Conduct disorder

Readings

Wenar, C. & Kerig, P. (2000)“ Wenar, C. & Kerig, P. (2000)“ Conduct disorder and the Conduct disorder and the devlopment of antisocial devlopment of antisocial behaviour” in behaviour” in Developmental Developmental Psychopathology Psychopathology (pp. 189-210). (pp. 189-210). Singapore: McGraw-HillSingapore: McGraw-Hill

Lecture Questions

What is Conduct Disorder and how does What is Conduct Disorder and how does it affect children/adolescents lives?it affect children/adolescents lives?

What are the diagnostic issues related What are the diagnostic issues related to Conduct Disorder?to Conduct Disorder?

What is the developmental picture and What is the developmental picture and course in Conduct Disorder?course in Conduct Disorder?

What are some of the social issues What are some of the social issues related to Conduct Disorder?related to Conduct Disorder?

Conduct Disorder in Popular Culture

Overview Another externalising problemAnother externalising problem Impacts on all rings of the social context Impacts on all rings of the social context

web- young person, family, school, web- young person, family, school, communitycommunity

NZ prevalence 3.4% age 11, 7.3% age 15, NZ prevalence 3.4% age 11, 7.3% age 15, 5.5% age 185.5% age 18

More prevalent in clinical samples, around a More prevalent in clinical samples, around a third to a half of all child and adolescent third to a half of all child and adolescent casescases

Comorbidity with ADHD, ODD, learning Comorbidity with ADHD, ODD, learning disorders, depressiondisorders, depression

Gender issues

Ratio 3:1, more diagnosed in boysRatio 3:1, more diagnosed in boys Research biased to study of boysResearch biased to study of boys DSM criteria differences and DSM criteria differences and

presentation differencespresentation differences Girls CD patterns more likely to begin in Girls CD patterns more likely to begin in

adolescenceadolescence Girls >comorbidity-depression, anxietyGirls >comorbidity-depression, anxiety Influence of developmental factorsInfluence of developmental factors Influence of how gender constructedInfluence of how gender constructed

Factors in drawing the line

Context for the behaviour, Context for the behaviour, adaptation or mental disorder?adaptation or mental disorder?

Seriousness of rule violationsSeriousness of rule violations Frequency, intensity, endurability, Frequency, intensity, endurability,

pervasivenesspervasiveness Age appropriateness of rule Age appropriateness of rule

violationsviolations

Rule violation developmental picture

Pre-school aggression to other children, Pre-school aggression to other children, disobedient to parentsdisobedient to parents

School age classroom disruption, unco-School age classroom disruption, unco-operative in playground, defiant at homeoperative in playground, defiant at home

Adolescence delinquent peers, violating Adolescence delinquent peers, violating the law, ignoring parental discipline, the law, ignoring parental discipline, failing in schoolfailing in school

Rule violation ‘normal’ in adolescenceRule violation ‘normal’ in adolescence Childhood behaviour better predictor of Childhood behaviour better predictor of

adult antisocial behaviour than adult antisocial behaviour than adolescent behaviouradolescent behaviour

DSM Criteria

Aggression to people and animals (cruelty, Aggression to people and animals (cruelty, bullying, fights, forced sex, mugging)bullying, fights, forced sex, mugging)

Destruction of property (fire-setting and Destruction of property (fire-setting and other ways)other ways)

Deceitfulness or theft (breaking & Deceitfulness or theft (breaking & entering, ‘conning’, stealingentering, ‘conning’, stealing

Serious rule violations (staying out at Serious rule violations (staying out at night, running away, truanting)night, running away, truanting)

Repetitive, persistent, violation of others Repetitive, persistent, violation of others rights or social norms, at least three in rights or social norms, at least three in each categoryeach category

Types of Conduct Disorder

Childhood onsetChildhood onset Overt aggressionOvert aggression Physical violencePhysical violence Multiple problemsMultiple problems More common in malesMore common in males PersistentPersistent Better predictor of antisocial behaviour in Better predictor of antisocial behaviour in

adulthood adulthood

Types of Conduct Disorder

Adolescent onsetAdolescent onset Less severe behaviour Less severe behaviour

problemsproblems Less complex problemsLess complex problems Less violent crimeLess violent crime

Different childhood temperaments Different childhood temperaments (‘difficult’ for child type, emotional (‘difficult’ for child type, emotional detachment for adolescentdetachment for adolescent

sub-types

Two behavioural dimensions:Two behavioural dimensions: Destructiveness- Destructiveness- (a)(a)those that harm those that harm

others and others and (b)(b)those that violate those that violate rulesrules

Overtness- Overtness- (c) (c) those that lie, steal those that lie, steal (covert) and (covert) and (d)(d)those that bully, fightthose that bully, fight

Subtypes- oppositional Subtypes- oppositional (b&d)(b&d), , aggressive aggressive (a&d)(a&d), property violations , property violations (a&c)(a&c), status violations , status violations (b&c)(b&c)

Frick et al. (1993)

Children who kill

1950s ‘Heavenly Creatures’1950s ‘Heavenly Creatures’ Mark and Luke ReihanaMark and Luke Reihana Bailey Junior KurarikiBailey Junior Kurariki

Children who kill-psychopaths?

