Conduct Disorders

Conduct Disorders and Externalizing Disorders

  • Terms used interchangeably in this class: conduct disorders & externalizing disorders.

  • DSM refers to conduct disorders as a class of disorders.

Types of Conduct Disorders

  • There is one specific disorder called conduct disorder but it also represents a broader category.

  • Externalizing behavior is defined as a pattern that leads to conflict with others, characterized by:

    • Disruptiveness

    • Under-control

    • Oppositional behavior

    • Antisocial conduct

    • Delinquency

    • Impulsivity

  • ADHD, while not directly a conduct disorder, increases the risk of conduct issues due to its symptoms, particularly impulsivity and hyperactivity.

Intermittent Explosive Disorder (IED)

  • Characterized by recurring behavioral outbursts due to failure to control impulsive and aggressive behavior.

  • Focus is on behavioral regulation rather than emotion regulation, although anger is common.

  • Key features of IED include:

    • Outbursts not premeditated or goal-directed: No specific intention behind outbursts.

    • Typically rapid and brief, often disproportionate to perceived provocation.

    • Perceived provocation often differs from actual intent; children misinterpret events as provocations.

  • Diagnosis constraints:

    • Not diagnosed under age 6 or when another disorder explains the behavior better.

    • More common diagnosis among younger children than older adolescents.

  • Pathway of disorders:

    • Diagnosis of IED often leads to ODD and subsequently to conduct disorder (CD).

    • No maximum age for diagnosis; adults can also be diagnosed but it's rare.

Oppositional Defiant Disorder (ODD)

  • Characterized by three symptoms:

    • Angry and irritable mood

    • Argumentative and defiant behavior

    • Vindictiveness (not required for diagnosis)

  • Diagnosis of ODD requires evidence of argumentative/defiant behavior.

  • Commonly comorbid with mood disorders like DMDD, but ODD itself is not classified as a mood disorder.

  • Four dimensions of ODD according to research:

    • Oppositionality: Noncompliance, stubbornness, argumentative behavior, negative attitude.

    • Irritability: Chronic anger, frustration, temper tantrums.

    • Aggression: Verbal and physical aggression intended to harm others.

    • Callous unemotional traits: Includes vindictiveness, lack of remorse, low empathy.

Conduct Disorder (CD)

  • Characterized by serious antisocial behaviors impacting others.

  • Four areas defining conduct disorder:

    • Aggression to People and Animals: Use of weapons, bullying, physical fights, confronting victims.

    • Property Destruction: Arson, vandalism.

    • Deceitfulness: Breaking and entering, lying, stealing without confrontation.

    • Serious Rule Violations: Running away from home, skipping school, staying out late before age 13.

  • Diagnosis of CD not common in younger children and requires discernment from ODD.

  • Discussions include potential reevaluation of diagnostic criteria for younger individuals.

  • Gender differences noted in behaviors and diagnosis:

    • Typically diagnosed in boys, who exhibit more overt aggressive behaviors.

    • Girls may exhibit relational aggression, often underdiagnosed due to criteria specificity.

Onset Specifiers for CD

  • Onset before age 10: Childhood onset.

  • Onset after age 10: Adolescent onset.

  • Generally, conduct disorder emerges in middle childhood or adolescence with variability in patterns of behavior.

  • Childhood onset linked to greater stability in conduct issues over time compared to adolescent onset.

  • Children with childhood onset often face academic issues and other developmental struggles.

  • Conduct problems may alleviate with age among some adolescents, whereas childhood onset tends to remain stable.

  • Discussion of trajectories:

    • Childhood-limited trajectory: Temporary issues with conduct problems; often resolves over time.

    • Life course persistent (LCP): Persistent issues starting in childhood, continuing into adulthood.

    • Adolescent onset: Issues arise during adolescence, often less serious and more transient.

Loeber's Three Pathway Model

  • Model describing the progression of conduct problems in children, particularly boys.

  • Pathways include:

    • Authority Conflict Pathway: Before age 12; starts with stubborn behavior, leading to defiance and authority avoidance behaviors.

    • Overt Pathway: Escalation of verbal and physical aggression.

    • Covert Pathway: Involves deceitful behaviors; generally develops later.

  • Important aspects:

    • Progression occurs with retention of previous behaviors; diversification of behaviors can occur.

    • Progress can vary individually; some may drop off at earlier stages.

Contributing Factors to Conduct Problems

  • Child Level Factors:

    • Impulsivity, irritability, temperamental issues, hyperactivity.

  • Family Factors:

    • Poor child rearing practices due to adversity, parental antisocial behavior, low socioeconomic status, neglect, abuse, and marital discord.

  • School Factors:

    • Peer rejection and associated behavior, influence of deviant peers leading to aggression.

  • Neighborhood/Societal Factors:

    • Availability of weapons, poverty, media portrayals of violence.

Race and Conduct Problems

  • Research suggests no significant differences among racial groups regarding conduct problems or aggression.

  • Awareness of biases and misdiagnosis leading to overdiagnosis in specific groups.

  • Perceived discrimination may exacerbate conduct issues.

  • General recommendation for restraint in diagnosing conduct disorders to mitigate stigma.