22 Conduct problems

Question 1

What was found in the Kim-Cohen et al. (2013) 26-year longitudinal study of rates at which childhood disorders preceded adult disorders?

Answer 1

Childhood conduct problems were the most common precursor to adult mental health problems.

Question 2

What are two corollaries of the Kim-Cohen et. al (2013) finding, in their longitudinal study of population of a small town until 26 years old, that conduct disorder are the most common precursor to adult mental health problems?

Answer 2

1. Best time to prevent antisocial behaviour is in childhood.
2. Childhood conduct problems are a mental health issue.

Question 3

What are the 3 externalising disorders in DSM-5?

Answer 3

Attention-deficit/hyperactivity disorder
Oppositional defiant disorder
Conduct disorder

Question 4

What are the 8 symptoms of the A criterion of Oppositional Defiant Disorder?

Answer 4

A. A pattern of negativistic, hostile and defiant behaviour lasting at least 6 months, during which four (or more) of the following are present:

Angry/Irritable Mood

1. Often loses temper
2. Is often touchy or easily annoyed by others
3. Is often angry and resentful

Argumentativeness/defiant behaviour

4. Often argues with adults
5. Often actively defies/refuses to comply with adults’ requests/rules
6. Often deliberately annoys people
7. Often blames others for mistakes/behaviour

Vindictiveness
8. Is often spiteful and vindictive

Question 5

What are the three dimensions of Oppositional Defiant Disorder in the DSM-5?

Answer 5

1. Angry/irritable mood (so strong emotional element)
2. Argumentativeness/defiant behaviour (can exist without 1, but unusual)
3. Vindictiveness

Question 6

What disorders are associated with each dimension of Oppositional Defiant Disorder?

Answer 6

1. Angry/irritable mood dimension –uniquely associated with mood and anxiety disorders
2. Argumentative/defiant dimension –uniquely associated with ADHD
3. Vindictiveness dimension –uniquely associated with callousness; empathic deficits; instrumental aggression

Question 7

What’s the difference between instrumental and reactive aggression?

Answer 7

Instrumental aggression is planned for a purpose

Reactive aggression is a reaction to something undesired –e.g. loss of control, tantrums

Question 8

What are the three severity specifiers for ODD, and how is their new inclusion in DSM-5 justified?

Answer 8

Mild: symptoms confined to only 1 setting
Moderate: Some symptoms present in at least 2 settings
Severe: Some symptoms present in 3 or more settings

Based on evidence that the number of settings the problem is present adds predictive value independent of how often the behaviour is occurring.

Question 9

How is the setting in which symptoms of ODD are present differ from the case of ADHD?

Answer 9

Not unusual to find kid with ODD where symptoms are just in the home. Very different from ADHD –deficits are more stable across contexts.

Question 10

What are the distal and proximal risk factors for conduct problems?

Answer 10

Distal

1. Family adversity (e.g., marital discord, unemployment)
2. Parent problems (e.g. depression, attributional biases - ‘child doing this to annoy me’

Proximal
Disrupted parenting practices (e.g., coercive interactions; monitoring/supervision)

Question 11

How do distal risk factors for conduct problems confer risk on proximal problems?

Answer 11

Distal factors, such as family adversity and attributional biases, confer risk of conduct problems through disrupted parenting practices, such as coercive interactions.

Question 12

Do conduct problems exist independently of a child’s environment?

Answer 12

No, they are highly embedded in the social relationships of a child’s life.

Question 13

What is the dominant causal model of conduct problems?

Answer 13

Patterson’s Coercion Theory (1982)

Question 14

Describe the coercive cycle in Patterson’s Coercion Theory?

Answer 14

1. Parent gives directive
2. Child noncomplies
3. Parent attacks
4. Child counterattacks (positively reinforced - child gets what it wants)
5. Parent withdraws (negatively reinforced - parent avoids unpleasant interaction)

Question 15

In coercive interactions, what percentage of exchanges were found to be in favour of the child?

