Disruptive, Impulsive-Control, and Conduct Disorders Flashcards
History
Pre-DSM-III
- “Undersocialized Aggressive Reaction to Childhood”
- “Group Delinquent Reaction to Childhood”
DSM-III - criteria operationalized
- Conduct Disorder: 1 symptom needed, 4 subtypes
- Oppositional Disorder - milder
- Axis II Personality Disorders added - Antisocial PD
DSM-III-R
- CD = 3 symptoms needed, 6 months or more
- ODD: 5/9 symptoms
- APD criticized for ignoring key aspects of psychopathy
DSM-IV Disruptive Behavior Disorders
- Oppositional Defiant Disorder
- Conduct Disorder
- Disruptive Behavior Disorder, NOS
- V71.02 Child or Adolescent Antisocial Behavior (isolated act)
DSM-5 Disruptive Behavior Disorders
- Moved to “Disruptive, Impulse-Control, and Conduct Disorders”
- ODD
- Conduct Disorder
- Other Specified Disruptive, Impulse-Control, and Conduct Disorder
- Unspecified Disruptive, Impulse-Control, and Conduct Disorder
- Section also includes Antisocial Personality disorder, Kleptomania, Pyromania, Intermittent Explosive Disorder
- May also consider Disruptive Mood Dysregulation Disorder
Oppositional Defiant Disorder DSM-5 Criteria
- 6 months, at least 4 symptoms from any of following categories, exhibited during interaction with at least one individual that is not a sibling
- Angry/Irritable Mood (often loses temper, easily annoyed, angry/resentful)
- Argumentative/Defiant Behavior (argues with authority figures/adults, actively defies requests/rules, deliberately annoys others, blames others for own mistakes)
- Vindictiveness (spiteful or vindictive at least twice within last 6 months)
Conduct Disorder DSM-5 Criteria
- Repetitive and persistent pattern of behavior that violates others’ basic rights and/or major societal norms/rules
3+ in past 12 months and 1+ in past 6 months: - Aggression to people and animals (bullies/threatens, fights, used a weapon, physical cruel to people/animals, stolen with confrontation, forced sexual activity)
- Destruction of property (fire setting, destroyed others’ property)
- Deceitfulness or theft (broken into house/car, cons others, stolen without confrontation)
- Serious violation of rules (staying out against parent rules before age 13, run away from home twice overnight, often truant from school before age 13)
CD DSM-5 Specifiers
- Childhood onset/Adolescent onset/Unspecified onset
- Mild/Moderate/Severe
- With limited prosocial emotions
CD with Limited Prosocial Emotions
2+ for 12 months in multiple relationships/settings; multiple information sources necessary for specifier
- Lack of remorse or guilt
- Callous-lack of empathy
- Unconcerned about performance
- Shallow or deficient affect
CD Epidemiology
- ODD: 1-11%
- CD: approx 2-10%
- ODD usually by age 8 and symptoms may increase or turn in CD
- More in males than females until puberty (ODD 1.4:1, then equal)
- Males show more overt behavior; females more covert
Factor Analysis: Different Axes of Disruptive Child Behavior
Property Violations: covert & destructive
Aggression: overt & destructive (more for boys)
Oppositional: overt & nondestructive
Status Violations: covert & nondestructive (more for girls)
Developmental Course of Disruptive Behavior
- Gradual onset ODD in preschool years
- ODD –> CD (25%) –> ASPD (25-40%)
- First onset during adolescence is rare (but then usually remits by adulthood)
- CD + low SES = strong predictor of ASPD
ODD: Risk Factors & Associated Features
- Difficult early temperament
- Harsh, inconsistent, neglectful child-rearing
- Neurobiological markers (lower HR/GSR; abnormal prefrontal cortex or amygdala)
- Low self-esteem
- Mood lability
- Swearing/precocious substance use
CD: Risk Factors & Associated Features
- Difficult, under-controlled temperament
- Low average verbal IQ
- Parental rejection/neglect; abuse, lack of supervision, parent criminality, large family, etc.
