Conduct Disorder - CP Flashcards
General Info
What is Conduct Disorder?
Like Antisocial Personality Disorder (not identical, but similar). The main difference is that it is diagnosed in childhood or adolescence (age<18)
What are the defining symptoms of CD?
- Aggressive behaviors (physical, verbal etc.)
- Destroying property
- Serious rule violations
- Deceitfulness (lying or stealing)
!!! In general, behavior is often marked by callousness, viciousness, or lack of remorse !!!
(What’s a diagnostic specifier?)
It’s an extension to a diagnosis to help further clarify a disorder
What is the limited prosocial emotions diagnostic specifier?
It’s a specifier for children with callous and unemotional traits. Unemotional traits are:
- Shallow emotions
- Lack of:
~ Remorse
~ Empathy
~ Guilt
Higher levels of callous and unemotional traits results in:
- more problems with peers and family
- more and more severe cognitive deficits
- more antisocial behavior
- poorer response to treatment
What disorders are comorbid with CD?
- Internalizing Disorders
- Substance Use Disorders (Some research says that CD precedes SUD, others say that both CD and SUD occur at the same time and that one makes the other worse)
- Anxiety and Depression
~ 15-45% comorbidity
~ CD usually precedes Anxiety and Depression (Apart from Specific Phobias and SAD: they precede CD)
What is the onset of CD?
Preschool years.
7% of preschool kids have CD symptoms
!!! Important to assess CD early on, given that symptoms start and increase from such a young age !!!
What are the 2 types of CD (Moffit)?
- life-course-persistent pattern of antisocial behavior: conduct problems arise from a young age and continue into adulthood. (Even up until 32 years old people have serious problems)
- Adolescence-limited: CD problems exist only in adolescence
What is an explanation for the Adolescence-limited CD?
It happens due to the maturity gap between an adolescent’s:
- Physical maturation
- Opportunity to assume adult responsibilities and obtain rewards that come about from problematic behaviors
What is a problem with the adolescence-limited CD?
Not limited to adolescence: People with CD continue having problems until mid 20’s.
(Change name to adolescence onset)
What are some gender differences in CD?
Both men and women have same amount of problems and defiant behaviors, men’s behavior is just a bit more violent than women’s
What is the prevalence of CD?
- Life-course-persistent type: 10.5% boys, 7.5% girls
- Adolescence-type: 19.6% boys, 17.4& girls
What is the prognosis of CD?
Difficult to determine.
(Study) Half of the boys with CD didn’t meet criteria later for diagnosis at a later assessment (1-4) years later, despite demonstrating some conduct problems
Related Disorders
What is Intermittent Explosive Disorder?
Verbal/Physical aggressive outbursts that are far out of proportion to the circumstances. Aggression though is IMPUSLIVE, NOT PLANNED (as in CD)
What is Oppositional Defiant Disorder (ODD)?
Disorder characterized by behaviors such as:
- Losing temper
- Arguing with adults and repeatedly refusing to comply with requests from them
- Deliberately doing things to annoy others
- Being angry, spiteful, touchy and vindictive (desire for revenge)
When is ODD diagnosed?
If child doesn’t meet criteria for CD, specifically if the child doesn’t not meet the criteria for extreme physical aggressiveness
What is the prevalence of ODD?
Within ages 13-17, 8.3%
What disorders are comorbid with ODD?
ADHD
What are some gender differences in ODD?
Boys are slightly more likely than girls to have ODD (very small differences though, maybe even non-existent)
What is a general debate on ODD?
Is it different from CD?
Is it a precursor of CD?
Is it a milder manifestation of CD?
Etiology - Genetic Influences
What plays a very big role in CD’s Etiology?
Gene-environment interaction:
- Aggressive behavior is more heritable than rule-breaking behavior, BUT, in wealthy neighborhoods, genetics played a bigger role in rule-breaking behaviors (interaction of SES - genes for behaviors)
- Combination of conduct problems and unemotional traits is more heritable than conduct problems alone, BUT, parenting of adopted child exerted a buffer against this predisposition.
What are some specific genes that play a role in CD?
MAOA and 5HTTLPR (Both play a role in the serotonin system)
Problems with studies on these genes and their relationship with CD:
- FX of genes is too small
- problems in MAOA gene and its expression may only be restricted to men
Etiology - Neurobiological influences
- Deficits in regions that support emotion, especially empathetic responses (children with CD, problems in perceiving distress/happiness, but not anger)
- Reduced activation of brain regions associated with emotion and reward: amygdala, PFC, ventral striatum. (Can’t associate behavior with a reward or punishment because of this problem)
- Deficits in Autonomic Nervous System: Lower heart rates, which results in lower arousal levels. (Adolescents may not fear punishment as much as controls because of this)
Etiology - Psychological Influences
- Children with CD lack moral awareness, and lack remorse for their wrongdoing
- Parents can play a role in the development of callous and unemotional traits
- Social info processing of children: They have a hostility bias
Etiology - Peer influences
- Acceptance/rejection by peers
~ As early as 1st grade can predict later aggression
~ Children more prone to react negatively to situations: more likely to be rejected: more likely to become aggressive - Associating with other deviant peers (due to modelling or persuasion from other peers)
–> Due to genetic influences, children might choose more deviant peers: likelihood for CD increases - Just being in a bad environment (just being around deviant peers) also plays a role whether a child will associate with peers: Increases likelihood for CD
Treatment
What are the 3 main types of treatment for CD?
- Family interventions
- Multisystemic Treatment
- Prevention Programs
Family interventions
2 aspects to it:
- Family Checkup (FCU): 3 meetings to get to know, assess and provide feedback to parents regarding their parenting, practices and children
- Parent Management training (PMT): Parents modify responses so they can reward prosocial and not antisocial behavior
~ Parents are taught techniques such as positive reinforcement and time-out
~ Most efficacious treatment for CD & ODD: decreases antisocial and aggressive behaviors of child
(The earlier the intervention, the better)
Multisystemic treatment
Based on the idea that CD is influenced by many factors
- Therapy services for family, adolescent, peer group, and school sometimes
- Strategies: Behavioral, Cognitive, Family-based, and case management techniques (professional helps client develop a plan that coordinates and integrates the support services that the client needs in order to gain the maximum output from his treatment)(what to use and how for the biggest benefit)
- Emphasizes individual and family strengths and identifies social context for problems.
- Uses present and action oriented interventions, using interventions that require effort by family members
Prevention programs
Fast Track Interventions: help children academically, socially and behaviorally by focusing on areas that are problematic in CD (e.g. aggressive behavior, peer, and family relationships, social info processing and more)
–> Works very well, in part due to reduction of the hostility bias
