Abnormal Child Psychology Sixth Edition 9 Conduct Problems

Abnormal Child Psychology Sixth Edition 9 Conduct Problems Eric J. Mash A. 2016 Wolfe ©David Cengage Learning © Cengage Learning 2016

Description of Conduct Problems • Age-inappropriate actions and attitudes that violate family expectations, societal norms, and personal or property rights of others • These disruptive and rule-violating behaviors range from: – Annoying minor behaviors (e. g. , temper tantrums) to serious antisocial behaviors (e. g. , vandalism, theft, and assault) © Cengage Learning 2016

Description of Conduct Problems (cont’d. ) • We must consider many types, pathways, causes, and outcomes of conduct problems • Are associated with unfortunate family and neighborhood circumstances – Circumstances do not excuse the behavior, but help us understand prevent it © Cengage Learning 2016

Context • Antisocial behaviors appear and decline during normal development – Behaviors vary in severity, from minor disobedience to fighting – Some may decrease with age; others increase with age and opportunity – Are more common in boys in childhood – Children who are the most physically aggressive in early childhood maintain relative standing over time © Cengage Learning 2016

Frequencies for Common Antisocial Behavior © Cengage Learning 2016

Social and Economic Costs • Conduct problems are the most costly mental health problem in North America • Early, persistent, and extreme antisocial behavior occurs in about 5% of children – These children account 50% of all crime in the U. S. and approximately 30 -50% of clinic referrals – Annual public costs (healthcare, juvenile justice, and educational systems) are $10, 000 per child © Cengage Learning 2016

Legal Perspectives • Juvenile delinquency – Legal definitions exclude antisocial behaviors of very young children – Including property crimes (e. g. vandalism, theft), violent crimes (robbery, aggravated assault, homicide) – Minimum age of responsibility is 12 (in most states) – Only a subgroup of children meeting legal definition of delinquency also meet definition of a mental disorder (needs to show persistent pattern) © Cengage Learning 2016

Psychological Perspectives • Conduct problems fall on a continuous dimension – Externalizing dimension: Impulsive and overactive • “Rule-breaking behavior”: running away, setting fires, stealing, dugs, vandalism, skipping school • “Aggressive behavior” : Fighting , destructiveness, disobedience, defiance, threatening – Overt (visible) –covert (hidden) dimension – (Most children with CD display both) – Destructive-nondestructive dimension – Crossing the overt-covert with the destructive-nondestructive • Yields four categories of conduct problems © Cengage Learning 2016

Four Categories of Conduct Problems © Cengage Learning 2016

Psychiatric Perspectives • Conduct problems are viewed as distinct mental disorders based on DSM symptoms – Disruptive behaviors are described as persistent patterns of antisocial behavior – Represented by the categories of Conduct Disorder (CD) and Oppositional Defiant Disorders (ODD) • The diagnosis of antisocial personality disorder (APD) is relevant to understanding childhood conduct and their adult outcomes © Cengage Learning 2016

Public Health Perspectives • Blends the legal, psychological, and psychiatric perspectives with public health concepts of prevention and intervention – Goal • To reduce injuries, deaths, personal suffering, and economic costs associated with youth violence • Cut across disciplines to: – Understand conduct problems in youths – Determine how these problems can be treated and prevented © Cengage Learning 2016

DSM-5 Defining Features • Two DSM-5 disruptive behavior disorders – Oppositional defiant disorder (ODD) – Conduct disorder (CD) – Both have been found to predict future psychopathology and enduring impairment in life functioning © Cengage Learning 2016

Oppositional Defiant Disorder • Age-inappropriate recurrent pattern of stubborn, hostile, disobedient, and defiant behaviors • Usually appears by age 8 • Severe ODD behaviors can have negative effects on parent-child interactions • Symptoms can be grouped into • 1)Negative affect ( angry, irritable mood) • 2) Defiance (defiant/strong-head behavior © Cengage Learning 2016

Diagnostic criteria for Oppositional Defiant Disorder © Cengage Learning 2016

Diagnostic criteria for Oppositional Defiant Disorder (cont’d. ) © Cengage Learning 2016

Conduct Disorder • Repetitive, persistent pattern of severe aggressive and antisocial acts – May have co-occurring problems, e. g. , ADHD, academic deficiencies, and poor peer relations – Family child-rearing practices may contribute to problems – Parents feel the children are out of control and feel helpless to do anything about it © Cengage Learning 2016