- Peer rejection/ delinquent peer group & exposure to violence
- Genetic/physiological risk factors
- Little empathy/callousness
- Misattribution of intentions
- Low self-esteem
- Easily frustrated/ temper
- Early-onset risk-taking behavior
- School and legal pxs
- Suicidal ideation
ODD/CD: Comorbid Disorders
- ADHD
- SLD
- Communication Disorders
- Anxiety/depression
- Substance-related disorder
ODD: Differential Diagnosis
- CD
- ADHD
- Depressive & bipolar disorder
- DMDD
- IED (discrete explosive episodes)
- ID
- Language Disorder (may be oppositional if can’t express self)
- Social anxiety disorder
CD: Differential Diagnosis
- ODD
- ADHD
- Depressive & bipolar disorder
- IED
- Adjustment disorder
Frick article
Different pathways to conduct disorder
- Adolescent onset: may be an exaggeration of normal teenage rebellion; less neuropsych deficits but more rebelliousness; might be better explained by family aspects/environment, less aggression/violence and less likely to show antisocial behavior as adult
- Childhood onset: may show callous-unemotional traits or emotional and behavioral dysregulation
- —Emotional and behavioral dysregulation: impulse control problems; feel bad after conduct problems; often paired with poor parenting; deficits in verbal intelligence; hostile attribution bias; mostly reactive forms of aggression
- —-CU subtype: lack of guilt, lack of concern for others’ feelings, lack of concern about performance, shallow affect; maybe genetic/less strongly related to inconsistent parenting; reward-focused; more severe and aggressive pattern of behavior; deficits in processing of negative emotional stimuli; deficits in reactivity to signs of fear and distress in others
Patterson article
Poor parental discipline –> Conduct problems –> Rejection by normal peers and/or academic failure –> Deviant peer group –> Delinquency
- Variables leading to negative parenting: antisocial parents and grandparents, family demographics, family stressors
- Families of antisocial children are characterized by harsh and inconsistent discipline, little positive parental involvement, and poor supervision
- Control theory: views harsh discipline and lack of supervision as evidence for disrupted parent-child bonding; child lacking in internal control
- Social-interactional perspective: family members directly train the child to perform antisocial behaviors; coercive behaviors directly reinforced by family members
- Successful intervention possible for preadolescents with parent-training interventions
Etiology: Biological Factors
- Genetic: child twins not that different; genetics accounts for 40-50% variance
- Physiological: autonomic/emotional underarousal; decreased skin conductance & HR
- Neurochemical: abnormal levels of NTs
- Neuroanatomical: frontal lobe and amygdala (hypoactive)
- Neuropsychological: deficits in attention, lower IQ, memory and verbal reasoning, increased emotional reactivity
Etiology: Child Predispositions
- Difficult temperament
- Reward Dominant theory: child overly focused on reward while ignoring cues to punishment
- Hostile Attribution Bias: deficits in social information processing/social cognition; interpret neutral stimuli as hostile/negative
- Callous/unemotional traits: associated with instrumental aggression; less sensitive to punishment; concerns with stigma
Social Information Processing Model
Encode cues –> Interpret cues –> Clarify goals –> Response access –> Response decision –> Behavioral enactment –> Peer evaluation –> Restart
- Ex: lunch line & chocolate milk spilled down back; interpret as accident or on purpose; goal could be to clean up and eat lunch or to get revenge; response - might fight the kid & if kid fights back he may get reinforcement by peers and then get in trouble
Etiology: Environmental Risk Factors
- Family structure (single-parent households, marital conflict, large family size, young maternal age)
- Parental psychopathology
- Parenting behaviors (strict, harsh, inconsistent discipline; lack of involvement/supervision)
- Multiple life stressor
- Family insularity
- Peer rejection/deviant peer group
- Neighborhood & SES
Patterson Coercive Family Process Model
- Child noncompliance and aggressive behavior learned through negative reinforcement of coercive parent-child interactions
- Aversive event (parent command) –> Child coercive response (whines/yells) –> Removal of aversive event (parent gives in); child’s coercive behavior reinforced
- Escalation: Aversive event (parent command) –> Child response (whines/yells) –> Aversive Event 2 (parent raises voice) –> Child response 2 (yells louder) –> Aversive Event 3 (parents repeats command) –> Removal of child coercive response (child complies); now parent escalation reinforced
Patterson Developmental Progression of Antisocial Behavior
- Family and contextual factors cause disruption in effective parenting; leads to conduct problems and related problems, leading to ASB/delinquency.
- — Family demographics/Grandparental traits/Family stressors –> Parental traits –> Disrupted family-management practices –> Child antisocial behavior
- — See Patterson article for pathway from poor parenting to delinquency
- Criticized as single pathway model, not addressing more serious delinquency/violence
Loeber’s Cumulative Risk Model
- Multiple risk factors (interchangeable/additive) result in ASB; more risk factors = greater risk of developing antisocial behavior
- Fails to identify specific causal mechanisms, combinations of risk factors, or developmental processes disrupted
- Large list of risk factors: child factors, family factors, school factors, peer factors, and neighborhood factors (see slide)
- 3 pathways: overt pathway, covert pathway, authority conflict pathway (earlier onset)
Antisocial Personality Disorder: location in DSM-5
Now listed in the disruptive/impulse-control section and the personality disorders section
ASPD DSM-5 Criteria
Pervasive pattern of violation of and disregard for rights of others, occurring since age 15. 3+ of following:
- Repeated unlawful behavior
- Deceitfulness (lying, using aliases, conning)
- Impulsivity
- Irritability and aggression (repeated fights/assaults)
- Reckless disregard for safety of self/others
- Consistent irresponsibility (failure to sustain work or honor financial obligations)
- Lack of remorse
At least 18 years old; evidence of conduct disorder with onset before age 15
Criticisms of ASPD Diagnostic Criteria
- Age 15 criterion; what about late bloomers?
- Criteria are relatively non-specific & criminal
ASPD and Psychopathy
- Shift in DSM toward behavioral indicators, and away from psychopathy (and why behaviors occur)
- Most psychopaths meet criteria for ASPD, but most with ASPD are not psychopaths
ASPD Prevalence
- 2-3.3%
- Higher rates with A/D populations
- 3x more common in men (social bias?)
ASPD Etiology
- Genetic/Biological: impulsivity linked to frontal lobe deficits; emotional deficits tied to amygdala
- Learning: attachment problems, dysfunctional families/criminal parents and siblings, physical abuse
- Low SES and accompanying issues
- Lower overall arousal
- CU traits
- Psychopathy?
Scheepers article
- CU traits included in DSM-5
- Concerns with using specifier: difficult to observe some of the traits, stigmatization
- Differentiating CU or not: genetic/biological basis of CU, different cognitive profiles
- Amygdala hyporeactivity has been found in response to fearful faces in antisocial youth with CU traits
- CU traits: environmental factors play a less dominant role; could explain why interventions are less effective
