Conduct Disorders (Exam 2)

conduct problems

general group of disruptive/antisocial behavior problems

conduct disorder/disruptive behavior disorder

refer to particular diagnostic grouping that addresses conduct problems

delinquency

describe youth who exhibit conduct problem/antisocial behavior

intermittent explosive disorder

Recurring and frequent behavioral outbursts, represent individual’s failure to control impulsive aggressive behavior. Diagnosed in children over 6.

Antisocial Personality Disorder (APD)

Individuals who display a persistent pattern of aggressive and antisocial behavior after the age of 18. Pattern must be present since age of 15 and individual met criteria for Conduct Disorder before 15.

Oppositional Defiant Disorder (ODD)

Described by a pattern of symptoms grouped into 3 clusters: angry/ irritable mood, argumentative/defiant behavior, and vindictiveness. Symptoms must be present for a period of 6 months. Behaviors must cause distress for youth or others.

Frequency of symptoms required for ODD diagnosis

children younger than 5 years: symptoms must occur on most days

youth 5 or older: symptoms must occur at least once a week

Conduct Disorder

Repetitive and persistent pattern of behavior that violates both the basic rights of others and major age-appropriate societal norms. 4 categories: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules. Three or more of these behaviors must be present during the past 12 months, and at least one in the past 6 months. More likely to be diagnosed in boys (3:1)

Subtypes of Conduct Disorder

childhood-onset (before 10), adolescent-onset (after 10), unspecified onset

limited prosocial emotions

seen in Conduct Disorder, lack of guilt, lack of empathy, lack of concern, shallow feelings. also describes as “callous-unemotional traits.”

externalizing

empirically derived syndrome involving aggressive, oppositional, destructive, and antisocial behaviors.

aggressive behavior syndrome

argues, destroys, disobedient, fights

rule-breaking behavior syndrome

breaks rules, lies, steals, is truant

relational aggression

girls’ attempts to harm others may focus on behaviors intended to damage another individual’s feelings or friendships

Conduct Problems Epidemiology

ODD: 1-15%, avg 3.3%

CD: 2-10%, avg 4%

Co-occurrence

most youths who are diagnosed with CD meet the criteria for ODD

most youth with ODD do not progress to a CD

ODD and CD considerable co-occurrence with ADHD

childhood-onset developmental pattern

Life-course persistent antisocial behavior, less common than adolescent-onset pattern. More likely to exhibit other problems such as ADHD

adolescent-onset developmental pattern

Most common path, show little oppositional behavior during childhood. Antisocial behaviors are less likely to persist

early childhood

problem behaviors: noncompliance, oppositional, temper tantrums

related disorders: oppositional defiant disorders

middle childhood

problems behaviors: overt/covert, antisocial behavior, relational aggression

related disorders: oppositional defiant disorder, conduct disorder

adolescence

problems behaviors: delinquency, substance use, high-risk sexual behavior

related disorders: conduct disorder

Loeber’s Three-Pathway Model

1. overt pathway starting with minor aggression, followed by physical fighting, followed by violence;

2. covert pathway starting with minor covert behaviors, followed by property damage, and then moderate to serious delinquency; and

3. an authority conflict pathway prior to age 12, consisting of a sequence of stubborn behavior, defiance, and authority avoidance

developmental pathways of conduct problems

socioeconomic, aggression as learned behavior, family influences, peer relations, cognitive-emotional influences, biological influences, substance use

substance use disorder

pattern of behavioral, cognitive, and physiological symptoms that indicate that the individual continues to use the substance despite appreciable substance-related problems

substance-induced disorders

conditions of intoxication, withdrawal, and other mental disorders that are due to the recent use of a particular substance

assessment

interviews, behavior rating scales (Achenbach, Self-Report), behavioral observations

Intervention

Family-based interventions: parent management training

Cognitive problem-solving skills: Coping Power and Anger Coping Program

Combined Treatment: PMT and PSST

Community-Based Programs: Teaching Family Model

Multisystemic Therapy: family and community-based approach

pharmacological intervention

mood stabilizers, antipsychotics, little support for effectiveness

Prevention

improvement of parenting skills and family interactions, same programs as treatment