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Flashcards in Conduct Disorders Deck (17)
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1

What are the main symptoms of conduct disorder?

 Often initiate violent or aggressive behaviour Have little respect for property Are lying and deceitful Display little empathy with the feelings and intentions of others Regularly display risk taking, frustration, irritability, impulsivity and temper tantrums Associated with early onset sexual behaviour, drinking, smoking, substance abuse and risk-taking behaviour

2

What are the Sub-Types of Conduct Disorder

 Childhood-onset conduct disorder (prior to 10-years-of-age) Adolescent-onset conduct disorder (after 10-years-of-age) Oppositional Defiant Disorder (ODD)

3

What is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD): A mild form of disruptive behaviour disorders reserved for children who do not meet the full criteria for conduct disorder.

4

What are the Changes in the DSM 5 for ODD?

Conduct disorder: New descriptive specifier added for individuals with callous unemotional personal style Oppositional defiance disorder: - Symptoms grouped into 3 types - Removal of exclusion criteria for CD- Frequency and severity guidance added

5

The Prevalence & Course of Conduct Disorder

 Prevalence rates range from 4-16% in boys and 1.2-9% in girls (Loeber et al., 2000) Comorbidity is the rule rather than the exception  Childhood conduct disorder predicts adult antisocial personality disorder, but only in lower socioeconomic-status families (Lahey et al., 2005)

6

Genetic Factors to CD and ODD

 Twin studies suggest that both conduct disorder and aggressive and violent behaviour has a significant genetic component Adoption studies also suggest substantial inherited rather than environmental causes (Simonoff, 2001) Recent studies have identified the genes MAOA and GABRA2 with conduct disorder (Caspi et al., Dick et al., 2006)

7

Neurological Deficits of CD

 Conduct Disorder is associated with deficits in executive functioning, verbal IQ and memory (Lynam & Henry, 2001) However, executive functioning deficits may only be found in individuals where conduct disorder is comorbid with ADHD (Oosterlaan et al., 2005)

8

Prenatal Factors to CD

 Prenatal factors include maternal smoking and drinking during pregnancy, and prenatal and postnatal malnutrition Delinquent behaviour is more common in children prenatally exposed to alcohol (Schonfeld et al., 2005) Confounding influence of other risk factors such as low socioeconomic status and genetic factors

9

Psychological Factors to CD

 Family Environment & Parent-Child Relationships Media & Peer Influences Cognitive Factors Socioeconomic Factors

10

Family Environment & Parent-Child Relationships

 Risk factors for ODD include parental unemployment, having a parent with antisocial personality disorder, and childhood abuse and neglect (Lahey et al., 1995) Inconsistent and harsh parenting is associated with conduct disorder Childhood abuse is generally associated with increased aggression, violence and criminal behaviour in adulthood (Fergusson et al., 1996)

11

Cognitive Factors to CD

 Cognitive distortions: highly biased ways of interpreting the world Hypervigilance for hostile cues (Dodge, 1993) Hostile attributional bias (Nasby et al., 1979)

12

Socioeconomic Factors to CD

 Delinquent, violent behaviour is highly associated with poverty, low socioeconomic status, unemployment, urban living and poor education A natural experiment by Costello et al. (2003) indicated that poverty may have a causal effect on symptoms of conduct disorder

13

Treatment of Conduct Disorders

(1) Individual Approaches (e.g., skills training )(2) Parent management training / family therapy(3) Multi-systemic therapy (MST)

14

Individual Approaches

 Cognitive problem solving techniques /social skills training to address the cognitive processes used in everyday social situations  Model and reward pro-social behaviour  Role play, homework, music, video vignettes,, child-size puppets, practical activities, letters and phone calls to parents and teachers.

15

Parental Management Training

 Encourage ‘positive parenting approaches’ with the therapist key in demonstrating helpful techniques

16

Multi-Systemic Therapy

 Addresses the multi-dimensional nature of behavioural problems (Bronfenbrenner, 1979) Therapist acts as advocate and a specific treatment package is built

17

Evaluation of Treatments

 Importance of early intervention (and perhaps prevention?) Need for long term treatment and follow up ‘booster’ sessions Difficulties due to confounding factors and co-morbidity