Answer 15

70%

Question 16

Describe the steps whereby exchanges resolve in favour of the parent in coercive interactions?

Answer 16

... Parent resumes attack
Child noncomplies
Parent escalates
Child escalates
Parent escalates sharply (positively reinforced)
Child complies

Question 17

What do the child and the parent both learn from the coercive cycle?

Answer 17

Child learn that usually gets his way if he reacts. Negative behaviour is reinforced. Positive behaviour is rarely reinforced.

Parent learns that shouting is the only thing that works. Avoids unnecessary interactions; engages with child only when it misbehaves.

Question 18

What happens in coercive cycle over time if unchecked?

Answer 18

The misbehaviours escalate. Family members train each other in coercion. Child becomes more skilled and therefore more difficult to discipline.

Question 19

According to Patterson, the aggressive child is ______ and _________ of the coercive system.

Answer 19

According to Patterson, the aggressive child is victim and architect of the coercive system.

Question 20

The development of which skills might be disrupted by coercive family life?

Answer 20

Coercive patterns disrupt the developmental prerequisites for emerging self-regulation
(internal controls over behaviour / emotion / thinking)

Question 21

In order to develop ____________ a child must first develop the capacity for compliance with _________ ____________.

Answer 21

In order to develop self-regulation a child must first develop the capacity for compliance with external regulation.

Question 22

What might happen to a child who has been through the coercive cycle when it enters school. 3 things

Answer 22

1. Enters school with self-regulation deficits.
2. Social skills deficits (parents have avoided child because difficult).
3. Entrained coercive exchanges generalise to teachers and peers.

Question 23

According to the idea of Deviancy Training, how might antisocial children reinforce antisocial behaviour in each other?

Answer 23

By selectively attending to deviant talk (e.g. reinforced by laughter) and ignoring/punishing prosocial talk (e.g. you’re a homo).

Question 24

Deviancy Training conforms to what behaviourist law?

Answer 24

This process conforms to Skinner’s Matching Law –individual will opt for most reinforced behaviour, and will engage in that behaviour at rate that behaviour has been reinforced.

Question 25

Why can bootcamps be bad for kids with ODD, according to a peer contagion model?

Answer 25

If you stick a lot of antisocial kids together, deviant behaviours can be reinforced and amplified.

Question 26

__-__% of kids with Oppositional Defiant Disorder develop Conduct Disorder, __-__% of whom develop Antisocial Personality Disorder.

Answer 26

40-60% of kids with Oppositional Defiant Disorder develop Conduct Disorder, 30-50% of whom develop Antisocial Personality Disorder

Question 27

What is the A criterion – and the four presentations – of Conduct Disorder in DSM-5?

Answer 27

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following 15 criteria in the past 12 months, with at least one criterion present in the past 6 months: 1. Aggression to people and animals 2. Destruction of property 3. Deceitfulness or theft 4. Serious violations of rules

Question 28

What are the 7 symptoms in the Aggression to People and Animals presentation of Conduct Disorder in DSM-5?

Answer 28

Aggression to people and animals (1) often bullies, threatens, or intimidates others (2) often initiates physical fights (3) has used a weapon that can cause serious physical harm (4) has been physically cruel to people (5) has been physically cruel to animals (6) has stolen while confronting a victim (7) has forced someone into sexual activity

Question 29

What are the two symptoms in the Destruction of Property presentation of Conduct Disorder?

Answer 29

Destruction of property (8) has deliberately engaged in fire setting with the intention of causing serious damage (9) has deliberately destroyed others' property (other than by fire setting)

Question 30

What are the 3 symptoms in the Deceitfulness or Theft presentation of Conduct Disorder?

Answer 30

Deceitfulness or theft (10) has broken into someone else's house, building, or car (11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) (12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting)

Question 31

What are the 3 symptoms in the Serious Violations of Rules presentation of Conduct Disorder?

