Day 9-10 - Disruptive Behavioural Disorders Flashcards
What are the core features of disruptive behaviour disorders? What diagnoses are possible in DSM-5?
- age-inappropriate actions and attitudes that violate family expectations, societal norms, and personal or property rights of others
- ODD and CD
What 2 dimensions characterize most behaviours seen in ODD/CD?
destructuve-nondestructive and covert-overt
What are the 3 categories of symptoms for ODD? What are the symptoms for each (total 8)?
Angry/Irritable Mood
- often loses temper
- often touchy or easily annoyed
- often angry or resentful
Argumentative/Defiant Behavior
- often argues w adults
- often actively defies requests from adults or rules
- often deliberately annoys others
- often blames others for own mistakes/misbehavior
Vindictiveness
- has been spiteful or vindictive at least twice in last 6mo
For a diagnosis of ODD, __ symptoms need to be present
4 (across any categories)
What are 2 additional requirements (beyond symptoms) for ODD diagnosis?
- often means more than is normative for dev level
- behavior needs to occur w at least one person who is NOT a sibling
What are the 3 specifiers for ODD? How are they determined?
- mild: occurs in only one setting
- moderate: occurs in two settings
- severe: occurs in three or more settings
(T/F) fighting/aggression between siblings is common and usually harmless
FALSE, very common but mounting evidence that sibling aggression is harmful
What are two ways we generally assess ODD?
- interviews and checklists
- observation
Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) is used to assess ____. How does it work?
- assesses ODD in preschoolers
- have them interact in 3 contexts (interactive examiner, busy examiner, parent)
- “press” for disruptive behaviour (compliance, frustration, rule-breaking)
Conduct disorder is defined as a repetitive and persistent pattern of violating ____ and/or ____, including ____, ____, ____, and _____
- violating basic rights of others and/or age-appropriate societal norms or rules
- including aggression to ppl or animals, destruction of property, deceitfulness or theft, serious violations of rules
What are the 7 symptoms for CD falling under the “Aggression to people and animals” category?
- Often bullies, threatens, or intimidates others.
- Often initiates physical fights.
- Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
- Has been physically cruel to people.
- Has been physically cruel to animals.
- Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
- Has forced someone into sexual activity.
What are the 2 symptoms for CD falling under the “destruction of property” category?
- Has deliberately engaged in fire setting, with the intention of causing serious damage.
- Has deliberately destroyed others’ property (other than by fire setting).
What are 3 symptoms for CD falling under the “deceitfulness or theft” category?
- Has broken into someone else’s house, building, or car.
- Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
- Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
What are 3 symptoms for CD falling under the “serious violations of rules” category?
- Often stays out at night despite parental prohibitions, beginning before age 13 years.
- Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period.
- Is often truant from school, beginning before age 13 years
What are the diagnostic requirements for conduct disorder?
- 3 or more behaviours within last 12mo, at least one in last 6mo
What are the 3 types of specifiers for conduct disorder?
- childhood onset (before 10) vs adolescent onset
- mild: few symptoms in excess of requirement, cause mild impairment and harm to others
- moderate: number of conduct problems and impact on others between mild and severe
- severe: many conduct problems or behaviours are causing serious harm
- with limited prosocial emotions (2/4 characteristics persistent over 12mo and multiple settings; lack of remorse, callous/lack of empathy, unconcerned ab performance, shallow affect)
What are CU traits?
- callous and unemotional traits
- trats for with limited prosocial emotions specifier of CD
- lack of remorse/guilt
- callous, lack of empathy
- unconcerned ab performance
- shallow/deficient affect
__-__% of youth w CD have significant CU traits
2-6%
CU traits are associated with…
- earlier onset CD
- more severe and instrumental aggression
- insensitivity to punishment
Can you have CD and ODD?
YES (in DSM-4 CD subsumed ODD but can now be diagnosed w both at same time)
Nearly __% of all children with CD have NOT been diagnosed with ODD
50%
About __% of children with ODD do NOT progress to more severe CD
50%
What is the lifetime prevalence for ODD? For CD?
- ODD: 12%
- CD: 8%
The Ontario child health study found that the 6 month prevalence for ODD is ____ and is ___ for CD
- ODD: 7.5%
- CD: 1.3%
Prevalence of disruptive behavior disorders is strongly correlated with ____ and _____
poverty and exposure to violence
(CD diagnosis should not be applied when the behavior is only a reaction to environment/is adaptive in that bad environment)
What are the 2 theories about the cause for the link between poverty and disruptive behavior disorders?
- social causation: stress of poverty leads to increase in child psychopathology
- social selection: families w genetic predisposition drift down towards poverty
What was the Great Smoky Mountains study, and which theory for the link btw poverty and DBDs did findings support?
- longitudinal study of child psychopathology
- partway through, casino opened and many families got a stipend
- had 4 groups: persistently poor, ex-poor, never poor, and newly poor (excluded bc low numbers)
- kids in ex-poor families reported decrease in disruptive behaviors!!!
- results support social causation theory
What mediator(s) did the Great Smoky MOuntain study identify for the ass btw increase in income and decrease in behavioral symptoms?
- increased parental supervision fully mediated relationship!
Conduct problems are __-__x more common in male kids
2-4x
In early-onset persistent CD, there is a __ male to __ female ratio
10 male : 1 female
In adolescent-limited CD, there is a __ male to __ female ratio
2 male : 1 female (or no difference)
(T/F) girls engage in much more relational aggression than boys
FALSE, slightly more but not meaningful diff
What are the most common comorbidities for ODD/CD
- ADHD (35%+ in ODD; over 50% in CD)
- Depression and anxiety (50% for both ODD/CD)
What are 5 common correlated of ODD/CD?
