4 - Oppositional and conduct disorder Flashcards
What is diagnostic criteria A for oppositional defiant disorder?
A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling
- Angry/Irritable Mood
1) Often loses temper
2) Is often touchy or easily annoyed
3) Is often angry and resentful
- Argumentative/Defiant Behaviour
4) Often argues with authority figures or, for children and adolescents, with adults.
5) Often actively defies or refuses to comply with requests from authority figures or with rules.
6) Often deliberately annoys others.
7) Often blames others for his or her mistakes or misbehaviour.
- Vindictiveness
8) Has been spiteful or vindictive at least twice within the past 6 months.
What is diagnostic criteria B for oppositional defiant disorder?
B. The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.
- Specify current severity:
→ Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).
→ Moderate: Some symptoms are present in at least two settings.
→ Severe: Some symptoms are present in three or more settings
How is ODD seen?
→ collection of behavioural descriptions; doesn’t say much about the underlying processes that lead to this behaviour
→ can be quite a bit of diversity in those with ODD
→ controversial diagnostic category; depending on the setting, it might just give somebody a label that may or may not be helpful
What is diagnostic criteria A for conduct disorder?
A. A repetitive persistent pattern of behaviour in which the basic rights of other or major age-appropriate societal norms or rules are violated, as manifested by the presence of three or more of the following criteria in the past 6 months:
- Aggression to people and animals
1) Often bullies, threatens or intimidates others
2) Often initiates physical fights
3) Has used a weapon that can cause serious physical harm to others (p.ex: bat, brick, etc.)
4) Has been physically cruel to people
5) Has been physically cruel to animals
6) Has stolen while confronting a victim (p.ex: mugging, purse snatching, extortion ,etc.)
7) Has forced someone into sexual activity
- Destruction of property
8) Has deliberately engaged in fire setting with the intention of causing serious damage
9) Has deliberately destroyed others’ property (other than by firesetting)
- Deceitfulness or theft
10) Has broken into someone else’s house, building or car
11) Often lies to obtain goods or factors or to avoid obligations (i.e., “cons” others)
12) Has stolen items of nontrivial value without confronting a victim (shoplifting but without breaking and entering, forgery)
- Serious violation of rules
13) Often stays out at night despite parental prohibitions, beginning before age 13 years
14) Has run away overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
15) Is often truant from school, beginning before age 13 years
What are diagnostic criteria B and C for conduct disorder?
B. The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning
C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder
How is conduct disorder seen?
→ lots of kids in the court system would meet the diagnosis for conduct disorder
What are the 3 subtypes of conduct disorder?
1) (F91.1) Childhood-onset type: meeting criteria from childhood onwards
2) (F91.2) Adolescent-onset type: criteria weren’t present earlier but are in adolescence
3) (F91.9) Unspecified onset: people
- Specify if:
→ With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings:
→ Lack of remorse or guilt
→ Callous—lack of empathy
→ Unconcerned about performance
→ Shallow or deficient affect
→ afraid of being caught because of the negative consequence, but not actually feeling guilt for what they’ve done – consistent with psychopathy in adults
Behaviour is partially controlled by our emotions, so if the ___ ___ ___ doesn’t go off, it can lead to this type of disorder
Internal alarm system
True or false: With conduct disorder, child onset is more common than adolescent onset.
False: Adolescent onset more common than child onset
→ more serious problem of conducts in adolescence
True or false: Childhood onset of conduct disorders is associated with a more severe course.
True: greater severity if more extreme behaviours present in childhood
How are ODD, CD, psychopathic traits and APD associated?
- ODD -> CD -> psychopathic traits, APD
→ a big group meets the criteria for ODD, a subgroup of that meets the criteria for CD, and a subgroup of that meets the criteria for further disorder in adulthood
What is the ASEBA?
- It’s the Achenbach System of Empirically Based Assessment that evaluates adaptive and maladaptive behaviours
- There are different versions of this questionnaire
- There’s a child self-report, parent’s report and a teacher’s report possible as well
- The questionnaire will start with positive behaviours, which will also be compared to normative groups to see how the behaviour plays out
How many standard deviations is the clinical cutout?
