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Psychopathology > Disruptive, Impulsive-Control, and Conduct Disorders > Flashcards

Disruptive, Impulsive-Control, and Conduct Disorders Flashcards

1
Q

History

A

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

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2
Q

DSM-IV Disruptive Behavior Disorders

A
  • Oppositional Defiant Disorder
  • Conduct Disorder
  • Disruptive Behavior Disorder, NOS
  • V71.02 Child or Adolescent Antisocial Behavior (isolated act)
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3
Q

DSM-5 Disruptive Behavior Disorders

A
  • 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
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4
Q

Oppositional Defiant Disorder DSM-5 Criteria

A
  • 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)
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5
Q

Conduct Disorder DSM-5 Criteria

A
  • 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)
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6
Q

CD DSM-5 Specifiers

A
  • Childhood onset/Adolescent onset/Unspecified onset
  • Mild/Moderate/Severe
  • With limited prosocial emotions
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7
Q

CD with Limited Prosocial Emotions

A

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
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8
Q

CD Epidemiology

A
  • 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
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9
Q

Factor Analysis: Different Axes of Disruptive Child Behavior

A

Property Violations: covert & destructive
Aggression: overt & destructive (more for boys)
Oppositional: overt & nondestructive
Status Violations: covert & nondestructive (more for girls)

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10
Q

Developmental Course of Disruptive Behavior

A
  • 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
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11
Q

ODD: Risk Factors & Associated Features

A
  • 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
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12
Q

CD: Risk Factors & Associated Features

A
  • 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
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13
Q

ODD/CD: Comorbid Disorders

A
  • ADHD
  • SLD
  • Communication Disorders
  • Anxiety/depression
  • Substance-related disorder
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14
Q

ODD: Differential Diagnosis

A
  • CD
  • ADHD
  • Depressive & bipolar disorder
  • DMDD
  • IED (discrete explosive episodes)
  • ID
  • Language Disorder (may be oppositional if can’t express self)
  • Social anxiety disorder
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15
Q

CD: Differential Diagnosis

A
  • ODD
  • ADHD
  • Depressive & bipolar disorder
  • IED
  • Adjustment disorder
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16
Q

Frick article

A

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
17
Q

Patterson article

A

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
18
Q

Etiology: Biological Factors

A
  • 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
19
Q

Etiology: Child Predispositions

A
  • 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
20
Q

Social Information Processing Model

A

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

21
Q

Etiology: Environmental Risk Factors

A
  • 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
22
Q

Patterson Coercive Family Process Model

A
  • 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
23
Q

Patterson Developmental Progression of Antisocial Behavior

A
  • 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
24
Q

Loeber’s Cumulative Risk Model

A
  • 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)
25
Q

Antisocial Personality Disorder: location in DSM-5

A

Now listed in the disruptive/impulse-control section and the personality disorders section

26
Q

ASPD DSM-5 Criteria

A

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

27
Q

Criticisms of ASPD Diagnostic Criteria

A
  • Age 15 criterion; what about late bloomers?

- Criteria are relatively non-specific & criminal

28
Q

ASPD and Psychopathy

A
  • 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
29
Q

ASPD Prevalence

A
  1. 2-3.3%
    - Higher rates with A/D populations
    - 3x more common in men (social bias?)
30
Q

ASPD Etiology

A
  • 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?
31
Q

Scheepers article

A
  • 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

Psychopathology (16 decks)

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