- cognitive and verbal challenges (not intellectual impairment but specific verbal deficits)
- poor academic functioning
- higher family conflict, lack of family cohesion
- peer problems (often rejected, form friendships w other antisocial peers)
- health risks
Boys with conduct problems are __x more likely to die before age 30
3-4x
How do disruptive behavior disorders present in infants?
- difficult temperament
- fussy/irritable
What are 2 diagnostic challenges for DBDs in preschoolers?
- impossible or improbable symptoms (eg truancy, staying out all night)
- normative misbehavior (preschoolers generally misbehave more than older groups and this is normal)
Normative misbehavior in preschoolers:
- children’s physical aggression increases until ____mo
- __% of girls and __% of boys are reported by parents to hit, kick, and bite occasionally
- __% of preschoolers have temper tantrums
- 27 months
- 40% and 50%
- 75%
What are 5 ways to distinguish typical preschool misbehavior from problematic behavior?
- frequency
- severity
- flexibility (can you shape behavior w conditioning)
- expectability
- pervasiveness (how many settings)
describe the early-onset/lifecourse persistent pathway for DBDs (onset age, gender ratio, persistance)
- at least 1 symptom before 10y
- 10:1 male to female ratio
- 50% persist in antisocial behavior in adulthood
- aggression in childhood, less serious but antisocial behavior in middle childhood, more serious delinquency in adolescence
describe the late-onset/adolescent-limited pathway for DBDs (onset age, gender ratio, persistance)
- onset in adolescence, frequently w social change
- 2:1 or 1:1 male female ratio
- less extreme antisocial behavior, less likely to commit violent offenses
- less likely to persist
What are snares?
- outcomes of antisocial behavior that put ppl on a problematic path
- eg unplanned pregnancy, dropping out of school, drug addiciton
- make it more likely that adolescent-limited pathway will actually be persistent
Adoption and twin studies indicate that __% of variance in antisocial behavior is hereditary
50% or more
What are prenantal/birth related risk factors for DBDs?
- low birth weight
- malnutrition during pregnancy
- led poisoning
- mother use of nicotine, alcohol, weed, or other drugs
What is the genotype x maltreatment interaction in the development of antisocial behavior?
- childhood maltreatment is universal risk factor
- likely that vulnerability to these adversities is conditional and dependent on genetic factors (eg MAOA enzyme)
The relationship between childhood maltreatment and antisocial behavior is (weaker/stronger) for those with low MAOA activity. This is a(n) (mediation/moderation) effect
STRONGER; MODERATION
(T/F) negative parenting behaviors that do not constitute abuse are not associated with DBDs
FALSE
What is coercion theory?
- cycle of increasingly negative interactions btw parent and child
- problematic parent behaviors end up acting as reinforcers for child misbehavior
What are the 5 social information processing steps and what problems can occur at each one in DBDs?
- Encoding (what I pay attention to; little is known)
- Interpretation (aggressive behavior linked to hostile attribution bias)
- Response Search (usually just think of aggression options)
- Response Decision (high self-efficacy for aggression and think it will get them the outcome they want)
- Enactment (little work looking at this)
How do parents and peers reinforce the development of problematic social information processing?
- moms of aggressive boys also show hostile att bias
- parents may reinforce or approve of behaviors
- aggression usually works against peers/children
What are the 3 main treatments for DBD?
- parent management training
- problem solving skills training
- multisystemic treatment
What is the underlying theory of problem solving skills training for DBD?
social-information processing theory
What are the STEPS for problem solving in problem solving skills training
S: say what the problem is (encoding/interpretation)
T: think of solutions (response search)
E: examine each one (response selection)
P: pick one and try it out (response decision/enactment)
S: see if it worked
What 4 cognitive biases does the anger coping program focus on?
- interpretation (hostile attribution bias)
- distorted perceptions of aggressiveness
- faulty emotional identification (misidentify other emotions as anger)
- response search and selection
What are the 3 steps of anger coping program?
- inhibit early angry and aggressive reactions
- cognitively relabel stimuli perceived as threatening
- solve problems by generating alternative coping responses and choosing adaptive alternatives
Why are problem solving skills training (and anger coping) often not enough?
in real world, problematic behaviors may be reinforced
What are the 3 main elements of parent management training?
- operant conditioning
- education
- communication (clearly established consequences and reasoning)
Time outs involve removal of _____. As a rule of thumb, they should last 1 minute for every ___
positive reinforcement (eg toys, electronics)
1 minute for every year of age
(T/F) time outs are not recommended by the american academy of pediatrics
FALSE, one of only discipline strategies recommended
Why are claims that time outs are bad for kids not correct?
- cited data on social exclusion in adults and not clear that time outs are comparable to experiences adults have
- research suggests no association between time outs at age 3 and emotional and behavioral health in grade 5
Is parent management training effective? Which age group does it work best with?
- yes, reduction in problem behaviors
- stronger effects for preschoolers and elementary vs adolescents (might have more significant impairment and might have more other ppl reinforcing wrong behavior)
What is MST and how does it work?
- treatment that acts at multiple levels of ecological system
- involves problem solving skills training, parent management training, AND changes in global reinforcement context
- services in the home and other settings, available 24/7 for 4 months
What did Littel’s 2021 systematic review and meta-analysis of multisystemic therapy for youth 10-17 find?
- mixed evidence for increased efficacy of MST vs other tx
- reduced self-reported delinquency and increases in family functioning but not other important outcomes
- might be better than other methods but we don’t rly know
MST may work primarily by ___
improving family functioning