Diagnostic Criteria for Conduct Disorder © Cengage Learning 2016

Diagnostic Criteria for Conduct Disorder (cont’d. ) © Cengage Learning 2016

Diagnostic Criteria for Conduct Disorder (cont’d. ) © Cengage Learning 2016

Conduct Disorder Age of Onset • Children with childhood-onset CD display at least one symptom before age 10 – More likely to be boys – Show more aggressive symptoms – Account for disproportionate amount of illegal activity – Persist in antisocial behavior over time © Cengage Learning 2016

Conduct Disorder Age of Onset (cont’d. ) • Children with adolescent-onset CD – As likely to be girls as boys – Do not show the severity or psychopathology characterizing the early-onset group – Are less likely to commit violent offenses or persist in their antisocial behavior over time © Cengage Learning 2016

Are CD and ODD Separate? • Nearly half of all children with CD have no prior ODD diagnosis • Most children who display ODD do not progress to more severe CD • For most children, ODD: – Is an extreme developmental variation – Is a strong risk factor for later ODD – Does not signal an escalation to more serious conduct problems © Cengage Learning 2016

Antisocial Personality Disorder (ADP) and Psychopathic Features • Pervasive pattern of disregard for and violation of the rights of others; involvement in multiple illegal behaviors – As many as 40% of children with CD later develop APD – Adolescents with APD may display psychopathic features – Signs of lack of conscience occur as young as 3 -5 years © Cengage Learning 2016

Antisocial Personality Disorder (ADP) and Psychopathic Features (cont’d. ) • A subgroup of children with CD are at risk for extreme antisocial and aggressive acts and for poor long-term outcomes – Display callous and unemotional (CU) interpersonal style • Lack guilt and empathy; do not show emotions; display narcissism and impulsivity; and lack behavioral inhibition – Different developmental processes may underlie behavioral and emotional problems © Cengage Learning 2016

Associated Characteristics • Many factors are associated with conduct problems in youths – Cognitive and verbal deficits – School and learning problems – Self-esteem deficits – Peer problems – Family problems – Health-related problems © Cengage Learning 2016

Cognitive and Verbal Deficits • Most children with conduct problems have normal intelligence • Verbal deficits are present in early development: may interfere with self-control, emotional regulation, receptive listening, expressive speech • Deficits in executive functioning – Co-occurring ADHD may be a factor – Types of executive function exhibited may differ - cool : attention, working memory, planning and inhibition, (such as in ADHD) versus hot executive functions: involve incentive and motivation (more often in CD). © Cengage Learning 2016

Deficits in Executive Functions • Rarely consider the consequences of their behavior or the impact on others • Fail to inhibit their impulsivity • Fail to consider future rewards • Fail to adapt their action to future circumstances • May be related to the comorbidity with ADHD © Cengage Learning 2016

School and Learning Problems • Underachievement, grade retention, special education placement, dropout, suspension, and expulsion • Relationship between conduct problems and underachievement is firmly established by adolescence – May lead to anxiety or depression in young adulthood © Cengage Learning 2016

Family Problems • General family disturbances • Specific disturbances in parenting practices and family functioning • High levels of conflict are common in the family, especially between siblings • Lack of family cohesion and emotional support • Deficient parenting practices • Parental social-cognitive deficits © Cengage Learning 2016

Peer Problems • Young children with conduct problems display poor social skills and verbal and physical aggression toward peers • Often rejected by peers, although some are popular – Children rejected in primary grades are five times more likely to display conduct problems as teens – Some become bullies © Cengage Learning 2016

Peer Problems (cont’d. ) • Often form friendships with other antisocial peers – Predictive of conduct problems during adolescence • Underestimate own aggression and its negative impact, and overestimate others’ aggression toward them © Cengage Learning 2016

Peer Problems (cont’d. ) • Reactive-aggressive children display hostile attributional bias • Proactive-aggressive view their aggressive actions as positive © Cengage Learning 2016

Self-Esteem Deficits • Low self-esteem is not the primary cause of conduct problems – Instead, problems are related to inflated, unstable, and/or tentative view of self • Youths with conduct problems may experience high self-esteem – Over time may permit them to rationalize their antisocial conduct © Cengage Learning 2016

Health-Related Problems • High risk for personal injury, illness, drug overdose, sexually transmitted diseases, substance abuse, and physical problems as adults • Rates of premature death (before age 30) – Are 3 to 4 times higher in boys with conduct problems © Cengage Learning 2016

Health-Related Problems (cont’d. ) • Early onset and persistence of sexual activity and sexual risk-taking by age 21 • Substance use disorders and adolescent antisocial behavior are strongly associated • Childhood conduct problems are a risk factor for adolescent and adult substance abuse – Mediated by drug use and delinquency during early and late adolescence © Cengage Learning 2016

