Conduct Disorder

Question 1

What are the main symptoms of conduct disorder?

Answer 1

 Often initiate violent or aggressive behaviour

 Have little respect for property

 Are lying and deceitful

 Display little empathy with the feelings and intentions of others

 Regularly display risk taking, frustration, irritability, impulsivity and temper tantrums

 Associated with early onset sexual behaviour, drinking, smoking, substance abuse and risk-taking behaviour

Question 2

What are the Sub-Types of Conduct Disorder

Answer 2

 Childhood-onset conduct disorder (prior to 10-years-of-age)

 Adolescent-onset conduct disorder (after 10-years-of-age)

 Oppositional Defiant Disorder (ODD)

Question 3

What is Oppositional Defiant Disorder?

Answer 3

Oppositional defiant disorder (ODD): A mild form of disruptive behaviour disorders reserved for children who do not meet the full criteria for conduct disorder.

Question 4

What are the Changes in the DSM 5 for ODD?

Answer 4

Conduct disorder: New descriptive specifier added for individuals with callous unemotional personal style

Oppositional defiance disorder:

• Symptoms grouped into 3 types
• Removal of exclusion criteria for CD
• Frequency and severity guidance added

Question 5

The Prevalence & Course of Conduct Disorder

Answer 5

 Prevalence rates range from 4-16% in boys and 1.2-9% in girls (Loeber et al., 2000)

 Comorbidity is the rule rather than the exception

 Childhood conduct disorder predicts adult antisocial personality disorder, but only in lower socioeconomic-status families (Lahey et al., 2005)

Question 6

Genetic Factors to CD and ODD

Answer 6

 Twin studies suggest that both conduct disorder and aggressive and violent behaviour has a significant genetic component

 Adoption studies also suggest substantial inherited rather than environmental causes (Simonoff, 2001)

 Recent studies have identified the genes MAOA and GABRA2 with conduct disorder (Caspi et al., Dick et al., 2006)

Question 7

Neurological Deficits of CD

Answer 7

 Conduct Disorder is associated with deficits in executive functioning, verbal IQ and memory (Lynam & Henry, 2001)

 However, executive functioning deficits may only be found in individuals where conduct disorder is comorbid with ADHD (Oosterlaan et al., 2005)

Question 8

Prenatal Factors to CD

Answer 8

 Prenatal factors include maternal smoking and drinking during pregnancy, and prenatal and postnatal malnutrition

 Delinquent behaviour is more common in children prenatally exposed to alcohol (Schonfeld et al., 2005)

 Confounding influence of other risk factors such as low socioeconomic status and genetic factors

Question 9

Psychological Factors to CD

Answer 9

 Family Environment & Parent-Child Relationships

 Media & Peer Influences

 Cognitive Factors

 Socioeconomic Factors

Question 10

Family Environment & Parent-Child Relationships

Answer 10

 Risk factors for ODD include parental unemployment, having a parent with antisocial personality disorder, and childhood abuse and neglect (Lahey et al., 1995)

 Inconsistent and harsh parenting is associated with conduct disorder

 Childhood abuse is generally associated with increased aggression, violence and criminal behaviour in adulthood (Fergusson et al., 1996)

Question 11

Cognitive Factors to CD

Answer 11

 Cognitive distortions: highly biased ways of interpreting the world

 Hypervigilance for hostile cues (Dodge, 1993)

 Hostile attributional bias (Nasby et al., 1979)

Question 12

Socioeconomic Factors to CD

Answer 12

 Delinquent, violent behaviour is highly associated with poverty, low socioeconomic status, unemployment, urban living and poor education

 A natural experiment by Costello et al. (2003) indicated that poverty may have a causal effect on symptoms of conduct disorder

Question 13

Treatment of Conduct Disorders

Answer 13

(1) Individual Approaches (e.g., skills training )
(2) Parent management training / family therapy
(3) Multi-systemic therapy (MST)

Question 14

Individual Approaches

Answer 14

 Cognitive problem solving techniques /social skills training to address the cognitive processes used in everyday social situations

 Model and reward pro-social behaviour

 Role play, homework, music, video vignettes,, child-size puppets, practical activities, letters and phone calls to parents and teachers.

Question 15

Parental Management Training

Answer 15

 Encourage ‘positive parenting approaches’ with the therapist key in demonstrating helpful techniques

Question 16

Multi-Systemic Therapy

Answer 16

 Addresses the multi-dimensional nature of behavioural problems (Bronfenbrenner, 1979)

 Therapist acts as advocate and a specific treatment package is built

Question 17

Evaluation of Treatments

Answer 17

 Importance of early intervention (and perhaps prevention?)

 Need for long term treatment and follow up ‘booster’ sessions

 Difficulties due to confounding factors and co-morbidity