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Child Health > Conduct Disorder > Flashcards

Conduct Disorder Flashcards

1
Q

What is Conduct Disorder?

A

Conduct disorder is a diagnostic term used to describe children and young people who present with persistent, repetitive , aggressive and antisocial behaviours.
All current diagnostic criteria is antisocial behaviours which means that they can be objectively measured but does not give a true reflection of the difficulties a young person could be experiencing

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2
Q

What is the “Diagnostic Criteria ICD10” of Conduct Disorder?

22

A

Has unusually frequent or severe temper tantrums for his or her developmental age

Often argues with adults

Often actively refuses adult’s requests or defies rules

Often, deliberately does things to annoy other people

Often blames others for his or her own mistakes and misbehaviours

Is often touchy or easily annoyed by others

Is often angry or resentful

Is often spiteful or vindictive

Often lies or breaks promises to obtain favours or avoid obligations

Frequently initiates physical fights (not siblings)

Has used a weapon that can cause serious harm

Often stays out after dark (without permission)

Exhibits physical cruelty to other people

Exhibits physical cruelty to animals

Deliberately destroys property of other people

Fire settings

Steals objects without confrontation

Frequently truanting before age 13 years

Commits a crime involving confrontation

Forces another person into sexual activity

Frequently bullies others

Breaks into someone else’s car or house

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3
Q

Under what age is a conduct disorder classified as “early onset”?

A

Under 10 years

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4
Q

What is ODD?

A

Oppositional defiant disorder (ODD) is a childhood disorder that is defined by a pattern of hostile, disobedient, and defiant behaviors directed at adults or other authority figures.
ODD is also characterized by children displaying angry and irritable moods, as well as argumentative and vindictive behaviors.

Some people consider ODD a precursor to CD with reportedly 60% of children the CD meeting diagnostic criteria for ODD; persistent fighting is thought to be a marker of progression of ODD to CD but should be considered separate diagnostic entities.

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5
Q

Is CD more prevalent in males or females?

A

Males

Males = 9.9%
Females = 3.5%

Prevalence in UK = 6.6%

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6
Q

According to Moffit, what are the two types of Conduct Disorder?

A

Lifecourse persistent offenders

Adolescent limited offenders

Life course persistent offenders -start early and continue their behaviour.
Adolescent limited group who become influenced by social issues and peers. Their behaviours stops when they get more adult roles.

Moffitt suggests that there is something fundamentally different about the life course persistent group in terms of affect, and cognition.

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7
Q

According to the more recent stuy describing 4 types of CD, which has the worst outcomes?

A

Childhood Onset (i.e. Life Course Persistent Offenders

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8
Q

What is the observed heretability estimate for early onset antisocial behaviour?
(Asreneault et al, 2003 study)

A

82%

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9
Q

What structural brain differences have been reported in people with conduct disorder? (2+)

A

Overall brain volume reduction

Significantly reduced grey matter in anterior insula bilaterally

Other areas significantly reduced:
Left inferior frontal gyrus 
Middle frontal gyrus 
Left amygadal
Right parahippocampus
Fusiform gyrus
Cingualte gyrus
Right caudate
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10
Q

What difference in brain functioning have been reported in people with CD? (2)

A

Increased response in left side amygdala to negative pictures.

CInualate and temporal- parietal under-activation

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11
Q

What pre-natal aetiological factors have been linked to developing CD? (2)

A

Maternal Smoking (most strongly linked)

Maternal alcohol (not a strong associated factor) (more in first trimester than others)

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12
Q

Which peri-natal aetiological factor has been linked to developing ADHD?

A

Low birth weight

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13
Q

What type of prognosis is there for children with early-onset CD according to Fergusson et al 2005?

A

More likely to be involved in crime

Associated with nicotine and drugs (not alcohol)

Lower educational attainment

More likely to be dependant on welfare

More inter-partner violence

More teenage pregnancies

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14
Q

What type of prognosis is there for children with CD according to Von Strumm et al, 2011 (Scotland)?

A

Increased risk of poorer general health

Lower feelings of well being

Increased risk of becoming obese

Having more hangovers

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15
Q

What are callous and unemotional traits?

A

Lack of remorse or guilt

Callousness/ lack of empathy

Lack of concern about performance

Shallow or deficit affect

(Callous and unemotional traits beginning to be used as specifier for Conduct Disorder) - 10-50% would meet this specifier (meet 2 of the criteria listed)

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16
Q

What is the prevalence of CU Traits (callous and unemotional traits) in the UK?

A

0.6%

17
Q

What is the treatment for Conduct Disorder?

3

A

Collaborative Problem Solving (CPS)

Multi-systemic Therapy (MST)

Psychopharmacology

18
Q

According to Ross greene, what are the features of CD that can be targeted with CPS?

