Conduct Problems in Children

Question 1

Why was Conduct Disorder historically left out of psychiatry?

Answer 1

Because the children with conduct problems were considered untreatable.

Question 2

What does ‘heterogeneity among children with conduct problems’ mean?

Answer 2

The traits/behaviours among these children are diverse in content.

Question 3

What did the data gained from the Christchurch study find? (Include how many participants there were and what ages.)

Answer 3

The study involved nearly the entire population of Christchurch (98%) and followed them from 0 - 28 years old. It found that nearly ALL psychiatric disorders present later in life had a childhood precursor of either anxiety, ODD or CD.

Question 4

What often happens to naughty children (CD problems) when they grow up? Why is this important?

Answer 4

They often grow up to become anxious and mentally ill in a number of different ways. CD is an important precursor in mental health.

Question 5

How many children display behaviours categorised by Oppositional Defiant Disorder?

Answer 5

5-10%

Question 6

What is feature A. of Oppositional Defiant Disorder? And what are the 8 symptoms that define the feature?

Answer 6

A. A pattern of negativistic, hostile, and defiant behaviour lasting at least 6 months, during which four (or more) of the following are present:

1. Often loses temper.
2. Often argues with adults.
3. Often actively defies/refuses to comply with adults’ requests/rules.
4. Often deliberately annoys people.
5. Often blames others for mistakes/misbehaviour.
6. If often touchy or easily annoyed by others.
7. Is often angry and resentful.
8. If often spiteful or vindictive.

Question 7

The 8 symptoms outlined in Oppositional Defiant Disorder fall along three dimensions, they are?

Answer 7

1. Angry/irritable mood.
2. Argumentative/defiant behaviour.
3. Vindictiveness.

Question 8

‘Angry/irritable mood’ is one of the dimensions described in the definition of ODD, explain what it is and the three features associated with it (3). What future mental disorders is it associated with?

Answer 8

It is emotional dysregulation, and the child will:
- often loose their temper,
- often be touchy or easily annoyed,
- often be angry and resentful.
Associated with Mood and Anxiety Disorders (Negative Affectivity).

Question 9

What defines the ‘argumentative/defiant dimension’ of ODD symptoms? (4)
What future mental disorders is it associated with?

Answer 9

Argues, refuses to comply/cooperate, deliberately annoys others, blames others.
Associated with ADHD.

Question 10

Explain the ‘vindictiveness’ dimension of ODD symptoms.

What future mental disorders it associated with?

Answer 10

Has been spiteful or vindictive at least twice within the past 6 months (getting back at people with revenge).
Associated with Psychopathy (Cold Conduct problems & Unemotional Traits).

Question 11

Patterson’s Coercion Theory is the dominant causal model of conduct problems, give a brief explanation of how it works.

Answer 11

It involves a process of mutual reinforcement during which caregivers inadvertently reinforce children’s difficult behaviours, causing the child to act out more, which in turn elicits negativity from the caregiver, and so on, until the interaction is discontinued when someone ‘wins’.

Question 12

In Patterson’s Coercion Theory, if a child never repeats a behaviour again after being reprimanded what kind of operant conditioning is that? What if they DO continue to repeat the behaviour after being reprimanded?

Answer 12

• Don’t repeat behaviour –> positive punishment.

- Do repeat behaviour –> positive reinforcement.

Question 13

According to Patterson’s Coercion Theory, why does reprimanding a child’s naughty behaviour often reinforce it?

Answer 13

Because parents often only give attention to naughty behaviour, and attention is a primary need of a child. So, they begin to learn that naughty behaviour produces attention from the parent and will continue their naughty behaviour.

Question 14

Patterson’s Coercion Theory infers that something can arise out of mundane/everyday/moment-to-moment interactions - what?

Answer 14

Violence and psychopathology.

Question 15

Often, when parents and children are in conflict, the parent will escalate and the child will comply – what kind of reinforcement is this? And what kind of reinforcement happens when the parent backs off from the child’s escalation and the child ‘wins’ (more common scenario)?

Answer 15

If the child backs down, the parent experiences positive reinforcement. If the child wins they experience negative reinforcement.

Question 16

In Patterson’s Coercion Theory, what is the 3-step escape-avoidant dance?

Answer 16

Attack-counterattack-positive outcome.

Question 17

According to Patterson’s Coercion Theory, negative parent-child interactions play out as an interlocking pattern of reinforcement, what does this train a child to become?

Answer 17

How to be aggressive and anti-social MORE QUICKLY in order to achieve a certain outcome.

Question 18

In Patterson’s Coercion Theory, parents become fatigued after dealing with their naughty child’s behaviour. What did this cause them to do to and how does this maintain the coercive cycle?

