Disruptive Behaviour Disorders Flashcards
Oppositional Defiant Disorder:
symptoms –> requires 4+ over at least 6 months; at least one individual is not a sibling , and leads to impairment in academic/social/occupational functioning:
Very BAD RAT(?)
V: vindictive
B;blaming others for mistakes
A; annoying (deliberately to others)
A: argumentative
D: defies rules
R: resntful
A: annoyed easily
T: temper lost often.
outline the difference between mild and severe subtypes of oppositional defiant disorder
Subtypes: mild (symptoms confined to one setting), moderate vs severe specifier (present in three or more settings)
what sex more commonly has ODD
higher in boys in childhood.
Conduct Disorder
Definition: a repetitive and persistent pattern of behaviour in which the __ __ of other and major age appropriate __ norms or __ are violated
Epi: 1-10%; more common in __ (more __ behaviour in boys than in girls)
Symptoms: at least __of the following over the past year and ___ in the past 6mo that causes impairment
(TRAP):
Conduct Disorder
Definition: a repetitive and persistent pattern of behaviour in which the basic rights of other and major age appropriate societal norms or rules are violated
Epi: 1-10%; more common in boys (more aggressive behaviour in boys than in girls)
Symptoms: at least 3 of the following over the past year and 1 in the past 6mo that causes impairment
(TRAP):
T: theft and Deceitfulness
R: rule breaking
A: agression to people and animals
P: property destruction.
Etiology of conduct disorder: multi-factorial
- Parental factors: harsh/___ parenting, __ home environment, parental __
- Psychological: poor emotional __, poor modeling of __ control
- Biological: low levels of 5-___ in CSF is associated with aggression and violence
- Social: child abuse, maltreatment, lower SES
- Parental factors: harsh/punitive parenting, chaotic home environment, parental psychopathology
- Psychological: poor emotional modulation, poor modeling of impulse control
- Biological: low levels of 5-HIAA in CSF is associated with aggression and violence
- Social: child abuse, maltreatment, lower SES
Best replicated biological correlate of antisocial behaviour in children and adolescents:
low resting heart reate due to underarousal of the autonomic system
Brain regions involved in ODD and CD
Brain regions involved in ODD and CD: -violence has been shown through PET to be associated with decreased glucose metabolism in the prefrontal cortex and orbitofrontal damage has been linked to impulsive aggression -neurotransmitters
suggested link between aggression and low levels of serotonin
Neuropsychological features seen in children with ODD and CD:
___ sensitivity to punishment→ reduced ability to ___ in appropriate behaviour and consequences (the result of __ __ conditioning, reduced ___ reactivity to stress, ___ hyperactivity to negative stimuli, and altered serotonin and noradrenaline transmission)
____ to __ (mediated by the ___ NS hyperactivity to incentives, ___ basal heart rate, orbitofrontal cortex hyperactivity to regards nad altered dopamine function)
Lower sensitivity to punishment→ reduced ability to associate in appropriate behaviour and consequences (the result of impaired fear conditioning, reduced cortisol reactivity to stress, amygdala hyperactivity to negative stimuli, and altered serotonin and noradrenaline transmission)
Hyposensitivity to reward (mediated by the sympathetic NS hyperactivity to incentives, low basal heart rate, orbitofrontal cortex hyperactivity to regards nad altered dopamine function)
risk factors to developing a conduct disorder (inidivdual, family risk factors, social risk factors, biological RF)
Individual Risk Factors
below average IQ (especially verbal IQ) -difficult temperament -aggressiveness -impulsivity and hyperactivity -attentional problems -language impairment -reading problems
Key family risk factors for ODD and CD: hardh discipline, maltreatment or neglect, child abuse, lack of parental supervision, excessive parental control
Social Risk factors; -poverty -association with deviant peers/siblings -rejection by peers -history of victimization or of being bullied -disorganized, disadvantaged or high-crime neighbourhoods -dysfunctions or disorganized schools -intense exposure to media violence
Biological Risk Factors
-genetic -low birth weight -antenatal and perinatal complications -brain injury, brain disease -male sex
ODD Comorbidities:
ADHD most common, anxiety disorders, mood disorders, safety concerns (high risk of suicide)
Approximately 30% of children who have an early onset of ODD later progress to develop CD.
- ODD symptoms like __, __, and __ all confer the greatest risk for developing conduct disorder.
- ODD symptoms of anger, irritable mood confer the greatest risk for developing __ disorders
Approximately 30% of children who have an early onset of ODD later progress to develop CD.
- ODD symptoms like defiance, argumentative, and vindictiveness all confer the greatest risk for developing conduct disorder.
- ODD symptoms of anger, irritable mood confer the greatest risk for developing emotional disorders
how does the M:F ratio change for conduct disorder depending on childhood vs adolescent onset type
M>F for childhppd-onset type
M=F for the adolescent-onset type
Conduct disorder comorbidities
CD Comorbidities: ADHD most common, oppositional defiant disorder, depressive disorders, substance use disorder (esp in adolescents)
Prgonosis of CD
Prognosis: remits by adulthood in majority of individuals
-conduct problems that emerge first tend to be less serious (eg. lying, shoplifting), whereas those that emerge last tend to be more severe (eg. rape, theft while confronting a victim)
What features are common in individuals with childhood-onset CD?
What features are common in individuals with childhood-onset CD?
- Male
- Frequently display physical aggression toward others
- Have disturbed peer relationships
- ODD is a common precursor of child-hood onset CD
- Usually have symptoms that meet full criteria for CD prior to puberty
- May also have ADHD or other neurodevelopmental difficultires
*
Questionnaires/scales to diagnose 1. odd and 2. CD
- ODD –> snap scale, connrers
- CD –> Conners
both; clinical diagnosis, outburst monitoring scale, difficulties in emotional regulation scal.e
T/F for disruptive behavioural disorders, antipyschotics and maybe SSRIs (situation dependent) are irst line
false.
Treatment: Psychological Interventions are FIRST LINE
- Individual therapy CBT
- Parent management training** common in childhood presentations
- Multisystemic therapy
- Therapeutic foster care
- Problem solving social skills training
- Anger management programs
No specific meds are approved for conduct disroder, but you can target aggression with ___ ___, ___ ___ and ___ classes of drugs.
For Conduct Disorder: no specific medications approved but you can target aggression with atypical antipsychotics (risperidone, quetiapine, olanzapine, aripiprazole), mood stabilizers, and stimulants
Outcome: decrease affective aggression symptom/behaviours (rage), increase stability of affect, no effect on predatory aggression
Side effects: more common than in adults
Common: dose-dependent extrapyramidal side effects, weight gain, sedation, fatigue
Serious: hyperglycemia, dyslipidemia, tardive dyskinesias, neuroleptic malignant syndromes, seizures
T/F Scared straight have been shown to be ineffective against conduct disorder
true.
*Scare tactic approaches (boot camps, scared straight) have been shown to be ineffective and can actually worsen behaviors.
