundamental if people are going to change, but there is currently little provision for supporting families, especially around the time of release.

Markson (2016) - Fragile families study

A major longitudinal study of families that experience dimensions of disadvantage. Divided the sample based on whether they had a parent in prison. Found there were higher levels of maternal depression if fathers were imprisoned, and families experienced higher degrees of poverty.

Metcalfe et al. (2023)

Used randomised control data from the Parent Child Study of incarcerated mothers and fathers. Found that witnessing a parents’ arrest predicted greater internalizing behaviours when parents were incarcerated. Six months post release, children under age 8 demonstrated significantly higher internalizing and externalizing behaviours.

Kjellstrand et al. (2020)

Took data from a previous longitudinal study and used logistic regression. Found that when controlling for other risks, parental incarceration is not a significant risk factor for trajectories in the development of internalizing problems. Suggests incarceration may be a risk marker rather than a risk factor.

Other controlled variables included inconsistent and harsh disciplinary practices, maternal depressive symptoms, stressful life events and SES.

Nichols et al. (2016)

Longitudinal survey looking at academic attainment and truancy. Found small but significant risks associated with parental incarceration for all outcomes. Found that family and school connectedness have the potential to compensate for this.

Payler et al. (2024)

Mixed-method study looking at a support service for children of prisoners in Worcestershire. Programme wanted to act as a point of contact for families, help well-being, prevent school exclusions and adult reoffending.

Conducted surveys, document analysis and interviews and activities with the families and children of prisoners.

Supported families in a strengths based approach helped to boost children’s agency and coping mechanisms. Helped children to express their feelings and manage their emotions.

Families often do not self-refer to these services due to fear of stigma and having children taken away.

Morgan et al. (2013)

Interviewed representatives of schools e.g. headteachers, parents and children in one local authority.

Critiques the current support available and suggests that schools can play a role e.g. raising awareness of this group of children through training.

Focus on the individual needs of children, and how schools can enable children to maintain contact with an imprisoned parent. Wanted to challenge the one-size fits all mentality - could prevent children of prisoners having lower school attainment and higher school exclusions

Bronfenbrenner's ecological model of child development (1986)

Looks at the relationships in the immediate family (micro-system), the family’s socio-economic circumstances (meso-system), and the wider influences such as prison policies (exo-system)  

• Also has theoretical links to attachment theory (Bowlby), the disruption of parent-child bonds through separation can cause psychosocial difficulties for children 

Murray and Murray (2010)

Review of research looking at parental incarceration, attachment and psychopathology. Parental incarceration can threaten children’s attachment security because of separation, confusing communication and unstable caregiving arrangements.

Maternal incarceration is of particular risk for insecure attachment and psychopathology.

Besemer et al. (2013)

Considered the extent that convicted parents may have higher risk of future convictions for the child - intergenerational transmission of criminal behaviour.

Prospective longitudinal London based study. Most boys were white British. Measured self reported offending, official convictions. Convicted parent as well as poorer social circumstances such as a father’s poor job record, low family income and poor housing predicted an increased conviction risk while controlling for self-reported offending.

Families Imprisonment Research Study (2018-2019)

• ective longitudinal study, sample with 54 families in England and Wales who experiences the imprisonment of a father  

• Conducted interviews and standardized assessments with fathers, mothers and children  

• Across 3-time periods – during imprisonment, 6 months after release, 7 years after release  

• Children were aged between 4 and 18 at time

Found that contact with the imprisoned parent helped, and that the type of contact was less important than the frequency (interactional model of relationships)

Quality of the parental relationship, material resources, social support, parent’s involvement before prison also allowed families to cope better/

Bandura (1977) - Self efficacy theory

Learning that you have the skills will help you to cope with difficulties, persuading children that they have the capabilities to cope better in adverse experiences.

Interventions for parental imprisonment can involve promoting individual resilience.

Social Care Institute for Excellence (2008)

Argues that prisons need to take into account the needs for communication between families, families should be contacted when prisoners are moved between prisons, children’s needs and situations should be taken into account when developing prison policy 

However, there is often a lack of communication between policy recommendations and practice? Sometimes what is best for the parent is not what is best for the child, so there is no single one size fits all solution.

Van Arr et al. (2017)

Conducted a meta-analysis to investigate the long term impacts of parenting interventions.

Found that some interventions show fade out or sleeper effects. Overall lack of change in effect sizes – improvements were sustained in the long term (up to 3 years after intervention)

Dadds et al. (2019)

Compared the efficacy of online versus face-to-face parenting intervention for reducing child conduct problems. Rural families where children had a diagnosis of conduct disorder travelled to Sydney and received either online (6-10 weeks) or FTF training (1 week).

