Conduct Disorder


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Conduct Disorder

  1. 1. Conduct Disorder<br />John Carmichael<br />Abnormal Psychology<br />
  2. 2. Conduct Disorder<br />Objectives<br />Know what Conduct Disorder is <br />Why it’s important<br />Significant facts regarding this disorder<br />
  3. 3. Conduct Disorder<br />Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as &quot;bad&quot; or delinquent, rather than mentally ill.<br />
  4. 4. DSM IV Categories<br />Within the DSM IV, Conduct Disorder is placed in the category of Attention-Deficit and Disruptive Behavior Disorders. <br />This category is defined in the DSM IV as a set of externalizing negative behaviors that co-occur during childhood<br />Oppositional Defiant Disorder (ODD), is defined as &quot;a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures&quot;. <br />Attention-Deficit/Hyperactivity Disorder (ADHD), is defined as a “Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.”<br />
  5. 5. Conduct Disorder<br />Definition:<br />The essential features of Conduct Disorder (CD)involve “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated”, resulting in a clinically significant impairment in functioning. <br />This includes<br />aggressive behaviors, <br />behaviors that result in property loss or damage,<br />deceitfulness or theft, <br />other serious rule violations (e.g., running away from home, truancy). <br />
  6. 6. DSM IV Conduct Disorder Criteria<br />For 12 months or more has repeatedly violated rules, age-appropriate societal norms or the rights of others.<br />Shown by 3 or more of the following, with at least one of the following occurring in the past 6 months:<br />Aggression against people or animals<br />Frequent bullying or threatening<br />Often starts fights<br />Used a weapon that could cause serious injury<br />Physical cruelty to people<br />Physical cruelty to animals<br />Theft with confrontation <br />Forced sex upon someone<br />
  7. 7. DSM IV Conduct Disorder Criteria<br />Property destruction <br />Deliberately set fires to cause serious damage<br />Deliberately destroyed the property of others (except fire-setting)<br />Lying or theft<br />Broke into building, car or house belonging to someone else<br />Frequently lied or broke promises for gain or to avoid obligations (&quot;conning&quot;)<br />Stole valuables without confrontation (burglary, forgery, shoplifting)<br />
  8. 8. DSM IV Conduct Disorder Criteria<br />Serious rule violation <br />Beginning by age twelve, frequently stayed out at night against parents&apos; wishes<br />Runaway from parents overnight twice or more (once if for an extended period)<br />Frequent truancy before age 13<br />These symptoms cause clinically important job, school or social impairment. <br />If older than age 18, the patient does not meet criteria for Antisocial Personality Disorder. <br />
  9. 9. DSM IV Conduct Disorder Criteria<br />Childhood-Onset Type:at least one problem with conduct before age 10<br />Adolescent-Onset Type: no problems with conduct before age 10<br />Note. Age of onset subtypes have been supported using trajectory analyses in longitudinal cohorts by finding that those with childhood-onset type typically continue to meet criteria up to their late 20’s (Mofitt, 2007)<br />Severity:<br />Mild (both are required):There are few problems with conduct more than are needed to make the diagnosis, and Problems cause little harm to others.<br />
  10. 10. DSM IV Conduct Disorder Criteria<br />Severity: (cont.)<br />Moderate. Number and effect of conduct problems is between Mild and Severe<br />Severe. Many more conduct symptoms than are needed to make the diagnosis, orSymptoms cause other people considerable harm.<br />
  11. 11. Distinctions between Disorders<br />Diagnosis of ODD and CD have tested and proven differences<br />Subjecting gathered data to multidimensional scaling techniques resulted in some significant findings which has helped narrow the focus of study regarding behaviors associated with CD<br />oppositional defiant and aggressive characteristics were located on one end of the dimension (overt symptoms).<br />Substance use and other non-aggressive conduct disorder symptoms were located on the other (covert symptoms).<br />Behavior directed towards property or persons in a destructive way was located on one of the dimension (destructive behavior).<br />Behavior on the opposite end were non-destructive such as substance abuse, status offenses (non-destructive behavior).<br />
