Disruptive Behaviour Disorders

Question 1

Core Features

Answer 1

Age-inappropriate actions and attitudes that violate family expectations, societal norms, and personal or property rights of others. Problems in the self-control of emotions and behaviours. 2 diagnoses: Oppositional Defiant Disorder (ODD), Conduct Disorder (CD).

Question 2

Oppositional Defiant Disorder (ODD)

Answer 2

A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of categories, and exhibited during interaction with at least one individual who is not a sibling.

Question 3

ODD: Negative affect (Angry-irritable mood)

Answer 3

1) Often loses temper
2) Is often touchy or easily annoyed
3) Is often angry or resentful

Question 4

ODD: Defiant/headstrong behaviour

Answer 4

4) Often argues with adults / authority figures
5) Often actively defies to comply with requests from adults or with rules
6) Often deliberately annoys others
7) Often blames others for his or her mistakes or misbehaviour

Question 5

ODD: Hurtful Behaviour (Vindictiveness)

Answer 5

8) Has been spiteful or vindictive at least twice in the last 6 months

Question 6

ODD Diagnostic Criteria

Answer 6

Four of the behaviours are present. For children younger than 5, behaviour should be occurring on most days for a period of at least six months. For children older than 5, the behaviour should be occurring at least once a week for a period of six months. Child has to be engaging in behaviour more than is normative for children of their developmental level, gender, & culture.

Question 7

ODD Diagnostic Criteria: mild, moderate, severe.

Answer 7

Mild: Occurs in only one setting.
Moderate: Some symptoms present in at east 2 settings
Severe: Some symptoms present in three or more settings

Question 8

ODD: Siblings

Answer 8

Fighting between siblings is common. But there is evidence that sibling aggression is harmful. Sibling conflict, hostility, and negativity uniquely predict greater emotional and behavioural problems over time. Conflict with siblings may lead to maladaptive behaviour problem in other relationships.

Question 9

Assessment of ODD

Answer 9

Interviews and Checklists. Observation: Disruptive Behaviour Diagnostic Observation Schedule

Question 10

Assessment of ODD: Disruptive Behaviour Diagnostic Observation Schedule (DB-DOS)

Answer 10

Preschoolers interacting in 3 contexts: with an interactive examiner, with a busy examiner, with their parent. Examiner presses a kid to elicit disruptive behaviour. Tests their frustration tolerance, compliance or likelihood of rule-breaking.

Question 11

Conduct Disorder (CD)

Answer 11

A repetitive and persistent pattern of violating basic rights of others and/or age-appropriate societal norms or rules. 15 symptoms, need 3 in past year, 1 in past 6 months.

Question 12

Conduct Disorders: Specifiers

Answer 12

Onset: Childhood onset. Onset of at least one symptom before age 10. Adolescent-onset.

Question 13

Conduct Disorder: Mild

Answer 13

Few if any symptoms one excess of those required to meet diagnostic criteria, symptoms are causing mild impairment and harm to others (e.g. lying, truancy).

Question 14

Conduct Disorder: Moderate

Answer 14

Number of conduct problems and impact on others is in between mild and sever (e.g. vandalism, stealing without confronting a victim).

Question 15

Conduct Disorder: Severe

Answer 15

Many conduct problems in excess of those required to make a diagnosis are present, or the behaviours are causing serious harm (e.g. forcing someone into sexual activity, use of a weapon).

Question 16

Questioning 3 Symptom cutoff - Lindheim et al., 2015

Answer 16

Study looking at all of the different potential combination of symptoms, and how sever different combinations are. Each dot on graph is a different symptom combination. There are certain combinations of 2 symptoms that are more severe than certain combinations of 3 symptoms. If cutoff stays 3, we might be missing some high severity people who happen to be right below the cutoff.

Question 17

CD: Additional Specific (new to DSM5) - ‘Limited prosocial emotions’

Answer 17

With ‘limited prosocial emotions’ specifier. Two of the following characteristics persistently present over the last 12 months, and in multiple relationships and settings. Lack of remorse or guilt, lack of empathy, unconcerned about performance, shallow or deficient affect. Thes are callous and unemotional (CU) traits.

Question 18

CU Traits

Answer 18

2% to 6% of youth with CD have significant CU traits. When youth have CU traits, CD is earlier onset, aggression is more severe and more instrumental. CU associated with insensitivity to punishment - harder to treat.

Question 19

Conduct Disorder and ODD

Answer 19

In DSM-IV, CD subsumed ODD. In DSM-5, they can be diagnosed at the same time. Nearly half of al children with CD have not been diagnosed with ODD. ~50% of children with ODD do not progress to more severe CD. Some do - may start with ODD diagnosis then add CD with age.

Question 20

Prevalence of CD and ODD

Answer 20

Cultural and contextual differences. Strongly associated with poverty. Strongly associated with exposure to violence.

Question 21

Poverty and Disruptive Behaviour Disorder: Social Causation & Social Selection

Answer 21

Social causation: Stress of poverty leads to an increase in childhood psychopathology. Social selection: Families with genetic predisposition drift down towards poverty.