A

Based on a fit between child and environment (child-environment compatibility)

When there is child-environment compatibility –> good outcomes are expected.
When there is not good fit –> more disadvantages outcomes are possible

Ross Greene suggests that the child with difficult behaviours is lacking in the development of some general skills:

Being able to tolerate frustration

Being able to tolerate flexibility/adaptation

Difficulties with problem solving

19
Q

What does CPS stand for?

A

Collaborative Problem Solving

20
Q

Which specfic areas does Ross Greene theorise could be underdeveloped in some children with CD, that can be targetted with CPS?

A

Executive Functioning

Language Communication skills

Emotional Regulation skills

Cognitive Flexibility Skills

(CPS therapy is very much about the lagging skills and the parents helping the child to learn these skills, and NOT about the behaviour itself)

21
Q 
According to Ross Greene's theory about CD and CPS, "when the demands of th environement exceed a child's capacity to respond adaptively then behaviours occur", these can be Mild, Moderate or Severe.
What are (3) examples of "Mild" behaviours in this case?
A

Whining

Sulking

Pouting

22
Q 
Accordin to Ross Greene's theory about CD and CPS, "when the demands of th environement exceed a child's capacity to respond adaptively then behaviours occur", these can be Mild, Moderate or Severe.
What are (4) examples of "Moderate" behaviours in this case?
A

Screaming

Swearing

Hitting

Property Destruction

23
Q

Accordin to Ross Greene’s theory about CD and CPS, “when the demands of th environement exceed a child’s capacity to respond adaptively then behaviours occur”, these can be Mild, Moderate or Severe.
What does “Severe” behaviour mean in this case?

A

Behaviour resulting in injury of self or others

24
Q

CPS has 3 plans that is describes to parents. What are these 3 plans?

A

Plan A - “You will do it”

Plan B -
Empathy Step
Defining Step
Invitation Step
Mutually Satisfactory Paln

Plan C - Removing the expectation

(Plan B is the one that CPS asks parents to move towards)

Plan B has 3 main steps:
Empathy Step
Define the Problem
Invitation Step (mutally agreeable plan between child and parent)

25
Q

What does MST stand for?

A

Multi-systemic therapy

26
Q

What is multi-systemic therapy (MST)?

A

Family and Community based treatment for serious conduct problems at imminent risk of ‘out of home’ placements.

Care-givers and the key to achieving and sustaining positive long term outcomes..

27
Q

What is the usual treatment duration of MST?

A

3-5 months

over 60 hours (or more), therapy would be delivered over that time

28
Q

Who should be present at MST, according the the model?

A

2 experiences therapists. (Probably more CBT, systemic therapist would be preferable)

(24/7 availability)

29
Q

According to the nine treatment principles of MST, what is the primary purpose of assessment?

A

To understand the “fit” between the identified problems and their broader systemic context. (1.)

30
Q

According to the nine treatment principles of MST, what should therapeutic contacts emphasise as levers for change?

A

Therapeutic contacts should emphasise the positive and use systemic strenghts as levers for change (2.)

31
Q

According to the nine treatment principles of MST, how should interventions be designed?

A

Interventions should be designed to promote responsible behaviour and decrease irresponsible behaviour in family members (3.)

32
Q

According to the nine treatment principles of MST, what should the interventions be like and what type of probelms should they target?

A

Interventions should be present focused and action orientated, targeting well defined problems (4.)

Interventions should target sequences of behaviour within and between multiple systems (5.)

33
Q

According to the nine treatment principles of MST, how should interventions take development into account?

A

Interventions should be developmentally appropriate and fit the developmental needs of the young person (6.)

34
Q

According to the nine treatment principles of MST, how frequently should interventions be designed to be implemented?

A

Interventions should be designed to require daily or weekly effort by family members (7.)

35
Q

According to the nine treatment principles of MST, how should intervention efficacy be evaluated?

A

Intervention efficacy should be evaluated continuously and from multiple perspectives (8.)

36
Q

According to the nine treatment principles of MST, what should interventions be designed to promote?

A

Interventions should be designed to promote treatment generalisability and long term maintenance of therapeutic gain

37
Q

Which types of psychopharmacology is used in CD?

A

Mood Stabilisers:
Lithium - evidence in under 12 years
Carbamazepine (No evidence)
Sodium Valporate (Some promising but no conclusive evidence)

Antidepressants:
SSRI’s including Trazadone: (Efficacy not proved)
SNRI: Atomoxetine (No evidence)

Anxiolytic: No evidence

Stimulants: If comorbid ADHD

Typical Antipsychotics: (short-term use possible)

Atypical anti-psychotics:
Risperidone: (Evidence in Learning Disorders)
Olanzapine: (poor evidence and side effects)
Quetiapine: (limited evidence at present)

Child Health (17 decks)

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