CONDUCT DISORDERS CD

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CONDUCT DISORDERS (CD)
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Vocabulary

• Punitivepunishing, negative
• Insular-isolation
• Retaliation-revenge tit for tat
• Vandalize- to destroy anothers property
• Risk factor-those conditions, traits, or
  experiences that increase poor outcome
• Protective factorthose conditions, traits, or
  experiences that improve outcome

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Definition

• a repetitive and persistent pattern of behavior
  in which the basic rights of others or major
  age-appropriate social norms or rules are
  violated
• AND

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the presence of 3 (or more) of the following
characteristics in the past 12 months, with at
least 1 present in the past 6 months

• Deliberately starts fires
• Destroyed property
• Forced sexual activity
• Initiates fights
• Often lies
• Physically/emotionally cruel to people
• Physically cruel to animals
• Runs away from home
• Steals (includes forgery)
• Truancy
• Used a weapon a fight

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Often defined simply as

• VIOLATIONS OF PERSON OR PROPERTY
• Under age 18
• 6-16 of boys
• 2-9 of girls

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Prevalence

• Affects 1 to 4 percent of 9 to 17-year-olds-- as
  early as age 5.
• violence decreases with age for most children
• covert behaviors (theft, setting fires) increase
  steadily after fourth grade
• More common among boys than girls (Boys 10)
  (Girls 5)

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BOYS WITH CD

• fighting in the hall
• overtly violating rules
• vandalize property
• 6-16 of boys
• Boys are at a high risk if biological father was
  an alcoholic (Arluke, 1999, 965)

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GIRLS WITH CD

• 2nd most common psychiatric disorder in girls
• 2-9 of girls
• Girls at higher risk for conduct disorder if
  stepfather was an alcoholic
• (Arluke, 1999, 965)
• Aggression may appear as
• gossip intended to significantly hurt another
• purposely withdraw friendship or acceptance in
  order to hurt or control another (ice)
• spreading malicious rumors, revengefulness,
  lying, firesetting, vandalism.

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Co-Occurring conditions

• EXTERNALIZING DISORDERS
• ADD/ADHD
• Oppositional Defiant Disorder (ODD)
• INTERNALIZING DISORDERS
• Bipolar disorder
• Depression
• Learning disability
• Seizure disorder (unusually common in very
  violent children)

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Social/Behavioral Characteristics

• Trouble reading social cues
• Trouble feeling and expressing empathy or remorse
  (Copur, 2005, 151)
• Aggressive toward people and animals
• Hostile bully, threaten, or intimidate others
• Substance abuse
• Risk-taking behaviors

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Physical Characteristics

• Physical injury from accidents or fights (Copur,
  2005, 151)

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Cognitive Characteristics

• A vast literature links cognitive deficits to
  antisocial behavior in children and adolescents
  (Caspi, 227-228).

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Types of Violent Perpetuators

• Self-indulger has the view that others must cater
  to him/her. NPD
• Self-defender is intensely afraid of others and
  acts as a bully (the best defense is a good
  offense)

• Undercontrolled lacks inhibitions--may be TBI or
  impulsive.
• Overcontrolled is overly afraid of catastrophies
  and inhibits aggression until frustration reaches
  a point where they explode --thus reinforcing
  their fears (e.g., women in abusive relationships)

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Academic Characteristics

• Have low functioning and low academic achievement
• Reading skills fall behind, with one study
  finding their reading level at 28 months behind
  normal peers
• (American, 1994)

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Etiology

• Biology Interacts with Culture
• (the Community,School, Family)