Antisocial behaviour-associated with Antisocial behaviour-associated with impulsivity and conduct problemsimpulsivity and conduct problems

Psychopathy associated with Psychopathy associated with callousness, lack of empathy and callousness, lack of empathy and emotionemotion

Psychopathy linked with violence of Psychopathy linked with violence of offendingoffending

Different pathwaysDifferent pathways

Developmental course

At age 3, aggressive, temper At age 3, aggressive, temper tantrums, torturing the family cat, tantrums, torturing the family cat, destroying property, no playmatesdestroying property, no playmates

In the school years, academic In the school years, academic deficienciesdeficiencies

As a teenager, poor interpersonal As a teenager, poor interpersonal skills, high peer rejectionskills, high peer rejection

50% of children diagnosed with CD 50% of children diagnosed with CD will develop anti-social personality as will develop anti-social personality as adults (Kazdin)adults (Kazdin)

Risk factors-child/adolescent

Prematurity, low birth weight, anoxia, Prematurity, low birth weight, anoxia, medical stresses at birth (interact with medical stresses at birth (interact with family factors)family factors)

No substantial evidence for genetic factorsNo substantial evidence for genetic factors Temperament (emotionality, activity level, Temperament (emotionality, activity level,

sociability) –’difficult’sociability) –’difficult’ Frontal lobe deficits-inability to plan or Frontal lobe deficits-inability to plan or

redirect potentially harmful behaviour and redirect potentially harmful behaviour and learn from negative consequenceslearn from negative consequences

Problems with self-controlProblems with self-control

Risk factors-parents

Alcoholism/substance abuseAlcoholism/substance abuse history of parent criminalityhistory of parent criminality psychiatric problems, especially psychiatric problems, especially

antisocial personality disorderantisocial personality disorder

Risk factors- family system harsh parenting or lax parenting, poor harsh parenting or lax parenting, poor

supervision, inconsistency, ‘coercion’supervision, inconsistency, ‘coercion’ low attachment, warmthlow attachment, warmth less supportive and more defensive less supportive and more defensive

communicationcommunication dominance of one family memberdominance of one family member low stress threshold, stress related to low stress threshold, stress related to

significant othersignificant other exposure to violence, abuse, neglect- exposure to violence, abuse, neglect-

increase risk from 5% to 20%increase risk from 5% to 20%

Risk factors-social

large family size, overcrowding, large family size, overcrowding, untoward living conditionsuntoward living conditions

poor housingpoor housing disadvantaged school settingdisadvantaged school setting financial hardshipfinancial hardship adversarial contact with an outside adversarial contact with an outside

agencyagency

NZ dataFergusson et al. (Christchurch Development Fergusson et al. (Christchurch Development

Study) Study) social and material disadvantagesocial and material disadvantage parental criminality, substance abuse and parental criminality, substance abuse and

other adjustment problemsother adjustment problems impaired parenting and lower standards of impaired parenting and lower standards of

child carechild care family instability, change and marital family instability, change and marital

conflictconflictOne risk factor in itself not predictive, the One risk factor in itself not predictive, the

greater the number, the more likely anti-greater the number, the more likely anti-social career from early age escalating in social career from early age escalating in seriousnessseriousness

Peers factors

Peer rejection in early childhood Peer rejection in early childhood Association with ‘deviant’ or Association with ‘deviant’ or

antisocial peer group (especially antisocial peer group (especially adolescence)adolescence)

Girls with older boyfriendsGirls with older boyfriends

Societal factors

Media violence and tolerance for Media violence and tolerance for violenceviolence

Neighbourhood violence Neighbourhood violence School ‘climates’School ‘climates’ Constructions of genderConstructions of gender

Buffers or protective factors Being a girl Being a girl Being very intelligentBeing very intelligent Having a positive social orientationHaving a positive social orientation Having a resilient temperamentHaving a resilient temperament Having warm, supportive affective Having warm, supportive affective relationships with family or other adultsrelationships with family or other adults Being committed to values of school or Being committed to values of school or other social institutionother social institution Family and community norms opposed to Family and community norms opposed to crime and violence & supportive of crime and violence & supportive of educational success and healthy educational success and healthy

developmentdevelopment