Externalising Disorders - ODD and Conduct

Question 1

Children of conduct disorders and ODD are at high risk of both ________ and __________ disorders as adults

Answer 1

internalising, externalising

Question 2

Oppositional Defiant Disorder criterion A (part a): a pattern of…. (part a)

Answer 2

negative, hostile and defiant behaviour lasting at least 6 months

Question 3

Oppositional Defiant Disorder criterion A (part b): during which 4 or more of the following are present

Answer 3

Angry/Irritable mood

• loses temper
• touchy, or easily annoyed
• angry/resentful

Argumentative/Defiant

• argues with authority
• acts defiantly / refuses to comply with adults requests
• deliberately annoys people

Spitefullness
- spiteful/vindictive

Question 4

ODD and Conduct Disorder symptoms can be classified under 3 dimensions, these are?

Answer 4

1. Negative affectivity - grumpy, irritable and hostile mood.
2. Argumentative/defiant
3. Vindictiveness

Question 5

Negative affectivity dimension is mostly associated with…

Answer 5

mood and anxiety disorders; reactive aggression.

Question 6

What is the difference between reactive and instrumental aggression?

Answer 6

Reactive aggression involves thinking the world is against them (they stole my book)
Instrumental aggression is deliberately targeting others to get what they want - proactive aggression

Question 7

The augmentative/defiant dimension is mostly associated with…

Answer 7

ADHD

Question 8

The vindictiveness dimension is uniquely associated with…

Answer 8

Callousness (insensitive and cruel disregard for others), empathic deficits and proactive/instrumental aggression.

Question 9

Patterson’s Coercion Theory is a ______ model of how conduct problems and ODD _______. It states that the mechanisms by which we develop this ___________ is embedded in the _____-__-________ interactions between parents and children. This theory is embedded in _______ conditioning theory

Answer 9

causal, develops, psychopathology, moment-to-moment, operant

Question 10

Explain the reinforcement schedules evident in Patterson’s Coercive Theory. What are the immediate implications of it?

Answer 10

The child is positively reinforced - their attack eventually gets the other person to back down so they get what they want - they are rewarded for that behaviour as they get out of, for example, cleaning their room. Some children also benefit from the emotional intensity they receive from their parents.

The parent is negatively reinforced - they get a negative thing removed when they back down (the child calming down)

So one person is positively reinforced and the other is negatively reinforced SIMULTANEOUSLY. So this pattern is likely to continue.

Question 11

Eventually, these coercive cycles will continue over time, reaching higher levels more ______, and reaching higher and higher levels of _________.

Answer 11

rapidly, amplitude

Question 12

Unfortunately, the majority of the interactions between parents and child will consist of _____ ______, thereby reducing the amount of reinforcement of ________ behaviour. As soon as the child does something pro-social, the parent ______ or even _____ the child instead of _______ this good behaviour. This is known as a _______ ________ pattern - most of the attention is given to these coercive interchanges.

Answer 12

coercive cycles, positive, relaxes, ignores, rewarding, differential attention

Question 13

What are the wider consequences of these coercive cycles, at school, with peers, for learning, etc?

Answer 13

• The child will become increasingly more difficult to discipline and socialise
• Without proper external regulatory systems, and compliance to these systems, the child does not learn to self-regulate
• With only these coercive system to rely on, coercive behaviours become their only social skill - limited social skills - generalises to teachers and peers
• At school, they interact with peers similar to them, and reinforce each others behaviour - “gangs”
• rejected status in society

Question 14

Explain the externalising trajectory of ODD and CD.

Answer 14

These behavioural issues with children often start in the home, and generalise to the school by middle-childhood. The ODD can amplify into CD by adolescence which can lead to drug-use/criminality.

Question 15

In the externalising trajectory, early childhood is associated with family coercion, _______, and conflict with _______. In middle childhood, often poor ______ is seen, and at school they experience ______ and form ________. Finally, by adolescence, there is often poor ________ of children by their parents, and _______ behaviour with friends, leading to drug-use/crime.

Answer 15

rejection, siblings
poor parenting, rejection, clique
monitoring, deviant

Question 16

Conduct disorder is characteristic of a persistent pattern of behaviour in which the basic ______ of others or age-appropriate societal _____ are violated. This is manifested by _____ or more of the following 15 criteria in the last ____ months AND ___ criterion present in the last ____ months

Answer 16

rights, norms, 3, 12, 1, 6

Question 17

Conduct disorder criteria are divided into four dimensions, these are:

Answer 17

1. Aggression to people and animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violation of rules

Question 18

Aggression to People and Animals involves…

Answer 18

1. bullying, threatening or intimidating others
2. initiating fights
3. use of a weapon
4. physically cruel to people
5. physically cruel to animals
6. stolen with victim present
7. forced sexual activity

Question 19

Destruction of Property involves…

Answer 19

1. Deliberately engaging in fire-setting

2. Deliberately destroyed others’ property

Question 20

Deceitfulness or Threat involves…

Answer 20

1. Breaking into someone’s house/car
2. Intentionally lying to obtain goods
3. Stealing without victim present

Question 21

Serious Violation of Rules involves…

Answer 21

1. Staying out at night despite parental rules
2. Running away from home
3. Absence from school

Question 22

What are the two sub-types of CD and what does this suggest about treatability/prognosis?

Answer 22

Child-onset type - prior to 10 years. This is often life-course persistent (or chronic)
Adolescent-onset type - after to 10 years. This often desists and is considered a “normal” teenage behaviour

Question 23

Conduct disorder, gender effects?

Answer 23

More common in males, often female CD starts in adolescence if at all.

Question 24

The child-onset subtype of CD is associated with __________ deficits, temperament/personality factors (such as _______ and poor ______ ______, potentially _____) as well as _______ cycles with parents.

Answer 24

neurocognitive, impulsivity, emotion regulation, ADHD, coercive

Question 25

Adolescent onset subtype of CD is considered an ________ of the normative _______ process.

Answer 25

exacerbation, teenage

Question 26

There is substantial _________ in the child-onset subtype of CD

Answer 26

heterogeneity

Question 27

The child-onset of CD can be further divided into high and low ______ _______ traits AKA limited _______ _______

Answer 27

callous unemotional, pro-social emotions

Question 28

High CU traits means lack of _____/______, callousness (insensitive and cruel), lack of ______, shallow/deficient _________, and unconcerned about ________

Answer 28

remorse/guilt
empathy
performance
emotions

Question 29

Children with ODD and CD that exhibit low CU traits are more common. What characteristics are seen here?

Answer 29

• emotionally dysregulated
• over-reactive to emotion
• reactive aggression (world is against me)
• difficulty recognising neutral faces - may interpret as hostile

Question 30

Children with high CU traits are rare. They show…

Answer 30

• pro-active aggression
• under-reactive to emotional cues
• reward-dominance
• punishment insensitive
• more severe/chronic trajectory
• difficulty recognising emotions, especially fear

–> often still driven by the rewards despite the punishment

Question 31

Boys with high CU traits have shown underactivity in the ______. It has also been shown that high CU traits are strongly _______, while low CU traits are more mediated by the ________, hence are learned.

Answer 31

amygdala
heritable
environment