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• Delinquency/Aggression
• Genetics "The three genetic polymorphisms that
  predict delinquency include1.the 30-base pair
  (bp) promoter-region with a variable number
  tandem repeat (VNTR) in the monoamine oxidase A
  (MAOA) gene,2.the 40-bp VNTR in the dopamine
  transporter 1 (DAT1) gene and3.the Taq1
  polymorphism in the dopamine D2 receptor (DRD2)
  gene. MAOA regulates several brain
  neurotransmitters important in behavioral
  motivation, aggression, emotion and cognition
  (e.g., serotonin, dopamine, norepinephrine).
• Culture "While genetics appear to influence
  delinquency, social influences such as family,
  friends and school seem to impact the expression
  of certain genetic variants," said Guang Guo, the
  study's lead author and a professor of sociology
  and faculty fellow at the University of North
  Carolina-Chapel Hill's Carolina Population Center
  and Carolina Center for Genomic Sciences.
  "Positive social influences appear to reduce the
  delinquency-increasing effect of a genetic
  variant, whereas the effect of these genetic
  variants is amplified in the absence of social
  controls.""Our research confirms that genetic
  effects are not deterministic," Guo said. "Gene
  expression may depend heavily on the
  environment. Things such as aggressive models,
  TV

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Nature or Biology

• Species-specific Factors
• Aggression protects territory and gets resources
  and is seen often in tribes when the population
  is at capacity or the availability of women
  decreases (yet cooperation also has advantages,
  e.g., wolves hunt in packs, sharing food among
  chimps and whales)
• Individual Difference Factors
• Difficult temperament predict behavioral problems
  at age 3, which can show up as CD at age 5, 8,
  and 10
• Parents of difficult children did not differ in
  practices and interactions initially but became
  more negative over time.

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Cultural Factors School Settings Contribute to
Aggression

• Entering a new situation
• Scarce resources
• Frustration (sibling preferred severe
  punishment/coersion/threat)
• Teacher and peer models, who are aggressive
• Heightened arousal situations of
• competitive activities
• vigorous exercise
• loud noise, lots of people or activity (crowding)

Zentall, 2006
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School Factors

• that contribute to delinquency and low academic
  performance
• Low teacher availability
• Low teacher use of praise
• Low teacher to student ratio

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Contributing Family Factors

• Factors that may develop conduct disorder are
  early maternal rejection, separation from parents
  without an adequate alternative caregiver, family
  neglect, abuse or violence, parental mental
  illness, parental divorce, large family size, and
  crowding and poverty (Foley, 2004, 687).

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Family Factors cont.

• Marital problems in parents (psychopathology
  depression)
• Severe inconsistent of punishment
• Extent of parental disagreement
• Punitive, rejecting, or permissive parents
• Lack of attention to children (neglect)
• Insular mothers more serious behavior problems
  of children
• Low SES increases secondary disorder

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Outcomes--Prognosis

• early and violent death,
• arrest,
• substance abuse and dependence,
• failure to finish high school,
• pregnancy, sexual promiscuity and contraction of
  STDs.
• about 40-50 CD will be adults with antisocial
  personality disorder (Gelhorn, 2005, 581)
• However, research has shown that most children
  and adolescents with conduct disorder do not grow
  up to have behavioral problems or problems with
  the law as adults (Arluke, 1999, 970).

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Accommodations

• Positive social experiences
• Rules must be explicit with consistent
  consequences for misbehavior
• Praise for mundane behaviors to get them to do
  them more often.
• Provide quiet time to unwind and calm down (walk
  in the hall and complain).
• Plan ahead (entering/leaving, resources)

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Related Areas

• ADHD and Aggression
• Gangs

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Family Factors Contributing to Aggression in ADHD

• Fathers
• More physical fights as adolescents
• Half in prison at least once before child 9
• More antisocial, alcoholic, abusing, absent
  fathers than fathers of ADHD without aggression
• Mothers
• More verbal and physical aggression directed
  toward and received from partner
• Parents
• Child rearing strategies retaliation

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Family of ADHD

• Negative Factors
• Disengagement
• Let sleeping dogs lie w/ hectic life style
• Parents punishment, aggression, and high control
  produces
• short term results
• long term failure escalation then disengagement
• High c. aggression little parent monitoring