Accompanying Disorders and Symptoms • Attention-Deficit/Hyperactivity Disorder – More than 50% of children with CD also have ADHD – Possible reasons for overlap • A shared predisposing vulnerability may lead to both ADHD and CD • ADHD may be a catalyst for CD • ADHD may lead to childhood onset of CD – Research suggests that CD and ADHD are distinct disorders © Cengage Learning 2016

Accompanying Disorders and Symptoms (cont’d. ) • Depression and anxiety – About 50% of children with conduct problems also have depression or anxiety • ODD best accounts for the connection between conduct problems and depression • Increasing severity of antisocial behavior is associated with increasing severity of depression and anxiety • Anxiety may serve as a protective factor to inhibit aggression © Cengage Learning 2016

Prevalence • ODD is more prevalent than CD during childhood; by adolescence, prevalence is equal • Lifetime prevalence rates – 12% for ODD (13% for males, 11% for females) – 8% for CD (9% for males, 6% for females) • Prevalence for CD and ODD across cultures of Western countries are similar © Cengage Learning 2016

Gender • Gender differences are evident by 2 -3 years of age – During childhood, rates of conduct problems are about 2 -4 times higher in boys – Boys have earlier age of onset and greater persistence – Early symptoms for boys are aggression and theft; early symptoms for girls are sexual misbehaviors © Cengage Learning 2016

Explaining Gender Differences • Possible explanations – Genetic, neurobiological, environmental risk factors, and definitions of conduct problems that emphasize physical violence • Girls use indirect, relational forms of aggression • Early maturing boys and girls are at risk for recruitment into delinquent behavior by peers © Cengage Learning 2016

General Progression • Earliest sign is difficult temperament in infancy • Hyperactivity and impulsivity during preschool ad early school years • Oppositional and aggressive behaviors peak during preschool years • Diversification - new forms of antisocial behavior develop over time © Cengage Learning 2016

General Progression (cont’d. ) • Covert conduct problems begin during elementary school • Problems become more frequent during adolescence © Cengage Learning 2016

General Progression (cont’d. ) • Some children break from the traditional progression – About 50% of children with early conduct problems improve – Some don’t display problems until adolescence – Some display persistent low-level antisocial behavior from childhood/adolescence through adulthood © Cengage Learning 2016

Different Forms of Disruptive And Antisocial Behavior © Cengage Learning 2016

Two Common Pathways • Life-course-persistent (LCP) path begins early and persists into adulthood – Antisocial behavior begins early • Subtle neuropsychological deficits heighten vulnerability to antisocial elements in social environment – Complete, spontaneous recovery is rare after adolescence – Associated with family history of externalizing disorders © Cengage Learning 2016

Two Common Pathways (cont’d. ) • Adolescent-limited (AL) path begins at puberty and ends in young adulthood – Less extreme antisocial behavior, less likely to drop out of school, and have stronger family ties – Delinquent activity is often related to temporary situational factors, especially peer influences © Cengage Learning 2016

The Changing Prevalence Of Participation In Antisocial Behavior Across The Lifespan © Cengage Learning 2016

Adult Outcomes • 50% of active offenders decrease by early 20 s, and 85% decrease by late 20 s • Negative adult outcomes are seen, especially for those on the LCP path – Males - criminal behavior, work problems, and substance abuse – Females - depression, suicide, and health problems © Cengage Learning 2016

Causes • Early theories focused on a child’s aggression • No single theory explains all forms of antisocial behavior • Today conduct problems are seen as resulting from: – The interplay among a predisposing child, family, community, and cultural factors operating in a transactional fashion over time © Cengage Learning 2016

Genetic Influences • Aggressive and antisocial behavior in humans is universal – Run in families within and across generations • Adoption and twin studies – Indicate 50% or more of variance in antisocial behavior is hereditary – Suggest contribution of genetic and environmental factors © Cengage Learning 2016

Prenatal Factors and Birth Complications • Pregnancy and birth factors – Low birth weight – Malnutrition (possible protein deficiency) during pregnancy – Lead poisoning – Mother’s use of nicotine, marijuana, and other substances during pregnancy – Maternal alcohol use during pregnancy © Cengage Learning 2016

Neurobiological Factors • Overactive behavioral activation system (BAS) and underactive behavioral inhibition system (BIS) • Variations in stress-regulating mechanisms • Structural and functional brain abnormalities in amygdala, prefrontal cortex, anterior cingulate, and insula © Cengage Learning 2016