Study 2 – same but conducted with urban families. In both studies – child behaviour improved, showing large effect sizes in post-treatment and in a 3-month follow up. 

Suggests that online interventions can be equally as effective as FTF – may be particularly relevant in hard-to-reach families that live in rural areas.  

Caporaso et al. (2019)  

• Looked at the role of executive functions in toddlers' abilities to competently solve peer conflict  

• 4 –5-year-old children were administered measures of EF and took part in the Challenging Situations Task, consisting of three physical provocation scenarios 

• EF accounted for age related increases in competent responding  

• Argues that representational abilities associated with working memory may be associated with the development of social competence  

Deters et al. (2020)

• Compared participants with a primary diagnosis of a disruptive behaviour disorder (including CD) against health controls, aged 8-18 

• Cross – cultural study – Netherlands, German, Switzerland and Spain  

• Measured executive functioning, emotion recognition and ADHD traits  

• Found that visual working memory and inhibitory control were impaired in the CD group compared to healthy controls, as well as emotion recognition – emotional recognition could suffer if visual WM is poor  

• Found that deficits were not explained by comorbid ADHD symptoms  

Noordermeer et al. (2016)

• Conducted a meta-analysis and systematic review of neuroimaging studies relating to brain structure and function in CD  

• Looked at brain areas associated with both hot (ER, impulse control, decision making) and cold EF (working memory, cognitive flexibility) 

• Few significant findings for cool EF – align with the traits of CD  

• Found abnormalities in performance on hot EF tasks, and abnormal activity in hot EF related areas e.g. amygdala  

• Perhaps the EF account of CD needs to be more specific, more likely to be hot EF that plays a role  

Anning et al. (2024)

• Children aged 4 to 8 were referred by teachers for moderate to high conduct problems at school, which were assessed using the strengths and difficulties questionnaire 

• Compared to children with ADHD symptoms and a control group with no reported problems  

• Found that CD children had EF difficulties in tasks with positive or negative valence (heightened emotions), which relate to hot EF 

• In comparison – ADHD children had difficulty on tasks that measured generic cognitive control – cold EF  

• Therefore, not enough to say that EF is associated with CD, need to be more specific  

Husby et al. (2025)

Children with conduct disorder are likely to be rejected by their socially competent peers due to their demonstrations of aggressive or antisocial behaviour.  

Fernandez-Garcia et al. (2021)

conducted a systematic review and highlights that hot EF is more closely related to social skills. Argues that deficits in hot EF can lead to poor decision-making in social situations, especially in emotionally charged environments – computer-based lab tasks lack this emotional charge.  

Flouri and Midouhas (2017)

• Sample from the Millenium Cohort Study – analysed trajectories of conduct problems at 3, 5 and 7 years.  

• Measured harsh parenting (physical and verbal discipline) using parent reports (reliability?) 

• Found that SES disadvantaged and adverse life events were associated with more behavioural problems 

• Harsh parental discipline moderated the effect of environmental risk on conduct problems  

• High-risk children experiencing harsh parental discipline had the highest levels of conduct problems   

Feinberg et al. (2013)

• RCT of siblings are special intervention – conducted with older siblings in groups after school 

• Pre and post-test design – home visits, parent questionnaires, child interviews, and teacher ratings of school behaviour  

• Found positive effects for child self-control, but no significant effect on externalising problems  

• However – argue that these findings are based on a short term follow up, and that externalizing behaviours could be reduced over time  

Hartmann et al. (2020)

• Compared children with CP and low CU, children with CP and high CU, and typically developing children  

• Took part in a picture based emotional stroop task, and hostile attribution task  

• Found no significant differences in hostile attribution bias between groups  

• However, boys with CP and high CU had significantly higher hostile attribution bias, and an attention bias to angry stimuli, compared to girls with CP and high CU  

Verhoaf et al. (2019)

• Meta-analysis of the relationship between hostile attribution bias and aggressive behaviour  

• Found a significant positive relationship between the two, but argued that findings should be interpreted with caution because they were highly heterogeneous  

• The relationship was found to be stronger in emotionally engaging situations – could link to findings on Hot EF  

DSM5 (APA, 2013) - Callous Unemotional Traits

• Limited prosocial behaviour e.g. lack of remorse or guilt, lack of empathy  

• Associated with a greater risk of chronic antisocial behaviour  

Hiemstra et al. (2019)

• Measured the efficacy of cognitive bias modification training to reduce hostile interpretations in aggressive goys  

• Found that the training effectively reduced hostile interpretation of facial expressions  

• However, improvements did not generalise to state anger and aggression, or to hostile attribution that was measured in a game context  

• Suggests that benefits are highly restricted