• Positive Factors
• Overinvolvment
• Mothers over protective less aggression
• Strict mother children higher self-esteem
• Parents self-rated too strict good c. social
  outcomes employment

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Gangs as Replacement Families

• Roles leader, treasurer, thieves, hit men, etc.
• Strict norms clothes, hair styles, colors,
  jargon, symbols (tatoos, logo), codes of honor,
  territory (graffiti)
• Member similarity age, ethnicity, physique,
  intellectual and phyical abilities, personality

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Sample Questions

•  1. Cognitive deficits often contribute to
  antisocial behavior and RD in which group
• ADHD
• ODD
• CD
• 2

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References

• American Psychiatric Association. (1994).
  Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV). (Fourth ed.). Washington
  DC American Psychiatric Association.
• Arluke, A. Levin, J. Luke, C. Asione, F.
  (1999). The Relationship of Animal Abuse to
  Violence and Other Forms of Antisocial Behavior.
  Journal of Interpersonal Violence, 14, 963-975.
• Ascieone, Frank R. (2001). Animal Abuse and
  Youth Violence. Washington, DC U.S. Dept of
  Justice.
• Copur, Mazlum, Turkean, Ahmet. Erdogmus, Meral.
  (2005). Substance Abuse Conduct Disorder and
  Crime Assessment in a Juvenile Detention House
  in Istanbul, Turkey. Psychiatry and Clinical
  Neurosciences, 59, 151-154.
• Foley, Debra L. Pickles, Andrew. Rutter,
  Michael. Gardner, Charles O. Maes, Hermine H.
  Silberg, Judy L. Eaves, Lindon J. (2004).
  Risks for Conduct Disorder Symptoms Associated
  with Parental Alcoholism in Stepfather Families
  versus Intact Families from a Community Sample.
  Journal of Child Psychology and Psychiatry, 45,
  687-696.
• Gelhorn, Heather L. Stallings, Michael C.
  Young, Susan E. Corley, Robin P. Rhee, Soo
  Hyun. Hewitt, John K. (2005). Genetic and
  Environmental Influences on Conduct Disorder
  Symptom, Domain, and Full-Scale Analysis.
  Journal of Child Psychology and Psychiatry, 46,
  580-591. Herbert, Martin. Griffith, Mark. Carr,
  Alan. Guerin, S. Hennessy, E. Maqttis, S.G.
  Olledick, T.G. Heyne, D. Rollings, S. Hollin,
  C.R. Brown, D. Palmer, E. (2004). Book New
  Parent, Adolescent and Child Training Skills
  (PACTS). Child and Adolescent Mental Health, 9,
  92-96.
• Kauffman, James M. (1997). Characteristics of
  Emotional and Behavioral Disorders of Children
  and Youth. New Jersey Merill.
• Kunitz, Stephen J. (2000). Drinking, Conduct
  Disorder, and Social Change Navajo Experiences.
  New York Oxford University Press.
• Paley, Vivian Gussin. Goto, Kazuhiro, Lea,
  Stephen E. G. Snyder, Gabrie, McNary, Dave.
  (2005). One in Ten Children has a Mental
  Disorder. National Statistics, 7, 387-392.
• Von Der Meer, Dirk-Jan. Von Der Meer, Jaap.
  Waldsee, Klinik Am. (2004). Response Inhibition
  in Children with Conduct Disorder and Borderline
  Intellectual Functioning. Child Neurpsychology,
  10, 189-194.
• Wakefield, Jerome C. Kirk, Stuart A. Pottick,
  Kathleen J. Hsieh, Derek K. Tian, Xin. (2006).
  The Lay Concept of Conduct Disorder Do
  Nonprofessionals Use Syndromal Symptoms or
  Internal Dysfunction to Distinguish Disorder from
  Delinquency? Can J Pssychiatry, 51, 210-217.