  12. 12. Distinctions between Disorders<br />These findings provide general support for the distinction between oppositional defiant and conduct disorder.<br />They also suggest that conduct problems may be more meaningfully grouped into four, rather than two, general categories. <br />These include<br />overt & nondestructive behaviors reflecting symptoms of ODD<br />overt & destructive symptoms of aggression<br />covert & destructive behaviors, such as lying and stealing<br />covert & nondestructive behaviors such as truancy and running away from home (status offenses)<br />
  13. 13. Four Dimensions of Conduct Disordered Behavior<br />OVERT/DESTRUCTIVE<br />(Aggressive Behaviors)<br />Fights <br />Bullies<br />Assault<br />Spiteful<br />
  14. 14. Four Dimensions of Conduct Disordered Behavior<br />OVERT/NONDESTRUCTIVE<br />(Oppositional Features)<br />Annoys<br />Defies<br />Stubborn<br />Angry<br />COVERT/DESTRUCTIVE COVERT/NONDESTRUCTIVE<br />(Property Violations) (Status Offenses)<br /> Cruel to Animals Runaway<br /> Vandalism Truancy<br /> Steals Substance Use<br /> Fire setting Breaks Rules<br />
  15. 15. Under the Umbrella of Conduct Disorder<br />However defined, the general term conduct disorder refers to a heterogeneous groupof problem behaviors.<br />Some are aversive, disruptive and problematic for parents and teachers.<br />Others involve aggression toward property or persons.<br />Others involve actual violations of the law which might result in the child being labeled as delinquent if the behavior were to come to the attention of legal authorities. <br />
  16. 16. Delinquency: A Definition<br />Delinquency is a legal term rather than a psychological construct. <br />It refers to a juvenile (usually under 18 years) who is brought to the attention of the juvenile justice system for committing a criminal act or displaying a variety of other behaviors not specified under criminal law. <br />These &quot;other behaviors&quot;, are usually referred to as status offenses. <br />They include truancy, curfew violations, running away from home and the use of alcohol.<br />These are only violations of the law as a result of the child&apos;s age and his/her status as a minor. <br />
  17. 17. What follows Conduct Disorder<br />Antisocial Personality Disorder<br />Note: Antisocial is used under a technical definition<br />“Pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”<br />For diagnosis, must have a history of some Conduct Disorder symptoms before age 15.<br />Not actually diagnosed prior to age 18.<br />
  18. 18. Etiological Factors in Childhood Conduct Disorder<br />While the etiology of Conduct disorder is not fully understood it has been shown to be related to a range of psychosocial factors including;<br />living in environments with high crime rates.<br />marital conflict & broken homes, <br />dysfunctional and rejecting family environments, <br />inconsistent and severe discipline, <br />Physical and sexual abuse<br />social learning experiences (e.g., the learning of problem behavior through observation and/or its reinforcement by parents, siblings and others).<br />
  19. 19. Etiological Factors in Childhood Conduct Disorder<br />While a range of factors has been implicated in the development of conduct disorders, no one factor has been determined to be “the cause”.<br />Each of the factors listed here may contribute to conduct disordered and delinquent behavior in some instances.<br />It’s likely that there are numerous possible combinations of contributing variables that can result in the clinical manifestations of these disorders.<br />
  20. 20. Coercive Family Behavior and Conduct Problems <br />Conduct problems has been strongly associated with ongoing patterns of coercive parent-child interactions that are characterized by;<br />Escalating parent and child demands,<br />Escalating negative consequences<br />Where the person who dispenses the most negative consequence “wins”.<br />Problems with “winning the battle” while “losing the war”.<br />
  21. 21. Treatment of Conduct Disorder<br />Treatment of children and adolescents who have Conduct Disorder has frequently been carried out in institutions or within community based programs. <br />Research suggests that treatment within the context of standard institutional programs is often unsuccessful, with a 70-80% rate of recidivism. <br />
  22. 22. Treatment of Conduct Disorder<br />Use of multiple forms of treatment, using a combination of family-systems therapy, child-focused therapy, and Multi-systemic therapy has had modest success<br />Research suggests that treatment within the context of standard institutional programs is often unsuccessful, with a 70-80% rate of recidivism. <br />
  23. 23. Conclusion<br />Treat your kids well and most likely you won’t have a child with Conduct Disorder.<br />Understanding Conduct Disorder and the associated symptoms and causes will help you if you ever want to have kids, or work with kids.<br />
  24. 24. Questions and Discussion<br />