Question 22

Poverty and Disruptive Behaviour Disorder: Great Smoky Mountain Study

Answer 22

Longitudinal Study of epidemiology of childhood psychiatric disorder. Significant positive association between poverty and disruptive behaviour Sample included a significant number of indigenous youth, many of whom lived in a reservation. Partway through the study, a casino opened on the reservation. All indigenous participants’ families got a stipend. Led to 3 groups: persistently poor, ex-poor, never poor. Naturally-occurring experiment allowed for test of 2 competing theories: 1. Social causation theory: increase in income should reduce children’s symptoms. 2. Social selection theory: Increase in income should have effect on children’s symptoms. Youth whose families were no longer poor due to the stipend from the casino reported decrease in disruptive behaviours. Results support social causation theory.

Question 23

Great Smoky Mountain Study: Why is Poverty Associated with Disruptive Behaviour Problems?

Answer 23

Follow-up analysis examined possible mediators of the association between increase in income and decrease in behaviours symptoms. Fount that increased parental supervision fully mediated relationship. Increased income –> Improved parental supervision –> Fewer disruptive behaviour problems.

Question 24

Gender and Disruptive behaviour Disorders

Answer 24

Conduct problems are 2-4 times more common in male children. Smaller differences in early teens. Boys are more physically aggressive than are girls, across the lifespan. Relational aggression: among girls, this is more common than physical aggression. Available evidence suggests that gris engage in slight more rational aggression than do boys, but the difference is small and not meaningful. Boys’ antisocial behaviour is more overt, may get them noticed at an early age

Question 25

ODD/CD & Comorbid Psychopathology

Answer 25

ADHD: 35% of youth with ODD also have ADHD. More than 50% of children with CD also have ADHD. Depression and anxiety: About 50% of children with ODD and CD also have depression or anxiety.

Question 26

Correlates of ODD/CD

Answer 26

Cognitive and verbal challenges. Academic functioning. Antisocial Personality Disorder. Family functioning. Peer problems. Boys with conduct problems are 3 to 4 times more likely to die before the age of 30.

Question 27

Developmental course of DBDs

Answer 27

Infants: Difficult temperament. Fussy, irritable, hard to soothe. Some evidence that this is linked to later ODD in boys. Preschoolers: Two diagnostic challenges: 1. Impossible or improbable symptoms: Truancy, staying out all night.

Question 28

DBD in Preschoolers

Answer 28

Normative misbehaviour: Non-compliance, temper loss, and aggression are common. Children's physical aggression increases until 27 months of age. Misbehaviour is normative for many preschoolers and will decrease with age. For some, misbehaviour is an indicator of significant behavioural and emotional dysregulation that will escalate with time if left untreated.

Question 29

DBD in Preschoolers: Diagnostic Challenges

Answer 29

How do we distinguish "typical" misbehaviour from that represent a significant problem: Frequency, severity, flexibility, expectability, pervasiveness.

Question 30

DBD Developmental Course - Early-onset/life-course consistent pathway.

Answer 30

At least one symptom before age 10. 10:1 female ratio. 50% persist in antisocial behaviour into adulthood. Aggression in childhood. Less serious nonaggressive antisocial behaviour in middle-childhood. More serious delinquency in adolescence. Diversification.

Question 31

DVD Developmental Course: Late-onset / 'adolescent-limited'

Answer 31

Onset in adolescence, frequently with social change: peer influences. 2:1 or 1:1 male to female ratio. Less extreme antisocial behaviour. Less likely to commit violent offences. Less likely to persist.

Question 32

Snares

Answer 32

Outcomes of antisocial behaviour that put people on a problematic path. Unplanned pregnancy, dropping out of school etc.

Question 33

Heritability of Disruptive Behaviour Problems

Answer 33

Adoption and twin studies indicate that 50% or more of the variance in antisocial behaviour is hereditary.

Question 34

Pregnancy and birth factors

Answer 34

Low birth weight. Malnutrition (possible protein deficiency) during pregnancy. Lead poisoning. Mother's use of nicotine, marijuana, and other substances during pregnancy. Maternal alcohol use during pregnancy.

Question 35

Genotype x Maltreatment Interaction in the Development of Antisocial Behaviour

Answer 35

Childhood maltreatment is universal risk factor for antisocial behaviour - but most people who are maltreated do not develop severe anti-social behaviour. It may be that vulnerability to adversities is conditional, depending on genetic factors - MAOA is an enzyme that metabolizes neurotransmitters such as dopamine and norepinephrine (makes them inactive). Relationships between maltreatment and antisocial behaviour is stronger for those with low MAOA activity.

Question 36

Parenting and Disruptive Behaviour Problems (Caspi et al.)

Answer 36

Caspi et al. examined associations between maltreatment and antisocial behaviour. Maltreatment is a risk factor for disruptive behaviour problems and other types of psychopathology. Negative parenting behaviours that do not constitute abuse are also associated with disruptive behaviour problems.