2 SD’s away from T
What is reactive aggression? Give a case study of this
- p.ex: somebody tells him no, gets frustrated and he acts out aggressively
- behaviour is aggressive but in REACTION to a stimulus in the environment
- for the child it can be impulsive
Case study - FSIQ = 70 (2nd percentile)
→ 2 SD’s lower than the average mean - impulsive offending
- highly influence by peers, very vulnerable to them
- conduct a robbery with a weapon and got in trouble for it
→ but largely because he was at the wrong place in the wrong time, surrounded by peers giving him bad advice and had a hard time knowing what to do in this context
What is instrumental aggression? Give a case study of this
- use aggression as a tool, in a much more strategic way
- acting in a way to scare people and get what you want
- when used in a conscious way
Case study - FSIQ = 130 (98th percentile)
→ 2 SD’s higher than the average mean - instrumental offending
- highly planful
- conduct disorder, sells drugs at his school and has students work for him
- asserts dominance by threatening people, but very strategic and planful
What are gender differences in these disorders?
- Conduct problems are way more commonly observed in boys than girls (and this is seen through into adulthood)
- Not to say that girls aren’t aggressive, but the categories that we currently use may not capture the aggression more often seen in girls and women
What is relational aggression?
→ Ignoring
→ Sharing personal information (weaponizing it)
→ Teasing and put-downs
→ Rumors and gossip
→ Exclusion
→ Cyberbullying
According to the NICE guidelines, what are the clinical practice guidelines for ODD and CD in 3 to 11-year-olds?
- Individual or group parent training (PMT); also evidence for working with children directly to build relevant skills
→ p.ex: when kids get angry, adults try to talk to them too much, but the kid is already too far gone to have a rational discussion – we thus focus on training the kids to recognize that they’ve gotten angry, and tell them to do some activity that might calm them down that they like to do
→ the intensity of the emotion goes down, and they’re then able to approach a discussion in a productive way
→ the parent would then reward them for engaging in the distraction behaviour
→ we have to understand what’s causing and reinforcing these behaviours
According to the NICE guidelines, what are the clinical practice guidelines for ODD and CD in 11 to 17-year-olds?
- Multisystemic therapy
→ parents and teachers have less control over these kids lives
→ so these interventions involve a lot more elements from the environment
→ focus on changing context
→ there are multiple multisystemic interventions
What is the rationale of a multisystemic or multimodal intervention?
- Multimodal interventions have been shown to be effective in helping older children and young people with a conduct disorder to manage their behaviour in different social settings
- Parental participation is an important part here because the focus is on changing the environment around the young person (which will help change behaviour)
What are the NICE guidelines on pharmacological interventions for ODD and CD?
- Do not offer pharm interventions for the routine management of behavioural problems in children and young people with ODD and CD
- Offer methylphenidate or atomexetine, within their licensed indications, for the management of ADHD in children and young people with ODD and CD
- Consider risperidone for the short-term management of severely aggressive behaviour in young people with a conduct disorder who have problems with explosive anger and severe emotional dysregulation and who have not responded to psychosocial interventions
What are 3 things recommended for parents to do to help with management?
1) One-on-one time
2) Praise
3) Active ignoring
In help for parents, what do we tell them to do during one-on-one time?
1) After watching child play, describe out loud what the child is doing (narrate the child’s play like a sportscaster)
- Make tone of voice exciting and action-oriented, not dull or flat
2) Provide the child with positive statements of praise, approval and positive feedback about what you like about their play
- Be accurate and honest
3) Be as immediate as possible with approval when you see smt good
4) If the child misbehaves, turn away and look elsewhere for a few moments
- If the misbehaviour continues, tell them calmly that one-on-one time is over and leave the room; and tell them that one-on-one can continue later if they behave nicely
In help for parents, what do we tell them NOT to do during one-on-one time?
- Don’t ask questions
- Don’t give instructions
- Don’t criticize
