Week4: ODD/CD Course

Question 1

Fussy infants might be linked to ADD/CD in…

Answer 1

Infants
Difficult temperament
Fussy, irritable, hard to soothe
Some evidence that this is linked to later ODD in boys

Question 2

The two diagnostic challenges in dealing with preschoolers

Answer 2

Preschoolers

• Two diagnostic challenges
  (1) Impossible or improbable symptoms

How can you diagnose preschoolers like this, they do not do these activities!
It is necessary to adapt symptoms to younger age ranges i.e.
Verbal aggression, physical aggression, lying, property destruction

And even then you have to remember, misbehaving is common in preschoolers:

(2) Normative misbehavior
- Noncompliance, temper loss, and aggression are common
- Children’s physical aggression increases until 27 months of age
- 40% of girls and 50% of boys are reported by their parents to hit, kick, and bite occasionally
- 75% of preschoolers have temper tantrums

So you have to take that into account

Question 3

Study on the course of ODD/CD in preschoolers

Answer 3

STUDY

Approximately 10,000
children

(1) Parent report on physically aggressive behavior
- “Kicks, bites, hits”
- “Gets into many fights”
- “Reacts with anger and fighting”

(2) First assessment at 2 years of age
- Repeated assessments
- For many preschoolers, some misbehavior is normative and will decrease as they grow older

Over time 3 groups emerged:
Started off low and got lower (less aggression)
Medium start, got less
High aggression, did not go down

For some, misbehavior is an indicator of significant behavioral and emotional dysregulation that will escalate with time if left untreated
-How do we tell which is which?

Question 4

How do you diagnose preschoolers

5 things we use

Answer 4

How do we distinguish “typical” misbehavior from that representing a significant problem?

We use:

• Frequency - how often
• Severity - How extrme (eg weapons/objects)
• Flexibility - Can someone calm the child? If not, worse
• Expectability - is the behavior provoked (worse if not or if done to get what they want)
• Pervasiveness - Home/school? With anyone or just with some?

Question 5

Developmental course of ODD/CD

there are two pathways

Answer 5

Early-onset/life-course consistent pathway

• at least one symptom before age 10
• 10:1 male to female ratio
• 50% persist in antisocial behavior into adulthood
• Aggression in childhood
• Less serious nonaggressive antisocial behavior in middle childhood
• More serious delinquency in adolescence

Late-onset pathway
-Onset in adolescence, frequently with social change
-Peer influences
-2:1 or 1:1 male to female ratio
-Less extreme antisocial behavior
-Less likely to commit violent offenses
-Less likely to persist
BUT
Snares: Outcomes of antisocial behavior that put people on a problematic path
e.g. Unplanned pregnancy, dropping out of school, drug addiction