Flashcards in 22 Conduct problems Deck (46):
What was found in the Kim-Cohen et al. (2013) 26-year longitudinal study of rates at which childhood disorders preceded adult disorders?
Childhood conduct problems were the most common precursor to adult mental health problems.
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?
1. Best time to prevent antisocial behaviour is in childhood.
2. Childhood conduct problems are a mental health issue.
What are the 3 externalising disorders in DSM-5?
Oppositional defiant disorder
What are the 8 symptoms of the A criterion of Oppositional Defiant Disorder?
A. A pattern of negativistic, hostile and defiant behaviour lasting at least 6 months, during which four (or more) of the following are present:
1. Often loses temper
2. Is often touchy or easily annoyed by others
3. Is often angry and resentful
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
8. Is often spiteful and vindictive
What are the three dimensions of Oppositional Defiant Disorder in the DSM-5?
1. Angry/irritable mood (so strong emotional element)
2. Argumentativeness/defiant behaviour (can exist without 1, but unusual)
What disorders are associated with each dimension of Oppositional Defiant Disorder?
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
What's the difference between instrumental and reactive aggression?
Instrumental aggression is planned for a purpose
Reactive aggression is a reaction to something undesired – e.g. loss of control, tantrums
What are the three severity specifiers for ODD, and how is their new inclusion in DSM-5 justified?
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.
How is the setting in which symptoms of ODD are present differ from the case of ADHD?
Not unusual to find kid with ODD where symptoms are just in the home. Very different from ADHD – deficits are more stable across contexts.
What are the distal and proximal risk factors for conduct problems?
1. Family adversity (e.g., marital discord, unemployment)
2. Parent problems (e.g. depression, attributional biases - 'child doing this to annoy me'
Disrupted parenting practices (e.g., coercive interactions; monitoring/supervision)
How do distal risk factors for conduct problems confer risk on proximal problems?
Distal factors, such as family adversity and attributional biases, confer risk of conduct problems through disrupted parenting practices, such as coercive interactions.
Do conduct problems exist independently of a child's environment?
No, they are highly embedded in the social relationships of a child's life.
What is the dominant causal model of conduct problems?
Patterson's Coercion Theory (1982)
Describe the coercive cycle in Patterson's Coercion Theory?
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)
In coercive interactions, what percentage of exchanges were found to be in favour of the child?
Describe the steps whereby exchanges resolve in favour of the parent in coercive interactions?
... Parent resumes attack
Parent escalates sharply (positively reinforced)
What do the child and the parent both learn from the coercive cycle?
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.
What happens in coercive cycle over time if unchecked?
The misbehaviours escalate. Family members train each other in coercion. Child becomes more skilled and therefore more difficult to discipline.
According to Patterson, the aggressive child is ______ and _________ of the coercive system.
According to Patterson, the aggressive child is victim and architect of the coercive system.
The development of which skills might be disrupted by coercive family life?
Coercive patterns disrupt the developmental prerequisites for emerging self-regulation
(internal controls over behaviour / emotion / thinking)
In order to develop ____________ a child must first develop the capacity for compliance with _________ ____________.
In order to develop self-regulation a child must first develop the capacity for compliance with external regulation.
What might happen to a child who has been through the coercive cycle when it enters school. 3 things
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.
According to the idea of Deviancy Training, how might antisocial children reinforce antisocial behaviour in each other?
By selectively attending to deviant talk (e.g. reinforced by laughter) and ignoring/punishing prosocial talk (e.g. you're a homo).
Deviancy Training conforms to what behaviourist law?
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.
Why can bootcamps be bad for kids with ODD, according to a peer contagion model?
If you stick a lot of antisocial kids together, deviant behaviours can be reinforced and amplified.
__-__% of kids with Oppositional Defiant Disorder develop Conduct Disorder, __-__% of whom develop Antisocial Personality Disorder.
40-60% of kids with Oppositional Defiant Disorder develop Conduct Disorder, 30-50% of whom develop Antisocial Personality Disorder
What is the A criterion – and the four presentations – of Conduct Disorder in DSM-5?
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
What are the 7 symptoms in the Aggression to People and Animals presentation of Conduct Disorder in DSM-5?
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
What are the two symptoms in the Destruction of Property presentation of Conduct Disorder?
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)
What are the 3 symptoms in the Deceitfulness or Theft presentation of Conduct Disorder?
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)
What are the 3 symptoms in the Serious Violations of Rules presentation of Conduct Disorder?
(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
What age of onset subtyping accompanies Conduct Disorder?
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
Antisocial behaviour in teenage years can be divided into two groups on which grounds?
Those whose AS behaviour continues into adulthood are usually those whose AS behaviour originated in early life.
Compare the risk factors that predict Childhood-Onset Conduct Disorder with those for Adolescent-Onset Conduct Disorder?
- 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
No such risk factors – "an exaggeration of the normative processes of adolescent rebellion"
What is the specifier in Conduct Disorder for Limited Prosocial Emotions? Include the four characteristics
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
Which presentation of Conduct Disorder is most associated with the specifier 'with limited prosocial emotions'?
Severity specificity rating of severe
What was the 'with limited prosocial emotions' specifier formally known as?
Psychopathic traits, then
Callous-unemotional traits, then
Limited prosocial emotions
What patterns of behaviour are associated with having low CU traits vs. high CU traits?
Low CU traits
Less severe and chronic
High CU traits
More severe and chronic
What percentage of children with Conduct Disorder meet the limited prosocial emotions specifier?
32% in community samples
50% in clinic referrals
What different causal processes may underlie low CU traits vs. high CU traits?
Low CU traits
- Emotionally dysregulated
- Overreactive to emotional cues
- Executive function deficits
High CU traits
- Fearless and uninhibited temperament affecting conscience development
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?
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.
What characterises the sensitivity to punishment and reward of kids with Conduct Disorder with CU traits?
They are hypersensitive to reward cues and insensitive to punishment cues.
What neurological structures are associated with CU traits in boys?
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.
What is different about the amygdala functioning of boys with CU traits?
Reduced amygdala reactivity and connectivity in response to emotional (fear) stimuli
How does the heritability of conduct problems differ for those with and without CU traits?
Low CU traits
Moderate genetic and environmental influence. h2g = .30
High CU traits
Extremely strong genetic influence; minimal environmental influence. h2g = .81