Answer 18

Because they are exhausted, the parent will stop attending to the child when they have calmed down. The child still needs/wants attention and because being naughty seems to be the only way to get attention, they will act out again.
The parent needs to pay attention to the child’s GOOD behaviour as well, so as to reinforce it.

Question 19

What does Patterson call every member of a family involved in constant cycles of coercion?

Answer 19

A ‘victim and architect’.

Question 20

What integral developmental emotional ability do patterns of coercion inhibit in the child? (According to Patterson’s Coercion Theory).

Answer 20

Emotional self-regulation.

Question 21

What are the early signs/implications for early development of Oppositional Defiant Disorder? (the pathway)

Answer 21

1. Failure be compliant/cooperative in early childhood.
2. Coercive behaviour becomes a substitute social skill.
3. Child becomes harder to discipline and socialise.
4. Enters school with social deficits.
5. Coercive exchanges start to occur with teachers and peers.

Question 22

When a child enters school with conduct problems, what are some influences from peers?

Answer 22

Children with conduct problems often gang together, and antisocial children might mutually reinforce such behaviour in one another.

Question 23

When a toddler has conduct problems that are not dealt with, what are the potential implications?

Answer 23

Can have a childhood/adolescent problematic behaviour trajectory, whereby the young child has issues, then as a teenager and can get into serious trouble.

Question 24

A child normally starts off having ODD, if it continues on a poor trajectory, what can eventuate?

Answer 24

The development of Conduct Disorder.

Question 25

When does Conduct Disorder normally develop?

Answer 25

Late childhood/teen years. Although more and more young children (i.e. 5 year olds) are developing the disorder.

Question 26

What is criteria A. for Conduct Disorder? And what are the 4 symptoms outlined?

Answer 26

A. A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violates, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one present in the past 6 months:

1. Aggression to people or animals.
2. Destruction of property.
3. Deceitfulness or theft.
4. Serious violations of rules (often staying out at night).

Question 27

There are two age-groups for the onset of Conduct Disorder, why is it important to distinguish the two groups?

Answer 27

1. Childhood-onset type: before age 10.
2. Adolescent-onset type: after 10.
   Adolescent onset is considered more normative (the majority of conduct problems occurring at around the age of 15) and is not normally diagnosed as a psychiatric problem.

Question 28

What are some associated risks of having the childhood-onset type of Conduct Disorder?

Answer 28

• more likely to have ADHD.
• neuro-cognitive risk factors.
• temperamental/personality risk factors (e.g., impulsivity, emotional dysregulation).
• coercive parent-child dynamics.

Question 29

There is one very important specifier in Conduct Disorder, what is it?

Answer 29

‘Limited prosocial emotions’ or callous- unemotional (CU) traits.
They show a lack of remorse, no guilt, no empathy, don’t care about performance.

Question 30

The ‘limited prosocial emotions’ (LPE) specifier is found in children with what type of Conduct Disorder? Compared to the other type?

Answer 30

It is found in Cold Conduct Disorder (high CU traits), compared to Hot Conduct Disorder (low CU traits).

Question 31

According to the LPE specifier, the two different types of Conduct Disorder involve what traits? Which is more common?

Answer 31

Low CU trait (hot CD) MORE COMMON:
- emotionally dysregulated.
- over reactive to emotional cues.
- reactive aggression.
- hostile attributional biases.
High CU traits (cold CD):
- aggression is reactive AND proactive.
- aggression is used instrumentally to get what they want.
- they are manipulative and don't reactive emotionally. 
- don't notice the emotions of others.

Question 32

When shown distressed/frightened faces, how do children with high CU traits react? Why is this disconcerting?

Answer 32

They don’t react, can’t tell or don’t care what the emotion is. Even in a scanner, their brains have low/no reactivity to emotional faces.
This is disconcerting because reaction to distressed faces is a normal, biological, primitive reaction nearly all humans have.

Question 33

What is the difference in heritability of low (hot) vs. high (cold) CU traits in children?

Answer 33

Low CU traits: lower heritability, more drive by environmental factors (parenting).
High CU traits: more heritability, strong genetic influence.

Question 34

Are high and low CU traits categorical?

Answer 34

No, they are dimensional, they lie on the one spectrum that goes full empathy, etc. to complete lack of empathy, etc.

Question 35

When measuring both girls and boys with similar nasty callous traits, what is often found?

Answer 35

The girls, when measured are highly empathetic and sensitive, while the boys that display the same traits are not empathetic at all.

Question 36

Between high CU traits, no CU traits and conduct problems and no conduct problems, what are the four types of trait/behaviour interaction?

Answer 36

• high CU traits –> conduct problems.
• high CU traits –> no conduct problems (the more sinister, manipulative types).
• no CU traits –> conduct problems (this is the majority).
• no CU traits –> no conduct problems (good family life/parenting).