Answer 31

(13) often stays out at night despite parental prohibitions, beginning before age 13 years (14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) (15) is often truant from school, beginning before age 13

Question 32

What age of onset subtyping accompanies Conduct Disorder?

Answer 32

Childhood onset type – onset of at least one criterion characteristic of CD prior to age 10 Adolescent onset type – absence of any criteria characteristic of CD prior to age 10

Question 33

Antisocial behaviour in teenage years can be divided into two groups on which grounds?

Answer 33

Adolescence-limited Life-course persistent Those whose AS behaviour continues into adulthood are usually those whose AS behaviour originated in early life.

Question 34

Compare the risk factors that predict Childhood-Onset Conduct Disorder with those for Adolescent-Onset Conduct Disorder?

Answer 34

Childhood-Onset type: - Neurocognitive risk factors – e.g., executive function deficits, low verbal IQ - Temperamental/personality risk factors (e.g., impulsivity and problems in emotional regulation) - Coercive parent-child dynamics Adolescent-Onset type: No such risk factors – "an exaggeration of the normative processes of adolescent rebellion"

Question 35

What is the specifier in Conduct Disorder for Limited Prosocial Emotions? Include the four characteristics

Answer 35

To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings. Lack of remorse or guilt – doesn't feel bad when done sth wrong Callous - lack of empathy – unconcerned about feelings of others Unconcerned about performance – e.g., at school Shallow or deficient affect – can switch on or off, uses for gain

Question 36

Which presentation of Conduct Disorder is most associated with the specifier 'with limited prosocial emotions'?

Answer 36

Childhood onset Severity specificity rating of severe

Question 37

What was the 'with limited prosocial emotions' specifier formally known as?

Answer 37

Psychopathic traits, then Callous-unemotional traits, then Limited prosocial emotions

Question 38

What patterns of behaviour are associated with having low CU traits vs. high CU traits?

Answer 38

Low CU traits Less severe and chronic Reactive aggression High CU traits More severe and chronic Instrumental aggression

Question 39

What percentage of children with Conduct Disorder meet the limited prosocial emotions specifier?

Answer 39

32% in community samples | 50% in clinic referrals

Question 40

What different causal processes may underlie low CU traits vs. high CU traits?

Answer 40

Low CU traits - Emotionally dysregulated - Overreactive to emotional cues - Executive function deficits High CU traits - Fearless and uninhibited temperament affecting conscience development

Question 41

What is the difference in ability to recognise emotional cues between children with Conduct Disorder AND CU traits compared to those with ONLY Conduct Disorder?

Answer 41

Children only with conduct problems see emotion when faces are actually neutral. They see threat in its absence. Children with CU are fine at recognising neutral faces as neutral. They have trouble recognising fear and distress cues.

Question 42

What characterises the sensitivity to punishment and reward of kids with Conduct Disorder with CU traits?

Answer 42

They are hypersensitive to reward cues and insensitive to punishment cues.

Question 43

What neurological structures are associated with CU traits in boys?

Answer 43

Increased grey matter in boys with CU traits in medial orbitofrontal and anterior cingulate cortex. Delays in cortical maturation in brain region implicated in decision-making, morality and empathy.

Question 44

What is different about the amygdala functioning of boys with CU traits?

Answer 44

Reduced amygdala reactivity and connectivity in response to emotional (fear) stimuli

Question 45

How does the heritability of conduct problems differ for those with and without CU traits?

Answer 45

Low CU traits Moderate genetic and environmental influence. h2g = .30 High CU traits Extremely strong genetic influence; minimal environmental influence. h2g = .81

Question 46

How do CU traits moderate the links between parenting (coercion and warmth) and conduct problems?

Answer 46

Coercive parenting is more strongly positively associated with conduct problems in boys with lower levels of CU traits Parental warmth was more strongly negatively associated with conduct problems in boys with higher levels of CU traits