Week 4: ODD and DC Epidemiology

Question 1

Prevalence of CD and ODD

Answer 1

Lifetime prevalence

• ODD – 12%
• CD – 8%

Ontario Child Health Study Sequel

• 6 month prevalence of ODD is 7.5%
• 6 month prevalence of CD is 1.3%

Question 2

Cultural and contextual differences in the prevalence of these disorders

Answer 2

Cultural and contextual differences

• Strongly associated with poverty
• Strongly associated with exposure to violence

“Concerns have been raised that the Conduct Disorder diagnosis may at times be misapplied to individuals in settings where patterns of undesirable behavior are sometimes viewed as protective (e.g., threatening, impoverished, high crime) . . . a Conduct Disorder
diagnosis should only be applied when the behavior in question is . . . not simply a reaction to the immediate social context” DSM-IV-TR

Taken out now but still valid. If joining a gang protects a boy, that is not CD even if he is behaving in disruptive ways.

Question 3

What theories about the way poverty and disruptive behavior disorders exist? (2)

Answer 3

Social causation: Stress of poverty leads to an increase in childhood psychopathology

Social selection: Families with genetic predisposition drift down towards poverty

Question 4

Social causation evidence (Smoking Mountain Study)

Answer 4

Great Smoky Mountains Study

• Longitudinal study of epidemiology of childhood psychiatric disorder
• Sample included a significant number of Indigenous youth, many of whom lived on a reservation
• Significant positive association between poverty and disruptive behavior

Partway through the study, a casino opened on the reservation
-Everyone got a stipend
-Led to four groups:
Persistently poor
Ex-poor
Never poor
Newly poor (excluded because of small number)

RESULTS

The persistently poor peoples behavior did not change
The Ex-poor children showed less behavioral disorder and became close to the never poor

Evidence for social causation

Question 5

Moderators and Mediators

Answer 5

Moderator: A variable that influences the direction strength of the relationship between two variables
E.g., age as a moderator of treatment effects

Can be thought of as Who? Who gets it?

Mediator: A variable that explains the relationship between two other variables
E.g. child abuse may mediate the relationship between SES and conduct
Can be thought of as Why? Why do people get this?

Question 6

Mediators in the Smokey Mountain Study

Answer 6

Examined possible mediators of the association between increase in income and decrease in behavioral symptoms

Found that it was increased parental supervision
Increase in income led to improved parental supervision, which in turn led to decreased behavior problems

Question 7

Disruptive Behavior Disorder: Gender statistics

Answer 7

Conduct problems are 2-4 times more common in male children
-Smaller differences in early teens
-Increase in girls engaging in covert, nonaggressive behavior (lying, truancy)
-Early-onset persistent CD
10 male: 1 female ratio

-Adolescent-limited CD
2 male: 1 female or no gender difference

Question 8

Disruptive Behavior Disorder: Gender effects

Who is more aggressive

Do girls do more relational aggression?

Why are boys found earlier/more?

Answer 8

Boys are more physically aggressive than are girls, across the lifespan

Relational aggression; harming other people by attacking their social relationships e.g. Rumor spreading, exclusion
Among girls, this is more common than physical aggression

Available evidence suggests that girls engage in slightly more relational aggression than do boys, but the difference is small and not meaningful. They are just less aggressive across board.

Boys’ antisocial behavior is more overt, may get them noticed at an
early age

Question 9

ODD/CD Comorbities

Answer 9

ADHD:

• 35% of youth with ODD also have ADHD
• More than 50% of children with CD also have ADHD

Depression and anxiety:
-About 50% of children with ODD and CD also have depression or anxiety

Question 10

Correlates of ODD/CD

5 main categories and their details

Answer 10

Cognitive and verbal challenges

• CD and ODD are not associated with intellectual impairment
• Specific verbal deficits may be present

Academic functioning

• Underachievement, grade retention, dropout, suspension, expulsion
• May lead to anxiety or depression in young adulthood

Family functioning

• High levels of conflict
• Lack of family cohesion and emotional support

Peer problems

• Children with ODD/CD many engage in aggressive behavior with peers
• Often rejected by peers, although some are popular
• Form friendships with other antisocial peers (might increase antisocial behavior as they do more together)

CD is associated with significant health risks

• Personal injury, substance abuse, sexually transmitted infections
• Boys with conduct problems are 3 to 4 times more likely to die before the age of 30