Neurobiological Factors (cont’d. ) • Early findings suggest three neural systems are involved: – Subcortical neural systems • Aggressive behavior - dysfunction in the integrated functioning of brain circuits involving the amygdala – Prefrontal cortex • Decision-making circuits and socioemotional information processing circuits – Frontoparietal regions • Emotions and impulsive motivational urges © Cengage Learning 2016

Social-Cognitive Factors • • Immature forms of thinking Cognitive deficiencies Cognitive distortions Deficits in facial expression recognition and eye contact • Dodge and Pettit comprehensive socialcognitive framework model – Cognitive and emotional processes are mediators © Cengage Learning 2016

Steps In The Thinking And Behavior Of Aggressive Children In Social Situations © Cengage Learning 2016

Family Factors • Severe forms of antisocial behavior – Are associated with a combination of child risk factors and extreme deficits in family management skills • Influence of family environment is complex • Reciprocal influence – Child’s behavior is influenced by and influences the behavior of others • Child behaviors exert greater influence on parenting behavior than the reverse © Cengage Learning 2016

Family Factors (cont’d. ) • Coercion theory – Parent-child interactions provide a training ground for the development of antisocial behavior – Four-step escape-conditioning sequence • The child learns to use increasingly intense forms of noxious behavior to avoid unwanted parental demands (coercive parent-child interaction) – Children with callous-unemotional traits display significant conduct problems regardless of parenting quality © Cengage Learning 2016

Family Factors (cont’d. ) • Attachment theories – Children with conduct problems have little internalization of parent and societal standards – There is a relationship between insecure attachments and the development of antisocial behavior © Cengage Learning 2016

Other Family Problems • Family instability and stress – High family stress may be both a cause and an outcome of child’s antisocial behavior • Unemployment, low SES, multiple family transitions, instability, and disruptions in parenting practices are stressors – Amplifier hypothesis • Parental criminality and psychopathology – Aggressive and antisocial tendencies run in families within and across generations © Cengage Learning 2016

Societal Factors • Individual and family factors interact with the larger societal and cultural context in determining conduct problems • Social disorganization theories • Adverse contextual factors are associated with poor parenting • Neighborhood and school – Social selection hypothesis • Media © Cengage Learning 2016

Cultural Factors • Across cultures, socialization of children for aggression is one of the strongest predictors of aggressive acts • Rates of antisocial behavior vary widely across and within cultures • Antisocial behavior is associated with minority status in the U. S. – Likely due to low SES © Cengage Learning 2016

Treatment and Prevention • Some treatments are not very effective – Office-based individual counseling and family therapy – Group treatments can worsen the problem – Restrictive approaches (residential treatment, inpatient hospitalization, incarceration) © Cengage Learning 2016

Treatment and Prevention (cont’d. ) • Comprehensive two-pronged approach includes – Early intervention/prevention programs – Ongoing interventions © Cengage Learning 2016

Effective Treatments For Children With Conduct Problems © Cengage Learning 2016

Parent Management Training (PMT) • Teaches parents to change the child’s behavior in the home and in other settings using contingency management techniques • Focus is on: – Improving parent-child interactions – Promoting positive behavior – Decreasing antisocial behavior • Makes numerous demands on parents © Cengage Learning 2016

Problem-Solving Skills Training (PSST) • Focuses on cognitive deficiencies and distortions in interpersonal situations • Five problem-solving steps are used to: – Identify thoughts, feelings, and behaviors in problem social situations © Cengage Learning 2016

Problem-Solving Skills Training (PSST) (cont’d. ) • Children learn to: – Appraise the situation – Identify self-statements and reactions – Alter their attributions about others’ motivations – Learn to be more sensitive to others © Cengage Learning 2016

Multisystemic Therapy (MST) • Intensive family- and community-based approach – For teens with severe conduct problems who are at risk for out-of-home placement • Attempts to empower caregivers to improve youth and family functioning • Effective in reducing long-term rates of criminal behavior – Reduces association with deviant peers © Cengage Learning 2016

Preventive Interventions • Main assumptions – Conduct problems can be treated more easily and effectively in younger than older children – Counteracting risk factors/strengthening protective factors at young age limits/prevents escalation of problem behaviors – Costs to educational, criminal justice, health, and mental health systems are reduced © Cengage Learning 2016

Preventive Interventions (cont’d. ) • Incredible Years intensive multifaceted early-intervention program for parents and teachers – Support for effectiveness of early interventions in reducing later conduct problems and maintaining positive outcomes • Fast Track program to prevent development of antisocial behavior in highrisk children, using five components © Cengage Learning 2016