ODD/CD Flashcards
All behavioural problems diagnosible?
It is very prevalent to have conduct problems (2nd most common cause of mental health referral) but not everyone with behavioural problems will meet the criteria for a disorder.
What are conduct problems?
Conduct problems are age-inappropriate actions and attitudes that violate family expectations,
social norms and personal or property rights of others
Spectrum of conduct problems
- These can occur on a spectrum of covert (hidden) to overt (in the open) and destructive to non-destructive so can range from annoying temper tantrums to serious vandalism, theft and assault
Normal problem behaviur vs disorder
Antisocial behaviours appear and decline during normal development
- some may decrease with age, others increase with age and opportunity
- Anger appears around 6 months old
- By 1-1.5 years old 50% of peer social exchanges are conflict in nature
- Under 6 years old aggression is primarily used to obtain things
- are more common in boys in childhood
- children who are the most physically aggressive in early childhood maintain relative standing over time
Oppositional defiant disorder ODD clasification
ODD
* 4 symptoms from 1/3 categories V
* A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness
* Lasting 6+ months
* Shown towards someone other than a sibling
* Usually appears by age 8
* Distress for person or family, friends, school, work
Conduct disorder CD classification
Conduct disorder
* Basic rights of others/age-inappropriate societal norms or rules are violated
* 3 in the past year, 1 in 6months
1) Aggression to people and animals
2) Destruction of property
3) Deceitfulness or theft
4) Serious rule violations
- Onset:
- Adolescent = lower severity, symptoms less likely to persist over time, M=F
- Childhood = before age 10, M>F, either: aggressive/impulsive, callous-unemotional (CU)
CU
low empathy, (less sensitive to punishment, reward dominant), problems with amygdala-pre frontal cortex connectivity – lower levels of fear and anxiety, poor recognition of fearful faces
- Harsh inconsistent parenting styles = increase CU, positive warm parenting = decrease CU. Disorganised attachment.
- HARD TO TREAT – 90% of studies found those with high CU have poor outcomes but early intensive tx can work (eg Somech et al 2012 with 3-5 year olds, ES 0.85 decline in CU traits)
- Treatment:
* Teaching them how to interpret emotional expressions in interpersonal contexts, based on work with autistic kids
* Teach them how to “look at the eyes” of faces to overcome fear blindness
* Emotional Engagement Therapy: increasing eye contact between child and parent to enhance quality of the relationship (can increase oxytocin)
* Efficacy: 4 year follow-up showed that 63% of children no longer met criteria for ODD/CD (Kolko et al., 2014) / Others shown 50% remission
Does all ODD turn to CD
ODD can precede CD but most with ODD do not develop into more severe CD
Comorbidities and differentials
Differentials:
1. DMDD (different ODD bc low mood persists between temper outbursts),
- ADHD (is the function of the outbursts because they are inattentive or ‘intentional’),
- normal behaviours for children,
- anxiety/mood (manifest behaviourally in children),
- poor parent-child fit
Comorbidities:
ID, ADHD
Assessment
- ASEBA (CBCL, parent, teacher)
- Screen with WISC/WIAT?
- (therapeutic relationship)
- Parent stress Scale
- FIDO tantrums and chain what’s before and after (reinforcers to maintain)
- Mood between tantrums
- Developmental history esp language development (increased aggression with limited language communication abilities)
- Common triggers
- Parent Stress Scale
- Diet
Possible causes
- Language processing problems
- children with poorly developed language abilities may have greater difficulty managing frustration
- Mood difficulties
- For children who are prone to these negative mood states, more chronic difficulties with frustration and temper are thus likely to be evident
Risk factors
Birth complications
Low IQ
Emotional regulation skills
Genetics (low cortisol, high testosterone)
Poor communication skills
Male Gender
Living in disadvantaged neighbourhoods
Parents:
Dysregulated parent emotions
Non-responsive parenting in first 2 years
Modelling (parent uses aggression)
Lack of supervision
Lack of warmth
Maltreatment to child
Inflexible rigid discipline
INCONSISTENT = rewarded and punished for similar problems
Behavioural difficulties are to do with impulse difficulties which is to do with brain differences, environment, and dysregulation therefore biological and environmental
Models bronfrenners
Bronfenbrenners
- The child is influenced by their internal world, close relationships, community and society
Model - Patterson’s Coercive Theory
Patterson’s Coercive Theory
- Both child and parent responses offer negative reinforcement that increase intensity of behaviour over time
MODEL/PHOTO:
Child problem behaviour -> parent responds emotionally -> child escalates -> parent escaltes -> patent withdraws or gives in
Child problem behaviour -> parent responds differently -> child de-escaltes -> parent stays engaged
Pattersons Coercion Model of Aggression says that parents who lack parenting skills unwittingly train their children to be noncompliant and act in antisocial ways. His research shows that poor parental discipline skills and coercive management practices cause escalation of child-parent conflict and increase children’s aggression toward others. The child and parents elicit negative behaviour from each other.
Operant conditioning – behaviourism.
Family operates via positive and negative consequences.
Dysfunction results from coercive and reciprocal patterns of interaction. Coercion – aversive and negatively reinforced reactions used to control other family members. Reciprocity – interpersonal exchanges where participants positively reinforce each other enough to maintain the relationship.
The child learns to avoid parent demands through a process of negative reinforcement. Repeated over thousands of trials, the child learns to use coercive behaviours to gain control over a disrupted, chaotic, or unpleasant family environment. These patterns become overlearned and automatic, and operate without conscious, cognitive control. In the absence of countervailing forces, the child may progress from displaying these trivial aversive behaviours in the family to exhibiting similar patterns with other people in other settings, to engaging in other social behaviours, including physical aggression, lying, or stealing
Examples of ABC’s for conditioning and parent behavior:
Reward given for a deviant behavior – reinforces deviant behavior.
A. Parent says no to buying a toy in shop
B. Child has tantrum
C. Parent buys toy to make child be quiet
Parents make repeated requests – no consequences in place
A. Child asked to do something
B. Child does not comply
C. Parent repeats the request in increasing loud voice
B. Child does not comply
C. Parent repeats the request (yelling)
B. Child complies
C. Argument stops
Model - dodges
Dodges Social Information Processing Model (1993)
- If there is difficulty at some stage of processing they might get frustrated and act out
PHOTO:
Informational processing (attention memory)
Meaningful interpretation of the stimulus (causal attributions, NATs and cognitive errors)
Possible responses from long-term memory
Decision-making (consequences, morals)
Behaviour (verbal, action, / can be automatic)
Encoding
Interpreting
Long term memory
Deciding
Behaviour
Emad
Is
PRobably
Dancing
Badly
