Lecture 11 Conduct Problems

Question 1

DSM-5 diagnostic criteria for ODD A

Answer 1

A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months, with 4+ of the following:

angry/irritable mood:

(1) often loses temper
(2) often touchy or easily annoyed
(3) often angry and resentful

argumentative/defiant behaviour

(4) often argues with authority figures or with adults
(5) often actively defies or refuses to comply with requests from authority figures or with rules
(6) often deliberately annoys people
(7) often blames others for mistakes/misbehavior

vindictiveness
(8) often spiteful or vindictive

children < 5yrs: occur most days for at least 6 months
children >= 5yrs: occur at least once per week for 6 months

Question 2

Other diagnostic criteria of ODD

Answer 2

B. disturbance associated with distress in individual or others in immediate social context, impacts negatively on social, educational, occupational or other important areas of functioning

C. behaviour not exclusive during a course of psychotic, substance use, depressive or bipolar disorder. also not met for disruptive mood dysregulation disorder

Question 3

dimensions as predictors of impairment and comorbidity

Answer 3

• angry/irritable mood -> mood and anxiety disorders
• argumentative/defiant -> ADHD
• vindictiveness -> callousness, empathic deficits, instrumental aggression

Question 4

coercion theory

Answer 4

dominant causal model of conduct problems

Mechanisms based in the moment-to-moment interactions between parents and children

conceptualised in terms of social learning (operant conditioning) theory.

Parent-child interactions play out as an Interlocking pattern of reinforcement

A 3-step escape-avoidant dance (attack-counterattack-positive outcome)

Coercive cycles will continue over time but reach high levels more rapidly and be pushed to higher and higher amplitudes

Family members continuously training each other in coercion

The child becomes more skilled therefore more difficult to discipline

Question 5

implications of coercion for early development

Answer 5

Coercive patterns disrupt the developmental prerequisites for emerging self-regulation (internal controls over behaviour / emotion / thinking)

In order to develop self-regulation a child must first develop the capacity for compliance with external regulation

Failure to establish normative compliance in early childhood ->

Coercive behaviour functions as a substitute social skill ->

Child becomes increasingly harder to discipline and socialise ->

Enters school with social skills deficits ->

Entrained coercive exchanges generalise to teachers and peers

Question 6

Deviancy training

Answer 6

Through the contingencies supplied by peers, antisocial children mutually reinforce such behaviour in one another

selectively attending to deviant talk

ignore / punishing prosocial talk.

Question 7

DSM-5 diagnostic criteria for conduct disorder A

Answer 7

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of 3+ of the following criteria in the past 12 months, with at least 1 criterion present in the past 6 months:

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

Question 8

Aggression to people and animals

Answer 8

(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim
(7) has forced someone into sexual activity

Question 9

Destruction of property

Answer 9

(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others’ property (other than by fire setting)

Question 10

Deceitfulness or theft

Answer 10

(10) has broken into someone else’s house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting)

Question 11

Serious violations of rules

Answer 11

(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) 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)
(15) is often truant from school

Question 12

onset types of CD

Answer 12

Childhood-Onset Type:

• Onset of at least one criterion characteristic prior to age 10
• neurocognitive risk factors (eg. executive function deficits, low verbal IQ)
• temperamental/personality risk factors (eg. impulsivity)
• coercive parent-child dynamics

Adolescent-Onset Type:

• Absence of any criteria characteristic prior to age 10
• no such risk factors
• exaggeration of the normative process of adolescent rebellion

Question 13

Specifier for ‘limited prosocial emotions’ (callous-unemotional/psychopathic)

Answer 13

2+ of the following characteristics persistently over at least 12 months in multiple relationships and settings.

Lack of remorse or guilt

Callous-lack of empathy

Unconcerned about performance

Shallow or deficient affect

Question 14

low vs high CU traits

Answer 14

low CU traits:

• Emotionally dysregulated
• Overreactive to emotional cues
• Reactive aggression
• Hostile attributional biases
• moderate genetic & environmental influence

high CU traits:

• More severe & chronic
• Proactive aggression
• Reward-dominance
• Under-reactive to emotional cues
• reduced amygdala reactivity to emotional stimuli
• connectivity with ventromedial prefrontal cortex
• extremely strong genetic influence, minimal environmental influence