Question 37

Coercion Theory (conditioning principles)

Answer 37

Cycle of increasingly negative interactions. Delay/escape strategies and demands by child. Cycle continues if parental reactions are either met with anger or if the parent is inconsistent in their behaviour. Inconsistent response reinforces the kid not doing the chore in the first place. Parenting behaviours are associated with an increase in disruptive behaviour problems.

Question 38

Social information procesing

Answer 38

A series of cognitive steps that take a person from situation to action. (Encoding, interpretation, response search, response decision, enactment).

Question 39

Encoding

Answer 39

What to pay attention to. Relatively little is known about encoding and aggressive behaviours.

Question 40

Interpretation - Hostile attribution bias

Answer 40

Children with aggressive behaviour problems are more likely to think the other child did it on purpose. Very robust evidence linking hostile attribution bias and aggressive behaviour.

Question 41

Response search

Answer 41

What could I do?

Question 42

Response Decision

Answer 42

1. Evaluate response on different dimensions. Outcome expectancies: what will happen if I do this? Self-efficacy: how well can I carry out this response? Children who are aggressive perceive themselves as being very able to carry out those behaviours. 2. What will I actually do? Children who are aggressive pick aggressive strategies.

Question 43

Enactment

Answer 43

Carry out response. How well can you actually do it? Can children with aggressive behaviour problems carry out other types of responses? Very little work examining this issue.

Question 44

How to patterns of BDB develop?

Answer 44

Parents: Mothers of aggressive boys also show the hostile attribution bias. Parents may reinforce or approve behaviours. May see aggression as a competent response to peer provocation. Peers: May be reinforcing. Children with aggressive behaviour problems think aggression works, probably because it often does.

Question 45

Bronfenbrenner's Ecological Model of Human Development

Answer 45

Problem-Solving Skills Training: Microsystem Parent-Management Training: Mesosystem Mulstisystemic Therapy: Exosystem

Question 46

Problem Solving-Skills Training

Answer 46

Work with the child to reduce behaviour problems. Done so by targeting upstream cognitive processes upstream - thinking processes that happen and might lead to later behaviours. Underlying theory - Social-Information processing.

Question 47

Anger Coping Program

Answer 47

Treatment for aggressive behaviour designed by John Lochman and colleagues. Kids with aggressive behaviour benefit because they often tend to mislabel any type of physiological arousal as anger. focuses on specific cognitive biases: Interpretation, distorted perceptions of aggressiveness, faulty emotional identification, response search and selection.

Question 48

Anger Coping Problem: Three critical steps

Answer 48

Children taught: 1) To inhibit early angry and aggressive reactions 2) To cognitively re-label stimuli perceived as threatening. 3) To solve problems by generating alternative coping response and choosing adaptive, nonaggressive alternative.s

Question 49

Anger Coping Program: Goal

Answer 49

To inhibit early angry and aggressive reactions.

Question 50

Anger Coping Program: Simply Activities

Answer 50

Building domino towers while being verbally distracted by peers. Learn to identify bodily cues that signal angry arousal and identify thoughts that contribute to greater or reduced anger.

Question 51

Problem-Solving Skills Training

Answer 51

Generally work well, but may. not be enough in certain situations (especially the severity is more moderate or severe). Because in the real world, problematic behaviours may be reinforced.

Question 52

Parent Management Training (PMT)

Answer 52

Operant Conditioning: Consequences of a behaviour will determine whether you get more or less of it in the future. Education: Reasonable expectations for child's behaviour. Behaviour will get worse before it gets better. Communication: Say what you mean, mean what you say. Learn to observe your child's behaviour. ABC model: in which situations does this behaviour occur, what happens next? Modify the contingencies. Monitor changes in behaviours.

Question 53

Are time outs detrimental to children's long-term development?

Answer 53

Time out involves removal of positive reinforcement for a brief period of time. It is one of the only discipline strategies recommended by the American Academy of Paediatrics. Use of time outs has been shown to decrease behaviour problems in youth.

Question 54

Parent Management Training: Efficacy

Answer 54

In general, studies have shown that parent management training results in significant reduction in problem behaviours, relative to no-treatment control groups and wait-list control groups. Stronger effects for preschoolers and elementary-school aged children than adolescents.

Question 55

Multi systemic Therapy

Answer 55

Serious clinical problems result form the interplay of multiple factors. Caregivers are key to positive long-term outcomes for youth. Integration of evidence-based practice: problem solving skills training, PMT, change global reinforcement context (association with deviant peers). Intensive services that overcome barriers to service access (therapist available 24/7, services in home and other settings).

Question 56

MST: Evidence for Efficacy

Answer 56

MST has been tested with your presenting a wide range of problems: chronic and violent juvenile offenders, substance using juvenile offenders, youth in psychiatric crisis. MST has been shown to improve important variables: statistical vs clinical significance, functional outcomes.

Question 57

Little et al., 2021: Systematic review + meta-analysis of Multi systemic Therapy for Youth

Answer 57

23 studies reviewed. Mixed evidence for increased efficacy of MST vs other treatments. E.g. 1-year education in child out-of-home placements only for trials in US but not in other countries. Reduced self-reported delinquency and increases in family functioning but not other important outcomes. Family functioning is mediating mechanism shown to drive effects of MST.