Externalising disorders Flashcards
(39 cards)
What are the 4 externalising disorders?
Conduct disorder, Oppositional defiant, Attention deficit hyperactivity disorder Antisocial Personality (adult version of conduct disorder)
Can you have both CD and ODD?
No. Only one. CD is much more severe and takes precedence.
Common features of CD and ODD?
- Breaking rules
- Argumentative
- Often aggressive
What is ODD?
Compared to OD that is
- More argumentative
- Often touchy and angry
- Often in ONE setting (e.g., home)
more for the high spirited kid, argumentative child, touchy, be sensitive. But generally okay kids. Problems occur more so in some settings than others. E.g. fine at school where there are strict rules, but difficult at home.
What is OD , compared to ODD?
• More social violations
• More “severe” behaviours (e.g., fire setting, use
of weapons)
• Typically across ALL settings
• Often engages peers -Gang like mentality where these kids will interact with peers similar to them.
ADHD?
• Difficulty with appropriate attentional focus and/or control over activity levels
• Must be more than for typical age
• E.g., unable to sustain attention, follow tasks,
organise activities
• E.g., unable to sit still, wait turn, stay quiet
(Tend to get a lot of overuse of the term. If you use the criteria strictly, you do find a unique set of children. )
Prevalence of ODD CD ADHD Lumping these three together?
ODD affects 2-3%, conduct 1-2% and ADHD least common 1-2%. ODD most common though.
• Lumping these three externalising disorders together, 8-10%
Comorbidity of ODD, CD, ADHD with
anxiety/depression/substance abuse?
- High overlap between all of them. Kids often with ADHD will develop conduct disorder down the track.
- High levels of depression. Kids have difficulty with school, fitting in with society.
- Higher overlap btn ODD and anxiety and ADHD and anxiety but NOT with conduct disorder (protected from anxiety).
- Conduct disorder kids often grow up to develop substance abuse, but not with ODD.
- Learning difficulties, mental retardation
Sex distribution for externalising disorders generally?
Mostly male disorders
– Especially CD ~4x
– ADHD ~ 3-4x
– Less ODD ~1.5-2x
Externalising disorders are disorders of childhood onset. They (ADHD/ODD and CD) generally occur before age…
– ADHD by definition before age 7
– ODD usually early childhood
– CD mid/late childhood – rare after 16
ODD find in earlier childhood and then go on to develop ……?
CD
Social Difficulties of externalising disorders?
academic difficulties, trend towards deviant peers, high risk behaviours like drug taking, unemployed, peer rejection, truancy (missing school), family conflict, marginalised, often have a history of juvenile delinquency and go on into prison. So in other words, not looking good for these kids.
What is anti-social behaviour
- Extension of conduct disorder but for adults
- Little guilt, little remorse, engage in a lot of deceit, breaking the law
- Affects 2% of population, primarily males.
- Problem decreases with age often.
- History with fights and aggression, difficulty sustaining a job.
- Violation of social and personal rights and rules
- Early history of CD
- Continued characteristics such as fighting, breaking law, deceitfulness
More characteristics of anti personality disorder.
- Up to 2% of population
- Largely male
- Tends to decrease with age
- Inconsistent work history
- History of fights, aggression, and risky behaviour
- Common comorbid substance abuse and mood disorders
- Common prison history
What is psychopathy and how does it differ to APD (anti personality disorder).
- Early term (back in DSM4) referred to adults who have a lack of remorse, don’t have empathy or moral engagement, self gain focus.
- DIFFERENT from antisocial personality (this is more behavioural factors), not exactly the same thing though.
Are there such things as successful psychopaths?
Possibly, Yes can be an intelligent person who manipulates others to their own ends.
Callous unemotional traits are:
• kids who lack empathy or moral engagement with others (this is a subset of disorders).
Detection of fear or distress in others for those with callous unemotional traits?
Decreased empathy but especially reduced
recognition of fear and distress in others.
Poor recognition of distress or fear in other people. Suggests this is part of why they are aggressive, because they cant detect when someone is scared.
Response to punishment in callous unemotional traits?
Abnormalities in responsiveness to cues of punishment.
Strong reward drive.
o CUK also have reduced responsiveness to punishment cues. For most of us it would make us scared and we’d stop misbehaving. They don’t. Have a STRONG reward drive as well and reduced punishment. Impulsively chasing reward without worrying about punishment.
Any cognitive processing biases/ social info processing biases in externalising kids?
WHAT IS THE BUT in the equation?
o Some of the aggression involved is mediated by biases in the processing of social information. The aggression can be directly predicted by attributions of hostile intent = kids with conduct problems tend to attribute a greater level of hostile intent to other kids. E.g. if you have kids laughing in the corner and you ask the conduct kid what they’re laughing about they will say they’re laughing at me, they’re plotting to get me. Other kids: they’re sharing a joke. So they attribute hostile intentions to others. So naturally they will increase their aggression to people.
BUT their aggression may be their social experience, their hostile attributions are probably somewhat true because these kids are marginalised. But not to the same extent they attribute. So disproportionate attribution.
Demographic risk factors
Demographic risk factors
• Externalising children characterised by: – Male – Low SES – Impoverished neighbourhoods – Low education
Risk factors in family?
larger families usually, with a lot of marital distress, maternal depression, parents abusing substances, paternal absence= more likely to come from single parent family.
What is an example of the cycle of escalation?
What does it suggest about parenting styles?
a parent might say I need u to clean your room, child says no and parent gives in. That reinforces child to say no and then get away with it. Then later mother says YOU REALLY need to clean your room, child then has a tantrum, and parent does it herself, again rewarded and reinforced to say no. Parent gets more and more desperate, child learns to produce tantrum and argumentative types of behaviour.
Suggests: poor parenting practices are involved in externalising disorders.
What is poor parenting characterised by?
Characterised by harsher punishment (unconstructive). More inconsistency and poorly defined instructions.
Poor parent supervision e.g. Ask them ‘do you know where your child is right now’ parents of ODD or conduct disorder kids are more likely to say no to that question.
