Conduct disorder Flashcards
Conduct problems and DSM5: ODD and CD
Symptoms?
Onset/Life course pattern?
Risk factors?
CD/ODD is the biggest predictor of mental health issues in adulthood
Symptoms grouped along 3 dimensions
1. Angry/irritable mood - uniquely associated with mood and anxiety disorders (negative affectivity)
- Often loses temper
- Touchy or easily annoyed
- Often angry or annoyed
- Argumentative/defiant behaviour - Uniquely associated wth ADHD
- Arguing
- Defying/ deliberately annoying
- Blaming - Vindictiveness - goal is to hurt or upset others - Callousness; empathic deficits; instrumental aggression
- Spiteful or vindictive twice within the past 6 months
The earlier symptoms begin the longer the symptoms will persist throughout their lifecourse
The later symtpoms begin, the duration of CD will decrease (offending in the teens is normative)
If symptoms begin before age 10, they will offend well into their 40s and 50s
Risk factors include
1. Executive function deficits, low verbal IQ
2. Impulsivity, emotional regulation deficits
3. Coercive parent-child dynamics
Adolescent-Onset Type: being a little naughty is actually protective/normative
Causal influences on conduct problems?
Paterson’s (1982) coercion theory
- Base on Operant conditioning
- Based on repeated interactions between parent and children
Gives directive -> Non-compliance -> Attacks -> Counterattack (positively reinforced) -> Withdraws (negatively reinforced) -> Suspends attack
This process happens multiple times a day. Parent withdrawals become more and more negatively reinforced and counterattack behaviours become positively reinforced and requires more intense behaviours to coerce
UNTIL
Parent avoids unnecessary interactions due to punishment -> parent engagement is increasingly contingent upon misbehaviour -> child receives low positive reinforcement for appropriate behaviour and high positive reinforcement for misbehaviour
- Both the parent and the child are the victim and the architect
Coercive patterns disrupt prerequisites for self-regulation. In order to learn self-regulation skills you need to do things you don’t want to do (comply with external regulation). Failure to establish normative compliance in early childhood -> coercive behaviour functions as a substitute social skill -> child becomes increasingly harder to socialise and discipline -> Enters school with social skills deficit
Deviancy training - contingencies provided by antisocial peers reinforce each others behaviours
Callous-unemotional traits and heterogeneity among children with conduct problems?
Studies/neural correlates?
Low CU traits - characterise vast majority of children
- Overly reactive to cues
- Emotionally dysregulated
- Hostile attributional biases
High CU traits - smaller portion of children
- Extremely difficult to treat
- More severe and chronic
- Proactive/instrumental aggression
- Reward-dominance
- Under reactive to emotional cues
Research on attention to emotion on faces
Children with Antisocial behaviour = not good at recognising neutral faces
Children with CU traits = substantial deficit in recognition to faces with eyes of fear
Children with Conduct problems and CU traits show less amygdala activation when looking at fearful faces. Hypothesis: do not move their eyes to look at the eye region of the face.
Heritability of conduct problems in 7 year olds: meta-analysis
Low CU traits: small to moderate genetic/environmental influence = .3 (primarily environmentally driven)
High CU traits: low environmental/extremely high genetic influence: minimal environmental influence = .81 (primarily genetically driven)
Conduct disorder facets
- Aggression to people and animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
Addressing/treating ODD/CD
- Must target ecology of the child
- Highly embedded in the ecological systems in which children develop
- Interventions that do not address ecological dynamics are less likely to produce lasting change
Early to middle childhood - Parent training
aka: Parent management training
Late-Childhood/Adolescence - Parent training + youth focused components - Take a develpomental approach
- Optimal time for intervention = early the better
- Can only involve the child in cognitively demanding therapy when they are of age (Older children/adolescence as active participants)
- Behavioural Parent training is one of the best characterised, empirically supported and easily transportable psychological treatments.
Addressing Coercive family Process (PARENTS ARE MAIN FUNDAMENTAL AGENT OF CHANGE)
Positive behaviours: ignored, do not get much reinforcement
Negative behaviours: garner attention and more reinforcement
Post treatment attempts to flip/reverse these patterns - Be Formulation-driven
Address distal factors
- Family adversity (e.g., marital discord, unemployment)
- Parent problems (e.g., depression in the family, attributional biases)
Proximal factors
- Disrupted parenting practices (Coercive interactions; monitoring/supervision)
